Before the AID’s pandemic of the mid-1980s infection control practices were designed almost exclusively to protect the patient from developing a ‘nosocomial infection’ – which means an infection acquired after admission to the hospital.
Protocols focused on protecting the patient with little to no emphasis on the
healthcare worker’s potential to become infected.
Hepatitis B has been an occupational hazard for healthcare workers for decades now, and it is 100 times more infectious than the AIDS virus. But it was the AIDS epidemic in the early ’80s that brought an awareness of exposure vulnerability to bloodborne pathogens.
This information led to the development of early protocols aimed at protecting healthcare workers, and eventually, the development of the OSHA Bloodborne Pathogen standard.
The Chain of Infection
To understand the importance of preventive measures in cross-contamination, it helps to
understand the chain of infection. These are the three interrelated elements that must be present for an infection to occur.
- There must first be an infectious agent present -in this case, a bloodborne pathogen.
- There must be a means of transmission. In a healthcare setting, many aspects of patient care involve potential contact with a patient’s blood or other body fluids.
- Finally, there must be a susceptible host. In the case of bloodborne pathogens, even caregivers who are in generally good health are susceptible.
Controlling infection means breaking this chain. Healthcare worker’s hands play an important role in transmitting microorganisms as many of the microbial inhabitants on the hands are capable of colonizing and infecting wounds, cuts, needle-sticks, and other sites.
The most effective means of preventing transmission of infection is through always following safe handwashing procedures.
History of Bloodborne Pathogen Controls
In 1987, the CDC developed a system of infection control guidelines commonly referred to as universal blood and body fluid precautions.2 Universal Precautions refers to a system of infection control practices that encourages caregivers to presume that all patients are potentially infected with HIV, HBV, or other bloodborne pathogens. Specific infection control precautions are used with all patients to minimize the risk of exposure to blood or body fluids.
As a supplement to universal precautions, the CDC permits healthcare facilities to design their own isolation systems. For instance, body substance isolation focuses on the separation of the hands of the caregiver from all body substances of all patients by using appropriate shielding techniques, particularly gloves, to reduce contact transmission.
OSHA Final Rule
The original CDC guidelines were not backed by the force of the law, but in 1991, the Occupational Safety and Health Administration (OSHA), used its authority under the Occupational Safety and Health Act to issue enforcement instructions for a bloodborne pathogens standard.
The OSHA Bloodborne Pathogens Standard enforces rules regarding occupational exposure to HBV and HIV, the final rule on Occupational Exposure to Bloodborne Pathogens based on the concept of universal precautions to prevent occupational exposure to bloodborne pathogens.
The Final Rule defines occupational exposure as any “reasonably anticipated skin, eye, mucous membrane, or parenteral contact with blood or other potentially infectious material(s) that may result from the performance of an employee’s duties.”
According to OSHA, infectious materials include semen, cerebrospinal fluid, vaginal secretions, synovial fluid, pleural fluid, pericardial fluid, peritoneal fluid, amniotic fluid, saliva in dental procedures, any body fluid visibly contaminated with blood, and all body fluids in situations where it is difficult or impossible to differentiate between body fluids.
Infectious materials can also include unfixed tissue or organs other than intact skin from a human (living or dead), HIV-containing cell or tissue cultures, and HIV or Hepatitis B containing culture, media or other solution, as well as blood, organs, or other tissues from experimental animals infected with HIV or HBV.
OSHA’s “final rule” made it mandatory that all healthcare facilities assumed responsibility for protecting their employees from exposure to bloodborne pathogens.
The law has eight main elements:
- Employers Exposure control plan
- Use of Universal precautions
- Use of Engineering controls
- Use of Work practice controls
- Supply and use of Personal protective equipment
- Provision of Hepatitis B prophylaxis (immunization)
- Provision of Bloodborne Pathogens Training and education to OSHA minimum standards
- Record keeping
Let’s take a closer look at each of those requirements:
Bloodborne Pathogen Exposure Control Plan
The Exposure Control Plan requires a facility to develop a written document detailing
specific needs, including exposure determination, a schedule, and method of how compliance will be implemented, and procedures for the evaluation of exposure incidents.
