Emergency Department » Bloodborne Pathogens (BBP)

Bloodborne pathogens are pathogenic microorganisms present in human blood that can cause disease in humans. These pathogens include, but are not limited to, Hepatitis B Virus (HBV), Hepatitis C Virus (HCV), Human Immunodeficiency Virus (HIV) and Viral Hemorrhagic Fevers (e.g. Ebola). [29 CFR 1910.1030(b)]

Hazards

Emergency Department workers are at particular risk for exposure to bloodborne pathogens because they are often exposed to blood and other fluids resulting from traumatic, life-threatening injuries treated in the emergency department.

Requirements under OSHA's Bloodborne Pathogens Standard, 29 CFR 1910.1030

The Bloodborne Pathogens Standard requires precautions when there is occupational exposure to blood or OPIM (as defined by the standard). Under the standard, OPIM means (1) the following human body fluids: semen, vaginal secretions, cerebrospinal fluid, synovial fluid, pleural fluid, pericardial fluid, peritoneal fluid, amniotic fluid, saliva in dental procedures, any body fluid that is visibly contaminated with blood, and all body fluids in situations where it is difficult or impossible to differentiate between body fluids; (2) any unfixed tissue or organ (other than intact skin) from a human (living or dead); and (3) HIV-containing cell or tissue cultures, organ cultures, and HIV- or HBV-containing culture medium or other solutions; and blood, organs, or other tissues from experimental animals infected with HIV or HBV.

For a complete explanation, see Hospital-wide Hazards - Bloodborne Pathogens.

OSHA requires employers to:

  • Ensure that the biosafety officer or other responsible person conducts an exposure determination to determine the exposure of workers to blood or OPIM throughout the hospital setting. [29 CFR 1910.1030(c)(2)(i)].
  • Use engineering and work practice controls
    • Engineering (e.g., engineered safer needle devices and sharps) and work practice controls must be the primary means to eliminate or minimize exposure to bloodborne pathogens. Where engineering controls, including SESIP (Sharps with Engineered Sharps Injury Protection) will eliminate or minimize employee exposure, either by removing or isolating the hazard, they must be used. [29 CFR 1910.1030(d)(2)(i)]
  • Ensure that employees use appropriate personal protective equipment (PPE), (e.g., gloves, gowns, face masks), as required by the standard, when there is anticipated blood or OPIM exposure. [29 CFR 1910.1030(d)(2)(i), 29 CFR 1910.1030(d)(3)(ii)]
  • Ensure that employees discard contaminated needles and other sharp instruments into appropriate containers immediately or as soon as feasible after use. [29 CFR 1910.1030(d)(4)(iii)(A)(1)]
  • Establish a written Exposure Control Plan (ECP). The ECP must contain, among other elements, annual documentation of consideration and implementation of appropriate commercially available and effective safer medical devices designed to eliminate or minimize exposure to blood and OPIM. Solicit input from non-managerial employees responsible for direct patient care who are potentially exposed to injuries from contaminated sharps in the identification, evaluation, and selection of effective engineering and work practice controls. Document the solicitation in the Exposure Control Plan. Any change to the use of engineering controls (and any other change affecting exposure) must also be reflected in the ECP. [29 CFR 1910.1030(c)(1)]
  • Establish Universal Precautions:
    • Universal Precautions: An approach to infection control that treats all human blood and certain human bodily fluids as if they were infectious for HIV and HBV or other bloodborne pathogens. [29 CFR 1910.1030(b)]
    • The requirement to use Universal Precautions in the Bloodborne Pathogens Standard [29 CFR 1910.1030(d)(1)] means implementing the precautions required by the standard (e.g., engineering and work practice controls, appropriate PPE such as gloves, masks, and gowns) whenever there is exposure to blood or OPIM (or in some cases other body fluids).
    • Alternative concepts in infection control are called Body Substance Isolation and Standard Precautions. These alternatives define all body fluids and substances as infectious, and OSHA permits the implementation of these approaches, as an alternative to universal precautions, provided that facilities utilizing them adhere to all other provisions of the Bloodborne Pathogens Standard.
  • Establish and maintain a sharps injury log for recording needlestick/sharps injuries. [29 CFR 1910.1030(h)(5)] The confidentiality of the injured employee must be protected.
  • Make immediately available to an exposed employee a confidential medical evaluation and follow-up, after a report of a needlestick injury or other exposure incident. The initial medical evaluation often occurs in the emergency department. [29 CFR 1910.1030(f)(3)]
  • Provide BBP training to employees at the time of initial assignment where occupational exposure may take place and at least annually thereafter. [29 CFR 1910.1030(g)(2)]
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