What should a phlebotomist use to clean up a blood or cerebrospinal fluid spill?
OSHA standards for bloodborne pathogens (BBP, 29 CFR 1910.1030) and personal protective equipment (PPE, 29 CFR 1910 Subpart I) require employers to protect workers from occupational exposure to infectious agents. The BBP standard applies when workers have occupational exposure to human blood or other potentially infectious materials (OPIM), as defined in paragraphs (a) and (b) of the BBP standard, and requires the use of universal precautions to prevent contact with these materials.1 Adhering to standard and transmission-based precautions in healthcare settings is recommended by Centers for Disease Control and Prevention (CDC), and protects workers from a wider range of infectious disease hazards than the BBP standard. Show Employers and workers should be familiar with several key approaches to infection control, including universal precautions, standard precautions and transmission-based precautions.
The BBP standard requires the use of UP, and extends UP to protect workers against pathogens found in saliva during dental procedures and body fluids in situations where it is difficult or impossible to differentiate between body fluids (e.g., vomit mixed with blood). During recent outbreaks of emerging infectious diseases, other body fluids to which UP and the BBP standard do not apply have been identified as potential sources of worker exposures and infections. For example, the CDC identified contact with urine, saliva, feces, vomit, and breast milk as potential sources of Ebola virus exposure.4, 5 Studies also found that urine of individuals with Zika can contain high concentrations of infectious virus that could persist in urine longer than it is detectable in serum, a component of blood.6, 7 (Note that exposure to urine has not been a recognized cause of Zika transmission.) By using SP in healthcare settings, additional protection is provided by expanding UP to protect workers where UP and the BBP standard do not apply. For example, SP applies, without limitation, to urine, feces, nasal secretions, sputum, vomit, and other body fluids that may be potential sources of worker exposure to infectious agents. SP assumes that every person is potentially infected or colonized with an organism that could be transmitted in the healthcare setting. Since SP was developed to integrate principles of UP and body substance isolation,8 the infection prevention and control methods used under SP encompass what employers should already be implementing to protect workers against exposures under the BBP standard and its requirements for use of UP. Other OSHA requirements, such as the PPE standards (see 29 CFR 1910 Subpart I) and Section 5(a)(1), the General Duty Clause, of the Occupational Safety and Health Act, 29 USC 654, also may apply.9 The following tables highlight key distinctions among UP as originally written, the BBP standard (which incorporates UP), and SP. Table 1 outlines the body fluids and other materials to which each applies. Table 1. Body fluids to which UP, the BBP standard, and SP apply Exposure to… Covered by UP BBP SP Table 2 compares selected controls, actions and other measures for the protection of workers against exposure to blood and OPIM and for the protection of workers against exposure to material that is not blood or OPIM. Note that Table 2 discusses only selected provisions of the BBP standard, as well as only selected elements of SP and TBP, and is not intended to describe all provisions with which employers may need to comply. The General Duty Clause of the Occupational Safety and Health Act and additional OSHA standards, including those for personal protective equipment in 29 CFR 1910 Subpart I, also may apply. Table 2. Selected elements of infection prevention and control under BBP, SP, and TBP Control, action or other measure To protect workers against exposure to... Blood and OPIM1Material that is not blood or OPIM, including body fluids not covered under OPIM (e.g., urine6 and feces)Blood and body fluid precautions for all patients, regardless of infection statusBBP, SPSPExposure control plan and required elements thereof12BBP Patient isolation/placementTBPTBPHand hygieneBBP, SPSPSafe injection practicesBBP, SPSPSafe sharps management/disposalBBP, SPSPProhibiting eating, drinking, smoking, or application of cosmetics or lip balm and handling of contact lenses in areas where there is a reasonable likelihood of occupational exposure13BBP Separating food and drink from areas where blood and OPIM are present13BBP Prohibiting mouth pipetting and suctioning of blood or OPIM13BBP Safe specimen storage, packaging, shipment13BBP PPE – Gloves, gowns, masks, eye protection (e.g., goggles), face shieldsBBP,14 SP, TBPSP, TBPPPE – Aprons and other protective body clothingBBP, TBPTBPPPE – Surgical capsBBP, TBPTBPPPE – Shoe/boot coversBBP, TBPTBPPPE – N95 or higher respirators for aerosol-generating procedures on patients with suspected or proven infections transmitted by respiratory aerosolsSP, TBPSP, TBPPPE – Any additional appropriate equipment to prevent blood or other potentially infectious materials to pass through to or reach the employee's work clothes, street clothes, undergarments, skin, eyes, mouth, or other mucous membranes under normal conditions of use and for the duration of time which the protective equipment will be used. See 29 CFR 1910.1030(d)(3)(i).BBP PPE – Any additional appropriate equipment (i.e., not specifically listed already) to protect workers against transmission of infectious agentsTBPTBPHousekeeping and environmental control proceduresBBP, SPSP
