Applying the OSHA Bloodborne Pathogen Standard Chiropractic Setting

Transcription

1 Applying the OSHA Bldbrne Pathgen Standard Chirpractic Setting 1

2 Pre test 1. Wh is cvered by the OSHA Bldbrne Pathgen Standard? a) A- All emplyees wh culd be reasnably anticipated as a result f perfrming their assigned jb duties t face cntact with bld r ther ptentially infectius materials are cvered by the standard b) B- Only persns wh are trained t perfrm invasive prcedures. 2. Is an Expsure Cntrl Plan required by the emplyer if emplyees are at risk f expsure t bld r ptentially bld cntaining bdy fluids? a) N b) Yes 2

3 Pre test 3. What is the definitin f an expsure incident? a) A specific eye, muth, ther mucus membrane, nn-intact skin, r parenteral cntact with bld r ther ptentially infectius materials that result frm the perfrmance f an emplyee s duties. b) A used needle stick r bld expsure t a cut r pen skin area. 4. Hw ften is educatin regarding this OSHA standard t be ffered t thse at risk fr expsure and what shuld be cvered in the educatin? a) On hire and at least annually there after educatin related t the standard shuld ccur b) The cntent fr inclusin in the training is defined in the standard 3

4 Pre test 5. What shuld an emplyee d if they have a bld r bdy fluid expsure? a) Wash the site f expsure with sap and water and reprt the expsure t the designated persn at yur facility. This shuld be dne as sn as pssible and include a descriptin f hw the incident ccurred, including the name f the persn wh was the surce f the expsure if it is knwn and the device being used if any at the time f the expsure. b) Reprt the expsure when yu have time t d s is sufficient. 6. What des bldbrne pathgen mean? a) Human Immundeficiency virus (HIV) and Hepatitis B virus (HBV) b) HIV and HBV are specifically referenced in the standard but the term bldbrne pathgen includes any pathgen that is present in bld and can infect/cause disease in peple wh are expsed t bld cntaining the pathgen. 4

5 Pre test 7. What are the requirements fr a bldbrne pathgen expsure (BBPE)? a) Send emplyee t a healthcare prfessinal (HCP) with a cpy f the standard, descriptin f the incident, emplyee s relevant medical infrmatin as available and jb descriptin. HCP reviews incident, arranges testing f emplyee and surce persn, ntifies emplyee f all results, prvides cunseling & prphylaxis as needed. Evaluates reprted illnesses. (All f this infrmatin is cnfidential.) b) Wait and see what happens. 8. What are the precautins t take fr persns wh perfrm prcedures with risk f BBPE risk? a) Use f safety devices t minimize risks f expsure. This incudes glves and ther prtective equipment and safety devices if available t minimize expsure, fr example, safe sharps devices. b) Use cautin. D nt use tw hands t recap sharps. 5

6 Objectives Recgnize key cmpnents f the Federal & MNOSHA Bldbrne Pathgen Standard. Identify required elements fr cmpliance with the standard related t an expsure cntrl plan (ECP). Requirements fr staff wh perfrm acupuncture, bld draws, sharps handling r specimen handling related t these prcedures. Define a bldbrne pathgen expsure and state the requirements fr emplyees in jbs with bld expsure risk and the required fllw-up if an expsure ccurs. Link t the MNOSHA Bldbrne Pathgen Standard: 6

7 Where are yu and yur staff at risk fr expsures Bld drawing safety Acupuncture needle handling when remving and discarding the needle Patients with areas f pen wunds r drainage related t therapy sites 7

8 Scpe f the OSHA Bldbrne Pathgens Standard OSHA Regulatin

9 Health Care Wrker s Risks Health care wrkers may be expsed t bldbrne pathgens by: Injury by a sharps bject r Cntact f mucus membrane r nn-intact skin with bld, tissue, r ther ptentially infectius bdily fluids Sme studies estimate that every year: Mre than 400,000 US healthcare wrkers are expsed t bldbrne pathgens 1 ut f 10 US healthcare wrkers suffers a splash expsure r a needle stick injury (Karmn, Mehta, Brehm, 2013; Hendersn, 2012). 9

10 What Are Bldbrne Pathgens? Micrrganisms in human bld that can cause infectin in humans including: Hepatitis B (HBV) Human immundeficiency virus (HIV) And Hepatitis C alng with bacteria and viruses that can be transmitted by bld/ther regulated bdy fluids. Fr a bldbrne pathgen t be spread, the bdily fluids f an infected persn must enter int the bldstream f anther persn. 10

