Bloodborne Pathogens Manual 2408 Wanda Daley Drive | Ames, IA 50011-3602 | (515) 294-5359 | www.ehs.iastate.edu Copyright © | Reviewed 2021
2 Bloodborne Pathogens Environmental Health and Safety
3 Bloodborne Pathogens Environmental Health and Safety Service and Emergency Providers Environmental Health and Safety 2408 Wanda Daley Drive | (515) 294-5359 Iowa State University Occupational Medicine Department G11 Technical and Administrative Services Facility (TASF), 2408 Pammel Drive | (515) 294-2056 McFarland Clinic PC, Occupational Medicine 1018 Duff Avenue | (515) 239-4496 Thielen Student Health Center 2647 Union Drive | (515) 294-5801 Emergency Emergency - Ambulance, Fire, Police 911 Department of Public Safety/ Iowa State University Police Armory, 2519 Osborn Drive | (515) 294-4428 Mary Greeley Medical Center 1111 Duff Avenue | (515) 239-2011 Non-discrimination Statement “Iowa State University does not discriminate on the basis of race, color, age, ethnicity, religion, national origin, pregnancy, sexual orientation, gender identity, genetic information, sex, marital status, disability, or status as a U.S. veteran. Inquiries regarding non-discrimination policies may be directed to Office of Equal Opportunity, 3350 Beardshear Hall, 515 Morrill Road, Ames, Iowa 50011, Tel. 515 294-7612, email eooffice@iastate.edu”
Bloodborne Pathogens Environmental Health and Safety Table of Contents Service and Emergency Providers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 Non-discrimination Statement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 A Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 Regulatory Basis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 Definitions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 Bloodborne Pathogens . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 Potentially Infectious Materials . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 Responsibilities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8 Iowa State University . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8 Environmental Health and Safety (EH&S) . . . . . . . . . . . . . . . . . . . . . . . . 9 Occupational Medicine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9 Department Executive Officers . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9 Supervisors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9 Individual Personnel . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9 B Exposure Determination . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10 C How to Comply . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11 Medical Surveillance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11 Hazard Inventory Form . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11 Hepatitis B Vaccination . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11 If an Exposure Occurs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12 First Aid . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12 Medical Evaluation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12 Reporting . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13 Student Accidents and Injuries . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13 Medical Emergencies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14 Follow-up Investigation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14 Medical Records . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14 Training . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15 How to Get Training . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15 Training Records . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15 Safe Work Practices . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15 Universal Precautions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15 Specific Universal Precaution Requirements . . . . . . . . . . . . . . . . . . . . . . . 16
5 Bloodborne Pathogens Environmental Health and Safety Personal Protective Equipment (PPE) . . . . . . . . . . . . . . . . . . . . . . . . . . . 16 Sharps Safety . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17 Required Departmental Sharps Safety Program . . . . . . . . . . . . . . . . . . . . . 17 If no sharps injuries have occurred, think about where they might happen.. . . . . . . . . . . . . . . . . . . . . . 18 Labeling and Signs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19 Labels . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19 Signs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19 Laboratories . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19 D Decontamination and Disposal of PIM . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20 Decontamination of Non-disposable Items . . . . . . . . . . . . . . . . . . . . . . . . . 20 Appendix I Supervisor Checklist for use of Human Blood or Other Potentially Infectious Materials 22 Appendix II Resources . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23
6 Bloodborne Pathogens Environmental Health and Safety 6 A Introduction The Bloodborne Pathogens Exposure Control Program is designed to minimize personnel exposure to bloodborne pathogens. This manual describes special precautions that must be taken by Iowa State University personnel whose work involves potential contact with human blood and other potentially infectious materials, and defines the responsibilities of Iowa State University personnel. Regulatory Basis Implementation of the Bloodborne Pathogens Exposure Control Program is mandated by the Occupational Safety and Health Administration’s (OSHA’s) Bloodborne Pathogens Standard (29 CFR 1910.1030). This standard was revised on January 18, 2001, to incorporate changes required by the Needlestick Safety and Prevention Act. The regulation applies to all personnel likely to have occupational exposures to human blood and other potentially infectious materials. Definitions Bloodborne Pathogens Bloodborne pathogens are pathogenic microorganisms that are present in human blood and can cause disease in humans. These pathogens include, but are not limited to: • Human Immunodeficiency Virus (HIV), which causes Acquired Immune Deficiency Syndrome (AIDS) • Hepatitis B Virus (HBV), which causes Hepatitis B, a liver disease • Hepatitis C Virus (HCV), which causes Hepatitis C, a liver disease Potentially Infectious Materials Potentially infectious materials (PIMs) are materials that can carry bloodborne pathogens. They include: • human blood and blood products • semen • vaginal secretions • spinal fluid • amniotic fluid • other internal human body fluids from joints, chest cavity, heart sac, or abdomen • saliva during dental procedures (special case due to likelihood of blood being present)
