The PPE that is used when there is a risk of splashes of potentially infectious materials is

Methods of Exposure Control

Certain procedures must be followed and tools must be used to keep employees safe from exposure to infectious diseases found in blood, such as Hepatitis B Virus, Human Immunodeficiency Virus, and Hepatitis C Virus. These are explained in detail in the following pages. Here is a list of the general topic headings:

1. Universal Precautions
2. Engineering Controls
3. Work Practice Controls
4. Personal Protective Equipment
5. Housekeeping
6. Laundry Practices
7. Labels and Signs

Universal Precautions

Universal Precautions is a term that means a certain "mindset" or "attitude" toward other peoples' blood or body fluids. If all "at risk" employees adopt this way of thinking, chances are good that they will consistently act in a safe manner when working with human body fluids.

This new attitude can be summarized as follows:

• Assume that ALL blood is positive for HIV, HBV, and HCV
• Assume that ALL other human fluids/tissues are also positive
• When it's difficult to differentiate, treat ALL fluids as potentially infectious
• Assume that ALL individuals are carrying these disease organisms
• Avoid skin contact with blood and other potentially infectious materials
• Avoid eye, nose, and mouth contact with blood and other potentially infectious materials
• Avoid punctures/sticks with contaminated sharp objects

Engineering Controls

Engineering controls are devices and tools that prevent exposure to health hazards. These sorts of safety controls shall be used, in conjunction with Work Practice Controls, to eliminate or minimize employee exposure.

These controls are extremely important, as they are the best methods of preventing exposure.

These devices/equipment must be inspected and maintained on a regular basis by the Implementation Coordinator or designee. Worn parts and equipment must be replaced as soon as indicated through the inspection process.

Here are some common engineering controls used to protect employees from bloodborne pathogens:

Handwashing facilities:

Each department shall provide readily accessible handwashing facilities. This means that there must be a facility to supply adequate running water, soap, and single-use towels or hot-air drying machines.

Alternate Handwashing Devices:

When running water handwashing facilities are not feasible, the department shall provide either an appropriate antiseptic hand cleanser with clean cloth/paper towels OR antiseptic towelettes.

Needle Safety Devices:

Departments using medical sharps must make all reasonable attempts to implement the use of these safety devices, instead of traditional sharps. There are many new products on the market that are designed to prevent needle-stick-injuries.

Here are some examples:

• Needle-less connectors for IV delivery systems (e.g., blunt cannula for use with pre-pierced ports and valved connectors that accept tapered or luer ends of IV tubing)
• Protected needle IV connectors (e.g., the IV connector needle is permanently recessed in a rigid plastic housing that fits over IV ports)
• Needles that retract into a syringe or vacuum tube holder
• Hinged or sliding shields attached to phlebotomy needles, winged-steel needles, and blood gas needles
• Protective encasements to receive an IV stylet as it is withdrawn from the catheter
• Sliding needle shields attached to disposable syringes and vacuum tube holders
• Self-blunting phlebotomy and winged-steel needles (a blunt cannula seated inside the phlebotomy needle is advanced beyond the needle tip before the needle is withdrawn from the vein)
• Retractable finger/heel-stick lancets

Three examples of safety syringes

Desirable features in Needle Safety Devices:

• The device is needleless
• The safety feature is an integral part of the device
• The device preferably works passively (requires no activation by user)
• The user can easily tell whether the safety feature is activated
• The safety feature cannot be deactivated and remains protective through disposal.
• The device is easy to use and practical

Sharps Containers:

Proper containers for storage of contaminated sharps must be provided by the departments. These containers must meet the following description:

• Puncture resistant
• Closeable
• Leakproof
• Labeled (Biohazard) or color-coded (orange/red)

Splash Guards:

Laboratory equipment that can potentially vaporize or splash blood should be equipped with a splashguard or similar protective device.

Resuscitation Masks:

Resuscitation masks must be made available to all First Responders. These devices prevent fluid exchange during the administration of Cardiopulmonary Resuscitation.

Biosafety Cabinets:

Biosafety cabinets are used in biological laboratories across campus whenever the possibility of exposure to airborne pathogens is present.

Download the Department-Specific Information Sheet for
Engineering Controls ( doc | pdf )

Work Practice Controls

Work practice controls are procedures that employees need to follow in order to keep themselves safe. These required procedures are to be followed by all "at risk" employees and must be enforced by all departments.

Hand/Skin Washing

It is extremely important that all at-risk employees follow strict hand/skin washing procedures at the following times:

1. After removing gloves or other Personal Protective Equipment
2. Following contact with blood or other potentially infectious fluid

Hands and other skin areas must be washed with soap and water OR antiseptic cleanser (in the absence of water). Mucous membranes must be flushed with copious amounts of water. (at least 15 minutes of flushing)

When an antiseptic cleanser or towlette is used, washing with water and soap should follow as soon as possible.

Sharps Handling

Whenever a needle or other sharp device is exposed, injuries can occur. Data from show that approximately 38% of percutaneous injuries occur during use and 42% occur after use and before disposal.

Causes of percutaneous injuries

In addition to risks related to device characteristics, needlestick injuries have been related to certain work practices such as

• recapping,
• transferring a body fluid between containers, and
• failing to properly dispose of used needles in puncture-resistant sharps containers.

If recapping cannot be avoided, it must be accomplished through the use of a mechanical device, such as forceps. Also, the one-hand scoop method is allowed, if done safely.

Minimizing Splashing

All procedures involving blood or other potentially infectious materials must be performed in such a manner as to minimize splashing, spraying, spattering, and generation of droplets.

Avoiding Ingestion.