11 HBV (hepatitis B virus) Hepatitis B is a viral infectin f the liver It can cause liver failure, cancer, & death if nt treated It is spread by cntact bld, pen sres, r bdy fluids frm smene infected with hepatitis B Generally peple recver within a few mnths 11

12 Hepatitis B Vaccinatin Hepatitis B vaccinatin needs t be ffered t emplyees identified in the expsure cntrl plan as at risk fr expsure. It is an OSHA requirement fr emplyees wh in the curse f their jb culd have rutine expsure t used sharps r bld and bdy fluids if they did nt have persnal prtective equipment. This is the criteria fr determining if staff need t be included in the bld brne pathgen rule requirements. Training is required n hire and annually and if a new risk is identified (new prcedure, accident nt previusly cnsidered) fr emplyees determined t be at risk fr expsure. Hepatitis B Vaccinatin needs t be ffered n hire. This includes 3+ des ver 6+ mnths. The number f dses and the timing is determined by testing after the third dse. The emplyee at risk f bldbrne pathgen expsure needs t sign a cnsent fr the Hepatitis B vaccine r sign a declinatin. If the emplyee chses t decline vaccinatin, he/she can change his/her mind at any time while they are emplyed in a jb with risk f bld r bdy fluid expsure. The vaccine must be prvided free. 12

13 HIV (Human Immundeficiency Virus) HIV weakens a persn s immune system by destrying imprtant cells that fight disease and infectin N effective cure exists fr HIV. But with prper medical care, HIV can be cntrlled HIV is a virus spread thrugh certain bdy fluids that attacks the bdy s immune system, specifically the CD4 cells, ften called T cells. Untreated, HIV reduces the number f CD4 cells (T cells) in the bdy. This damage t the immune system makes it harder and harder fr the bdy t fight ff infectins and sme ther diseases Yu can get r transmit HIV nly thrugh specific activities. Mst cmmnly, peple get r transmit HIV thrugh sexual behavirs and needle r syringe use. 13

14 HCV (Hepatitis C Virus) Hepatitis C is a liver infectin caused by the Hepatitis C virus (HCV). HCV is a bldbrne virus. Tday, mst peple becme infected with the HCV by sharing needles r ther equipment t inject drugs. In healthcare settings it is imprtant t wear glves and perfrm hand hygiene whenever there is risk f expsure t bld r bdy fluids and t be sure that invasive equipment is nt shared between persns unless it has been disinfected/sterilized accrding t CDC & manufacturer recmmendatins. Be especially careful with sharps, discarding them immediately after use in a sharps cntainer and use devices that have a safety mechanism t minimize sharps injuries. Many peple d nt knw they have this disease. Symptms can include stmach pain, nausea, fatigue, lss f appetite, r jaundice 14

15 Defining Standard Precautins Standard precautins are designed t reduce the risk f transmissin f micrrganisms frm bth recgnized and unrecgnized surces f infectin. Standard Precautins apply t: Bld All bdy fluids, secretins, and excretins, except sweat, regardless f whether r nt they cntain visible bld Nn-intact skin Mucus membranes When risk f such expsures is anticipated apprpriate barriers are t be used. Depending n the situatin this may include glves, gwn, face prtectin, etc. 15

16 Engineering Cntrls Engineering Cntrls: reducing expsure risk by remving the hazard Ex. A sharps dispsal cntainer r a sharps safety device 16

17 Wrk Practice Cntrls These are methds that reduce the likelihd f expsure by altering hw the task is perfrmed An example wuld be n fd r beverages in areas where there is risk f bld bdy fluid expsure (prcedure area) 17

18 Reducing the Risk f Bld Expsure & Needle Stick Use well fitting, ne time use glves Use safe sharps device fr bld draws. Assure skin lcatin is disinfected befre each puncture. Discard bld draw items in sharps cntainer. Discard turniquet (these items are ne time use nly). This shuld be dne immediately after use. Discard the vacutainer tube hlder after each patient use. These items are labeled ne time use dispsable and it is against federal regulatin t reuse them. Hand hygiene is perfrmed befre and after each bld draw and wrkspace cleaning. Be sure that specimen is labeled crrectly and put in a bihazard specimen cntainer fr specimen transprt. There are a few different types f bld drawing equipment. The equipment has t have sharps safety devices n the needle and the hlder fr the bld tube is a dispsable ne time use item as are all turniquets tday. 18