7 Bloodborne Pathogens Environmental Health and Safety • breast milk (only by ingestion - known to transmit HIV) • human or primate cell lines or strains that have not been documented to be free of bloodborne pathogens by testing • unfixed human tissues or organs (living or dead) • blood or tissues from animals experimentally infected with bloodborne pathogens • cultures or other solutions containing specific bloodborne pathogens, such as HIV, HBV, or HCV • equipment contaminated with human blood or other PIMs • any body fluid that is visibly contaminated with blood, or that is difficult or impossible to distinguish Potentially infectious materials do not include the following, unless the material is visibly contaminated with blood or is difficult or impossible to distinguish. • tears • sweat • saliva (except during dental procedures) • vomit • feces • urine • nose fluids • intact human skin (living or dead source) Responsibilities Iowa State University The president of Iowa State University is ultimately responsible for all environmental health and safety issues at the university. This responsibility is exercised through the normal chain of authority within the university by delegating the charge for ensuring safe work practices and adherence to established policies and guidelines to the provost, vice presidents, deans, directors, department chairs, principal investigators, supervisors, and, ultimately, all personnel.
8 Bloodborne Pathogens Environmental Health and Safety Environmental Health and Safety (EH&S) EH&S is responsible for: • Formulating and implementing Iowa State University policy • Performing audits and assuring compliance with that policy • Ensuring that affected departments are aware of university policies and regulatory guidelines regarding the proper use of human blood or other PIMs Occupational Medicine Occupational Medicine is responsible for: • Administering Hepatitis B vaccinations to personnel who may face potential exposure to human blood or other PIMs • Providing relevant medical information regarding the benefits and contraindication to the vaccine Department Executive Officers Each department executive officer will identify departmental job positions and the personnel who may have exposure to human blood or other PIMs during the performance of their assigned duties. The exposure determination will be made without regard to the use of personal protective equipment. Records will be kept of the names of affected personnel, their job titles and duties, and their procedures that present bloodborne disease hazards. Each department that has personnel at risk will adopt this university policy as its Bloodborne Pathogens Exposure Control Plan and establish a program of compliance. This departmental program will include department-specific training, maintenance of required records, and compliance with the contents of this policy and those of the attached OSHA final regulation 1910.1030 -Bloodborne Pathogens. Supervisors Supervisors are primarily responsible for ensuring that the policies and guidelines established in this manual are strictly followed by all personnel under their jurisdiction. Refer to the checklist in Appendix I. Individual Personnel Individuals who work with human blood or other PIMs have a responsibility to follow the requirements presented in this manual and during personnel training. Personnel should consult with their supervisors regarding the safe handling and proper disposal of human blood or other PIMs used in their specific work areas.
9 Bloodborne Pathogens Environmental Health and Safety B Exposure Determination Personnel who may reasonably be expected to face exposure to bloodborne pathogens while performing assigned job duties must participate in the Iowa State University (ISU) Bloodborne Pathogens Exposure Control Program. Exposure to bloodborne pathogens can occur when PIMs contact the eyes, mouth, other mucous membranes or non-intact skin, or when PIMs enter the body through a break in the skin, such as a puncture wound with a contaminated object. At Iowa State University, personnel with the following job classifications must participate in the Bloodborne Pathogens Exposure Control Program: • Health Care Workers • Police Officers • Personnel who are designated as responsible, as part of their job duties, to render first aid or medical assistance, remove bandages, or have potential exposure to human blood in any way. Examples of departments with these personnel include, but are not limited to, the Athletic Department, Thielen Student Health Center, and Recreation Services. • Laboratory personnel working with human blood or other PIMs as determined by individual departments. • Any personnel designated to work with or around situations that may involve potential human blood or body fluid exposures that are covered by the OSHA Bloodborne Pathogens Standard. The exposure potential will be determined by individual departments. Preferably the exposure should be listed in employee job description.
