Bloodborne Pathogens

What are Bloodborne Pathogens?

Bloodborne pathogens (BBP) are microorganism in human blood that cause life-threatening diseases and pose a severe risk to health care workers. Contact with blood, tissue, or fluids, including semen, vaginal secretions, saliva, and serous fluids (pleural, pericardial, peritoneal, and amniotic) clear or visibly contaminated with blood have the potential to transmit pathogens and cause infectious disease.

In the work place, the most common source of bloodborne pathogen infections is percutaneous injuries from needles or other sharps. However, exposure can also occur via accidental puncture, human bites, cuts, abrasions, or through mucocutaneous exposure to infected patient's fluids. Universities pose a unique hazard because of the diversity of potential occupational exposures, including research laboratories where the study of these agents is conducted.

Of the more than twenty bloodborne pathogens that are known to cause disease such as malaria, syphilis, and hemorrhagic fever, there are three that are the most common pathogens of concern: Hepatitis B (HBV), Hepatitis C (HCV) and Human Immunodeficiency Virus (HIV). These three viruses account for the majority of occupationally-acquired infections. Although the majority of occupational exposure to bloodborne pathogens does not result in disease, the overall risk of the transmission is dependent upon several factors including the type of exposure, amount of infectious material present during exposure, and duration of exposure. It is estimated that approximately three million exposures to bloodborne pathogens occur annually and most are due to accident punctures from contaminated sharps. The the United States alone, there are an estimated 400,000 sharps injuries per year in the hospital setting alone.

Hepatitis B Virus (HBV)

Hepatitis B is capable of causing a persistent, chronic infection that can lead to acute and chronic disease in the liver. The virus can be transmitted via blood or semen from an infected person to someone with a weakened immune system. The virus is stable in the environment and can remain infectious on surfaces for up to one week. HBV is a global health problem and a well-established occupational risk for health care workers. The risk of infection after exposure ranges from 6 to 30% depending on the serology of the source. Vaccines to prevent HBV infection first became available in 1981 and have remained an important part of HBV prevention. The OSHA Bloodborne Pathogens Standard mandates that employers ensure that this vaccine is available to all employees at risk for occupational exposure to HBV.

Hepatitis C Virus (HCV)

Hepatitis C is another virus that attacks the liver and can cause both acute or chronic infections. It is the most commonly reported bloodborne pathogen in the United States and poses a serious threat to public health. HCV is primarily transmitted through contact with blood from an infected person via contaminated needles or other sharps. HCV is a well-established risk for healthcare workers however, the risk of transmission when a person is exposed to HCV positive blood is approximately 1.8% which is considerably lower than the risk of transmission of HBV. There is currently no preventative or post-exposure prophylaxis for HCV infection although new treatments are evolving with the development of targeted therapies.

Human Immunodeficiency Virus (HIV)

HIV infects the immune system causing the disease that is known as acquired immunodeficiency syndrome (AIDS). HIV is transmitted via direct contact with blood, semen, rectal fluids, vaginal fluids, and breast milk from an individual with a detectable amount of virus in their body. Individuals that are HIV positive but have a viral load that is below the detectable limit cannot transmit the virus. In the work place, transmission is influenced by several factors including the volume of the infectious material, type of procedure, type of injury (e.g. needle stick or splash to the face), and duration of exposure. Compared to HBV and HCV, the risk of HIV transmission is the smallest. There there is no cure for the disease, there are antiviral medications that slow progression. In the case of exposure, if taken within 72 hours, administration of post-exposure prophylactic medications are highly effective in preventing HIV infection.

Exposure Control Plan

Prevention is the key to protect workers from bloodborne pathogen transmission. LSU developed an exposure control plan that in accordance with federal regulations and guidelines in the conduct of research and other activities which might place personnel in direct contact with blood that could potentially contain infectious agents. The plan, detailed in LSU's Policy Statement 65 describes how human and primate tissue, fluids, and other potentially infectious materials shall be handled.

OSHA

In 1991, the Occupational Safety and Health Administration (OSHA) issued the Bloodborne Pathogens Standard in response to concern over occupational exposure to bloodborne pathogens. This standard ensures the safety of workers at risk for occupational exposure. The regulations prescribed to employers are located in Title 29 of the Code of Federal Regulations at 29 CFR 1910.1030. Strict adherence to these regulations and guidelines reduces the risk, minimizes exposure, and helps prevent bloodborne pathogens' transmission. Specifically, the federal standard mandates employers do the following:

Establish an exposure control plan.
Provide initial and annual education and training to workers.
Make the hepatitis B vaccination available for workers who might be exposed to BBP.
Implement the use of universal precautions.
Identify and use approved engineering controls.
Identify and ensure the use of work practice controls.
Use of warning labels and/or signs to communicate hazards.
Provide adequate and appropriate personal protective equipment (PPE) for employees.
Establish readily available post-exposure evaluation and follow-up plans.
Maintain employee medical and training records.