19 Reducing the Risk f Bld Expsure & Needle Stick: Acupuncture Hand hygiene shuld be perfrmed befre perfrming invasive prcedures The patient s skin shuld be disinfected with alchl befre puncturing the skin. The alchl shuld be allwed t dry If the alchl is dry there will be n burning nted by the patient If the patient has any bleeding, a bandage shuld be applied Glves may be recmmended 19

20 Persnal Prtective Equipment (PPE) In chirpractic settings bld drawing requires the use f glves and hand hygiene befre and after the prcedure. The device used t draw bld shuld have a safety feature t minimize expsure risk. The turniquet used t help find the bld vessel is a ne time use/dispsable item and this is a federal regulatin. Glves and bld draw equipment must als dispsable. Fr acupuncture, hand hygiene must be perfrmed befre each patient prcedure. Well fitting, ne time use glves are recmmended. 20

21 Requirements fr Cntaminated Waste/Sharps Used sharps: Needles and bld draw items are t be discarded immediately after use in designated sharps cntainers clse t the pint f use and in a lcatin that is safe frm children, etc. NIOSH recmmendatin: If the sharps cntainer is wall munted it is best t have it inches frm the flr fr safety reasns. This is nt a requirement. 21

22 Mre abut the OSHA Bldbrne pathgen Standard- 29 CFR Part OSHA s Bldbrne Pathgens Standard (29 CFR Part ) requires emplyers f at-risk wrkers t prtect their wrkers The standard includes the requirement fr an Expsure Cntrl Plan (ECP) 22

23 Engineering Cntrls & Wrk Practices Clinic settings that perfrm prcedures where there may be risk f bld/bld cntaining bdy fluid expsure need t address this OSHA standard. Specific engineering cntrls examples: Needleless systems Sharps with safety devices Sharps dispsal cntainers lcated fr dispsal f sharps immediately after use Other safety devices r prcedures as available fr specific prcedures Onging review fr system changes r new safer prducts shuld ccur at least annually. Staff need t be included in selectin and evaluatin f safer prducts. 23

24 Expsure Cntrl Plan (ECP) The ECP is the key tl fr prtecting emplyees and helping t ensure cmpliance with the OSHA Standard. An ECP is required if emplyees are at risk expsure t bld and ptentially infectius bdy fluids. ECP s include: 1. Determinatin f emplyee expsure 2. Implementatin f expsure cntrl methds 3. Offering Hepatitis B vaccinatin t thse at risk f expsure 4. Pst expsure evaluatin and fllw-up 5. Training fr new hires and annually fr all staff with risk t bld expsure 6. Recrdkeeping 7. Evaluatin f circumstances surrunding expsure incident The ECP dcument needs t be easily available t emplyees cvered by this regulatin. A sample template fr a plan is included at the end f the presentatin. 24

25 Clinic XYZ OSHA Bldbrne Pathgen Expsure Cntrl Plan 2017 See template link/attachment in the references n slide #

26 Determining risk expsure (example): Jb classificatins in which ALL emplyees have ccupatinal expsure Jb classificatins in which SOME emplyees have ccupatinal expsure- Include what activity puts the emplyee at risk Phlebtmist (draw bld) Acupuncturist Chirpractr Emplyees whse jb requires them t handle used sharps cntainers 26

27 Staff inclusin in the Bldbrne Pathgen Standard: Staff cmpleting the fllwing tasks require inclusin with the Bldbrne Pathgen Standard: Handling f used sharps/cntainers Handling f bihazardus waste (lab waste, used sharps/cntainers, bdy fluid cntaminated items/ ptentially bdy fluid siled laundry) Cleaning up any bdy fluid spills/areas Perfrming acupuncture Perfrming bld draws 27

28 Persnal Prtective Equipment (PPE) PPE is prvided at n cst t emplyees and includes: Training in the use f and availability f apprpriate PPE (crrect sizes and types must be made easily accessible) PPE must be remved and hand hygiene perfrmed befre leaving the prcedure area List items: -Types f PPE available: -Lcatin f PPE and prcess fr btaining them: -Required PPE precautins/hw and when t use them 28