10 Bloodborne Pathogens Environmental Health and Safety C How to Comply All personnel required to participate in the Bloodborne Pathogens Exposure Control Program must: • Complete a Hazard Inventory form • Be offered a Hepatitis B vaccination and complete a Hepatitis B Consent or Decline of Vaccination Form • Receive initial and annual Bloodborne Pathogens Exposure Control training • Follow safe work practices and proper waste disposal guidelines outlined in this manual Details are specified in following sections: Medical Surveillance Hazard Inventory Form Participation in the Occupational Medicine Program requires completion of a Hazard Inventory form. The online form must be completed by new employees who are exposed to hazards as part of their assigned job duties and/or current employees who have changes to their hazards or personnel information. Environmental Health and Safety (EH&S) will use this information to determine the need for enrollment in the ISU Occupational Medicine Program. Individuals and supervisors will receive an email after EH&S has completed the evaluation of the hazards, and can login to see the results. If it is determined that the individual’s workplace hazards require medical monitoring or training, the individual will receive a notice from the ISU Occupational Medicine Program with further instructions. Hepatitis B Vaccination Personnel who work with human blood or other potentially infectious materials (PIMs) must receive Bloodborne Pathogens Exposure Control Training and be offered the choice of receiving Hepatitis B vaccination within ten working days of initial assignment. Personnel may not begin work with human blood or other PIMs until the training and vaccination offer have been completed. Vaccinations will be administered by the Occupational Medicine office and billed to the vaccine recipient’s department. • Affected personnel choosing to receive the vaccination must complete a Consent or Decline of Vaccination Form. The consent form will be returned to the Occupational Medicine office (G11 Technical and Administrative Services Facility (TASF), 2408 Pammel Drive) and filed in the vaccine recipient’s medical history file.
11 Bloodborne Pathogens Environmental Health and Safety • Affected personnel choosing not to receive Hepatitis B vaccination must complete the Consent or Decline of Vaccination Form. The completed and signed declination form is returned to the Occupational Medicine office (G11 Technical and Administrative Services Facility (TASF), 2408 Pammel Drive ) and filed in the individual’s medical history file. • If affected personnel desire to be tested for Hepatitis B virus antibodies prior to deciding to receive immunization, the testing will be made available at no cost. If an adequate antibody titer is found, the offer of immunization is not required. • It is highly recommended that healthcare workers receive an HBV antibody titer test one to two months after the third and final vaccination dose. This will also be provided at no cost to the employee. If an Exposure Occurs Exposure to bloodborne pathogens can occur when human blood or other PIMs contact the eyes, mouth, other mucous membranes or non-intact skin, or when PIMs enter the body through an injury to the skin, such as a puncture wound with a contaminated object. First Aid If an exposure to human blood or other PIMs occurs or is suspected to have occurred, contaminated broken skin must be washed immediately with soap and water. If mucous membranes are involved, they must be flushed with water immediately for a minimum of 15 minutes. After thorough washing, apply first aid. Medical Evaluation Immediately following washing and application of first aid, a confidential post-exposure medical evaluation must be offered to the exposed individual. Costs of the post-exposure evaluation will be billed to the department in which the exposure occurred. • Iowa State University employees exposed or injured while at work or in the course of employment must seek medical attention at the McFarland Clinic PC, Occupational Medicine Department (1018 Duff Ave, Ames, IA; (515) 239-4496). Supervisors should call the McFarland Clinic Occupational Medicine Department during regular work hours to schedule an appointment for the employee. Any relevant safety information such as a Material or Pathogen Safety Data Sheet (MSDS or PSD) should accompany the employee to the appointment. • The post-exposure medical evaluation will include: ◦ Documentation of the exposure route, the HBV and HIV antibody status of the exposure source individual (if known), and the circumstances under which the exposure occurred.