This plan must be accessible to all employees and must be reviewed and updated annually.
The concept of Universal precautions is an infection control procedure that assumes every direct contact with blood and body fluids is potentially infectious.
The system is based on the notion that not all patients with bloodborne pathogen-related infections have been diagnosed, and therefore, precautions must be applied universally.
Universal precautions provide the minimum of behaviors and protocols required by law.
In many settings, such as hospitals, the application of universal precautions has been expanded beyond bloodborne pathogen transmission.
This expansion includes the use of protective barriers when having contact with urine and saliva to prevent transmission of other infections, such as herpes.
Engineering controls address devices that are used to isolate or remove the bloodborne pathogen hazards from the workplace. These controls include (among other things), sharps disposal containers, needle resheathing devices, needleless vascular access systems, and biohazardous waste containers.
Work Practice Controls
Work practice controls outline practices and procedures to describe methods of performing a work task in a way that is designed to reduce the likelihood of exposure.
Swapping the practice of recapping needles with two hands with a one-handed technique that is much safer is an example of a work practice control.
Personal Protective Equipment (PPE)
Personal protective equipment (PPE) is physical barrier equipment designed to shield the employee from blood and body fluid contamination.
PPE includes gloves, fluid-resistant masks and gowns, foot protection, splash shields, and eye protection, should be used whenever there is a risk of exposure to blood or other potentially infectious material (OPIM). The provision and repair of PPE is the responsibility of the employer.
Non-employee status healthcare professionals such as physicians and contractors must comply with the healthcare facility’s Exposure Control Plan and use of PPE. This compliance is to ensure their own safety as well as the safety of the Healthcare facility’s staff and patients.
In the event that the individual’s personal clothing becomes contaminated with blood, the clothing should be removed as soon as possible and laundered by the healthcare facility. OSHA does not permit contaminated clothing to be laundered at home due to the highly resistant nature of the Hepatitis B virus.
Over compliance in the use of PPE is not beneficial, necessary, or cost-effective. All PPE must be removed and disposed of properly before leaving the immediate work area to prevent transmission of contaminants and possible cross-infection.
Hepatitis B (HBV) Vaccination
Employers must provide the Hepatitis B vaccine at no cost to any employees who are likely to be exposed to bloodborne pathogens.
Policies and procedures detailing required postexposure practices include medical evaluation, laboratory testing, and provisions for confidentiality. The employee is responsible for reporting any exposure incident immediately to their supervisor.
Training is the cornerstone of any program that requires individual participation for its success. Healthcare workers need to recognize that cooperation and compliance with the components of the OSHA Bloodborne Pathogens standard are essential.
Compliance with OSHA’s rules and regulations is a matter of control.
Bloodborne Pathogens Training & Certification
Employers are required to provide a suitable OSHA Bloodborne Pathogens certification program at no cost and during working hours to all employees with potential of occupational exposure to blood and other body fluid.
This Bloodborne Pathogens training must be provided before the commencement of any work that may bring the danger of exposure, and at least annually thereafter, or when any new work tasks are introduced.
The OSHA BBP standard stipulates that employers must maintain medical and training records for every employee with either actual or potential occupational exposure; for a designated period of time.
Even when there are detailed guidelines, controls, and quality educational programs in place,
The management of cross-contamination and the prevention of infection in patients and healthcare workers depends on the employee’s compliance with prevention practices.
Healthcare facility workers must understand the goals of infection control, the mechanisms of cross-contamination, and prevention protocols, but more importantly, they must commit to infection control practices.
For example, the need for meticulous handwashing occurs frequently in a normal workday and competes for the time that healthcare workers would prefer to spend on patient care.
To ensure your healthcare facility employees are fully compliant with the OSHA bloodborne pathogen standard check out our easy online bloodborne pathogens training for groups and get your workers compliant fast.