Definition

“Bloodborne Pathogen Standard” was developed by Occupational Safety and Health Administration (OSHA) in an effort to protect the safety of health care workers and others who may come in contact with human blood or blood associated materials (also known as Other Potentially Infectious Materials or OPIMs). This standard serves as the basis for implementing workplace policies and practices which can effectively reduce the risk of exposure to BBP’s, specifically to Hepatitis B virus (HBV), Hepatitis C virus, Human Immunodeficiency Virus (HIV), and other pathogens. Bloodborne pathogens (BBPs) are bacteria, viruses and other microorganisms that associated with human blood and body fluids and, upon exposure, can cause disease and in some cases death.

While most frequently associated with human blood, bloodborne pathogens may also be found in potentially blood-contaning matter such as:

• blood products like plasma and serum
• semen
• vaginal secretions
• cerebrospinal fluid
• pleural (lung) fluid
• synovial (joint) fluid
• amniotic (uterine) fluid
• peritoneal (body cavity) fluid
• saliva and oral secretions
• any body fluid that is visibly contaminated with blood
• any undetermined body fluid

OPIMs include any unfixed tissue or organ, other than intact skin, living or dead, cell or tissue cultures that may contain blood, and organ cultures or other solutions. It is important to note that while urine, feces, vomit, tears, sweat, sputum (i.e. mucus and phlegm), and nasal secretions are not expected to contain BBP’s unless visibly contaminated with blood, good personal hygiene and normal precautions are highly recommended when handling these materials.

BBP VIRUSES

Human Immunodeficiency Virus (HIV)
HIV is a virus that progressively and irreversibly weakens the immune system of its host (infected person) leaving that person unable to fight off opportunistic and otherwise non-life-threatening infections. If left untreated, HIV can eventually lead to Acquired Immune Deficiency Syndrome (AIDS), a pandemic which, since it was first recognized in 1981, has killed more than 25 million people worldwide. While medical advances regarding HIV treatment have been made, there is currently no vaccine or cure for HIV (or AIDS) and avoiding exposure to the virus remains the only known method of prevention.

HIV-infected persons may show no symptoms or may experience symptoms such as swollen lymph nodes, fatigue, weight loss, diarrhea, persistent dry cough and fever. The virus may remain dormant and asymptomatic for months or years during which time it progressively infects and kills vital cells such as helper T cells, macrophages, and dendritic cells.

Viral Hepatitis
While HIV is considered to be one of the most destructive pandemics in recorded history, the likelihood of contracting Hepatitis B as an occupational exposure is significantly greater and it is estimated that 1 million Americans are carriers of the Hepatitis B virus.

In contrast to HIV, Hepatitis B:

• can survive in a dried state for up to a week
• when present in the bloodstream, it’s 100 times more concentrated than HIV
• is much more resistant to disinfectants

Approximately 70% of individuals who become infected experience either no symptoms or mild flu-like symptoms. Others experience more severe symptoms including nausea, abdominal pain, joint pain, fever, rash, or jaundice (a yellowing of the eyes and skin). Carriers of the Hepatitis B virus are highly infectious and are at high risk of death from liver failure or cancer and approximately 300 deaths are attributed to occupational Hepatitis B exposure each year. Effective Hepatitis B vaccines are commercially available and by law must be made available to employees who risk occupational exposure.

Hepatitis C virus is also transmitted by blood and blood products and results in inflammation of the liver and over time may lead to chronic liver disease, cancer of the liver, cirrhosis, and death. There is no vaccine or other means of preventing Hepatitis C infection but in severe cases treatment may be prescribed by a physician.

Other hepatitis viruses which have been identified are A, D, E and G.

BBP TRANSMISSION

Bloodborne pathogens can be transmitted when infected blood or OPIM is introduced into the bloodstream of another person. Consequently, any individual who handles or otherwise comes into contact with blood, tissue, or body fluids is at risk for exposure to bloodborne pathogens. BBP transmission may occur via direct transmission through a break in the skin, such as a needle-stick injury, or by contact with a mucous membrane found in the eye, nose or mouth. NOTE: while it is important to mention that BBPs can also be transmitted through sexual contact, this topic falls outside the scope of this course.

Employees who, as part of their job duties, are responsible for rendering First Aid or handle body fluids and/or OPIMs as outlined above are required by OSHA to receive Biosafety training due to the potential risk for occupational exposure to bloodborne pathogens.

Occupational Exposure
Healthcare providers and acute care facilities workers are considered to have the highest risk of occupational exposure to blood or other potentially infectious materials. CDC reports approximately 50 documented workplace sero-conversion cases, most attributed to accidental needle-sticks or exposure to blood through a break in the skin of an infected person.

OSHA defines an exposure incident as “a specific eye, mouth, other mucous membrane, non-intact skin, parenteral (piercing mucous membranes or the skin barrier through such events as needlesticks, human bites, cuts, and abrasions) contact with blood or other potentially infectious materials that result from the performance of an employee’s duties.” In other words, bloodborne pathogens are most commonly transmitted through:

• accidental sticking with a contaminated hypodermic needle
• direct contact between lacerated skin and infected blood or other body fluids
• contact between mucous membranes and infected blood or other body fluids

Who’s at risk
Healthcare professionals such as physicians, nurses, dentists, medical students, and laboratory technicians; First-responders such as EMT’s, officers of the peace, firefighters, life guards, flight attendants; Any individual whose job responsibilities include coming into contact with blood or body fluids.  

PREVENTION

Universal precautions is an increasingly accepted strategy that presumes that all blood, body fluids, and tissue are infected and are handled accordingly. This means always wearing protective equipment such as latex gloves, face shield and goggles, booties, apron, etc. when exposed to potentially infectious materials.

All potentially infectious materials must be stored and disposed of using specially-designed containers which are labeled with the international biohazard symbol and fluorescent orange or orange-red letters. All surfaces, equipment, and tools must be immediately decontaminated and sterilized with OSHA-approved disinfectant such as sodium hypochlorite.

In case of exposure

• immediately wash exposed body part with anti-bacterial soap and water, or in the case of an eye splash, an eye wash solution
• if possible, save any contaminated object so that it may be tested for virus
• report the incident to your employer as soon as possible
• a medical evaluation may be required for post exposure treatment which will include Hepatitis B immunoglobulin and the Hepatitis B vaccine
• in accordance with OSHA regulations, a detailed documentation of post exposure management must be compiled and retained