12 Bloodborne Pathogens Environmental Health and Safety ◦ Blood collection and testing of the source individual to determine the presence of HBV or HIV infection if the source individual is known and permission is obtained. The source individual’s test results will be made available to the exposed employee, and the employee will be informed of applicable laws and regulations concerning disclosure of the identity and infectious nature of the source individual. When the source individual is known to be infected with HIV or HBV, testing of the source individual’s blood need not be repeated. ◦ Collection of blood from the exposed employee as soon as possible after the exposure incident for determination of HIV and/or HBV status. (Actual testing may be done at that time or at a later date if the employee so requests.) ◦ Additional follow-up, including antibody or antigen testing, counseling, illness reporting, and safe and effective post-exposure treatment according to standard recommendations for medical practice. Reporting All work related injuries, illnesses, or exposures must be reported to the employee’s supervisor, even when medical attention is not required or is refused by the employee: An Incident Report (IR) must be completed by the injured employee and/or the supervisor through the ISU Incident Portal. within 24 hours of the incident. Upon submission of the report, the supervisor will receive an email requesting information relating to the Accident Investigation as part of the incident reporting process. The supervisor is asked to reply directly to the email with answers to the questions asked within 24 hours of receiving the email. Questions regarding the form may be forwarded to University Human Resources at (515) 294-3753. Contact Environmental Health and Safety at (515) 294-5359 for guidance and assistance, especially when a serious injury or major loss occurs. Student Accidents and Injuries Students not employed by Iowa State University who are exposed or injured in the classroom or laboratory should seek medical attention at the Thielen Student Health Center, 2647 Union Drive, (515) 2945801 or Mary Greeley Medical Emergency Department for after-hours treatement or emergencies (515) 239-2011 or 911. All accidents and injuries sustained by Iowa State University students while in academic classes or events sponsored by the university must be reported to Risk Management by the student and a university representative using the ISU Incident Portal. Refer to the Accidents and Injuries web page for more information.
13 Bloodborne Pathogens Environmental Health and Safety Medical Emergencies If injury, illness, or exposure necessitates immediate treatment, transport the employee to the Mary Greeley Medical Emergency Department (515) 239-2011. If emergency transport is needed, dial 911. Be prepared to provide any relevant safety information, such as an MSDS or PSD. When an employee requires emergency treatment, the incident must be reported to EH&S at (515) 294-5359 as soon as possible. Provide assistance to injured or exposed personnel by following the First Aid Procedures. Follow-up Investigation The department inwhich the exposure incident occurredmust evaluate the incident in order to prevent repeat incidents. The evaluation will include documentation of the following: • safety equipment in use at the time of the exposure incident • work practices in place at the time of the exposure incident • personal protective equipment or clothing in use at the time of the exposure incident • evaluation of the policies and “failures of controls” at the time of the exposure incident Medical Records Confidential records will be established and maintained for all personnel with occupational exposure to human blood or other PIMs. These records will include at least the following: • Personnel names and University ID numbers • Signed Consent or Decline of Vaccination Forms for each participating individual • Hepatitis B vaccination status, dates of vaccinations, and any medical records relative to each individual’s ability to receive vaccination • Copies of all examination results, medical testing, and follow-up procedures for each participating individual • Copies of the health care professional’s written opinion following any evaluation of the medical status of individual personnel. This written opinion will be provided to the participating individual and his/her department chair within 15 working days of the completion of the evaluation. The opinion will be limited to the following, (any other information will remain confidential): ◦ Recommendations as to the limitations of the individual’s ability to receive Hepatitis B vaccination ◦ Specific findings or diagnoses which are related to the individual’s ability to receive Hepatitis B vaccination
