OSHA, LABORATORY SAFETY,BIOMEDICAL AND BIO-HAZARDOUS WASTE TRAININGPART AHARRY H. HOLDORF

Hazard Communication/Chemical and Biohazard SafetyBloodborne Pathogens/Exposure Control PlanBiomedical/Biohazardous Waste

OSHA

Occupational Safety and Health AdministrationA federal agency of the United States that regulates workplace safety and health.

INTRODUCTION

The threat of infectious disease through occupational exposure is a primary concern for all healthcare employees and employees with exposure risks.

Health care workers are responsible for protecting both their patients’ health and their own.

UPON COMPLETION OF BIOMEDICAL WASTE CONTROL TRAINING, THE EMPLOYEE WILL BE ABLE TO:

1. Identify items defined as Biomedical waste.

2. Identify points of origin for all Biomedical waste generated

by his/her specific educational program.

3. Summarize Personal Protective Equipment worn when handling Biomedical waste per OSHA standards.

4. Label Biomedical waste bags and containers in compliance with your facilities’ Biomedical Waste Plan.

5. Dispose of Biomedical waste bags and containers in compliance with your facilities’ Biomedical Waste Plan

6. Identify the correct disinfectants utilized in areas generating Biomedical waste.

7. Explain important aspects in the current Biomedical Waste Plan.

UPON COMPLETION OF OSHA/BLOODBORNE PATHOGENS TRAINING, THE EMPLOYEE WILL BE ABLE TO:

1. Evaluate a bloodborne pathogen.

2. Identify three viruses of special concern to healthcare providers.

3. Identify several sources of potentially infectious material in the workplace.

4. Explain engineering and work practice controls used to minimize exposure to Bloodborne pathogens.

5. Identify specific infection control measures used in clinics, labs, and externship site facilities by employees.

6. Summarize legal and ethical guidelines used when a significant exposure has occurred.

7. Explain post-exposure step-by-step instructions taken in the event of an occupational exposure to blood

8. Identify local, state, and national informational resources to contact in case of a need for counseling and/or treatment services.

UPON COMPLETION OF HAZARD COMMUNICATION/LABORATORY SAFETY TRAINING, THE EMPLOYEE WILL BE ABLE TO:1. Identify items defined as chemical or biohazardous waste.

2. Identify points of origin for all chemical and biohazardous waste generated by his/her specific educational program.

3. Summarize Personal Protective Equipment worn when handling chemical or biohazardous waste per OSHA standards.

4. Label chemical and biohazardous waste containers in compliance with a Chemical Safety and Bio-hazards Plan.

5. Dispose of chemical and biohazardous waste containers in compliance with a Chemical Safety and Biohazardous Waste Plan

6. Identify the correct storage methods for storing compatible and non-compatible chemicals

7. Explain basic steps for emergency and spill procedures

WHAT ARE OSHA AND THE STATE OF FLORIDA DEPARTMENT OF HEALTH REQUIREMENTS?

Exposure Control Plan

Biomedical Waste Plan

Hazard Communication Plan

BLOODBORNE PATHOGEN/EXPOSURE CONTROL PLAN CFR 1910.1030… is the OSHA Bloodborne Pathogens Standard…this

standard is located in your facilities’ Exposure Control Plan (ECP)

This standard is designed to protect employees from occupational exposure to HIV, HBV and other bloodborne pathogens.

Health care facilities shall ensure that all employees with occupational exposure are trained at no cost to the employee: at the time of initial assignment, within 90 days after effective date of the standard, when re-assigned to a new position, and then annually

The training shall consist of: contents of the regulatory text, explanation of epidemiology and symptoms of bloodborne pathogens, modes of transmission of bloodborne disease, explanation of ECP, the use of PPE and engineering controls, exposure risks, information on HBV vaccination, emergency procedures if exposed, post-exposure follow-up protocols and medical follow-up, and an explanation of sign, labels and color coding.

