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Occupational Safety and Health Administration

(OSHA) - Bloodborne Pathogens, HBV
Biohazard Symbol
The Occupational Safety and Health Administration (OSHA) developed the Bloodborne
Pathogens Standard to reduce and prevent workplace exposures to infectious diseases
among healthcare workers. This standard helps prevent workers from contracting
bloodborne diseases such as hepatitis B (HBV), hepatitis C (HCV), and the human
immunodeficiency virus (HIV), and was originally formatted to protect healthcare
workers from Hepatitis B and HIV. OSHA’S bloodborne pathogens standard,
incorporating the Needlestick Safety and Prevention Act of 2000, protects employees
who work in occupations where they are at risk of exposure to blood or other
potentially infectious materials. This standard requires employers to develop written
documents to explain how they will implement the standard, provide training to employees, and protect the
health and safety of their workers. The bloodborne pathogens standard describes how to determine who is
covered and the ways to reduce workplace exposure to bloodborne pathogens, including a written exposure
control plan.

Employees and healthcare workers covered by this standard include those who:

• Have direct patient/resident contact. • Work with blood and other bodily fluid
• Draw blood. specimens.
• Handle contaminated equipment.

The Standard Precautions/Transmission-Based Precautions system is designed to prevent the transmission of

infectious agents. It requires the use of protective apparel for all contact with blood and body substances but
uses Airborne, Droplet and Contact Precautions for patients with diseases known to be transmitted in whole or in
part by those routes.

Standard precautions requires that all human blood and other potentially infectious materials be treated as if
known to be infectious for HIV, HBV, HCV, or other bloodborne pathogens, regardless of the perceived “low risk”
status of a source individual. Standard Precautions are designed for the care of all persons—patients, clients and
staff—regardless of whether or not they are infected. Standard Precautions apply to blood and all other body
fluids, secretions and excretions (except sweat), non-intact skin and mucous membranes. Healthcare workers
should assume that all patients are potentially infectious and use handwashing, protective apparel, and special
procedures to prevent exposure to blood and body substances.

The OSHA Bloodborne Pathogens Standards apply to blood or Other Potentially Infectious Material (OPIM),
which includes:

• cerebrospinal fluid • semen

• synovial fluid • vaginal secretions
• pleural fluid • any body fluid contaminated with blood
• amniotic fluid • saliva in dental procedures
• pericardial fluid • body fluids in emergency situations that
• peritoneal fluid cannot be recognized
• unfixed tissue or body organs other than
intact skin

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Exposure Control Plan

OSHA's bloodborne pathogens standard requires the employer to prepare a written exposure control program.
The standard requires the employer's plan to identify workers performing routine tasks and procedures in the
workplace that involve exposure to blood or other potentially infectious materials, develop a schedule of how and
when the provisions of the standard will be implemented, and develop a plan of action to be taken when an
exposure incident occurs. The plan must be reviewed, updated at least annually or whenever new tasks and
procedures affect occupational exposure; be made accessible to employees.

Exposure Incident means an eye, mouth, other mucous membrane, non-intact skin, or parenteral contact with
blood or other potentially infectious materials that results from the performance of an employee's duties.

Engineering Controls means controls (e.g., sharps disposal containers, self-sheathing needles, safer medical
devices, such as sharps with engineered sharps injury protections and needleless systems) that isolate or remove
the bloodborne pathogens hazard from the workplace.

Work Practice Controls means controls that reduce the likelihood of exposure by altering the manner in which
a task is performed (e.g., prohibiting recapping of needles by a two-handed technique).

Source Individual means any individual, living or dead, whose blood or other potentially infectious materials
may be a source of occupational exposure to the employee. Examples include, but are not limited to, hospital and
clinic patients; clients in institutions for the developmentally disabled; trauma victims; clients of drug and alcohol
treatment facilities; residents of hospices and nursing homes; human remains; and individuals who donate or sell
blood or blood components.

Other Potentially Infectious Materials means (1) The following human body fluids: semen, vaginal
secretions, cerebrospinal fluid, synovial fluid, pleural fluid, pericardial fluid, peritoneal fluid, amniotic fluid, saliva
in dental procedures, any body fluid that is visibly contaminated with blood, and 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 (living or dead); and (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.

Parenteral means piercing mucous membranes or the skin barrier through such events as needlesticks, human
bites, cuts, and abrasions.

The Hepatitis B vaccine is a series of three intramuscular injections. The second injection is administered one
month after the first, and the third is administered six months after the first. Studies indicate hepatitis B
vaccination is effective against chronic hepatitis B virus infection for at least 15 years. Boosters are not needed
because immune memory remains intact indefinitely following immunization.

Personal protective equipment (or PPE) refers to those items that can be worn to protect an individual from
serious injuries or illnesses resulting from contact with blood or any other potentially infectious material. Personal
Protective Equipment includes gloves, gowns, masks, eye shields or goggles. The employer shall provide, at no
cost to the employee, appropriate personal protective equipment such as, but not limited to, gloves, gowns,
laboratory coats, face shields or masks and eye protection, and mouthpieces, resuscitation bags, pocket masks,
or other ventilation devices.

Occupational exposure means a “reasonable anticipated skin, eye, mucous membrane, or parenteral contact
with blood or other potentially infectious materials that may result from the performance of the employee’s
duties.”

