Bloodborne Pathogens and Sharps Safety

Bloodborne pathogens are germs carried in blood and some other body fluids that can cause serious disease. A needlestick, a cut from a broken glass that has blood on it or a splash in the eye can pass them to you. The risk from any single exposure is usually low, and it drops further with safe habits, vaccination and fast action after an exposure. Federal rules from the Occupational Safety and Health Administration (OSHA), in the standard 29 CFR 1910.1030, set out what employers and workers must do.

What You Will Be Able to Do

• Name the main bloodborne pathogens and how they spread.
• Know what your employer must provide if your job can expose you to blood.
• Handle and dispose of needles and other sharps safely.
• Clean up a blood spill the right way.
• Respond in the correct order if you are exposed.

The Germs and How They Spread

Three viruses cause most of the concern at work:

• Hepatitis B virus (HBV) attacks the liver. It can survive on surfaces for about a week, and a vaccine prevents it.
• Hepatitis C virus (HCV) also attacks the liver. There is no vaccine, but treatment can cure most infections.
• Human immunodeficiency virus (HIV) attacks the immune system. There is no vaccine, but treatment started soon after an exposure can lower the chance of infection.

These germs reach you when infected blood or certain other fluids enter your body through a needlestick or a cut, through broken skin such as a scrape or chapped hands, or through the eyes, nose or mouth. OSHA calls the other fluids "other potentially infectious materials." They include semen, vaginal fluid and any body fluid with visible blood in it. Treat a fluid you cannot identify as infectious.

You do not catch these germs through ordinary contact, such as shaking hands, sharing a room or using the same toilet.

Who Is Covered

The OSHA standard covers any worker who can reasonably be expected to contact blood or other potentially infectious materials as part of the job. Nurses, aides, phlebotomists and lab workers are covered. Depending on the job duties, others may be too, such as housekeepers in healthcare facilities, some janitors, childcare staff and workers assigned to give first aid. Ask your employer whether your job is covered.

If it is, your employer must:

• Keep a written exposure control plan, make it available to you and review it at least once a year.
• Train you when you are assigned to the job and at least once a year after that, during paid hours and at no cost to you.
• Provide protective equipment at no cost.
• Offer the hepatitis B vaccine at no cost within 10 working days of your assignment. If you decline, you sign a form, and you can still get the vaccine later if you change your mind.
• Provide safer devices, such as needles that retract or shield themselves, and ask direct-care workers for input in choosing them.
• Provide a free, confidential medical evaluation after any exposure.

Everyday Protection

Treat all blood and these fluids as infectious, for every person. OSHA calls this universal precautions.

1. Wear gloves whenever you may touch blood, body fluid or broken skin. Add a gown, mask and eye protection if splashing is possible.
2. Cover your own cuts and scrapes with a bandage before you start work.
3. Clean your hands right after removing gloves.
4. Do not eat, drink, apply lip balm or handle contact lenses where exposure is possible.
5. Do not store food in a refrigerator or on a shelf with blood or specimens.

Handling Sharps Safely

A sharp is anything that can cut or puncture the skin. That includes needles, lancets, syringes, razors, scalpels and broken glass.

Follow these rules every time:

1. Never recap a used needle. Recapping by hand is a well-known cause of needlesticks. The OSHA standard allows it only when no alternative exists and a required procedure calls for it, and then only with a one-handed method or a mechanical device.
2. Never bend, break or remove a contaminated needle by hand.
3. Activate the safety feature on the device right after use.
4. Take the container to the sharp. Keep it close to where you are working so you do not carry the sharp across the room.
5. Drop the sharp in point-first, one at a time. Do not push it in or reach inside.
6. Do not overfill. Replace the container at the fill line, usually about three-quarters full.
7. Never pick up broken glass with your hands, even with gloves on. Use tongs, a dustpan and brush, or forceps.

A proper sharps container is closable, puncture-resistant, leak-proof on the sides and bottom, and labeled with the biohazard symbol or colored red. Keep it upright. Close it before you move it, and put it in a second container if it could leak.