EXPOSURE CONTROL PLAN•A Control plan is accessible to all employees

•The plan must be reviewed/ updated at least annually

*Website location: Go to your facilities’ website, then click on policies or simply type in Exposure Control plan on the search area and it will bring up all of the plans

FLORIDA DEPARTMENT OF HEALTH REQUIREMENTS According to the State of Florida Dept. of Health Bureau of Community Environmental Health Chapter 64E-16, Florida Administrative Code, Biomedical Waste Regulation:

Each biomedical waste facility shall implement a written operating plan to manage biomedical waste, in accordance with

This plan shall be available for review by the department and facility personnel.

FLORIDA DEPARTMENT OF HEALTH REQUIREMENTS The plan shall include the following: a description of

training for personnel; procedures for segregating, labeling, packaging, transporting, storing, and treating, biomedical waste; procedures for decontaminating biomedical waste spills; and a contingency plan for emergencies.

Facilities which have multiple specialty services shall include procedures specific to each specialty if procedures vary. Plans shall be updated when regulations, facility policies, or procedures change.

Each facility or their designee shall train new personnel who handle biomedical waste as part of their work responsibilities.

FLORIDA DEPARTMENT OF HEALTH REQUIREMENTS This training shall be provided prior to commencement of duties

related to biomedical waste handling.

Refresher training shall be completed annually by all personnel who handle biomedical waste. Training shall detail compliance with the facility’s operating plan and Chapter 64E-16, F.A.C., and shall be maintained as a part of the operating plan.

Each facility or their designee shall train new personnel who handle biomedical waste as part of their work responsibilities.

This training shall be provided prior to commencement of duties related to biomedical waste handling.

Refresher training shall be completed annually by all personnel who handle biomedical waste. Training shall detail compliance with the facility’s operating plan and Chapter 64E-16, F.A.C., and shall be maintained as a part of the operating plan.

BLOODBORNE PATHOGENS, OCCUPATIONAL EXPOSURES, AND ROUTES OF TRANSMISSION

BLOOD OR OTHER POSSIBLY CONTAMINATED BODY FLUIDS Those fluids which have the potential to harbor

pathogens, such as human immunodeficiency virus and hepatitis B virus, hepatitis C virus and tuberculosis include: blood, blood products, lymph, semen, vaginal secretions, cerebrospinal, synovial, pleural, peritoneal, pericardial and amniotic fluids. In instances where identification of the fluid cannot be made, it shall be considered to be a regulated body fluid

Body excretions such as feces and secretions such as nasal discharges saliva, sputum, sweat, tears, urine, and vomitus shall not be considered biomedical waste unless visibly contaminated with blood.

OCCUPATIONAL EXPOSUREThe OSHA bloodborne pathogens standard defines occupational exposures as:

Any reasonably anticipated skin, eye, mucous membrane or parenteral contact with blood or other potentially infectious materials (to include saliva in dental procedures that is visibly contaminated with blood) that may result from the performance of an employees duties.

OCCUPATIONAL EXPOSURERoutes of transmission of bloodborne pathogens may occur in several ways:

Parenteral exposure (i.e., needle stick or cut by sharp instrument).

Contact with mucous membranes through direct contact or airborne contaminants…mouth, eyes.

Contact with wounds and abrasions in the skin (non-intact skin).

WORKPLACE SOURCESOF POTENTIALLY INFECTIOUS MATERIAL

Parenteral exposure, contact with mucous membranes and contact with non-intact skin

WHAT ARE BLOODBORNE PATHOGENS?

• A pathogen is any microorganism such as viruses and bacteria that can cause disease.

• Bloodborne pathogens are those agents found in the blood or other potentially infectious materials (BOPIM) that can cause disease.

• Hepatitis B (HBV), Hepatitis C (HCV), tuberculosis, and the human immunodeficiency virus (HIV) are the 4 bloodborne pathogens of most concern.

HEPATITIS B VIRUS• The most infectious of all the

bloodborne pathogens.

