Kevin Ian Schmidt

Understanding OSHA Bloodborne Pathogens Standard

Bloodborne pathogens are infectious microorganisms in human blood that can cause disease in humans. These pathogens include, but are not limited to, hepatitis B (HBV), hepatitis C (HCV) and human immunodeficiency virus (HIV).

Workers in many occupations, including first responders, housekeeping personnel in some industries, nurses and other healthcare personnel, all may be at risk for exposure to bloodborne pathogens.

Bloodborne pathogens are capable of causing serious illness and death. The most common illnesses caused by bloodborne pathogens are hepatitis B (HBV), hepatitis C (HCV, and acquired immunodeficiency syndrome (AIDS) from HIV.

Check Out: BloodBorne Pathogen Exposure Control Plan

Who is covered by OSHA’s Bloodborne Pathogens Standard?

The standard applies to all employees who have occupational exposure to blood or other potentially infectious materials (OPIM).

Employees who provide first aid as part of their job are required to have training on occupational exposure.

  • Occupational exposure is defined as “reasonably anticipated skin, eye, mucous membrane, or parenteral contact with blood or OPIM that may result from the performance of the employee’s duties.”
  • Blood is defined as “human blood, human blood components, and products made from human blood.”
  • Other potentially infectious materials (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.

You can find more information on recognizing workplace hazards associated with bloodborne pathogens on OSHA’s Hazard Recognition Page.

What is the purpose of OSHA’s Bloodborne Pathogens standard?

The purpose of the standard is to minimize or eliminate occupational exposure to disease-carrying microorganisms or “pathogens” that can be found in human blood and body fluids.

Who must be trained under OSHA’s Bloodborne Pathogens standard?

OSHA has mandated annual training is required for all employees with potential occupational exposure. This means if there is a reasonable possibility an employee might be exposed to blood or other potentially infectious materials (OPIM),other potentially infectious bodily fluids, they must receive training to minimize or eliminate their risk to potential exposure.

OSHA has determined employers can minimize or even eliminate occupational bloodborne hazards by developing and enforcing a combination of exposure control strategies which work for all bloodborne diseases. It is not enough for an employer to provide bloodborne pathogens training; they must also have a formal exposure control plan documented and implemented.

TRAINING IS NOT ENOUGH; an employer must implement a Formal Exposure Control Plan, which can be found at the EHS Center.

What are the primary bloodborne pathogens?

The primary bloodborne pathogens are:

  • Hepatitis B Virus (HBV)
  • Hepatitis C Virus (HCV)
  • Human immunodeficiency virus (HIV)

Other commonly recognized pathogens transmitted by body fluids include:

  • West Nile Virus
  • Malaria
  • Syphilis

 

Hepatitis B Virus (HBV)

The hepatitis B virus (HBV) is one of the primary causes of Hepatitis, an infection which causes inflammation of the liver. Complications of Hepatitis include cirrhosis (scarring) of the liver, liver cancer, and liver failure. There is no known cure for the hepatitis B virus. In the United States, approximately 15 to 25 percent of people infected with HBV will die because of the illness.

According to the Hepatitis B Foundation, thousands of people in the United States and 600,000 people worldwide die from hepatitis B-related liver disease annually.

The Center for Disease Control (CDC) reported 2,953 confirmed acute cases of hepatitis B in 2014. The CDC estimates 19,200 people were infected with the hepatitis B virus the same year.

Hepatitis B can be either acute or chronic:

  • Acute hepatitis B virus infection is a short-term illness that occurs within the first 6 months after someone is exposed to the Hepatitis B virus. Acute infection can, but does not always, lead to chronic infection.
  • Chronic hepatitis B virus infection is a long-term illness that occurs when the Hepatitis B virus remains in a person’s body. Chronic Hepatitis B is a serious disease that can result in long-term health problems, and even death.

An exposure that might place a worker at risk for HBV, HCV, or HIV infection is defined as:

  1. A percutaneous injury (e.g., a needlestick or cut with a sharp object); or
  2. Contact of mucous membrane or nonintact skin (e.g., exposed skin that is chapped, abraded, or afflicted with dermatitis) with blood, tissue, or other body fluids that are potentially infectious.
  3. Indirect exposure from contaminated objects is a risk because hepatitis B virus can remain infectious on environmental surfaces for up to a week (7 days) in the form of dried blood.

This means you must always treat blood, wet or dry, as infectious!

A vaccination to prevent Hepatitis B virus infection is available. The Hepatitis B vaccine series is a sequence of three shots, typically given one month apart, that stimulate a person’s natural immune system to protect against the virus. After the vaccine is given, the body makes antibodies to protect a person against the virus. Antibodies are specialized proteins found in the blood that produce an immune response to a virus invading the body. These antibodies are stored in the body to guard against future infections. They will fight off an infection if a person is exposed to the Hepatitis B virus in the future.

Hepatitis C Virus (HCV)

The hepatitis C virus (HCV) is also a significant cause of severe liver damage and death.

Hepatitis C kills more Americans than any other infectious disease. Deaths associated with hepatitis C reached 18,153 in 2016, according to surveillance data released by the Centers for Disease Control and Prevention (CDC).

About 3.5 million Americans are currently living with hepatitis C and roughly half are unaware of their infection. Approximately 1 to 5% of people infected with hepatitis C virus die as a result of the long-term damage caused to the liver and body.

Approximately 70%-80% of people with acute hepatitis C do not have any symptoms. Some people, however, can have mild to severe symptoms soon after being infected, including:

  • fever
  • fatigue
  • loss of appetite
  • nausea
  • vomiting
  • abdominal pain
  • dark urine
  • grey-colored bowel movements
  • joint pain
  • jaundice (yellow color in the skin or eyes)

Click here to view the CDC fact sheet for Hepatitis C.

