Lab managers, especially those in the health care arena and in biohazard labs, are well versed in the potential impacts of the human immunodeficiency virus (HIV), hepatitis B (HBV), and hepatitis C (HCV), and in preventing contact with potentially contaminated human body fluids. However, recent development of resistant pathogens—the most widely known of which is MRSA, or methicillin-resistant staphylococcus aureus—have major implications, primarily for the health care delivery sector. However, these hazards should not be discounted in any lab.
Inadvertent exposure to human pathogens such as HIV, HBV, or MRSA is a potential occupational risk that should never be overlooked, especially given that needlestick injuries, cuts, splashes, and other events contribute to an alarming number of exposures each year. Therefore, this month the Safety Guys hope to raise awareness and prevention of exposure to resistant and bloodborne pathogens, beginning with an overview of standard precautions as well as the OSHA revisions to the Bloodborne Pathogens standard.
Preventing exposure to human pathogens begins with developing and implementing an effective exposure control plan (ECP) and following universal precautions as laid out in OSHA’s Bloodborne Pathogens standard.1 In addition, standard precautions, developed by the Centers for Disease Control (CDC), aid in preventing the transmission of resistant organisms as well as bloodborne pathogens.2
While universal precautions were established by the CDC in 1987 to protect health care workers from bloodborne pathogens, standard precautions include secretions not covered by the universal precautions and should be used in the care of all patients. Standard precautions apply to blood and all body fluid secretions and excretions except sweat, non-intact skin, and mucous membranes.
First—know the symptoms
MRSA is classed as a type of staph infection that is very resistant to antibiotics and enters the body through openings in the skin such as wounds, cuts, abrasions, and even hair pores and through mucous membranes. It is usually contracted by direct skin-to-skin contact or from contaminated objects.
Infected individuals may have a fever and usually show infected areas of skin that are red, swollen, painful, and warm to the touch or contain pus or other fluids. Common areas of infection include the back of the neck, the groin and buttocks, armpits, beard areas on men, and anywhere there is non-intact skin.
Control actions—standard precautions
The main mode for transmission of MRSA and other resistant pathogens is via hands that have become contaminated by contact with:
- Colonized or infected patients
- Colonized or infected body areas of health care workers
- Devices, equipment, or environmental samples contaminated with body fluids containing MRSA or other infectious agents
Therefore, it stands to reason that the most important standard precaution is handwashing.
The CDC gives the following tips for proper handwashing:
- Wash hands after touching blood, body fluids, secretions, excretions, and contaminated items, regardless of whether gloves are worn.
- Wash hands immediately after gloves are removed, between patient contacts, and when otherwise indicated to avoid transfer of microorganisms. It may be necessary to wash hands between tasks and procedures on the same patient to prevent cross-contamination of different body areas.
- Use a plain (non-antimicrobial) soap or alcohol hand gel for routine handwashing.
- Use an antimicrobial agent or waterless antiseptic agent for specific situations (as defined by your infection control program).
After handwashing, the next preventive measures involve proper use of personal protective equipment. PPE will usually include:
- Gloves. Wear gloves when touching any blood, body fluids, secretions, excretions, or contaminated items.
- Put on clean gloves before touching mucous membranes or nonintact skin.
- Change gloves between tasks and procedures, especially after contact with materials suspected of being contaminated.
- Remove gloves promptly after use and before touching any uncontaminated items or surfaces.
- Wash hands after using gloves.
Depending on the situation and the tasks performed, additional PPE may be needed. This might include face masks, face shields, or eye protection if splashes or sprays are likely. This should be extended to gowns if activities are likely to produce similar splashes, sprays, or soiling of clothing.
Standard precautions should also cover environmental controls such as care, cleaning, and disinfection of surfaces and equipment as well as handling, transport, and processing of soiled or contaminated linens and uniforms. Ensure your procedures for environmental controls and linens prevent potential airborne exposure. Train employees and staff on proper droplet precautions to minimize exposures from coughing, sneezing, and talking.
In April 2001, OSHA revised its BBP standard, 29 CFR 1910.1030.3 In brief, this standard applies to all occupational exposure to blood or any other potentially infectious material (OPIM). Blood means human blood, blood components, or products made from human blood. OPIM is defined as human body fluids, including semen, vaginal secretions, cerebrospinal fluid, synovial fluid, pleural fluid, pericardial fluid, peritoneal fluid, amniotic fluid, or any body fluid that is visibly contaminated with blood. OPIM also includes any unfixed tissue or organ (other than intact skin) from a human (living or dead) and cell cultures or tissue containing HIV.
Paramount in preventing exposure is use of universal precautions. First and foremost, all blood and OPIM are always considered infectious. Therefore, you must prevent contact through the use of appropriate PPE that will create barriers between the fluids of concern and the routes of exposure. PPE is considered “appropriate” only if it does not permit blood or other potentially infectious materials to pass through or reach the employee’s clothes, skin, eyes, mouth, or other mucous membranes during normal conditions of use. Under the OSHA standard, when there is occupational exposure, the employer must provide all atrisk employees, at no cost to the employee, appropriate PPE such as but not limited to gloves, gowns, laboratory coats, face shields or masks and eye protection, and pocket masks or other ventilation devices.
The revisions added requirements to the exposure control plan and for keeping a sharps injury log. They specify more detail for engineering controls and use of technological advances in safer medical equipment. An annual review of the ECP must be performed, accounting for technological innovations that reduce exposure risk.
1) Bloodborne Pathogens. Occupational Safety and Health Administration, U.S. Department of Labor, Washington, D.C. April 2012. http://www.osha.gov/pls/oshaweb/owadisp.show_document?p_table=STANDARDS&p_id=10051
2) Bloodborne Pathogens and Standard Precautions, Infection Control, Saddleback University. Mission Viejo, CA. 2018. https://alfa.saddleback.edu/data/blood-bornepathogens-and-standard-precautions
3) Revision to OSHA’s Bloodborne Pathogens Standard. Occupational Safety and Health Administration, U.S. Department of Labor, Washington, D.C. April 2001. https://www.osha.gov/needlesticks/needlefact.html