29 Training and Equipment fr Use During Prcedures Where There is Risk f Bld/Bdy Fluid Expsure: Apprpriate Training Materials: PPE: Vides/training tls available fr safe bld drawing prcedures. Training materials may be available frm the labratry where the specimens are sent fr prcessing r with the equipment manufacturer Glves must always be wrn fr drawing bld Hand hygiene befre and after prcedure Safe sharps devices need t be used The surface where the bld draw is perfrmed shuld be disinfected befre & after each patient. Cllect all supplies befre initiating the bld draw prcedure. Use EPA apprved disinfectants fr healthcare t disinfect bld draw cunters befre and after use, even if they are cvered by a twel/drape. 29

30 Dispsable Impervius Glves FrCleaning up Ptentially Siled Areas ECP language is likely t include requiring PPE s when: Wrking in the area f a Bld draw/lab r prcedure table when a bld draw r lab is ccurring Cleaning visibly siled areas, especially nes with pssible bdy fluids/bld present Acupuncture area 30

31 Laundry ECP Requirements Articles shuld either be laundered at the facility where it is used r by a prfessinal laundry Include in the Expsure Cntrl Plan: Laundry dne by: name f respnsible persn/department /lcatin/ if nsite and name f respnsible persn nsite and name f cmmercial laundry and cntact persn if a cntract service is used. Specific laundry requirements Clearly designated clean vs siled laundry; usually this means labeled and/r clr cded laundry baskets/cntainers & impervius bags Clean separatin f clean vs. siled wrk flw separated strage lcatins *Used/siled laundry frm medical care facilities shuld nt be taken t an emplyee r wrker s hme t be laundered (MNOSHA) 31

32 Laundry requirements cntinued Cntaminated laundry means have bld r bdy fluids present. Used, cntaminated laundry shuld be handled as little as pssible, use glves and ther PPE (i.e. gwn if needed t prtect the wrker). Bagged r cntainerized at the lcatin where used. D nt srt r rinse at this lcatin. Placed in bags that are impervius and labeled r clr cded t indicatin that laundry is used/cntaminated. Many cmmercial laundries treat all used linen as cntaminated. 32

33 Labels fr Ptentially Cntaminated Materials Items t be labeled Specimens Cntaminated/siled laundry Labeling Bihazard label n specimens transprt cntainer. Designated cntainer/bag labeled cntaminated/used laundry unless all laundry is handled as cntaminated. Bihazardus waste Red bihazard labeled impervius bag fr bihazardus waste & bihazard labeled sharps cntainer fr used sharps devices Sharps cntainers must be sealed shut fr dispsal when ¾ full 33

34 Pst-Expsure Evaluatin & Fllw-Up In the event f an expsure incident, a clinic identified persn shuld be cntacted Include the name and cntact infrmatin in the expsure cntrl plan Fllwing initial first aid, perfrm activities as described in ECP: Direct the expsed persn regarding a cnfidential medical evaluatin. The persn shuld be a licensed healthcare prvider (HCP). The HCP shuld be prvided a cpy f the OSHA standard expsed emplyees rutine duties, circumstances f the expsure, bld test results and relevant medical recrds. It is very helpful t use a service that is familiar with this prcess i.e. a large hspital ER r an ccupatinal health service that specializes in healthcare. 34

35 Pst Expsure Evaluatin & Fllw-Up Health care prfessinal respnsible fr emplyee s hepatitis B vaccinatin and pst-expsure evaluatin are t have available: Cpy f OSHA Bldbrne Pathgen standard Infrmatin re: emplyee s relevant duties, rute/circumstances f expsure, bld test results, relevant medical recrds Bld wrk can be rdered fr rapid results and available within a few hurs. The expsed emplyee is t receives the written pinin f fllw-up within 15 days f cmpletin f evaluatin. Usually this ccurs at the time f the expsure, when the lab results are available and as a fllw-up, & when additinal lab tests r medicatin may be indicated. 35

36 After an Expsure Event, an Evaluatin f Circumstances Surrunding Expsure Incident is Required Name f respnsible persn/department at yur rganizatin will: Review circumstances f expsure incidents as described in ECP Recrd sharps injuries in Sharps Injury Lg and OSHA 300 Lg f Occupatinal Injuries and Illnesses (n persnal identifiers) Revise ECP as indicated by findings (nging) 36

37 37

38 Emplyee Training Emplyee training must include: All emplyees wh have ccupatinal expsure t bldbrne pathgens receive training cnducted by name f respnsible persn/department Training will address all items described in Emplyee Training sectin f ECP The training ccurs n hire and at least annually there after as lng as the persn is in a jb where there is risk f expsure 38

