What are Bloodborne Pathogens?
Pathogens are infectious microorganisms, such as bacteria or viruses, that can cause life-threatening diseases. Similar to a parasite, these microbes can cause damage to the health and quality of life of the host. These microorganisms pose a severe health risk to many employees whose occupation may cause them to be exposed to pathogens.
Depending on the characteristics of the pathogen, the disease can spread from person to person through different methods. Bloodborne pathogens (BBPs) are pathogens that can be found within the human bloodstream. And, in this case, they are transmitted through contact or exposure to infected blood. Hence the name; bloodborne.
Overall, there are only a total of about 20 types of bloodborne pathogens. Of these, three are considered the most common and directly mentioned throughout OSHA’s bloodborne pathogens standards. These three are:
- Hepatitis B
- Hepatitis C
- Human Immunodeficiency Virus (HIV)
Collectively, bloodborne pathogens are a threat to human lives and also a public health problem. It is estimated that approximately 3 million exposures to bloodborne pathogens occur annually. Within most work settings, bloodborne infections are normally caused by accidental punctures. This is called blood-to-blood contact, which will be covered later.
Hepatitis
Hepatitis is a group of highly contagious viruses that target the liver. There are many different types of the hepatitis virus, and we list them below as:
- Hepatitis A (HAV)
- Hepatitis B (HBV)
- Hepatitis C (HCV)
- Hepatitis D (HDV)
- Hepatitis E (HEV)
Despite these all causing the same disease, only three of them can be transmitted through exposure to infected blood. These three are considered bloodborne pathogens and are the hepatitis B, C, and D viruses. The other viruses are spread in other ways (food, water, or stool).
Hepatitis B
HBV is the most invasive of all bloodborne pathogens. It is a hundred times more infectious than any other hepatitis virus and even more infectious than HIV or AIDS. It is the top cause of liver cancer throughout America. HBV is the second form of the hepatitis virus and can be contracted through ingesting contaminated bodily fluids, sexual contact, sharing needles, blood-to-blood contact, or blood-to-mucous membrane contact. Symptoms of HBV could include:
- Jaundice
- Pale or discolored stool
- Dark urine
- Fever and nausea
- Vomiting
- Loss of appetite
- Fatigue
There are ways to prevent someone from being infected, such as the HBV vaccine. Unfortunately though, once hepatitis B infects the blood of a healthy person, there is no cure for it.
Hepatitis C
Unlike other forms of the hepatitis virus, hepatitis C is considered a silent infection. Those who are infected with HCV do not typically show any symptoms until the liver is irreversibly damaged, making it very hard to catch the infection. Hepatitis C progresses in stages the longer someone is infected. These stages are as follows:
- The incubation period is the first stage and can last anywhere from 14 – 180 days from the moment of infection.
- In the second stage, the disease progresses into an acute infection. This can last up to six months after the moment of first exposure before the human body can eliminate the virus on its own.
- If the infection lasts through these six months, then it will have progressed into a chronic infection, which is the third and final stage.
HCV is curable, but because it is so hard to catch, over half of the people infected with HCV are never treated for it. And if left untreated, hepatitis C can last a lifetime and will cause serious health problems such as:
- Cirrhosis
- Liver cancer
- Death
Currently, about 2.4 million people are living with Hepatitis C, and data shows that for every ten people that have HCV, four of them have no idea that they are infected.
Hepatitis D
HDV is the most severe form of hepatitis virus. However, it is uncommon and even rare to contract. It only exists in the presence of HBV. HDV can occur in one of two ways.The first one is when someone becomes infected with both hepatitis B and D simultaneously. The other way is when someone is infected with hepatitis D after first being infected with hepatitis B.
Bloodborne Pathogens Standards
All employees have a right to a safe work environment. Because of this, bloodborne pathogens and needlesticks are addressed specifically within OSHA standards for the general industry. These regulations and standards that are in place provide safeguards for every employee to protect themselves against health hazards related to BBP within their workplace.