14 Bloodborne Pathogens Environmental Health and Safety ◦ Statement that the individual has been informed of the results of the evaluation and any medical conditions resulting from exposure to human blood or other PIMs that require further evaluation or treatment All medical records will be kept for 30 years after the employee separates from Iowa State University. Training All personnel required to participate in the Bloodborne Pathogens Exposure Control Program must receive initial training and annual retraining. New personnel must be trained prior to working with human blood or other PIMs. Individual supervisors are responsible for providing training that is specific to each work site. How to Get Training Required training may be accomplished by completing the Bloodborne Pathogens and Sharps Safety Online Training Module, through Learn@ISU. Training Records Each department must maintain a copy of the current training status of all affected personnel. This documentation will include the dates of training, the instructor’s name, and the signatures of the individuals who have received the training to signify that they have received and understood the information and will comply with the requirements of this program. All training records must be kept for at least three years from the time the training is given. Safe Work Practices Universal Precautions All personnel participating in the Bloodborne Pathogens Exposure Control Program must practice universal precautions. Universal precautions means that all human blood and other PIMs are treated as if they contain bloodborne pathogens. Universal precautions prevent human blood and other PIMs from invading the body through typical routes of entry. The routes of entry for bloodborne pathogens include: • injection (such as an accidental needle stick or other puncture into the skin with a sharp object) • contact with broken skin (such as rash, acne, cut, scrape, hangnail) • contact with mucous membranes (eyes, inside of nose and mouth, genitals)
15 Bloodborne Pathogens Environmental Health and Safety Specific Universal Precaution Requirements When working in an area where human blood or other PIMs are present, personnel must not: • eat, drink, smoke, apply cosmetics, or handle contact lenses • store food in freezers, refrigerators, cabinets, or any other area where human blood or other PIMs are also stored or that may be contaminated with human blood or other PIMs • mouth pipette When working with human blood or other PIMs, personnel must: • minimize splashing or spraying of human blood or other PIMs • wash hands frequently, even if gloves have been worn ◦ hand, skin, and eye washing facilities must be provided in a location that is readily accessible to personnel. If facilities at field work sites are not feasible, then either an appropriate antiseptic hand cleanser and clean cloth/ paper towels or antiseptic towelettes will be provided. After use of the antiseptic cleansers or towelettes, hands and contaminated skin will be washed with soap and running water as soon as possible. • use leak-proof and non-breakable containers for human blood or other PIMs • affix biohazard symbols to containers of regulated waste, refrigerators, and freezers containing blood or other potentially infectious material, as well as any other containers used to store, transport, or ship blood or other potentially infectious materials • use a sealed secondary container for transporting human blood or other PIMs through hallways or between buildings • keep waste containers near the area where work with human blood or other PIMs is being performed • never overfill waste containers • use extreme caution when working with sharp objects such as needles, razor blades, or broken glass, and properly dispose of in an appropriate sharps container Personal Protective Equipment (PPE) Departments will provide readily accessible personal protective equipment (PPE) in appropriate sizes at eachwork site. Hypoallergenic gloves will be provided for those employees who are allergic to those normally provided. PPE and clothing should fit the working conditions. When skin or clothing may be splashed with human blood or other potentially infectious materials (PIMs), personnel should wear nitrile or latex
16 Bloodborne Pathogens Environmental Health and Safety gloves and lab coats, gowns, or aprons. When personnel may potentially be exposed via the head, eyes, mouth, or nose with human blood or other PIMs, they should wear goggles, dust masks or face shields, and possibly surgical caps, depending on the quantity of PIMs and degree of possible splashing. Where personnel may need to perform emergency resuscitation, pocket masks, resuscitation bags, or other ventilation devices use is encouraged instead of direct mouth-to-mouth procedures. Departments will provide for decontamination, cleaning, laundering, or disposal of required PPE and the repair or replacement of items as needed to maintain their effectiveness. All PPE must be removed immediately upon leaving the work area and placed in an appropriately designated container that displays the biohazard symbol for decontamination, storage, washing, or disposal. Personnel must wear appropriate gloves when performing procedures in which human blood or other PIMs may be handled or contacted. Gloves