Worker TrainingEmployers always should train workers about sources of infectious agent exposure and appropriate precautions for preventing infections. Two of the relevant OSHA standards requiring training are those for PPE and BBP. Under the PPE standards, employers must provide training to workers required to use PPE, including training on what equipment is necessary, when and how they must use the equipment, and how to dispose of the equipment. In addition, where workers are exposed to blood or other potentially infectious materials, employers must provide the training required by the BBP standard, including information about how to recognize tasks that may involve exposure and the methods to reduce exposure, including appropriate engineering controls, work practices, and personal protective equipment. Additional Resources
1 "Other Potentially Infectious Materials," as defined in the OSHA Bloodborne Pathogens standard (29 CFR 1910.1030(b)), means:
2 The CDC initially defined "universal precautions" as applying to blood and other body fluids containing visible blood. See: CDC (1988). "Update: Universal precautions for prevention of transmission of human immunodeficiency virus, hepatitis B virus, and other bloodborne pathogens in health-care settings. MMWR Morb Mortal Wkly Rep, 37(24): 377-82, 87-8." OSHA’s Bloodborne Pathogens standard (29 CFR 1910.1030) applies universal precautions to the prevention of contact with blood or other potentially infectious materials (OPIM). See footnote 1 for additional information about OPIM. 3 For additional information about transmission-based precautions for specific infectious agents, see "Part III: Precaution to Prevent Transmission of Infectious Agents" and "Appendix A: Type and Duration of Precautions Recommended for Selected Infections and Conditions" of the HICPAC "2007 Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings." 4 Dixon, M. G., & Schafer, I. J. (2014). Ebola viral disease outbreak—West Africa, 2014. MMWR Morb Mortal Wkly Rep, 63(25), 548-51. 5 Cardile, A. P., Murray, C. K., Littell, C. T., Shah, N. J., Fandre, M. N., Drinkwater, D. C., ... & Vento, T. J. (2015). Monitoring exposure to Ebola and health of US military personnel deployed in support of Ebola control efforts—Liberia, October 25, 2014–February 27, 2015. MMWR Morb Mortal Wkly Rep, 64, 690-4. 6 Although an infectious dose or ID50 of Zika virus is not known, urine of Zika patients is known to have significant viral load. For example, Fourcade et al. (2016) detected as much as 74,000 copies of viral RNA per mL of urine in a Zika-infected male and as much as 5,550 copies/mL in a Zika-infected female. See: Fourcade, C., Mansuya, J. M., Dutertre, M., Delpech, M., Marchou, B., Delobel, P., ... & Martin-Blondel, G. (2016). Viral load kinetics of Zika virus in plasma, urine and saliva in a couple returning from Martinique, French West Indies. Journal of Clinical Virology, 82: 1-4. 7 Centers for Disease Control and Prevention [CDC]. (2016). Interim Guidance for Zika Virus Testing of Urine — United States, 2016. MMWR Morb Mortal Wkly Rep, 65. 8 Body substance isolation focused on the isolation of all moist and potentially infectious body substances (blood, feces, urine, sputum, saliva, wound drainage, and other body fluids) from all patients, regardless of their presumed infection status, primarily through the use of gloves. 9 OSHA is considering the promulgation of an infectious diseases standard to supplement the infection control requirements of the BBP standard. This new standard would require, among other things, the use of SP and TBP when healthcare and healthcare support workers have occupational exposure to sources of infectious agents. 10 UP as originally defined by CDC does not necessarily apply in situations where it is difficult or impossible to differentiate between body fluids; OSHA’s BBP standard expanded application of UP under the standard to include such situations. 11 Under the category "Any body fluid that is visibly contaminated with blood," UP and the BBP standard would apply when there is visible contamination of these fluids with blood. 12 OSHA recommends that employers develop and implement exposure control plans for all types of infectious agents. 13 OSHA recommends that employers implement this control for all types of infectious agents. 14 Paragraph (d)(3)(ix) of the BBP standard requires gloves to be worn when it can be reasonably anticipated that the employee may have hand contact with mucous membranes, non-intact skin, and certain other potential sources of exposure, in addition to blood and other potentially infectious materials covered under the standard. 15 OSHA recommends implementing post exposure evaluation and follow-up for all types of infectious agents. What cleans a cerebrospinal specimen spill?Bleach must be used to disinfect all surfaces when a csf fluid is spilled.
What PPE is required for drawing blood?Answers 1: As you may know, when there is occupational exposure to blood or other potentially infectious materials (OPIM), the employer is required to provide, at no cost to the employee, appropriate personal protective equipment such as, but not limited to, gloves, gowns, laboratory coats, or other PPE deemed ...
Why did the phlebotomist apply the warm cloth?If a heelstick in an infant is being performed, the phlebotomist should apply a warming device for approximately 3-5 minutes to the heel to increase blood flow to the area, which will facilitate the collection of the capillary specimen.
Which of the following actions should a phlebotomist technician take when performing a blood culture collection?Which of the following actions should a phlebotomy technician take when performing a blood culture collection? Scrub the site with isopropyl alcohol for 1 min in outward, cocentric circles. 20. A phlebotomy technician experiences a needlestick injury while performing a draw.
|