Warning: Never reach into a sharps container or a trash bag. Do not push trash down with your hands or foot, and carry bags away from your body. Used needles are sometimes thrown away by mistake.

Sharps in a Home or Public Restroom

In a private home, a client's used lancets and syringes go in an approved sharps container, not in loose trash or the toilet. If one is not available, a heavy plastic bottle with a screw-on lid, such as a laundry detergent bottle, is the usual stopgap, labeled and kept away from children and pets. Disposal rules vary by state and community, so follow your employer's policy.

If you find a needle in a restroom, parking lot or playground, do not touch it with bare hands. Keep people away and report it. If you are trained and equipped, use tongs or a grabber to put it in a sharps container.

Cleaning Up Blood

Follow your employer's procedure. In general:

1. Keep other people away from the area.
2. Put on gloves, and add eye protection or a gown if there may be splashing.
3. Pick up any broken glass with tongs or a dustpan, never your hands, and put it in a sharps container.
4. Absorb the visible blood with paper towels or a spill kit.
5. Clean the area with detergent and water.
6. Apply an EPA-registered disinfectant and leave the surface wet for the full contact time on the label.
7. Throw away the materials as your employer requires, then take off your gloves and clean your hands.

If you use bleach, a 1 to 10 solution is common: one part household bleach to nine parts water. Mix it fresh each day, label the bottle and never mix bleach with other chemicals.

Soiled laundry should be handled as little as possible. Do not shake or sort it. Bag it where it was used in a leak-proof bag if it could soak through. OSHA uses the term "regulated waste" for items that could release blood if squeezed, along with sharps. These go in closable, leak-proof, labeled or red containers and are disposed of under state rules.

If You Are Exposed

An exposure is contact of blood or other infectious material with your eyes, mouth or other mucous membrane, with broken skin, or through a puncture. Act right away. Do not finish the task first.

1. Wash needlesticks and cuts with soap and water. Do not squeeze the wound or use bleach.
2. Flush splashes to the nose, mouth or skin with water.
3. Rinse the eyes with clean water, saline or an eyewash station.
4. Report to your supervisor immediately, and tell them what the source was.
5. Get medical evaluation right away, ideally within 1 to 2 hours. Medicine that lowers the chance of HIV infection works best when it is started within hours, and it may be offered only for a limited window. Hepatitis B treatment is also time-sensitive.

Your employer must provide the evaluation, any recommended treatment, testing, follow-up and counseling at no cost, and must keep the records confidential. The source person's blood may be tested if they consent or where the law allows it. Your employer must also record needlestick injuries in a sharps injury log if it keeps OSHA injury records.

Warning: Do not wait to see if the wound looks serious. A tiny needlestick needs the same response as a deep cut.

Common Mistakes

Check Your Understanding

1. You feel a sharp poke through a trash bag while carrying it. A used syringe is sticking out. What do you do first?

Wash the area with soap and water right away, then report to your supervisor and get evaluated. Do not wait, and do not squeeze the wound.

2. Your new employer offers a hepatitis B vaccine and you are not sure about it. Does declining mean you lose the option?

No. You sign a form if you decline, and you can still get the vaccine later at no cost while you are in a covered job.

3. A client drops a glass and cuts their hand, leaving blood on the floor and pieces of glass. How do you clean it?

Put on gloves, pick up the glass with tongs or a dustpan and put it in a sharps container, absorb the blood, clean with detergent, disinfect with an EPA-registered product for the full label contact time, then remove your gloves and clean your hands.

4. You used a needle in a home visit and cannot remember if the cap goes back on. What is the right action?

Do not recap it. Put it in a sharps container right away, using the device's safety feature if it has one.

Key Takeaways

• Treat all blood and other potentially infectious materials as infectious, for every person.
• Never recap, bend or break a used needle, and use a sharps container at the point of use.
• Never reach into a sharps container or push down trash with your hands.
• After an exposure: wash, report and get evaluated right away.
• Your employer provides the plan, training, protective equipment, hepatitis B vaccine and post-exposure care at no cost.