must also be worn when handling bagged PIMs or obviously contaminated linen. Appropriate gloves include either disposable or utility gloves made of either latex or nitrile. Disposable gloves must be replaced when visibly soiled, torn, punctured or otherwise compromised and may not be washed or disinfected for re-use. Sharps Safety Sharps pose the greatest hazard to personnel working with human blood or other PIMs. In order to prevent sharps injuries, personnel must: • never recap, bend, or break needles • use safer sharps devices, such as retractable or self-blunting syringes and needles whenever possible • if absolutely necessary to recap a needle, use a mechanical device, such as a hemostat or forceps, to handle the cap • handle other sharps, such as broken glass, scalpels, razor blades, broken Pasteur pipettes, and broken capillary tubes with mechanical devices whenever possible • dispose of all sharps in appropriate sharps containers • avoid the use of sharps or breakable materials and use safer sharps devices whenever possible Required Departmental Sharps Safety Program Each department must implement a Sharps Safety Program to evaluate the use of alternative devices for preventing sharps injuries to personnel working with human blood or other PIMs. Refer to Appendix II for useful references. To implement a departmental Sharps Safety Program:
17 Bloodborne Pathogens Environmental Health and Safety • Review available sharps injury data for the department, and answer the following questions: ¤ What personnel were involved? ¤ What sharps devices were being used? ¤ What were the circumstances of the sharps injuries? ¤ How frequent are sharps injuries? If no sharps injuries have occurred, think about where they might happen • Determine what alternative safer sharps devices exist to replace the devices currently used. More than a thousand devices designed to prevent sharps injuries are available. Examples are: ◦ retracting finger stick lancets ◦ breakage resistant plastic specimen/vacuum tubes ◦ plastic capillary tubes ◦ safety syringes with a cylindrical sheath to shield needles when blood is injected into tubes ◦ self-blunting or shielding needles for vacuum tube phlebotomy sets See Appendix II for resources to help identify available safer sharps devices. • Evaluate the effectiveness of different available safer sharps devices for each individual workplace setting in the department. • Non-managerial personnel who will actually be using the devices must be included in the selection of safer sharps devices. This will improve the quality of the selection process and improve personnel acceptance of the newer devices. • All evaluations must be documented annually in writing. ◦ Develop safety feature evaluation forms specific for alternative safer sharps devices to be tested in the department. A sample form is available in Appendix II. ◦ Have personnel using the devices complete the safety feature evaluation forms, and summarize the findings in a central location. ◦ Each year, summarize which alternative safer sharps devices were evaluated, and the reasons why the alternative devices were or were not implemented. Alternative safer sharps devices must be used wherever it will reduce personnel exposure, either by removing, eliminating or isolating the hazard, regardless of cost.
18 Bloodborne Pathogens Environmental Health and Safety Labeling and Signs Labels Labels with the universal biohazard symbol, the word “biohazard” and a predominantly fluorescent orange or orange-red background must be placed on all waste containers, refrigerators, and freezers containing human blood or other PIMs, and all other containers used to store, transport or ship human blood or other PIMs. The only exceptions to this labeling requirement are: • individual containers of human blood or other PIMs placed inside a labeled container • containers for storage, transport, shipment, or disposal are exempted from the labeling requirement • containers of human blood, blood components, or blood products that are labeled as to their contents and have been released for transfusion or other clinical use are exempted from labeling requirements. Central Stores, (515) 294-0408 stocks a variety of appropriate biohazard labels and containers. Signs Signs with the universal biohazard symbol, the word “biohazard” and a predominantly fluorescent orange or orange-red background must be posted at the entrance to any area where human blood or other PIMs are used or stored. These signs must also include the name of the potentially infectious material, any special instructions for entering the area, and the name and telephone number of the area supervisor. These door signs may be requested from EH&S. Laboratories All laboratory work must be performed in compliance with the Iowa State University Biosafety Manual and the Iowa State University Laboratory Safety Manual. Additional work practices and procedures are required if the work site activities involve the culture, production, concentration or manipulation of HIV, HBV, or HCV.