If symptoms do occur, the average incubation period is 45 days after exposure, but this can range from 14 to 180 days.

Many people infected with the hepatitis C virus do not develop symptoms.

Hepatitis C virus-infected individuals are infectious to other people, whether they show symptoms or not. Interestingly, Hepatitis C virus is strictly a human disease. It is not known to cause disease in any animals.

Blood testing for hepatitis C virus was not available until 1992. As a result, blood donation agencies did not screen for hepatitis C virus. Many hepatitis C virus infections occurred as a result of receiving blood products from infected individuals. Today, testing for hepatitis C is common place and should occur after any exposure to potential bloodborne pathogens.

There is no vaccine for Hepatitis C.

Treatment

According to the CDC, approximately 15% to 25% of people infected with acute Hepatitis C will naturally be able to clear the infection from their body without treatment.

There are several medications available to treat chronic hepatitis C, including newer, more effective drugs with fewer side effects.

Around the World

According to the World Health Organization (WHO), 1.75 million people are infected with the hepatitis C virus each year. Approximately 71 million people are chronically infected and at risk of developing liver cirrhosis and/or liver cancer. About 400,000 people worldwide die from hepatitis C-related liver diseases each year.

Decontamination for HCV

Any blood spills – including dried blood, which can still be infectious – should be cleaned using a 10% dilution (1 part household bleach to 9 parts water). Gloves should always be worn when cleaning up blood spills.

Human Immunodeficiency Virus (HIV)

The Human immunodeficiency virus (HIV) is the virus responsible for causing acquired immunodeficiency syndrome (AIDS). The HIV virus was originally identified on December 1st, 1981.

Statistics on HIV
  • 38,500 new cases of HIV/AIDS in adults, adolescents, and children were diagnosed in 2015.
  • As of 2015, approximately 1.1 million people are living with HIV. The CDC estimates 15% of people living with HIV do not know they are infected.
  • As of December 31, 2013, 58 confirmed occupational transmissions of HIV and 150 possible transmissions had been reported in the United States.
  • As of 2016, there are about 36.7 million people living with HIV around the world, with only 53% receiving treatment.
  • In 2016, about one million people died from AIDS-related illnesses around the world.

The Human immunodeficiency virus attacks and suppresses the immune system, reducing a person’s ability to fight infection. The virus specifically targets the cells crucial for fighting infection from pathogens. This allows diseases and infections to progress without resistance.

Within a few weeks of being infected with HIV, some people develop flu-like symptoms that last for a week or two, but others have no symptoms at all. People living with HIV may appear and feel healthy for several years. However, even if they feel healthy, HIV is still affecting their bodies. Untreated early HIV infection is also associated with many diseases including cardiovascular disease, kidney disease, liver disease, and cancer.

It can take many years before an HIV-infected person displays symptoms of the disease.

Symptoms include:

  • enlarged lymph nodes
  • fatigue
  • frequent fevers
  • persistent or frequent yeast infections of the mouth or vagina
  • persistent or frequent skin rashes
  • short-term memory loss
  • weight loss
  • enlarged liver and spleen

Presently, there is no known cure for HIV. Treatment for HIV is called antiretroviral therapy or ART. If people with HIV take ART as prescribed, their viral load (amount of HIV in their blood) can become undetectable. If it stays undetectable, they can live long, healthy lives. Today, someone diagnosed with HIV and treated before the disease is far advanced can live nearly as long as someone who does not have HIV.

HIV cannot reproduce outside the human body. It is not spread by:

  • air or water
  • insects, including mosquitoes: studies conducted by CDC researchers and others have shown no evidence of HIV transmission from insects
  • saliva, tears, or sweat: there is no documented case of HIV being transmitted by spitting
  • casual contact like shaking hands or sharing dishes
  • closed-mouth or “social” kissing

All reported cases suggesting new or potentially unknown routes of transmission are thoroughly investigated by state and local health departments with assistance, guidance, and laboratory support from the CDC.

Disease Comparison

Of the three major bloodborne pathogens, hepatitis B virus is the most contagious. Approximately 33% of individuals exposed to hepatitis B virus will become infected. Of those individuals exposed to hepatitis C virus, only about 2% will become infected. Comparatively, human immunodeficiency virus is much less contagious than either form of hepatitis. About 0.33%, or 1 in 300, people exposed to HIV will become infected with the virus. Despite these statistics, every exposure has the potential to transmit bloodborne pathogens and must be considered significant.

Transmitting Bloodborne Pathogens

Fluids that Spread Bloodborne Pathogens

Non-occupational bloodborne pathogens are most commonly transmitted through:

  • sexual contact; or
  • sharing hypodermic needles.

Occupational bloodborne pathogens are most commonly transmitted through:

  • puncture wounds from a sharp or contaminated object, such as broken glass; or
  • from a splash of blood to the mucous membranes of the eyes, nose, or mouth.

 

The transmission of bloodborne pathogens from one person to another occurs through the transfer of infected body fluids.

Common body fluids which can transmit pathogens include:

  • blood
  • cerebral spinal fluid
  • semen
  • vaginal secretions

Semen and vaginal secretions can transmit bloodborne pathogens, but only during sexual contact.

Wearing disposable gloves can help protect you from accidental exposure to bloodborne pathogens.

Fluids that Do Not Spread Bloodborne Pathogens

Some body fluids have no documented risk of transmitting pathogens, including:

  • sweat
  • saliva
  • urine
  • feces

Although the risk of contracting a pathogen from these bodily fluids might be low, you may not always be able to tell which fluids you are handling, or whether injury has mixed them with blood.

For example, a severe abdominal injury could cause blood to be present in urine or feces. Therefore, it is best to protect yourself from ALL bodily fluids.

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