Policy Statement 65

Policy Statement 54, entitled Management of Human/Primate Body Fluids/Wastes, summarizes the uniform procedures for the safe management of human and primate blood, unfixed tissues, body fluids including blood, cell lines, and waste. A copy of the policy is located here.

Additionally, The Inter-Institutional Biological and Recombinant DNA Safety Committee has established a policy for the Use of Human and Primate Cell Lines for Laboratory Personnel.

Disposal of Biohazardous Waste

Disposal of biohazardous and medical waste is regulated by OSHA, the Louisiana Department of Health and Hospitals, and the Louisiana Department of Environmental Quality. Biohazardous or medical waste is defined as waste considered likely to be infectious to humans, animals, or plants by virtue of what it is or how it may have been generated. If you work in a lab or other environment that generates biohazardous or medical waste, it must be disposed of according to applicable federal, state and location regulations. For details regarding what constitutes biohazardous waste and how it is disposed, please visit the Biohazardous Waste Disposal webpage.

Training

An important component to exposure control is training. On-the-job training is not an acceptable alternative to formal safety training. Interactive training sessions must be conducted upon initial hiring and annually thereafter. Training must be conducted by an individual who is knowledgeable about the OSHA standard, safety and the pathogens potentially present. Employees must be educated about their risk and the institution’s plan to control these risks. There must be no charge for training to the employee, be available during working hours and be understood by the employee. The topics required to be covered by training include:

Accessibility of the OSHA Bloodborne pathogen standard and Institutional exposure control plan.
Epidemiology, transmission and symptoms of common bloodborne pathogens.
Standard precautions.
Engineering controls, work practices and personal protective equipment.
Information on removing, handling, decontamination, and disposal of Personal Protective Equipment (PPE).
Emergency and post-exposure management.
Incident reporting protocols.
Hepatitis B virus vaccination program.
Hazard communications.

For more information or to arrange for bloodborne pathogen training, contact the LSU Environmental Health and Safety (EHS) office at 578-5640 or Dr. Abigail Fish at afish5@lsu.edu.

Hepatitis B Vaccine Program

The Bloodborne Pathogens Standard mandates employers to make the hepatitis B vaccination series available to the worker, at no cost after the required bloodborne pathogens training. The vaccination series, usually given as three or four shots over a six-month period, must be offered to the worker at a reasonable time and place. Employees have the right to decline the vaccination but must sign a declination form indicating such.

Universal Precautions

OSHA’s bloodborne standard for reducing exposure risk and infection control is grounded on the adoption of Universal Precautions. Universal Precautions assumes that all body fluids (blood, saliva, secretions) and sites (open wounds and mucous membranes) contain pathogenic microorganisms, such as HBV, HCV, and HIV potentially infectious. Employees that observe Universal Precautions will treat all potentially infectious materials with appropriate precautions such as hand hygiene, the use of personal protective equipment (PPE), and engineering and work practice controls to limit exposure. Visit the Universal Precautions webpage for more information.

Engineering and Work Practice Controls

Engineering controls are devices, tools and equipment that physically isolate the worker from the hazard. Examples of engineering controls include biosafety cabinets, safety sharps, puncture-resistant, leak-proof sharps containers, and PPE. Work practice controls are alterations in how a task is completed to reduce the likelihood of an exposure to the worker. Examples of work practice controls include standard operating procedures, proper handling, storage and disposal of hazardous waste, and proper handwashing techniques. When combined, these measures reduce or eliminate the risks of a task to a worker.

Post-Exposure Evaluation

The use of preventive strategies will not completely eliminate the possibility of exposure to infectious materials. LSU's exposure control plan includes a post-exposure evaluation program. The plan requires a confidential medical evaluation, follow-up and documentation of an exposure incident. An exposure incident is defined as a specific eye, mouth, other mucous membrane, non-intact skin, or parenteral contact with blood or other potentially infectious materials that results from the performance of an employee’s duties. LSU follows the CDC guidelines for post-exposure prophylaxis for exposures to HBV, HCV, and HIV. Post-exposure management may include HBV vaccine booster, anti-retroviral chemotherapy and/or immune gamma globulin injections.