19 Bloodborne Pathogens Environmental Health and Safety D Decontamination and Disposal of PIM All human blood and other potentially infectious materials (PIMs) must be disinfected and disposed of according to the Iowa State University (ISU) Sharps and Biohazardous Waste Procedures. All sharps, including uncontaminated sharps, must also be disposed of according to this procedure. Waste containers for human blood and other PIMs must be: • closable • leak-proof • labeled with the biohazard symbol Sharps waste containers must also be puncture-resistant. Containers that are contaminated on the outside must be double bagged. Potentially Infectious Materials NOT Regulated as Potentially Infectious Materials Waste According to Occupational Safety and HealthAdministration (OSHA), certain items that are used to contain fluids, such as bandages, towels, sanitary napkins, or other feminine hygiene products used to absorb menstrual flow, are not considered to be PIMs for waste handling purposes unless they fail the “squeeze test.” These items fail the “squeeze test” when squeezing the item would cause blood to drip out, or cause dried blood to flake off. In these situations, the items must be considered PIMs. Note that even when these items pass the “squeeze test,” they should always be discarded in appropriately lined waste containers in order to prevent personnel from having contact with them. Decontamination of Non-disposable Items Spills of human blood or other PIMs must be decontaminated and cleaned immediately with an appropriate tuberculocidal disinfectant. Equipment and work areas where human blood and other PIMs are used routinely must be decontaminated on a regular basis (daily). Appropriate disinfectants for decontaminating human blood or other PIMs include: • A freshly made solution of sodium hypochlorite (such as a 1:10 dilution of household bleach and water – about 2 cups of bleach in a gallon of water). Bleach solutions that are more than one day old should not be used. • Any commercial disinfectant that is tuberculocidal (“tuberculocidal” will be indicated on the product label) is also appropriate for decontaminating human blood or other PIMs.
20 Bloodborne Pathogens Environmental Health and Safety Sharp objects must not be picked up directly with the hands. Use mechanical means, such as a brush and dustpan or tongs, to prevent sharps injuries. Each department must ensure that equipment which may be contaminated with human blood or other PIMs is decontaminated prior to servicing, shipping, or handling. The servicing representative or shipment receiver must be informed of the decontamination status prior to servicing or shipping. Laundry and PPE contaminated with human blood or other PIMs must be placed in a leak-proof, labeled container marked “Potentially Infectious Materials” (or a similar marking) along with the biohazard symbol at the location where it was used. The contaminated items must then be decontaminated before re-use or disposal.
21 Bloodborne Pathogens Environmental Health and Safety Appendix I Supervisor Checklist for use of Human Blood or Other Potentially Infectious Materials Use this checklist to ensure that proper procedures have been followed before beginning any work with human blood or other potentially infectious materials. 1 Exposure Determination Click here to jump to this section of the manual 9A list has been prepared of individual personnel required to participate in the Bloodborne Pathogens Exposure Control Program. (see Section B) 2 Medical Surveillance Click here to jump to this section of the manual 9All affected personnel have either received Hepatitis B vaccinations or been offered the vaccinations and completed a Consent or Decline of Vaccination Form (Appendix II). 9Forms for personnel declining Hepatitis B vaccination are kept in department files. 9Procedures are in place to respond to an exposure incident (Post-exposure evaluation offered immediately at no cost to affected individual, incident reporting online, and all incidents evaluated to prevent repeat occurrences). 3 Training and Information Click here to jump to this section of the manual 9All personnel have completed a Hazard Inventory. 9All affected personnel have completed Bloodborne Pathogens and Sharps Safety training within the last year and all new affected personnel have completed the training prior to their first assignment involving potential exposure. 9All affected personnel have received training on work site specific practices. 9Records are kept documenting all training. 4 Safe Work Practices Click here to jump to this section of the manual 9All affected employees are following universal precautions. 9Appropriate personal protective equipment is provided at no cost to personnel. 9Handwashing and eyewash facilities, biohazard warning labels, and door signs are provided. 9Alternative safer sharps devices are used wherever it will reduce personnel exposure. 9Evaluations of alternative safer sharps devices are documented annually in writing using Safety Feature Evaluation Forms for Safer Sharps Devices (Appendix II).
22 Bloodborne Pathogens Environmental Health and Safety Appendix II Resources Forms • Hazard Inventory for Occupational Medicine Surveillance • Consent or Decline of Vaccination Forms • Sample Safety Feature Evaluation Form for Safer Sharps Devices Publications • Biosafety Manual • First Aid Procedures • Sharps and Biohazardous Waste Procedure & Flow Chart Regulations • OSHA Bloodborne Pathogens Regulation (Standard 29 CFR1910.1030) • Needlestick Safety and Prevention Act • Bloodborne Pathogens and Needlestick Prevention Bloodborne Disease Information • HIV/AIDS • Hepatitis B • Hepatitis C Safer Sharps Devices • OSHA booklet on How to Prevent Needlestick Injuries • Preventing Needlestick Injuries in Health Care Settings • Lists of available safer sharps devices • Latex Allergies
RkJQdWJsaXNoZXIy NTkwNTUw