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BBP Bloodborne Pathogens

This area will introduce you to the Occupational Safety and Health Administration (OSHA) Bloodborne Pathogen Standard(effective March 1992 per 29 CFR 1910.1030)

The OSHA standard was developed to help limit the potential exposure of healthcare workers to pathogenic microorganisms associated with human blood and blood products.  Currently, there are a limited number of clinically important microorganisms can be transmitted through exposure to either patient's blood or patient blood-contaminated materials. 
                  

BBP Standard Review

As previously stated, there are only a few BBP's that present a risk to you if you come in direct contact with them.  They are acquired through contact with potentially infectious materials such as human blood and certain body fluids.

The two most clinically important (present the greatest risk) BBP pathogens are the viruses human immunodeficiency virus (HIV) and hepatitis B virus (HBV). Hepatitis C virus (HCV) is often included in a discussions of BBP as it relates to healthcare worker exposure.

Additionally, there are several other BBP's included in the Standard.  They are malaria, syphilis, babesiosis, brucellosis, leptospirosis, arboviral infections, relapsing fever, Creutzfeldt-Jakob Disease, Human T-lymphotropic virus Type I,and Viral Hemorrhagic Fever.

The Bloodborne Pathogen Standard was created by OSHA to reduce and/or eliminate the occupational hazard to healthcare workers and others whose duties may put him or her at risk for contact with human blood or blood associated materials.  It was primarily "aimed at hospitals, funeral homes, nursing homes, clinics, law enforcement agencies, emergency responders, and HIV/HBV research laboratories."1 HCV has only been recently added to this list. 

Close adherence to the Standard's policies and practices will effectively reduce your risk of exposure to other infectious microbial pathogens as well.

Blood and Other Potentially Infectious Materials (OPIMs)2

Human blood remains the primary source of HIV and HBV.  However, they have also been isolated from other potentially infectious materials including body fluids.  These items are collectively known as OPIMs, which include:

  1. The following human body fluids:
    • Semen
    • Vaginal secretions
    • Cerebrospinal fluid (fluid surrounding the brain and spinal cord)
    • Synovial fluid (fluid surrounding bone joints)
    • Pleural fluid
    • Pericardial fluid
    • Peritoneal fluid
    • Amniotic fluid
    • Saliva in dental procedures
    • Any body fluid that is visibly contaminated with blood
    • All body fluids in situations where it is difficult or impossible to differentiate between body fluids
  2. Any unfixed tissue or organ (other than intact skin) from a human, or non-human primate (living or dead).
  3. HIV-containing cell or tissue cultures, organ cultures, and HIV or HBV-containing culture medium or other solutions, and blood, organs or other tissues from experimental animals infected with HIV or HBV.

 

Human Immunodeficiency Virus (HIV),  Hepatitis B Virus (HBV),  & Hepatitis C Virus (HCV)

Disease:

  • HIV - progressively weakens the immune system of the infected person. Infected individuals can longer fight off infections by opportunistic microorganisms (e.g., yeasts) that do not normally cause disease in healthy individuals.  Ultimately, this process leads to acquired immunodeficiency syndrome (AIDS) and eventually death. HIV infection can be treated but this is no CURE.
  • HBV - causes liver infection with symptoms ranging from a mild form lasting for only a few weeks  to a serious long-term (chronic) condition leading to liver disease, liver cancer and possibly death.  It is much more infectious than HIV.  According to CDC, chances of getting HBV is 100X greater than HIV.
  • HCV - also causes liver disease.   HCV infection mostly mimics that seen with HBV.  Most often, HCV becomes a chronic condition that sometimes results in liver cirrhosis (scarring) and liver cancer.  Approximately (70-80%) who are infected with HCV never have symptoms and therefore never seek medical care3.

Symptoms:

  • HBV or HCV - acute symptomatic infections may demonstrate:
    • Fever
    • Fatigue
    • Loss of appetite
    • Nausea
    • Vomiting
    • Abdominal pain
    • Dark urine
    • Clay-colored bowel movements
    • Joint pain
    • Jaundice (yellow color in the skin or eyes)
  • HIV - symptoms vary as the disease progresses from initial infection to full-blown AIDS4.
    • 1) Two-four weeks (post infection): 
      • brief flu-like illness (fever, headache, sore throat, swollen lymph nodes, rash)
    • 2) Years later: *
      • Swollen lymph nodes (often 1st sign of HIV infection)
      • Diarrhea
      • Weight loss
      • Fever
      • Cough and shortness of breath
    • 3) AIDS onset (~10 years if untreated):
      • Soaking night sweats
      • Shaking chills or fever higher than 100 F (38 C) for several weeks
      • Cough and shortness of breath
      • Chronic diarrhea
      • Persistent white spots or unusual lesions on your tongue or in your mouth
      • Headaches
      • Persistent, unexplained fatigue
      • Blurred and distorted vision
      • Weight loss
      • Skin rashes or bumps

* Can remain symptom-free for several years.

Transmission: 

Blood borne pathogens are transmitted when contaminated blood or OPIMs gains access to the bloodstream of an uninfected person. 

Workplace transmission:

  •  Accidental puncture from contaminated needles, broken glass, or other sharps
  • Contact between broken/damaged skin and infected body fluids
  • Contact between mucous membranes and infected body fluids

Special attention should be taken to cover open sores, cuts, abrasions, acne or any other type of damaged/broken skin such as sunburn or blisters.

Aerosols or splashes into eyes, nose, and/or mouth of contaminated blood could result in transmission

Non-workplace transmission:

  • Sexual contact
  • Sharing of hypodermic needles
  • From mothers to their babies before/at birth*

* Infected women may expose their child to BBP's through amniotic fluid, birthing process bleeding, and although less likely through breast milk.

Universal Precautions

Universal Precautions represents OSHA's approach to controlling healthcare worker exposure to BBP.  It states that "  all human blood and certain human body fluids are treated as if known to be infectious for HIV, HBV, and other bloodborne pathogens"2.

Universal Precautions should be strictly applied when handling either blood or OPIMs.   It should also be followed when handling following body fluids even if they are not  visibly contaminated with blood:

  • Urine
  • Feces
  • Vomit
  • Tears
  • Sweat
  • Sputum
  • Nasal secretions

These substances are not currently covered by universal precautions.  However, it's simply good practice to apply Universal Precautions all the time or "universally" when handling materials contaminated with these substances.  Visible blood contamination may not always be readily apparent, especially when handling bulk patient care materials (e.g., absorbant pads, bedding, etc.).

Standard Precautions is the Centers for Disease Control and Prevention (CDC) approach to controlling infection spread.  It incorporates the best practices of OSHA's Universal Precautions but is broader in its scope since it "includes all body fluids (except sweat) and excretions, regardless of whether they contain blood"2.

Go to next section: Exposure Control Plan

1Summary of OSHA's Bloodborne Pathogen Standard
2CDC - hepatitis C virus facts
3Symptoms