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Exposure Control Plan Summary

1. Each position and the tasks performed shall be evaluated to determine exposure to bloodborne
pathogens.
2. All employees should be provided in-service education concerning the Exposure Control Plan and how
he/she may access or secure a copy of the plan and a copy of the OSHA, Final Standard for Bloodborne
Pathogens.
3. All employees in job classification category I or II shall be offered, at no cost, HBV immunization and
information concerning Hepatitis B Vaccination.
4. Confidential employee medical records files shall be established and maintained for each employee.
5. Employees in job classification Category I or II shall adhere to Standard Precautions and workplace
controls.
6. Employee shall report to his/her supervisor prior to commencing work; any cuts, scrapes, wounds, skin
rashes, chapped skin or dermatitis.
7. Gloves must be worn by employees handling blood or body fluids, mucous membranes, or non intact
skin.
8. Employees shall use protective eyewear to protect the mucous membrane of the eye when splashes of
blood or body fluid are likely to occur and protective gowns or aprons when employee’s clothes may be
soiled with blood or other body fluids.
9. Employees shall follow hand washing policy to prevent the risk of infection.
10. Appropriate personal protective equipment specific to the job tasks shall be available to employees at all
times.
11. All spills and splashes of blood or other body fluids shall be cleaned up and the area decontaminated as
soon as practicable.
12. Employees shall report any exposure to bloodborne pathogens and the facility shall follow occupational
exposure protocols.
13. HIV antibody testing shall be offered to employees when appropriate following an exposure incident.
14. Materials containing blood or body fluids shall be identified with a hazard legend label when red-bagging
is not used.
15. Infectious waste shall be disposed of consistent with applicable federal, state, or local regulations.
16. The Exposure Control Plan shall be reviewed (and updated if necessary) annually.
17. Employee, resident, visitor suggestions for preventing or controlling exposure shall be directed to the
facility Administrator.

The word "hepatitis" means inflammation of the liver and also refers to a group of viral infections that affect the
liver. The most common types are Hepatitis A, Hepatitis B, and Hepatitis C. Hepatitis B is the underlying cause of
an estimated 3,000 to 5,000 deaths each year in the United States. In 2007 4,514 cases of acute Hepatitis B in
the United States were reported, but the estimated number of infections was 43,000, due to persons being
unaware they have the virus or cases not reported. There are 1.2 million people living with chronic Hepatitis B.
The main methods of transmission of the virus are: unprotected sex with an infected person, HBV carrier mother
to the newborn at birth, illegal drug injection use. There is no cure for hepatitis B, and ten percent of those
infected become chronic carriers, and can pass the virus to husbands, wives, children or sex partners, and even
patients. Chronic cases of Hepatitis B can lead to cirrhosis and liver cancer. The only hope for survival may be a
liver transplant.

You may not know if a patient has Hepatitis B until it’s too late. The virus can enter through the mucous
membrane of any break in the skin. The Hepatitis B virus can survive at least 7 days outside the body and still
be capable of causing infection. Healthcare providers should be vaccinated with the Hepatitis B vaccine. The
vaccine can be given before or after exposure. The number of Hepatitis B cases has decreased dramatically over
the years due to vaccination. The Hepatitis B vaccine is very safe, and cannot cause HBV infection. Healthcare

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personnel who have received Hepatitis B vaccine and developed immunity to the virus are at virtually no risk for
infection.

Infection Control and Safety Measures

Sequence for applying Personal Protective Sequence for removing Personal Protective
Equipment Equipment
1. Wash hands 1. Gloves
2. Gown 2. Wash hands
3. Mask 3. Goggles or face shield
4. Goggles or face shield 4. Gown
5. Gloves 5. Mask
6. Wash hands

Summary of Hepatitis Viruses

Hepatitis A Hepatitis B Hepatitis C Hepatitis D Hepatitis E
Non A Non B
Enteric Non A
Other Infectious Serum Hepatitis; (transfusion
Delta Agent; HDV Non B
Names Hepatitis; HAV HBV associated)
Hepatitis; HEV
Hepatitis C
Parenteral or Co-infection or
Routes of
Fecal-Oral Sexual; Infected Parenteral super infection Fecal-oral
Transmission
mother to infant with Hepatitis B
Incubation
15 to 50 days 45 to 160 days 14 to 180 days 15 to 64 days 15 to 50 days
Period
Begins before Begins before
Later half of symptoms symptoms
incubation appear and appear and
Infectivity
period until 1 to may continue may continue Not known Not known
Period
2 weeks after for patients’ for patients’
symptoms pass lifetime in carrier lifetime in
state carrier state
HBs Ag; Hbe Ag;
Serologic
Anti-HAV; IgM Anti-HBs & Anti ACV Anti ADV Anti HEV
Tests
numerous others
Standard Standard
Immune precautions; Standard precautions;
Preventive globulin therapy vaccine; Immune precautions; no Hepatitis B No vaccine; no
& Post may be globulin for post vaccine; Vaccine; Immune post-exposure
Exposure indicated; exposure & recombinant globulin for post- prophylaxis
Treatment Hepatitis A recombinant Interferon for exposure; available
Vaccine Interferon for chronic state Interferon is
chronic state being studied
Symptoms of all types of viral hepatitis are similar and can include one or more of the following:
 Fever  Fatigue  Loss of appetite  Nausea  Vomiting  Abdominal pain 
 Clay-colored bowel movements  Joint pain  Jaundice 

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