• Blood contains the highest HBV titers of all body fluids and is the most important vehicle for transmission

• HBV may be found in most body fluids, however, they are not efficient vehicles of transmission…they contain low quantities of infectious HBV

• HBsAg-positive saliva has not been found to be infectious when applied to oral mucous membranes

• Symptoms of hepatitis include: yellowing of skin and eyes (jaundice), fatigue, low-grade fever, loss of appetite, abdominal pain

• Yellowing of the skin, eyes and gingiva (jaundice)

HEPATITIS B VIRUS (HBV)• CDC recommends that saliva is

not considered potentially infectious unless it contains blood

• HBV is able to survive in dried blood at room temp on surfaces for at least 1 week

• Following a needle stick the risk of infection is approximately 30% in comparison to HIV which is 0.3%

• Vaccination of employees against HBV and the use of standard precautions is the key to preventing hepatitis infection

• Hepatitis can destroy the liver (cirrhosis). Hepatocellular carcinoma may be seen in final stages of the disease

• Stages of liver pathology from hepatitis

HEPATITIS C VIRUS (HCV)• HCV is not transmitted efficiently through

occupational exposures to blood• Efficient transmission of the virus requires

repeated exposure• IV drug users and transfusion patients are

at greatest risk• The HCV infected blood has lower levels of

transmissible virus than HBV• Seroconversion after accidental needle

stick is only 1.8%• Transmission rarely occurs from mucous

membrane exposures• No documented transmission from intact

or non-intact skin exposures• No immunization at this time• Over 50% of the patients develop chronic

liver disease• Conditions associated with HCV infection

include cryoglobulinemia which causes inflammation of the blood vessels in the tissue resulting in joint pain, nerve pain, accompanied by a raised purple skin rash

• Cirrhosis of the liver and hepatocellular carcinoma are seen in the final stages of the disease

patients with cryoglobulinemia rash

HEPATITIS C VIRUS

HUMAN IMMUNODEFICIENCY VIRUS(HIV) AND ACQUIRED IMMUNODEFICIENCY SYNDROME (AIDS)

• Risk of HIV transmission following a needle stick is 0.3%

• Risk of HIV transmission after a mucous membrane exposure is 0.09%

• No immunization available but there are specific post exposure guidelines to follow if occupational exposure occurs

• The virus destroys the bodies CD4 cells. These cells play a large role in fighting off disease

• Initially if infected you will develop flu-like symptoms within 1-2 months, then symptoms disappear

• There may be a latent period of up to 8-10 years where the individual is asymptomatic

• The disease then progresses to symptomatic HIV infection then to AIDS

• Secondary infections are common in late AIDS stage and include: yeast and fungal infections, Epstein Barr infections, Kaposi's Sarcoma, tuberculosis, toxoplasmosis

• Oral Hairy Leukoplakia (top) Coccidioidomycosis (fungal disease)(lower left), and Candidiasis (yeast infection)(lower right)

INTERESTING FACTS ABOUT HIV/AIDS IN FLORIDA

TUBERCULOSIS• Between 10-15 million people in

the United States are infected with mycobacterium tuberculosis and an increasing number of HIV positive patients will become infected with TB

• Cause by a bacterium, Mycobacterium tuberculosis. They usually attack the lungs but can attack anywhere in the body

• Bacilli are extremely resistant organisms capable of surviving in the air for up to nine hours and in dried sputum for several weeks.

• 82% of cases are acquired through inhalation

• Two tests for TB infection: TB skin test and TB blood tests

• Clinical manifestations include fever, night sweats, anorexia, weight loss, pain in chest, and cough

THE CHAIN OF INFECTIONThe process by whichinfectious diseases

aretransmitted from oneperson to anotherinvolves three

essential “links” in the chain ofinfection.A pathogen A reservoir of agent A mode of

transmissionA portal of entryA susceptible host

NOT ALL EXPOSURES RESULT IN INFECTION

Effective infection control strategies are intended to break one or more of these “links” in the chain, preventing infection

Route of exposure (parenteral exposure, mucosal exposure, exposure through non-intact skin)

The dose of the pathogen transferred during an exposure incident important. In some cases only a small amount of pathogen is needed, while in other cases large amounts of the pathogen must be present

Differences in host susceptibility. How good is your immune system?