Any workplace where there is a reasonable chance that employees could be exposed to bloodborne pathogens must have an established program for the education and training of the employees. This education will help employees recognize, avoid, and prevent any of these unsafe working conditions involving exposure to infected blood. This program is called an Exposure Control Plan.
This standard was revised to include the Needlestick Safety and Prevention Act. This revision imposed requirements on the employers who have employees with a chance they could be exposed to BBP at work. These requirements contain a great amount of detail concerning protocol for medical devices with points or edges (“sharps”).
The standards also discuss things that are vital for preventing exposure, along with procedures that are in place to help if someone is exposed to a BBP. A few examples of these would be:
- Work practice controls
- Vaccinations
- Hazard communication and training
- Recordkeeping
Strict adherence to these regulations and guidelines will reduce the risk, minimize exposure, and help to prevent bloodborne pathogens’ transmission. If an incident involving bloodborne pathogens were to occur, an investigation would follow. If the investigator determined that the employers did not have all the necessary controls established within their workplace, OSHA can issue a hefty fine. This can be up to $70,000 for violating employees’ safety and rights.
Universal Precautions are also discussed within OSHA’s BBP standard. Universal Precautions essentially state that all blood or bodily fluids should be treated as if infected. Abiding by these rules helps to prevent contracting a disease through contact and exposure to infected materials. Unfortunately, a big factor in BBP transmission is ignorance. Studies show that 80% of people who are infected with BBP do not show any signs, which makes it really hard for the affected person to catch that they have it.
Types of Exposure
Bloodborne pathogens are transmitted through exposure to or contact with contaminated blood. There are a few common ways this can occur within the workplace such as:
- Blood-to-blood contact
- Blood-to-mucous membrane contact
- Ingestion of contaminated areas
All of these transmission methods put employees at risk of contracting the disease. It is important that employees are aware of these, as well as ways to avoid exposure, which will be covered later on.
Blood-to-Blood Contact
Blood-to-blood contact is the most common BBP exposure type in the workplace. Blood-to-blood contact occurs when infected blood comes into direct contact with the circulating blood of someone who is not infected. An incident where an object with infected blood on it pierces someone’s skin would be considered blood-to-blood contact.
Blood-to-Mucous Membrane Contact
The mucous membranes that are most likely to be exposed within a workplace would include areas such as:
- Eyes
- Ears
- Lips
- Inside the nose and mouth
Blood-to-mucous membrane contact occurs when infected blood makes direct contact with one of the mucous membranes on the body of someone who is not infected.
Ingesting Contaminated Material
A third way that bloodborne pathogen transmission can occur is when contaminated material is ingested by a healthy person. This may occur when infected blood directly contacts food or drink and is ingested by someone who is healthy. It can also happen when infected blood contaminates surfaces that food or drink touches later. Hepatitis B, for instance, can live up to a week on a surface. During this period of time, it can infect anyone who is exposed to it.
Other Ways of Transmission
It is important to know that despite the fact that these are called bloodborne pathogens, they can be transmitted through more than just infected blood. Many other bodily fluids could also be infected. And, when exposed to these, it is highly possible to contract the disease as well. A few examples of these other bodily fluids are:
- Plasma
- Cerebrospinal fluid
- Lung fluid
- Saliva
- Mucus
- Amniotic fluid
Safety Procedures
Safety Training
Training must be provided for every employee who is at risk of exposure before their first assignments and then repeated and updated on an annual basis or even sooner. The training should include elements such as:
- General information about bloodborne pathogens
- Information on HBV vaccines
- Explanations of the Exposure Control Plan
- How to recognize high-risk exposure tasks
- Explanation of methods to reduce exposure including engineering and work practice controls, proper use of personal protective equipment (PPE), and hazard communications
- Post-exposure procedures and protocols
Any necessary materials for the safety training must be provided for the employees by their employer. Like all safety training, it must be conducted by a person who speaks the same language as the employee, and in terms each employee understands. This training must include accommodation for any language barriers and education limits that the employees might have.
