92-02-15a: OSHA Sets Standard For Occupational Exposure to Bloodborne Pathogens; U.Va. Already in Compliance The Centers for Disease Control (CDC) estimates that there are approximately 8,700 Hepatitis B virus (HBV) infections in healthcare workers with occupational exposure to blood and other potentially infectious materials in the U.S. each year. As of this month the CDC reports there are at least 28 healthcare workers who have become infected with the Human Immunodeficiency Virus (HIV), the virus which causes AIDS, through occupational exposures as well. Because both of these viruses - in addition to many others - are transmitted through blood and certain body fluids, persons who come into contact with these potentially infectious materials as a result of carrying out their duties are at an increased risk. With an estimated 1 percent or more of all hospitalized patients likely infected with HBV, and between 1 million and 1.5 million persons now infected with HIV in the United States alone, each at some point in the near future requiring medical attention, healthcare workers are among those at highest risk for acquiring these infections while on the job. To assist in minimizing these risks, the Occupational Safety and Health Administration (OSHA) recently issued a final rule on the Occupational Exposure to Bloodborne Pathogens that becomes effective nationally March 6, 1992. In certain states which have their own OSHA programs - such as Virginia - the ruling actually goes into effect six months after this date. This regulation affects not only hospitals, but also physicians' and dentists' offices, nursing homes, medical, dental and research labs, government clinics and any other occupational setting where employees may come into contact with bloodborne pathogens. A pathogen is simply any organism which causes disease to healthy humans. Examples of materials that could contain bloodborne pathogens include human blood, human blood products (serum, plasma, etc.), tissues, organs, certain body fluids, and items contaminated with these materials such as hypodermic needles, syringes and broken glass. The OSHA Standard is designed to help limit worker exposure to bloodborne disease by regulating the work environment. A key component of the Standard is the mandated practice of "universal precautions." This is a method of infection control in which all human blood and certain body fluids are presumed to be infectious for HIV, HBV and other bloodborne pathogens. In light of these universal precautions, certain work practice controls are required, such as careful handwashing after each patient, not recapping of needles by hand and not mouth pipetting. The use of proper personal protective equipment like disposable gloves, gowns and goggles when treating any patient where there is a likelihood ofexposure to human blood, body fluids, mucous membranes, or when directly handling items contaminated by these materials is an important requirement as well. Other provisions of the Standard include immunization programs for HBV, proper disposal and handling of contaminated waste, labeling and posting signs, the use of disinfectants, and most important, training and education programs. If you work at the Health Sciences Center (HSC), the requirements of this new OSHA Standard should be quite familiar to you. The HSC has already implemented measures to protect workers from occupational exposure to blood and other potentially infectious materials. A Joint Advisory Notice from OSHA on Protection Against Occupational Exposure to HBV and HIV has been strictly adhered to since 1987. In effect, we have been in compliance with the requirements of the new Final Ruling on Occupational Exposure to Bloodborne Pathogens for several years now. Central to compliance with the regulations is training in the practice of universal precautions. If your work involves potential exposure to bloodborne pathogens, and you have not already received this one-hour training session offered by the hospital's epidemiology department, you should alert your supervisor. The training coordinator is June Collmer, N.P., and she may be reached at 924-2777. There are various committees at U.Va. that oversee the methods of compliance with regulations such as this one. These include the Hospital Infection Control Committee (HIFC), which is responsible for creating the written hospital policies on infectious agents as required by OSHA and recommended by CDC or other safety agencies. The Health Sciences Center Safety Committee reviews accidents related to infectious materials and makes recommendations to HIFC and other departments when necessary. The safety policies and regulatory compliance programs for laboratories and departments outside of the Health Sciences Center are overseen by the Chemical and Biohazards Safety Committee. The contact person for each of these committees is listed below, along with the messenger mail address and phone number. Infection Control Committee Dr. Barry Farr Hospital Epidemiologist School of Medicine Box 473, 924-2777 Health Sciences Center Safety Committee Melvina Hamilton Director, Div. of Support Services Room 2153, McKim Hall, 982-1666 Chemical & Biohazards Safety Committee Dr. Ralph Allen Director, Environmental Health & Safety Special Materials Handling Facility, Edgemont Road Box 262 HS, 982-4911 One of the by-products of the universal precautions program is the generation of a large quantity of potentially infectious waste material. The HSC spent nearly $500,000 packaging and incinerating 700 tons of these materials during 1990-91. The quantity of infectious waste generated at U.Va. has increased at a rate of nearly 30 percent per year during the past three years. While universal precautions must be adhered to strictly, waste minimization also is everyone's responsibility. The Office of Environmental Health and Safety, which is responsible for transporting and incinerating all infectious waste generated at U.Va., in conjunction with the hospital's epidemiology department, offers the following recommendations for ways infectious waste can be minimized: o All common non-infectious waste (non-contaminated cans, wrappers, paper products, etc.) should be discarded in the normal trash containers, not in Contaminated Materials Containers (CMCs). o All disposable gloves, masks, and gowns should not be considered infectious unless visibly contaminated with blood or body fluids (unless otherwise instructed by your supervisor). o CMCs should be sealed and discarded only after they are filled to capacity (75 percent by volume or 50 lbs. by weight) or the waste begins to give off a disagreeable odor. o When possible, use CMCs for disposal of infected needles/syringes. While the smaller plastic 'needle boxes" are available for use, they are much more expensive, must eventually be packed inside a CMC, and they are unnecessary if a CMC is in the room. (Exceptions include family practice, pediatrics and behavioral medicine units, where there may be some concerns related to patient retrieval of used instruments). The CMCs are designed to safely contain sharps. o Finally, make waste segregation easy. If possible, place all CMCs and normal trash containers in locations within the immediate area where patient treatment is administered or lab work performed. Take a small amount of time to make a simple decision - infectious or not - and discard the waste appropriately. It is important to the University and the environment to treat infectious waste in a responsible manner. However, incineration of non-infectious materials is extremely expensive and wasteful. Should you have concerns or perhaps other suggestions that might help minimize the amount of infectious waste generated at U.Va., contact Joel Loving, U.Va. Hazardous Materials Officer, at 982-4910. This new OSHA regulation is vital for all of us who treat patients or handle potentially infectious materials at U.Va. It is estimated that the U.S. will spend $812 million per year to comply with this standard. This represents more than $4 million per life saved. There is no doubt - you are a valuable person in addition to being a valued employee. -- Joel Loving, Envi. Health & Safety --