Beware: Bloodborne pathogen exposure still a risk

Without a doubt, Blood-borne Pathogens (BBP) pose a very serious risk to nurses.

Here’s some important background: Before OSHA’s BBP Standard was promulgated in 1991, healthcare workers were frequently exposed to bloodborne pathogens through needlesticks, cuts, splashes, etc. Healthcare unions knew that there were measures that could provide protection to these workers, but healthcare employers for years fought to prevent protective regulations. Finally, after many years of struggle, the BBP Standard was put into place.

With implementation of the standard, the rate of BBP exposures dropped dramatically. In particular, Hepatitis B infections plummeted because the standard required employers to provide Hepatitis B vaccines to all workers who were at risk of occupational exposure.

However, the CDC estimates that there are still almost 400,000 needlesticks each year in the hospital setting, and almost twice that amount when all types of workplaces are measured (home care, long-term care, etc.). The numbers are likely far higher when underreporting is taken into consideration. If you suffer a bloodborne pathogen exposure, it is vital that you receive treatment immediately. See box, right for steps to take if you’ve been exposed.

Not inevitable

Many healthcare workers consider needlestick injuries and other forms of BBP exposure to be inevitable. “The patient jerked when I inserted the needle,” or, “I wasn’t paying attention,” or, “I was working too fast.” But it is the employer’s responsibility to ensure a safe working environment for employees. Human beings make mistakes. It is vital that measures be put in place that recognize the risks and try to prevent them if possible. The BBP Standard requires that employers investigate each exposure incident and take corrective actions to prevent similar incidents in the future.

Being a nurse shouldn’t put you at risk of becoming a patient. For more information or for assistance, contact the NYSNA Occupational Health and Safety staff at healthandsafety@nysna.org.

OSHA’S bloodborne pathogens standard: What you need to know

The BBP Standard requires employers to protect workers who are likely to come into contact with blood or other potentially infectious materials (OPIM).

Employers must:

• Establish an exposure control plan to eliminate or minimize occupational exposure to BBPs. The plan must include all job classifications and tasks that may put workers at risk for exposure. The plan must be updated annually.
• Identify, evaluate and implement effective engineering controls (e.g., safer needle devices, needless systems, sharps disposal containers) with frontline worker input.
• Identify and use work practice controls (i.e., procedures for handling contaminated sharps, specimens, laundry; cleaning contaminated surfaces; etc.) with frontline worker input.
• Maintain a sharps injury log.
• Implement universal precautions.
• Provide appropriate PPE (including gloves, gowns, eye protection, masks, etc.).
• Make available hepatitis B vaccinations free of charge.
• Make available post-exposure evaluation, prophylaxis and follow up at no cost to employee.
• Request that the source of exposure be tested for BBPs if the source’s BBP status is not known (if the individual agrees to testing, the results may allow prophylaxis to be stopped early).
• Use labels and signs to communicate hazards.
• Provide information and training to workers on initial assignment and at least annually thereafter with a trainer available to answer questions.
• Maintain worker medical and training records.

To review the OSHA Bloodborne Pathogens Standard, go to www.osha.gov.

What to do if you’re exposed

If you experience a bloodborne pathogen exposure by, for example, a needlestick or splash to a mucus membrane, time is of the essence. Studies have shown that, for prophylaxis to be most effective, it should begin within 2 hours of the exposure. Take the following steps:

1. Wash needlestick injuries and cuts with soap and water.
2. Flush splashes to nose, mouth, or skin with water.
3. Irrigate eyes with clean water, saline, or sterile wash.
4. Go to your facility’s employee health unit or the emergency department, depending on your facility’s post-exposure protocols.
5. It is very important to begin prophylactic treatment within 2 hours of when the exposure occurred. Make sure the healthcare workers treating you understand that you must be seen as quickly as possible to meet that timeline.
6. Request medication for potential side effects of prophylaxis such as nausea.
7. There may be a special prophylaxis protocol to follow based on factors such as pregnancy. Make sure to discuss this with your treating physician.
8. As stipulated by the OSHA Bloodborne Pathogens standard, there should be no out of pocket cost for your medical care.
9. The employer should make every effort to obtain consent for testing from the source patient.
10. File for workers’ compensation in case you miss work due to the injury or treatment.
11. Notify your supervisor and union representative so that the NYSNA Health & Safety Department can follow up on the potentially hazardous conditions that led to the exposure incident.