The volume of infectious body fluid is critical. In some cases it may only take one drop of blood to be an efficient transmission of the pathogen, while in other cases it requires repeated exposure to large amounts of blood containing the pathogen

UNIVERSAL/STANDARD PRECAUTIONS AND EXPOSURE DETERMINATION CATEGORIES

UNIVERSAL/STANDARD PRECAUTIONS

Universal /Standard precautions is a concept promoted by the Centers for Disease Control (CDC). It requires that all blood and body fluids be considered potentially infectious, regardless of the patients perceived infectious status. Their handling requires the use of personal protective clothing and equipment

EXPOSURE DETERMINATION Employees are categorized into 3

exposure categories based on potential of occupational exposure while performing their job duties

CATEGORY 1• The employee performs tasks that

involve potential for mucous membrane or skin contact with blood, body fluid, tissues or a potential for spills or splashes.

• Dentist, physician, PA/ANP, dental hygienist & assistant, registered nurses, histology/ laboratory technicians, housekeeping, security officer, paramedic and other healthcare workers or individuals that work in direct patient care areas

• Correctional institution employees, police officers

EXPOSURE DETERMINATION

CATEGORY 2

The employee performs tasks that involve no routine exposure to blood, body fluids or tissues during the normal work routine, but may be required to perform unplanned category 1 tasks.

CATEGORY 3

The employee performs tasks that do not involve exposure to blood, body fluids or tissues during the normal work routine.

REVIEW OF CATEGORY 1• The following job classifications have been determined to have

occupational exposure:• Dentist, physician, physicians assistant• Dental hygienist• Dental assistant, medical assistant• Radiology technician, surgical technician, medical laboratory

technician, phlebotomist• Nurse: RN,LPN, ANP, and CNA• Histology laboratory technician• Dental laboratory technician• Housekeeping working in a healthcare facility• Other worker in direct contact with healthcare • Correctional institution employees• Police officers

ENGINEERING CONTROLSEngineering controls are physical things that isolate or remove a hazard from the workplace

The following engineering controls:Sharps containers/regulated wasteRubber dam usageHigh volume evacuationNeedle re-capping devicesPersonal protective equipment (PPE)

MANAGERIAL AND NON-MANAGERIAL INPUT

OSHA requires that both managerial and non-managerial workers (employees) will be involved with the input and evaluation process regarding safer needle devices and other engineering control used in their area

Any suggestions for a safer work place should be made directly to your supervisor or the college Safety Specialist or designee

WHAT IS CONSIDERED REGULATED WASTE AND HOW DO WE HANDLE IT?

OSHA REGULATED WASTE DEFINITION

The OSHA standard defines regulated waste as: Liquid or semi-liquid blood or potentially infectious

materials (only includes saliva in that is visibly contaminated with blood)

Contaminated items that would release blood or other potentially infectious materials in a liquid or semi-liquid state if compressed

Items caked with dried blood or other potentially infected material (BOPIM) and are capable of releasing these materials during handling

Contaminated sharps to include needles, glass items, dental wires, and any object that has the potential to break and create a puncture hazard

Pathologic and microbiologic waste containing BOPIM and including teeth

FLORIDA DEPARTMENT OF HEALTH DEFINITION OF BIOMEDICAL WASTE

Biomedical waste - Any solid or liquid waste which may present a threat of infection to humans, including non-liquid tissue, body parts, blood, blood products, and body fluids from humans and other primates; laboratory and veterinary wastes which contain human disease-causing agents; and discarded sharps. The following are also included:

(a) Used, absorbent materials saturated with blood, blood products, body fluids, or excretions or secretions contaminated with visible blood; and absorbent materials saturated with blood or blood products that have dried.

(b) Non-absorbent, disposable devices that have been contaminated with blood, body fluids or, secretions or excretions visibly contaminated with blood, but have not been treated by an approved method

Biomedical waste mixed with hazardous waste, as defined in Chapter 62-730, F.A.C., Hazardous Waste, shall be managed as hazardous waste.

