Step 18: Blood Safety Guidelines

Each facility establishes guidelines for blood safety. Usually, these will be based on government regulations such as the Bloodborne Pathogens Standard. Blood safety is a primary concern for healthcare workers because of their frequent contact with blood samples and infected patients.

Diseases that can be transmitted through blood include HIV/AIDS, hepatitis B and hepatitis C. AIDS is caused by HIV, human immunodeficiency virus, which acts by destroying the white blood cells that provide immunity to the body, called T cells. HIV is carried in the blood, all other body fluids and the mucous membranes.

Like HIV, viral hepatitis is transmitted through direct contact with infected blood or fluid. Hepatitis is classified as Hepatitis A (HAV), Hepatitis B (HBV), Hepatitis C (HCV), Hepatitis D (HDV) and Hepatitis E (HEV). The three most common of these are HAV, HBV and HCV.

Healthcare employers are required to provide immunization for HBV to their personnel. Both HBV and HCV are progressive diseases carried in the blood and may become chronic. The virus may or may not result in any symptoms, although infected individuals can carry the virus and transmit it to others for a lifetime without knowing they have it. HCV causes liver damage, cirrhosis and liver failure. HBV also damages the liver and has been linked to liver cancer. Symptoms of HBV include fatigue, nausea, headache, fever and jaundice, a yellow discoloration of the skin. HBV can remain asymptomatic (have no symptoms) for years while it is causing damage. There is no vaccine for HCV; however, it has been treated with antiviral drugs with limited success.

Here are the most common ways that viral diseases are transmitted in the medical setting:

• Blood specimens during venipuncture
• Open wounds or lesions
• Nosebleeds
• Vaginal bleeding or menstruation
• Feces, vomit or other body fluids—even if they don’t have visible blood

Online Learning

Build on what you are learning by watching the video Hepatitis C- Needlestick Injuries.

Both the Standard and Transmission-based Precautions guidelines recommend personal protective equipment, such as gloves, mask, gown and goggles. Although this protective equipment is essential, remember that it cannot prevent injuries such as needlesticks.

OSHA Requirements

OSHA requires that safety needles be made available to medical employees. A variety of safety needles are available. In some safety needles, the needle is automatically covered when it’s pulled out of its packaging. Other safety needles require the phlebotomy technician to release a mechanism to make the needle pointed; otherwise it’s blunt to prevent needlestick injuries.

A sharps container is puncture-proof.

Safety tube holders are also used to prevent needlestick injuries. They are locking plastic covers that enclose the needle to prevent accidental needlesticks.

OSHA also requires that employers train employees in safe needle handling and to keep a log of any injuries caused by contaminated sharps.

Bloodborne Pathogen Standard

In March 1992, the Bloodborne Pathogen Standard became effective to limit medical employees’ exposure to bloodborne pathogens. It covers employees who may come into contact with blood and other infectious materials as part of their job. This includes mental health workers, first-aid caregivers and all part-time and full-time medical personnel.

The Bloodborne Pathogen Standard applies not only to blood, but to any body fluid containing blood, saliva, semen, vaginal secretions, cerebrospinal fluid as well as unfixed tissues.

The scope of this standard is broad, ranging from laundry handling to medical records. A few requirements that deal directly with an exposure are:

• Exposure determination—The employer must create a list of the jobs and employees who are exposed to infectious materials.
• Plan to control exposure—The employer must create a written exposure control plan, regularly update it and make it accessible to employees. The plan should contain an explanation of how exposure will be prevented; information about receiving an HBV vaccination; how exposures will be reviewed and evaluated; and communication about hazards.
• Labeling—The employer must label containers that are used to keep or transport blood or use a red bag if appropriate. The labels will be orange or orange-red and include the biohazard symbol.
• Training—Employees must receive annual training about exposure risks.

Let’s look at an example of how you will use blood safety guidelines in your workplace. Let’s say you accidentally receive a needlestick. After appropriate medical care, you will report the incident to the supervisor. Create a confidential document of the incident that includes the incident’s circumstances, exposure location and the source of the exposure.

In addition, under OSHA requirements, you should get tested for HBV and HIV. The source of the exposure (the patient who used the needle) can also be tested if she is willing. You will be offered an HBV vaccine and provided counseling about your exposure risks. OSHA also requires that your employer file an OSHA 301 form.

OSHA 301 form

Blood Spills

Another aspect of OSHA’s blood safety regulations has to do with how blood spills are handled. Employers must have a procedure for cleaning and decontaminating an area that has been in contact with blood. If blood is spilled, blood spill kits should be available and will include:

• Protective plastic safety apron
• Disposable gloves and a mask/faceshield combination
• Absorbent material, scraper and shovel
• Bottle of bleach solution
• Protective shoe coverings
• Hand-cleaning towelettes
• Biohazard disposal bags

The employee cleaning up the blood spill must wear latex gloves. Paper towels or other materials that were used to clean up the spill must be placed in a biohazard container, and the area should be cleaned with a 10 percent bleach solution.

 

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