5.3 Bloodborne Pathogens and Sharps Safety

Bloodborne Pathogens and Sharps Safety

Quick Answer: The OSHA Bloodborne Pathogens Standard (29 CFR 1910.1030) is the federal rule that protects healthcare workers from HBV, HCV, and HIV. It requires the employer to provide hepatitis B vaccine free of charge, supply PPE, engineer safer sharps, and pay for all post-exposure testing and treatment. CNAs follow Universal Precautions - all blood and OPIM are treated as infectious - and dispose of sharps at the point of use, never recapped.

The OSHA Bloodborne Pathogens Standard

Published in 1991 and updated by the Needlestick Safety and Prevention Act of 2000, 29 CFR 1910.1030 is the cornerstone bloodborne-pathogen rule in U.S. healthcare. It applies to anyone with reasonably anticipated occupational exposure to blood or other potentially infectious materials (OPIM).

OPIM includes:

• Semen and vaginal secretions
• Cerebrospinal, synovial, pleural, peritoneal, pericardial, and amniotic fluid
• Saliva in dental procedures
• Any body fluid visibly contaminated with blood
• Any body fluid in situations where it is impossible to differentiate (e.g., emergency response)
• Unfixed tissue, HIV/HBV cultures, organ cultures

The standard requires the employer to provide, AT NO COST to the worker:

1. A written Exposure Control Plan that is reviewed and updated at least annually.
2. Hepatitis B vaccination within 10 working days of assignment (the CNA may decline by signing a declination form and may accept later).
3. Personal protective equipment in the correct sizes and at no cost.
4. Engineering controls - safer sharps with built-in protective features (retractable, shielded), sharps containers, biohazard labels, handwashing facilities.
5. Work-practice controls - no eating, drinking, applying cosmetics, or handling contacts in work areas; no mouth pipetting; never recap needles.
6. Annual bloodborne pathogen training and additional training when procedures change.
7. Confidential post-exposure evaluation and follow-up, including source patient testing where allowed, baseline and follow-up testing of the exposed worker, prompt PEP if indicated, and counseling - all at no cost.
8. Recordkeeping - confidential medical records for 30 years past employment; sharps injury log.

The Three Major Bloodborne Pathogens

Universal Precautions

Universal Precautions (CDC, 1987) preceded Standard Precautions and are still the foundation for bloodborne pathogen control: treat all blood and OPIM as if known to be infectious, regardless of the source's diagnosis. You never need a positive HIV or hepatitis test to take precautions - you are required to assume infectivity from the start.

Sharps Safety (29 CFR 1910.1030 Engineering Controls)

Although CNAs do not give injections, they may handle lancets (blood glucose), sharps containers, and contaminated linen with hidden needles.

Sharps containers must be:

• Closeable with a one-way drop opening
• Puncture-resistant
• Leak-proof on sides and bottom
• Red or color-coded
• Labeled with the biohazard symbol
• Upright, accessible, and at the point of use
• Replaced when two-thirds full - never force more sharps in

Sharps handling rules:

• NEVER recap a needle with two hands. If recapping is unavoidable (rare), use a one-handed scoop technique or a mechanical device.
• Do not bend, break, shear, or remove needles from disposable syringes.
• Carry sharps point-down in a tray, never in a pocket.
• Inspect linens and trash before reaching in - many needlesticks happen during cleanup.

Hepatitis B Vaccination

OSHA requires the HBV vaccine series to be offered free to every employee with occupational exposure within 10 working days of assignment. Refusal must be documented on the standard OSHA declination form, but the employee may accept the vaccine at any later date at no charge. Post-vaccination titer testing is performed 1-2 months after the last dose.

Post-Exposure Steps (Memorize the Order)

If a CNA is stuck with a needle, splashed in the eye, or has blood land on non-intact skin:

1. Wash immediately. Soap and water for skin punctures and intact skin contamination. Flush mucous membranes (eyes, nose, mouth) with water or saline for at least 15 minutes at an eyewash station.
2. Report immediately to the supervisor or charge nurse - do not finish the shift first.
3. Complete an incident/exposure report as required by the facility.
4. Source patient testing is arranged by the employer where allowed by NC law.
5. Baseline testing of the exposed worker (HBV, HCV, HIV) and post-exposure prophylaxis (PEP) started promptly - ideally within 1-2 hours for HIV exposures.
6. Confidential follow-up testing at 6 weeks, 12 weeks, and 6 months.

Do NOT squeeze the wound to make it bleed, apply caustic agents (bleach, alcohol), or wait until the end of shift. Delay reduces PEP effectiveness.