Any other solid waste or liquid, which is neither hazardous nor radioactive in character, combined with untreated biomedical waste, shall be managed as untreated biomedical waste

EXAMPLES OF REGULATED WASTE Sharps Pathological/Anatomical waste

Patient care disposables from INFECTED patients only

Patient care disposables or any item visibly contaminated with blood or saliva that is visibly contaminated with blood

REGULATED WASTE CONTAINERS Biomedical waste, except

sharps, shall be packaged and sealed at the point of origin in impermeable, red plastic bags or, at the discretion of the generator, into sharps containers.

Containers must be closable and must be kept closed when not in use

Both regulated and non-regulated waste containers must be made readily available in clinics and laboratory areas

A designated person on each campus will maintain all vendor tracking logs for a minimum of 3 years

BIOMEDICAL WASTE LABELSLabels placed on all red bags or plastic containers to be disposed of in biomedical containment must include the following information. 

The following must be on the label: source (department or program) of the waste, does it contain animal parts or biology slides, the address, the date the items were placed in the red bag or container, and initials of the individual filling out the label. Labels may be obtained from college-wide printing or through the biomedical waste transporter

HOW LONG CAN RED BAGS BE USED?

Red bags may remain open for use in the lab or class setting for 30 days .Place label with date of first use on the bag when it is put into the waste container.

The state has specific specifications for the type of bags that may be used. (Impact resistance of 165 grams and tearing resistance of 480 grams in both the parallel and perpendicular planes with respect to the length of the bag. Impact resistance shall be determined using ASTM D-1709-91, and tearing resistance shall be determined using ASTM D-1922-89)

Temporary use tabletop biohazard bags used on laboratory and treatment area table tops must be disposed of into a biomedical waste container each day. These temporary bags cannot contain any sharps. The bags must be sealed prior to being placed into the larger container.

WHAT SHOULD I DO WHEN THE RED BAG IS

FULL OR THE 30-DAY TIME PERIOD IS UP? Tie bag tightly and make sure

the bag is labeled correctly. Use the “gooseneck" technique for closing bags. Refer to the Exposure Control Plan or Biomedical Waste Plan for details on this technique. The “rabbit ear” technique should not be used.

Seal and label the red bag before placing it in the storage/transport container located in the pick-up area. Include location where waste originated on label.

The transport container must also be labeled appropriately

TRANSPORTING THE RED BAG

• Transport the red bag to the storage/pick-up area and place in a puncture-proof container

• It is “recommended” when transporting a red bag to the containment area located in a different building, the red bag should be transported in a puncture-proof container.

HOW DO WE DISPOSE OF ANIMAL PARTS?

DISPOSAL OF ANIMAL PARTS

Cadavers treated with Carosafe or Wardsafe are considered chemically treated. These items must be disposed of via incineration. These items (if small parts) should be placed in a red bag, sealed, and labeled and then placed into the storage container for pick-up. Care should be taken to make sure no odors leak through the bag.

DISPOSAL OF CHEMICALLY TREATED ANIMAL PARTS – COCOA CAMPUS

Large QuantitiesParts should be sealed in a plastic container or red bag, labeled, and taken to the Veterinary Technology area, building 21 to be frozen then incinerated.

DISPOSAL OF CHEMICALLY TREATED ANIMAL PARTS – OTHER CAMPUSES

Large QuantitiesParts should be sealed in a plastic container or bag, labeled, placed in a puncture resistant container, and transported to be frozen and then transported for incineration.

DISPOSAL OF UNTREATED ANIMAL PARTS FOR ALL CAMPUSES

Very Small Quantities including clams and squid should be placed in a red bag, sealed, labeled, and placed in the storage container for pick-up. Be sure NO ODORS leak from the bag!

DISPOSAL OF UNTREATED ANIMAL PARTS INCLUDING PIG TRACHEAS FORCOCOA CAMPUS

Large QuantitiesParts should be sealed in a plastic container or red bag, labeled, and taken to be frozen and incinerated.

