**BLOODBORNE PATHOGENS (BBP)**

**FY 2008 Denver Medical Center & Denver NHCU**

OSHA's **Bloodborne Pathogen Standard** mandates that EMPLOYERS make
every effort to protect their EMPLOYEES against occupational exposure to
bloodborne pathogens. **Employees must be provided with knowledge of job
associated risk & protective devices/measures that can prevent most
exposures.**

**What are bloodborne pathogens?**

-   Disease causing **microorganisms** found in infected human blood

-   There are many BBPs but the three most associated with occupational
    exposure for health care workers are Hepatitis B, Hepatitis C, and
    Human Immunodeficiency Virus (HIV).

**Hepatitis B facts:**

-   Hepatitis B is an infection of the liver caused by the hepatitis B
    virus (HBV)

-   Symptoms can vary from asymptomatic (no symptoms) to severe and
    include: diminished appetite, fatigue, abdominal pain,
    nausea/vomiting, an enlarged liver, jaundice (yellowing of eyes and
    skin), and joint pain. 30% of infected people have NO symptoms.

-   Chronic carrier state possible (6% of persons infected after age 5)

-   Preventable with the Hepatitis B vaccine

## 

## **Hepatitis C facts:**

-   Hepatitis C is an infection of the liver caused by the hepatitis C
    virus (HCV)

-   Previously called "non-A, non-B hepatitis"

-   Was the cause of most transfusion hepatitis before 1992

-   75% - 85% become chronic carriers with subsequent liver damage

-   Leading cause for liver transplant

-   Symptoms are same as HBV (80% of infected people have NO symptoms)

## 

## **HIV facts:**

-   HIV is a virus that can damage the body's immune system making it
    unable to fight off certain types of infections.

-   Can lead to AIDS (Acquired Immunodeficiency Syndrome)

-   Symptoms of initial infection are usually self-limited flu-like
    symptoms. After that, infected people may be free of symptoms for
    months to years. Onset of symptoms is usually vague and nonspecific
    such as lymphadenopathy (swollen lymph nodes), anorexia (loss of
    appetite), chronic diarrhea, weight loss, fever and fatigue.
    Specific symptoms appear when opportunistic infections develop.

-   Can spread the disease even when symptom free

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-   For more information about these and other BBPs contact Infection
    Prevention and Control.

**How does transmission of a BBP actually occur?**

-   The infecting virus must get through your skin via:

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-   **[Parenteral contact]{.underline}** -- (i.e. blood to blood)
    includes such things as needle sticks, blood transfusion, sharing
    needles among IV drug users, and blood/body fluids in fresh open
    cuts or non-intact skin.

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-   **[Mucus membrane exposure]{.underline}** -- absorption via eyes,
    mouth, sexual organs.

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-   **[From mother to unborn child]{.underline}**

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-   Transmission does **NOT** occur when blood or Other Potentially
    Infectious Material (OPIM) come in contact with
    **[INTACT]{.underline}** skin.

**How can I protect myself?**

-   Use **[STANDARD PRECAUTIONS]{.underline}** - glove, gown, mask and
    eye protection if exposure anticipated regardless of patient's
    diagnosis.

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-   Get **vaccinated** against **hepatitis** **B**

-   Become familiar with the facility ***BBP Exposure Control Plan***.

**What is an [EXPOSURE CONTROL PLAN]{.underline} & how does it affect
me?**

The VA Eastern Colorado Health Care System BBP Exposure Control Plan is
a document describing how our facility will protect our employees from
occupational exposures to BBP**.**

**It is located in the on-line Infection Prevention and Control Manual.
Some Important information in this document for [YOU]{.underline} to
know includes:**

-   **Who is at risk** --

> Every position in the ECHCS is classified into one of **2 exposure
> risk categories:**

-   **Category I** -- employee can anticipate skin, eye, mucus membrane,
    or parenteral contact with blood or other potentially infectious
    material as a part of their normal duties. ***Most direct care
    providers will be Category I.***

-   **Category II** - employee does not anticipate exposure to blood or
    other potentially infectious material as a part of their normal
    duties.

> Check **Attachment A** of the plan, it outlines every position in the
> ECHCS by service & risk category.

-   **Tasks that may involve exposure** - Procedures or other
    job-related tasks are also classified as to their potential for
    exposure to blood or OPIM.

