A. Background for Trainer: B. What OSHA Requires: Bloodborne Pathogens. Lesson Plan 6080a

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1 Lesson Plan 6080a This training session outline is designed to follow the accompanying booklet, OSHA s Bloodborne Pathogens Standard. The booklet reviews what employees who are potentially exposed to the acquired immune deficiency syndrome (AIDS) and hepatitis viruses must do to protect themselves. This session is similar to the Universal Precautions chapter also included in this book. This session provides a broader view of the information, while Universal Precautions includes more detail on specific safety procedures and is oriented more specifically to healthcare workers. Trainers may want to conduct the two as sequential sessions or use Universal Precautions as part of an annual refresher training as required by OSHA. A. Background for Trainer: Workers in healthcare-related fields and certain other occupations can be exposed to extremely dangerous viruses such as AIDS and hepatitis that are primarily transmitted through contact with blood (bloodborne pathogens). For workers who may be exposed, OSHA has a standard requiring employers to have a written Exposure Control Program and to provide training in the measures workers must take to protect themselves. These include protective clothing, housekeeping, and certain specific procedures that workers must understand and practice (universal precautions). Note: Hospitals generally follow Standard precautions, which assumes all bodily fluids (except sweat), nonintact skin, and mucous membranes are potentially infectious. B. What OSHA Requires: OSHA requires all employees at risk of exposure to bloodborne pathogens to receive training at least once a year, plus training whenever required safety procedures change. Training must be language that employees can understand (that is, not overly technical), and should cover: s The content of OSHA s Bloodborne Pathogens Standard s Explanation of epidemiology s How bloodborne pathogens are transmitted s Engineering controls, work practices, and personal protective equipment (PPE) to eliminate or reduce exposure s Hepatitis B vaccine s Emergency response involving blood or infectious materials s Reporting incidents of exposure s Warning signs and labels There are additional regulations and training that apply to facilities that specifically deal with the human immunodeficiency virus (HIV) and hepatitis virus. Training records must be kept showing when the training was held, what was covered, who gave the training and their qualifications, and who attended. (29 CFR (g) and (h))

2 Lesson Plan 6080b C. Training Objectives: By the end of this session, employees should understand: s How HIV and hepatitis are transmitted s Universal precautions for protecting against HIV and hepatitis s Basic information about what is in your organization s Exposure Control Plan s PPE s Other precautions that apply in specific situations D. Pre-Quiz: Start off by asking the group some or all of the questions listed below. This tests their general knowledge of the topic and will guide you on what points to emphasize during the session. 1. True or False: The chances of becoming infected with HIV or hepatitis are very small. (Answer: True. Most people do not carry these viruses, and the viruses generally are not transmitted by casual contact. However, it s extremely important to reduce or eliminate even the slightest risk of exposure.) 2. How are HIV and hepatitis transmitted? (Answer: Generally, through contact with bodily fluids, such as blood, semen, saliva.) 3. True or False: Blood and other potentially infectious materials should always be treated as if they are infectious. (Answer: True. This is the fundamental rule, or universal precaution, in handling potentially infectious materials.) E. Session Outline: General Training Point: The trainer should present the information in this session as factually and objectively as possible, emphasizing that the risk of infection is relatively low but that the goal is to reduce this risk to zero. 1. Introduction: What Are Bloodborne Pathogens? a. Risk of exposure to bloodborne pathogens: i. Human immunodeficiency virus (HIV), which causes AIDS; and ii. Hepatitis virus, including hepatitis B (HBV) and C (HCV). b. Risk is small, but it s important to keep it to an absolute minimum. c. OSHA requires employers to provide a written Exposure Control Program. Training Tip: Show a copy of your company s Exposure Control Program. Ask the group how they can obtain and read it. 2

3 Lesson Plan 6080c 2. Exposure Control Program a. Universal precautions b. Work practices that eliminate or minimize exposure c. Housekeeping procedures d. Hepatitis B vaccinations for at-risk employees e. Evaluation and follow-up for exposure incidents f. Container warnings, such as biohazard labels g. Confidential medical records for employees h. Training program 3 Training Tip: Review what the training program will include (refer to Section B of this chapter or the OSHA standard). 3. Risks of HIV and Hepatitis a. HIV causes AIDS and attacks the immune system, reducing ability to fight disease: i. Early symptoms include fever, loss of appetite, weight loss, chronic fatigue, skin rashes. ii. Later, victims may develop cancers, infections. iii. Symptoms may appear soon or late but there is no cure for AIDS. b. HBV and HCV affect the liver and are more common than HIV and pose a greater health risk: i. Some HBV-infected people have no symptoms. ii. Some develop liver disease or liver cancer. c. Infectious diseases are transmitted by bodily fluids: This includes blood, semen, vaginal secretions, cerebrospinal fluid, synovial fluid, pleural fluid, pericardial fluid, peritoneal fluid, amniotic fluid, saliva (in dental procedures), or any unfixed human organ or tissue. Training Tip: Make sure the group understands what various medical terms (such as synovial fluid) mean. Ask your safety manager if you re not sure yourself Risks of Infection Handout: Distribute copies of Handout #1, especially if you are not using the training booklet. If using the training booklet, either use the handout here or review it at the end of the session. a. HIV and hepatitis risks of infection are small. b. Infection is not transmitted by: i. Coughing or sneezing ii. Touching an infected person iii. Using same items as an infected person 6