Exposure Control Plan
An Exposure Control Plan (ECP) is the key to mitigating the risk of exposure within a workplace. It is a written document that contains procedures both to prevent or to respond to the exposure of bloodborne pathogens. Regulations require employers to establish an ECP for their workplace if there is a reasonable chance of employees being exposed to infected blood or other body fluids.
Every Exposure Control Plan is dependent upon the specific hazards within individual worksites. However, every ECP must have the following at the least:
- List of exposure determinations
- Methods of compliance details
- Hazard communication explanations
- HBV vaccine information
- Post-exposure procedures
- How to collect incident documentation
Employers must update their ECP once a year or whenever experts release new or edited workplace procedures. Employers must ensure that employees are aware of any changes or task modifications. Employers should also update the ECP to reflect changes in technology that eliminate or reduce the risk of bloodborne pathogen exposure.
Exposure Determination
Exposure determination is essentially a list provided by an employer for employees. This list contains lists of positions in the workplace that put employees at risk of BBP exposure. It should include how high the risk is for these jobs specifically. The list should also include any and all tasks, procedures, and other activities that put employees at risk.
Employees should not eat, drink, or do anything that involves touching a mucous membrane while working in potentially infectious areas. Do not store food or drink in the same areas where blood or other bodily fluids may be present either.
Employees should expect that an employer has a written plan for exposure incidents. Employers should always determine the risk of exposure with the assumption that the employees have nothing to protect themselves from the bloodborne pathogen exposure. This will help employers to create the best reaction plan for when employees end up in a situation where they are exposed to any bloodborne pathogens.
Other Procedures
Methods of compliance are procedures that reduce the risk of exposure. This includes engineering and workplace practice controls and the usage of PPE. It is required that any workplace that has at-risk employees must meet the minimum requirements when it comes to procedures. The minimum requirements are procedures or policies that include but are not limited to:
- Work practice controls
- Handling and disposing of contaminated material
- Housekeeping
- Certain workplace restrictions
- Personal protective equipment
The goal of hazard communication is to provide labels, signs, and training to inform employees of when and where inside the workplace they are at risk of BBP exposure. Any signs communicating that a hazard is present should be large, red, and include the “biohazard” symbol.
Health
Aside from hepatitis viruses, there are other diseases that can be contracted through exposure to infected blood. Some examples of a few other BBPs are:
- Malaria
- Syphilis
- Brucellosis
- HIV & AIDS
There are many policies and procedures provided for employees within the workplace. All of these are specifically there to protect employees who are at risk of being exposed to any type of bloodborne pathogen. But these can only be effective if they are followed and used. An ECP won’t safeguard an employee who chooses to ignore the basic personal protective equipment guidelines. Therefore, it is important that every employee uses these safeguards to protect themselves and others.
Standards require employers to make HBV vaccines and vaccination series available free of cost to all employees at risk of HBV exposure. Employees can decline the vaccination if they’ve been educated on the dangers of the virus. But safety data shows that all employees who accept the vaccination lower their chances of contracting HBV by 75%. Employees have a right to be safe, and the vaccine certainly lowers the risk of contracting HBV through occupational exposure.
Unfortunately, not many bloodborne pathogens have a vaccine that will effectively prevent transmission. Of the four most common BBPs, only HBV and syphilis have a vaccine. It is not likely that employees will be at risk of exposure to syphilis at work, but it is still a good idea for employees to give themselves as much protection as possible.
Conclusion
Understanding the range of BBP risks can encourage employees to increase caution in handling and working with infectious materials. While employee safety training should provide some knowledge on HBV and HIV, it may not be necessary to train extensively on the other types of BBPs that may exist because the risk of transmission is so low.
In conclusion, contracting a bloodborne disease is something that can affect an employee for the rest of their life. Most BBPs are chronic, and as stated earlier, not many have cures or vaccines. Employers have a responsibility to educate their employees on the dangers of BBP transmission in the workplace. One small mistake can have a ripple effect on someone’s life, both at work and at home.