• Eating, drinking, smoking, applying cosmetics or lip balm, and handling contact lenses are strictly prohibited in work areas where there is a reasonable likelihood of occupational exposure. This, however, does not apply to hand-cream.
• Food and drink shall not be kept where blood or other potentially infectious materials are present.
• Mouth pipetting/suctioning of blood or other potentially infectious materials is prohibited.

Dealing with Contaminated Equipment

The following procedures must be followed when having potentially contaminated equipment serviced:

1. Look for evidence of contamination.
2. Decontaminate if necessary and feasible.
3. If NOT feasible, label equipment with BIOHAZARD label.
4. Include on the label which parts are contaminated.
5. Convey information to affected employees and servicing representative prior to shipping, so that precautions can be taken.

Download the Department-Specific Information Sheet for
Work Practice Controls ( doc | pdf )

Personal Protective Equipment

General:

Where occupational exposure remains after the implementation of Engineering and Work Practice Controls, Personal Protective Equipment (PPE) must also be used.

Departments shall provide, at no cost to the employee, appropriate PPE including, but not limited to:

• GLOVES
• GOWNS
• LAB COATS
• FACE SHIELDS
• MASKS
• EYE PROTECTION
• MOUTHPIECES
• RESUSCITATION BAGS
• POCKET MASKS
• MECHANICAL RESPIRATORY DEVICES

PPE is considered appropriate if it is needed for, and is capable of, preventing blood or other fluids from passing through to the employee's clothing, skin or mucous membranes. Departments must complete a formal PPE hazard assessment to determine and document what PPE must be provided and used for hazard exposures.

Departments must ensure proper use, accessibility, cleaning, disposal, repair and replacement of PPE.

Employees must remove PPE before leaving the work area or whenever the PPE has become saturated with blood or other potentially infectious materials. Used PPE must be placed in an appropriately designated area or container for storage, washing, decontamination, or disposal.

Gloves:

Gloves must be worn when it can be reasonably anticipated that the employee may have hand contact with:

• blood,
• other potentially infectious materials,
• mucous membranes,
• non-intact skin,

Or when:

• performing vascular access procedures,
• and when handling contaminated surfaces.

Guidelines for Glove Use:

Face and Eye Protection

Masks, goggles, glasses, and face shields are to be worn whenever splashes, spray, spatter, or droplets of blood or other potentially infectious materials may be generated and eye, nose or mouth contamination can be reasonably anticipated.

Body Protection

Gowns, aprons, lab coats, clinic jackets, and other protective body clothing are to be worn in occupational exposure situations when appropriate. The type and characteristics of the PPE will depend upon the task and degree of exposure anticipated.

Housekeeping

All worksites are to be maintained in clean and sanitary conditions at all times. To meet the OSHA regulatory requirements, each work area covered by this program must establish a written cleaning schedule. All such schedules should be included in this manual, following this section.

HOW?

Following is a table of Cleaning/Reprocessing methods recommended by the Centers for Disease Control (CDC). Decontamination methods can be selected according to that information.

WHEN?

Decontamination/Cleaning of surfaces and equipment must be performed at the following times:

1. At the frequency determined in the written schedule
2. Following a contamination incident
3. Following routine procedures that may cause contamination
4. At the end of work shifts, if contamination may have occurred since last cleaning

WHAT?

The following are surfaces that are likely to need decontamination:

• Lab equipment
• Bench/Counter tops
• Receptacles intended for reuse, that may store bloody material
• Environmental Surfaces: Large areas, such as ambulance interiors, entire lab rooms, etc.

Other Notes on Housekeeping:

1. Protective coverings must be removed and replaced as soon as feasible when they become obviously contaminated or at the end of the workshift if they may have become contaminated during that shift. Coverings include:
   • Plastic wrap
   • Aluminum Foil
   • Imperviously-backed absorbent paper
2. Broken glass must not be picked up directly with the hands. It shall be cleaned up mechanically. Use a brush and dust pan, tongs, or forceps.
3. Employees must never reach their hands into containers of contaminated sharps.

Cleaning/Decontamination Methods

Laundry Practices

Handling:

1. Contaminated laundry must be handled as little as possible.
2. Employees that have contact with contaminated laundry must wear protective gloves and other appropriate personal protective equipment.
3. Employees are not to take contaminated clothing home for laundering. The department must arrange to have an approved Laundry Service collect and clean these items or provide access to laundering equipment in the work area. Please contact EHSS for assistance if needed at 231-4034 or .

Storage:

1. Contaminated laundry must be bagged or contained at the location where it was used and must not be sorted or rinsed in the location of use.
2. Proper containers are as follows:
   1. labeled with the Biohazard symbol, or color-coded fluorescent orange or orange-red
   2. capable of preventing soak-through, if laundry is wet and presents reasonable likelihood of leakage to the exterior of the container

Transportation:

1. Contaminated laundry must be transported in proper containers, as described above.
2. Laundry personnel must use Universal Precautions when handling ALL laundry.

Labels and Signs

Lables:

What Is A Proper Label?

• A sticker or placard that contains:
  1. The word BIOHAZARD
  2. The biohazard symbol
• Anything color-coded
  1. Fluorescent orange
  2. Orange-red

What Should Be Labeled?

• Containers of Regulated Waste
• Refrigerators/Freezers Containing Blood or Other Potentially Infectious Materials
• Containers used to store or transport above mentioned fluids
• Equipment that cannot be decontaminated
• (location of contamination must be written on label)

Signs:

Departments must post signs at the entrance to HIV/HBV research laboratories. These signs must be color-coded and contain the following information:

(name of infectious agent)

(special requirements for entering the area)

(name, phone # of responsible person)

What is the proper PPE for splashing blood?

What PPE should be worn when there is a reasonable chance of exposure?

What PPE is used to prevent cross infection?

What are considered potentially infectious materials?