4 c. Infection can be transmitted by: i. Sexual contact ii. Shared drug needles iii. Punctures from infected needles or other sharps iv. Direct contact between broken skin and infected bodily fluid v. For hepatitis only, through dried blood and contaminated surfaces Bloodborne Pathogens Lesson Plan 6080d Training Tip: Refer to specific circumstances in your workplace that could allow the transmission of HIV or hepatitis. 5. Precautions Handout: Distribute copies of Handout #2, especially if you are not using the training booklet. If using the training booklet, either use the handout here or review it at the end of the session. a. Universal precaution: Treat all blood and potentially infectious material as though it is infectious. b. Standard precautions (apply to all bodily fluids and secretions except sweat): i. Wash hands and exposed skin immediately after exposure or taking off PPE. ii. Use cleanser or towelettes only if wash facilities are not available. iii. Minimize splashing or spraying of potentially infectious materials. iv. Put sharps in approved containers. v. Don t break, bend, recap, or remove needles and sharps. vi. Keep food and drink out of potential exposure area. vii. Don t eat, drink, smoke, apply cosmetics, or handle contact lenses in potential exposure area. viii. Don t pipette or suction potentially infectious materials by mouth. Training Tip: Make sure the group thoroughly understands the Universal Precaution they should always assume that blood and other material is infectious regardless of what they might be told otherwise PPE a. Always wear the protective clothing the company provides. 8 b. Gloves: i. If disposable, never reuse discard if they become torn or punctured. ii. Utility gloves can be reused if decontaminated and not damaged in any way. c. Masks, face shields, goggles prevent splashes and sprays into nose and mouth. d. Gowns, aprons, surgical caps, shoe covers, etc. protect body. e. Never wear anything that is damaged check it beforehand. f. Remove clothing after exposure, and dispose in approved container. Training Tip: Demonstrate items of PPE used in your workplace to protect against exposure.

5 Lesson Plan 6080e 7. Good Housekeeping a. Check the company s written decontamination and cleaning procedures. b. Cover equipment and surfaces with plastic, foil, or other impervious material. Remove and replace if exposed. c. Clean and decontaminate surfaces after contact with potentially infectious materials. d. Clean and decontaminate bins, pails, etc., regularly and immediately after exposure. e. Don t use hands to pick up potentially contaminated sharp objects. Training Tip: Modify this section as necessary to include your company s specific housekeeping and decontamination rules and procedures Containers for Infectious Materials a. Special care is required for handling, storing, and transporting infectious materials. b. Use only leakproof containers (and puncture-proof if necessary). c. If outside of container is contaminated, place it in second container. d. Decontaminate container or label it Contaminated. e. Containers must be clearly marked red and/or labeled with biohazard symbol. 10 Training Tip: Show the containers and labels used in your workplace. Make sure they recognize the Biohazard symbol. 9. Handling Laundry a. Bag contaminated laundry immediately; keep it away from patient area. b. Use leakproof bags. c. If facility does not follow universal precautions, separate bags and label contaminated bags. d. Wear gloves and other PPE to handle laundry. Training Tip: If laundry is not applicable to your workplace or to this group, simply emphasize that universal precautions apply to handling laundry as well as other activities. 10. Special Precautions for Specific Jobs a. Emergency response workers: Should always be equipped with replacement PPE, disposable equipment and replacements, decontamination equipment. b. Forensic, lab, mortuary workers: Always observe Universal Precautions. c. Public safety workers: Have necessary PPE in case of contact with blood or other bodily fluids

6 Lesson Plan 6080f d. Workers in HIV or hepatitis research facilities: Special rules and training are required. e. Others: Avoid contact with sharps, avoid touching infected material, use PPE. Training Tip: Modify this section to fit the jobs and conditions that apply to this training group. Demonstrate the equipment and safe use. 11. Reporting Exposure a. Report possible exposure immediately. b. Employer will provide confidential medical evaluation and blood test. c. Employer will provide free HBV vaccine. (There is no approved HCV vaccine.) 14 Training Tip: Make sure the group understands all procedures for reporting exposure. Emphasize that the medical evaluation will be confidential. 12. Conclusion: Protect Yourself Against Exposure a. Review basic protection rules: i. Treat all potentially infectious materials as if they are infectious. ii. Wear gloves if there s a possibility of contact with bodily fluids. iii. Wear other PPE as needed. iv. Use extreme caution with needles and sharps and dispose of them properly. v. Follow proper decontamination procedures for clothing and equipment. vi. Report any exposure immediately. b. Always know and follow OSHA and company rules, Universal and Standard Precautions (as appropriate). Handout: If you have not already used them in the session, distribute copies of Handouts #1 and #2, which summarize the key points. F. Quiz: Have the group take the Quiz included on the back of the booklet without looking at the correct answers shown at the bottom of the page. After they have finished, review each question. G. Wrap-Up s Ask for any final questions. s Distribute the Training Session Attendance Form, and have the group sign and return it. s Thank the group for their attention. 15