INFECTION CONTROL NEWSLETTER

June 1997
written by and for Long Term Care Infection Control Nurses

Broad Street Solutions
James Marx, RN, MS, CIC Editor
P.O. Box 16557
San Diego, CA 92176
(619)563-0274 Voice/FAX
jmarx@BroadStreetSolutions.com

UPDATE YOUR BLOODBORNE PATHOGENS EXPOSURE CONTROL PLAN

In 1991, the Occupational Safety and Health Administration (OSHA) issued the Bloodborne Pathogens Standard. This was done after the threat of bloodborne disease transmission to health care worker was accelerated with the AIDS epidemic.
In California, OSHA is governed by the State-run department, referred to as Cal-OSHA. This agency issued its own version of the federal Bloodborne Pathogens Standard. The two documents are very similar but not identical.
Part of the Standard is a mandate for employer's with workers who have occupational exposure to blood to create an Exposure Control Plan. The Plan includes ways the employer will protect the employee from occupational exposure to blood. The key components of the plan are:

Determine which employees are at risk of exposure
Compliance Methods, including the use of Universal Precautions, engineering and work practice controls, disposal of sharps, personal protective equipment (PPE), housekeeping and laundry procedures
Hepatitis B vaccination
Medical follow-up after an exposure
Signs and labels
Information and Training
Recordkeeping requirements

The Exposure Control Plan is designed to protect employees from exposure to bloodborne pathogens. Because of this, it does not address other basic infection control principles, which would protect residents from infection. In addition, it is not designed to protect employees from other infection risks, such as tuberculosis or varicella.

Key points:

The Exposure Control Plan must be updated annually
Universal Precautions are mandated
Hepatitis B vaccine must be offered to new employees at risk of exposure within 10 days of a possible exposure and after they have received the training
Hepatitis B vaccination records must be kept for the duration of employment plus 30 years
Training must be done on hire and annually for all employees at risk
Training records must be kept for at least three years.
Employees who are exposure to blood must be given a written evaluation of their exposure within 15 days
Sharps containers can be nay color, but must have the Biohazard label
Biohazardous waste must be in a red container with the Biohazard Label
Labels are not needed for laundry, if the facility uses Universal Precautions
Contact the Cal-OSHA consultation office at 619-279-3771 or 415-703-4050 for a Sample Exposure Plan or a copy of the Bloodborne Pathogens Standard

FEDERAL OSHA TO RELEASE NEW TUBERCULOSIS STANDARD
Within the next 30-60 days, Federal OSHA is expected to issue a Tuberculosis Standard, similar to the Bloodborne Pathogens Standard issued in 1991. The draft TB Standard will be published in the Federal Register, and will have a limited comment time. Among the issues which are expected to be debated is the requirement for fit-testing of mask/respirators for employees who enter the room of a TB patient. This issue is not expected to impact Skilled Nursing Facilities, who usually do not have mask/respirators.
Skilled Nursing Facilities may still be impacted by requiring a written Exposure Control Plan, which details how employees are protected from exposure to TB, and what the procedure for follow-up will be in the event of an exposure. This is already expected in the Cal-OSHA TB interim enforcement guideline which was revised on March 1, 1997.

James Marx © 1997