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-   **Category I** - include tasks that involve a **\"REASONABLY
    ANTICIPATED\"** potential for mucus membrane or parenteral contact
    with blood or OPIM or a potential for spills or splashes of them.
    The use of appropriate protective gear is **REQUIRED** for every
    employee while engaged in these tasks.

> Check **Attachment B** of the plan, it outlines Category I tasks by
> service and describes protective measures that are required.

-   **Category II** - This means that exposure is **\"NOT REASONABLY\"**
    anticipated, even though situations can be imagined or hypothesized
    under which anyone, anywhere might potentially be exposed to blood
    or OPIM.

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-   **Engineering & Work Practice Controls** -

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-   Items that can reduce your risk of occupational exposure to BBP such
    as **safety engineered sharps devices,** **readily available sharps
    containers, and handwashing facilities**.

-   Practices such as making sure you **do not eat or drink at the
    bedside** or anyplace where an exposure is likely to occur, and
    proper labeling of lab specimens.

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-   **Check the exposure control plan for more items.**

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-   **Personal Protective Equipment (PPE)** --

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-   GLOVES, GOWNS, MASKS, FACE SHIELDS, GOGGLES, RESUSCITATION DEVICES,
    etc.

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-   Use based on anticipated exposure to blood or OPIM.

-   Provided without cost to the employee.

-   Laundered or disposed of by this facility.

-   *[Regular cotton lab coats are not considered PPE]{.underline}.*

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-   **Hepatitis B vaccination**

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-   Can prevent infection if exposed to HBV

-   **Free** for all Category I employees via Employee Health.

-   Category I employees who choose not to take the vaccine must sign a
    declination form as required by OSHA.

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-   **What to do if an exposure occurs** --

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-   Immediately wash/flush the exposure site. DO NOT use bleach or
    surface disinfectants!

-   Report the incident promptly to your immediate supervisor & identify
    the source if possible.

-   Report to Employee Health (located on the 1^st^ floor above the
    canteen) as soon as possible after the exposure. If the exposure
    occurs on the weekend or during off-hours, report to the emergency
    room.

-   Employee Health will ensure a medical evaluation and follow-up for
    each exposure.

> ***For physicians that are covered under the University, VA Employee
> Health or the Emergency Room after hours will provide initial
> evaluation of exposures occurring at the VA. Please seek care PROMPTLY
> after exposure so that post-exposure prophylaxis (PEP) can be
> initiated rapidly when indicated. The VA will provide a starter pack
> for PEP. Follow-up care for University physicians is provided at the
> nearest Concentra clinic. You need to report to that clinic within 48
> hours after the exposure.***

-   **Infectious Waste Disposal**

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-   You should take the following measures when disposing of infectious
    waste:

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-   Place in closable, leak proof containers, red plastic bags, or bags
    with the biohazard symbol.

-   Dispose of syringes, needles, scalpel blades & other sharp items in
    puncture-resistant containers with a biohazard label.

-   Any trash, soiled dressing, or disposable articles that are grossly
    soiled (i.e. wet enough to drip) with blood & / or body fluids are
    bagged to prevent leakage at the point of use & taken to the
    contaminated trash (RED BAG) in the dirty utility room.

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-   **Signs, labels & tags**

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-   Warning labels must be affixed to containers of regulated waste,
    refrigerators & freezers containing blood or OPIM & affixed to
    containers used to store, transport or ship blood or OPIM. The
    figure below depicts the universal biohazard symbol.

![](media/image1.wmf)

For questions about Bloodborne Pathogens or other Infection Prevention
and Control issues contact one of the Infection Prevention and Control
Practitioners.

> **Georgiana Inskeep (CBOCs & Pueblo NHCU), 719-553-1026**
>
> **Linda Laxson, 303-399-8020, ext: 3132, pager 303-609-5460**
>
> **Keith Rains, 303-399-8020, ext: 3071, pager 303 -609-5461**
>
> **Karen Guerin, ext: 3065; pager 303-201-2658**

A copy of the OSHA standard can be found in the Infection Prevention and
Control & Safety Offices, and in the reference section of the online
Infection Prevention and Control Manual.

A copy of the ECHCS BBP Exposure Control Plan (EPC) can be found in the
On-Line **Infection Prevention and Control Manual** via the VA ECHCS
Intra-net Home Page (vaww.denver.med.va.gov).

The IPC Manual is located at the bottom of the Homepage. The Exposure
Control Plan can be found under the section "Infection Prevention and
Control Policies," is number D-9, and includes 2 attachments.