Bloodborne Pathogens and the OSHA BBP Standard
December 11, 2017 | Health System Risk Management
OSHA first promulgated the BBP standard, 29 CFR §1910.1030, in 1991, after being petitioned by unions representing healthcare workers concerned about occupational exposure to BBPs such as HBV, HCV, and HIV. Healthcare workers and laboratory personnel can be exposed to these BBPs in one of three ways. Sharps-related injuries, such as accidental needlesticks or injuries caused by scalpel blades or glass capillaries, receive the most attention; these are also referred to as “percutaneous" injuries. The two other types of occupational exposure are contact with a mucous membrane or contact with nonintact skin such as chapped skin. Note that, in addition to the term “percutaneous injury," OSHA sometimes uses the broader term “parenteral contact," which encompasses more than just sharps injuries. Parenteral means piercing the mucus membrane and includes needlesticks (percutaneous), human bites, cuts, and abrasions. In defining key terms, OSHA also uses the term “blood and other potentially infectious materials (OPIM)" rather than “blood and body fluids," commonly used in the clinical literature. See Key OSHA Definitions for the meaning of some terms OSHA uses.
OSHA determined that the risks from occupational exposure to blood and OPIM could be minimized or eliminated using a combination of the following, all of which OSHA set forth in its BBP standard:
Employers, including hospitals, nursing homes, ambulatory care facilities, physician practices, and other healthcare facilities, are required to develop a written ECP that describes how the facility would comply with the BBP standard.
The BBP Standard was revised in 2001 (as required by the Needlestick Safety and Prevention Act of 2000) to reflect the fact that new medical devices have been developed to reduce the risk of sharps injuries. Among other changes, the revised standard requires solicitation of employee input, especially in selecting safer medical devices and work practices; added some new definitions relating to safer medical devices; and required maintenance of a sharps-injury log. The standard requires the ECP to be reviewed and updated annually to reflect changes in technology and changes in the workplace. See the discussion Review OSHA Requirements for more details on the BBP standard.
OSHA defines "bloodborne pathogens" as pathogenic microorganisms present in human blood that cause disease in humans, and it specifically includes HBV and HIV (29 CFR 1910.1030b). In addition to viruses, occupationally acquired BBPs include a multitude of bacteria/rickettsia, parasites, and yeasts (Taranola et al.). OSHA notes that BBPs also include pathogens that cause syphilis, relapsing fever, Creutzfeldt-Jakob disease, adult T-cell leukemia/lymphoma, and viral hemorrhagic fever (OSHA "Enforcement"). Some of these other pathogens are more likely to be encountered in the laboratory setting than in the patient-care setting. For example, occupational transmission of parasites such as Plasmodium (which can cause malaria) and Toxoplasma gondii (which causes toxoplasmosis, which can be dangerous in pregnant women and immunocompromised individuals) have been reported in laboratories; the majority of these involved needlesticks or exposures through abraded skin, including microabrasions (CDC "Biosafety"). This guidance article focuses on the three viruses that account for most cases of occupationally acquired bloodborne infection in healthcare workers: HBV, HCV, and HIV (Deuffic-Burban et al.). Compliance with the BBP standard can reduce or eliminate exposure to all BBPs.
Most exposures to BBPs do not result in infection. The probability of infection depends on the type of BBP (HBV is very contagious), the nature of the exposure (percutaneous or mucosal), the volume of BBP and the concentration of the virus in the fluid, and the injured individual's health and immune system. In general, the risks of infection from...