Introduction

People who work in a healthcare setting are at increased risk of exposure to infectious diseases. The U.S. Centers for Disease Control and Prevention (CDC) estimates that about 5.6 million healthcare workers are at increased risk of occupational exposure to bloodborne pathogens [8]. Thus, healthcare professionals should be knowledgeable about the types of bloodborne pathogens and avenues of transmission. Additionally, they should be aware of prevention and safety strategies for reducing disease transmission. This course aims to teach learners about bloodborne pathogens, transmission, and prevention strategies.

What are Bloodborne Pathogens? 

Bloodborne pathogens are organisms carried in the blood that can cause an infectious disease. Examples of types of bloodborne pathogens are viruses, fungi, parasites, and bacteria. More specifically, pathogens like syphilis, malaria, and viruses like Hepatitis B or Hepatitis C are also bloodborne or disease-causing organisms [7]. According to CDC, the three pathogens of primary concern in the United States are the hepatitis B virus (HBV), hepatitis C virus (HCV), and human immunodeficiency virus (HIV), which causes acquired immunodeficiency syndrome (AIDS) [1].  

Transmission

People who work in the healthcare industry are particularly vulnerable to exposure to bloodborne pathogens due to the nature of their work. When thinking of the term bloodborne pathogens, we assume that these disease-causing organisms can only be transmitted through blood. However, they can also be transmitted through exposure to other body fluids, which include:

• Saliva
• Semen
• Vaginal secretions
• Cerebrospinal fluid
• Synovial (joint) fluid
• Fluid surrounding the heart or lungs [8].

Additionally, any body fluid that has visible blood or cannot be differentiated is considered a potential hazard. The transmission of bloodborne pathogens can occur in a variety of situations in a healthcare setting. Some examples are needlestick and sharps injuries, contact with the broken skin of an infected individual, or contact with body fluids on mucous membranes. Examples of potential bloodborne pathogen transmission outside of a healthcare setting may include sexual contact, sharing infected needles, or mothers transmitting disease to their babies during delivery [8].

Universal and Standard Precautions

To prevent bloodborne disease transmission in the healthcare environment, the Occupational Safety and Health Administration (OSHA) developed a set of guidelines called the Bloodborne Pathogens Standards in the early 1990s. Part of this guideline release was to begin implementing Universal Precautions, which apply to all situations and interactions of patient care. According to OSHA’s website, “all human blood and certain human body fluids are treated as if known to be infectious for HIV, HBV, or other bloodborne pathogens” [9].

In 1996, the CDC developed Standard Precautions, which apply to all types of disease transmission modes, including airborne, droplet, and contact. Standard Precautions further define hand hygiene practices, personal protective equipment (PPE) practices, injection safety, and disposal of contaminated materials [10]. Today, healthcare professionals and organizations must follow both Universal and Standard Precaution guidelines and safety practices to prevent disease transmission.

Hand Hygiene

Healthcare workers must practice safe hand hygiene practices in every healthcare setting. They should use either an alcohol-based hand sanitizer or soap and water to wash their hands. Alcohol-based hand sanitizers should contain at least 60% alcohol to kill germs and are the preferred method of hand hygiene. However, if a healthcare worker’s hands are soiled, they should wash them with soap and water [3]. The CDC provides six situations where healthcare workers should always wash their hands, which include:

• Before touching a patient
• Before performing any aseptic task or handling invasive medical devices
• Before moving from the soiled to the clean body site
• After touching a patient or their environment
• After contact with blood, bodily fluids, or any contaminated surface
• After glove removal and disposal [3].

Also, when washing hands with soap and water, you need to scrub your hands for at least 20 seconds. You should scrub areas like the backs of your hands, between the fingers, palms, and under your fingernails. After rinsing the soap away with water, dry your hands with a clean towel. When turning off the faucet, either use your elbow or a towel [3].

Personal Protective Equipment (PPE)

Personal protective equipment (PPE) helps to minimize exposure to bloodborne pathogens and other potentially hazardous materials. PPE includes gloves, gowns, masks, shoe covers, safety goggles, and other eye protection, like face shields. Depending on the type of transmission precaution the patient has (i.e., contact, droplet, standard, or airborne), certain PPE must be worn, and a sign must be posted outside the patient’s room. Examples of PPE that must be worn in relation to each mode of transmission include:

• Contact: gown and gloves
• Droplet: surgical face mask
• Airborne: N95 mask or powered air purifying respirator (PAPR)

If a patient has multiple contact precautions, like contact and droplet, then both types of precautions must be utilized. Regardless of additional transmission precautions, healthcare professionals should always abide by standard and universal precautions. Nurses and healthcare professionals should abide by their organization’s policies and procedures regarding required PPE. Furthermore, they must follow standard donning and doffing PPE procedures to reduce disease transmission [2].

Injection/Sharps Safety

Anyone who works in a healthcare setting is at increased risk of needlestick and sharps injuries due to the nature of their jobs. There are several strategies to prevent needlestick injuries from occurring, which include:

• Complete bloodborne pathogens and infection control training
• Avoid recapping needles
• Use needles with safety features (i.e., safety needles with built-in mechanisms to recap needles)
• Use needless systems whenever possible
• When using a needle, planning for proper disposal prior to use, with a sharps container
• Disposing of the needle in the proper receptacle as soon as possible
• Get a hepatitis B vaccine [4].

If a needlestick or sharps injury occurs, there are a few steps to immediately complete:

1. Wash the areas with soap and water
2. Immediately report the incident
3. Seek medical attention immediately [4].

Additionally, flush any areas that may have been splashed, including the nose, mouth, or skin. If anything gets into the eyes, irrigate with clean water or saline [4].

Proper Disposal of Contaminated Materials

Healthcare professionals should also know the proper waste disposal guidelines regarding certain materials. There are different categories of medical waste. Anything that is not sharp and is contaminated with blood or other infectious materials should be placed in a red biohazard disposal bag. Examples may include blood-soaked gauze, used specimen swabs, and urine dipsticks. Only needles and sharps should be placed in the red sharps containers. Sharps containers should not be overfilled; if they become filled, they should be removed and replaced immediately [5].

Workplace Requirements

As part of OSHA’s Bloodborne Pathogens Standard, healthcare organizations must also abide by certain requirements. First, healthcare facilities must have a written exposure control plan. The plan outlines job classification and occupational exposure to bloodborne pathogens and procedures to follow if an exposure occurs.

Healthcare organizations must update exposure control plans every year and document that they have implemented safety practices. Engineering controls, such as safety needles or sharps disposal containers, should also be part of this plan. Safe handling and cleaning practices of specimens, laundry, contaminated sharps, and other materials should be discussed as well. A post-exposure plan should also be outlined in the facility’s exposure control plan, including follow-up and occupational health appointments [6].

In addition, healthcare organizations are required to provide PPE to healthcare workers. They must repair, replace, maintain, and clean all PPE. Warning labels and signs communicating potential hazards should be affixed to containers and posted. They must also detail where potential hazard items are stored and how they are transported. Healthcare employers should also ensure that all employees have received initial and annual information and training regarding bloodborne pathogens and maintain these training records. Furthermore, hepatitis B vaccinations should be made available to all healthcare professionals with potential occupational exposure within 10 days of their employment date [6].

Conclusion

People who work in the healthcare industry can take several steps to reduce the likelihood of bloodborne pathogen transmission. These strategies include understanding modes of transmission, using universal and standard precautions, and wearing personal protective equipment. Other measures include hand hygiene practices, needle and sharps safety, and proper disposal of contaminated materials.