.

DISPOSAL OF UNTREATED ANIMAL PARTS INCLUDING PIG TRACHEAS FOR OTHER CAMPUSES

Large QuantitiesParts should be sealed in a plastic container or bag, labeled, placed in a puncture resistant container, and transported to be frozen and incinerated.

WHAT SHOULD I DO WITH BIOLOGY PLATES?

Biology plates with bacterial growth should be placed in a small biohazard bag and sealed. Place sealed red bag in a larger red bag.Plastic plates and tubes are not required to go into a sharps container. However, if you are concerned that the biology plate has the potential to break and become a puncture hazard, place in a sharps container or puncture resistant container. Seal in small biohazard bag prior to placing in container.

HOW DO WE DISPOSE OF SHARPS?

SHARPSAny contaminated object that can penetrate the skin should be disposed of in the approved sharps container, including but not limited to: Needles, Scalpels, Glass, Dental Wires• Containers will be closable, puncture resistant, leak-

proof and marked with the biohazard label • Located as close as possible to immediate area of use• Must be kept in an upright position• Replaced routinely to prevent overfilling (3/4 full or to

the designated fill line)• Must be closed before they are moved and once

closed they are not to be re-opened• Avoid placing on floor unless absolutely unavoidable• Never attempt to retrieve an item from a sharps

container

SHARPSNeedles must not be bent, recapped, or removed, except:• When administering multiple doses or anesthetic

• When not feasible to immediately discard the needle

• Prior to removal of the needle from the syringe

**Always use the one handed technique or a mechanical device if re-capping is unavoidable

NEVER THROW SHARPS INTO A BAG!!

DISPOSAL OF SHARPS CONTAINERS

DISPOSE OF SHARPS CONTAINERS WHEN THEY ARE ¾ FULL OR CONTENTS ARE UP TO THE FILL LINE. NEVER PUT YOUR HAND INSIDE OF THE CONTAINER TO RETRIEVE ITEMS OR TO PUSH ITEMS DOWN

TAPE AND LABEL THE SHARPS CONTAINER BEFORE PLACING IT IN THE TRANSPORT CONTAINER LOCATED IN THE STORAGE AREA. DO NOT LEAVE TAPED AND LABELED SHARPS CONTAINERS ON THE LABORATORY OR CLINIC COUNTERS AT ANY TIME

PLACE SEALED AND LABELED SHARPS CONTAINERS INTO THE TRANSPORT CONTAINER IMMEDIATELY AFTER SEALING. YOU MAY PLACE IN A CONTAINER WITH OTHER BIOMEDICAL WASTE

BIOMEDICAL WASTE STORAGE AND MATERIALS Each area has a designated location for biomedical waste storage, labels, supplies and containers. You are responsible for knowing these locations.

Refer to your Biomedical Waste Plan for the location of the storage area.

Remember You Are Responsible For handling the biomedical waste! If you need assistance please ask for it!

SIX STEPS TO REMEMBER

STEP 1 PREPARE SEAL/TAPE LABEL

STEP 2

Transport sealed and labeled waste to biomedical waste storage area

STEP 3• Pick up key for locked biomedical waste storage room

• Security can give you access to the storage area in the event no one is available to give you the key

STEP 4Place sealed & labeled RED BAG or TAPED AND LABELED SHARPS CONTAINERS into the transport

container

STEP 5Re-lock the biomedical waste storage area and return the key

STEP 6

Report Full, Sealed, & Labeled transport container

to the designated person on the campus

for pick-up.Items must be picked

up every 30 days unless pick-up is needed

sooner

6 STEPS FOR DISPOSING OF BIOMEDICAL WASTE

Step 1 – Prepare, Seal, Label/Tape

Step 2 – Transport biomedical waste to

onsite storage

Step 3 – Get key to storage room

Step 4 – Place waste in transport container

Step 5 – Lock room & return key

Step 6 – Report full container(must be sealed &

labeled)

END OSHA, Laboratory Safety,Bio-Medical and Bio-Hazardous Waste TrainingPart A