39 Bld Drawing Prcedure Dcumentatin: Clinic needs a written prcedure dcumenting: Use single use dispsable glves Use safe sharps device Use single use turniquet Use skin antiseptic n needle puncture site befre prcedure Use single use vacutainer tube hlder Apply bandage t site after bld draw is cmpleted Discard used sharps & bld draw equipment as sn as pssible after use 39

40 Acupuncture MN-OSHA MN-OSHA recmmends glves be used during Acupuncture treatments Exam type, sized glves prviding a gd fit Glves are required fr: all bld draw prcedures fr starting an IV Glves are ptinal fr injectin like prcedures. Needles shuld have a safety device t activate after use, if available. Sharps cntainers shuld be clse t pint f use fr quick dispsal but in a safe lcatin t prevent access by nn healthcare staff. 40

41 Recrdkeeping Training recrds are maintained in cmpliance with the ECP Recrdkeeping sectin Medical recrds are maintained fr each emplyee with ccupatinal expsure in accrdance with 29 CFR and the ECP (fr 30 years after emplyment is terminated) Expsure incidents are recrded in cmpliance with OSHA s Recrdkeeping Requirements Sharps injuries are recrded in the Sharps Injury Lg accrding t the ECP See the Expsure Cntrl Plan Template attached t this training material. 41

42 Sample Sharps Injury/Expsure Lg Example (individual identifiers are nt t be included) Year: Date/mnth f expsure Hw it ccurred- suggested Specific devices invlved (brand, prduct identified, size, ) Preventin recmmendatin based n feedback frm expsed persn and current safe practices (Lg reviewed at least annually) 42

43 References Sample expsure cntrl plan List f examples f engineering cntrls & wrk practice cntrls in healthcare Pst Expsure Evaluatin Flwchart MNOSHA Occupatinal Expsure t Bldbrne Pathgens slide set-oct gens_1011.pdf 43

44 Pst test 1. Wh is cvered by the OSHA Bldbrne Pathgen Standard? a) A- All emplyees wh culd be reasnably anticipated as a result f perfrming their assigned jb duties t face cntact with bld r ther ptentially infectius materials are cvered by the standard b) B- Only persns wh are trained t perfrm invasive prcedures. 2. Is an Expsure Cntrl Plan required by the emplyer if emplyees are at risk f expsure t bld r ptentially bld cntaining bdy fluids? a) N b) Yes 44

45 Pst test 3. What is the definitin f an expsure incident? a) A specific eye, muth, ther mucus membrane, nn-intact skin, r parenteral cntact with bld r ther ptentially infectius materials that result frm the perfrmance f an emplyee s duties. b) A used needle stick r bld expsure t a cut r pen skin area. 4. Hw ften is educatin regarding this OSHA standard t be ffered t thse at risk fr expsure and what shuld be cvered in the educatin? a) On hire and at least annually there after educatin related t the standard shuld ccur b) The cntent fr inclusin in the training is defined in the standard 45

46 Pst test 5. What shuld an emplyee d if they have a bld r bdy fluid expsure? a) Wash the site f expsure with sap and water and reprt the expsure t the designated persn at yur facility. This shuld be dne as sn as pssible and include a descriptin f hw the incident ccurred, including the name f the persn wh was the surce f the expsure if it is knwn and the device being used if any at the time f the expsure. b) Reprt the expsure when yu have time t d s is sufficient. 6. What des bldbrne pathgen mean? a) Human Immundeficiency virus (HIV) and Hepatitis B virus (HBV) b) HIV and HBV are specifically referenced in the standard but the term bldbrne pathgen includes any pathgen that is present in bld and can infect/cause disease in peple wh are expsed t bld cntaining the pathgen. 46

47 Pst test 7. What are the requirements fr a bldbrne pathgen expsure (BBPE)? a) Send emplyee t a healthcare prfessinal (HCP) with a cpy f the standard, descriptin f the incident, emplyee s relevant medical infrmatin as available and jb descriptin. HCP reviews incident, arranges testing f emplyee and surce persn, ntifies emplyee f all results, prvides cunseling & prphylaxis as needed. Evaluates reprted illnesses. (All f this infrmatin is cnfidential.) b) Wait and see what happens. 8. What are the precautins t take fr persns wh perfrm prcedures with risk f BBPE risk? a) Use f safety devices t minimize risks f expsure. This incudes glves and ther prtective equipment and safety devices if available t minimize expsure, fr example, safe sharps devices. b) Use cautin. D nt use tw hands t recap sharps. 47