The Safety Guys: Blood, Sweat and Fears, BBP, Part 1
By: Vince McLeod, CIH and Glenn Ketcham, CIH
Issue: April/May 2006
Untitled Document
Blood, Sweat, and Fears BBP - Part I
A significant concern for forensic scientists is preventing contact with potentially
contaminated body fluids, whether it is during collection of evidence in the
field or evaluation and analysis in the laboratory. Inadvertent exposure to
human immunodeficiency virus (HIV), hepatitis B virus (HBV), or other human
pathogens is a potential occupational risk that should never be overlooked.
Even so, needle-sticks, cuts, splashes, and other events contribute to an alarming
number of exposures each year. This issue the Safety Guys aim to raise awareness
and prevention of blood-borne pathogen (BBP) exposures beginning with an overview
of the OSHA standard and discussion of the Center for Disease Control’s
Universal Precautions.1
Not too long ago the National Institute of Occupational
Safety and Health (NIOSH) was requested to perform a health hazard evaluation
(HHE) for an Arizona sheriff’s office evidence drying room.2The HHE was
performed to address concerns about employee exposures to potential biological
hazards, including blood-borne pathogens. What the investigators found – poor
BBP practices and a lack of adequate ventilation combined with a non-existent
preventative maintenance program — is probably typical of many forensic
settings and prompted the topic for this column.
Preventing exposures to blood-borne pathogens begins with strong implementation
of OSHA’s BBP standard, 40 CFR 1910.1030.3This standard applies to all
occupational exposures to blood or other potentially infectious materials (OPIM).
Blood means as human blood, components thereof or products made from human blood.
OPIM is defined as human body fluids such as 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 HIV-containing cell cultures or tissues.
Applying the OSHA BBP standard starts with developing an Exposure Control
Plan (ECP), a mandated, written document designed to eliminate or minimize
employee
exposures. The ECP must be reviewed and updated annually and include documented
consideration or implementation of new technology or safer medical devices
to achieve its purpose. The main elements of the ECP are 1) exposure determinations,
2) communication of hazards to employees, 3) methods of compliance, and 4)
record-keeping. Exposure determination is simply a list of employee classifications,
tasks, and procedures in which occupational exposures occur and are made without
regard to personal protective equipment. Compliance methods include universal
precautions, engineering and work practice controls, personal protective equipment,
and housekeeping issues, especially waste handling. Other ECP elements address
Hepatitis B vaccination and post-exposure evaluation and HIV/HBV research laboratories.
The latter is not usually applicable to forensic activities.
Although the heart of OSHA’s BBP standard lies in the Methods of Compliance
section, we prefer to begin with training, or communicating the hazards. It
is paramount that every employee has a solid understanding of which fluids present
infection hazards and which do not. Be concerned with blood and OPIM, which
have been defined above. Other fluids typically encountered that are not covered
by the BBP standard include vomitus, feces, urine, sweat, tears, sputum, and
nasal secretions UNLESS these are visibly contaminated with blood. However,
one would obviously still want to avoid direct skin contact with these fluids
as well. So, make sure everyone knows which fluids present the greatest risks.
The next piece of the puzzle is to learn the avenues of potential exposure.
These are: 1) through the skin; 2) through mucous membranes (nose, mouth and
eyes); and 3) parenteral, a medical term for injection or breaking the skin
barrier. The last exposure route results from needlesticks, cuts, abrasions,
and other such injuries. The final piece of the training puzzle is to know
how to protect against potential exposures and that leads us back to Methods
of Compliance.
The golden rule of preventing exposures is the one of Universal Precautions.
Most forensic scientists reading this have the Universal Precautions tattooed
on the backs of their eyeballs. Refreshing your memory never hurts, so here
goes. First and foremost, all blood and OPIM are always considered infectious.
Therefore, you must prevent contact through the use of appropriate personal
protective equipment that will create barriers between the fluids of concern
and the routes of exposure. Personal protective equipment 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 shall provide all employees at risk,
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, pocket masks, or other ventilation devices.
For most forensic scientists, normal activities always entail the use of gloves
as the primary means of preventing contact with blood and OPIM. Gloves are
worn when it can be reasonably anticipated that the employee may have hand
contact with blood, other potentially infectious materials, mucous membranes,
or non-intact skin. Gloves are also worn for handling items or surfaces soiled
with blood or body fluids. Recommendations for the use of gloves are presented
in detail in the Morbidity and Mortality Weekly Report dated June 24, 1988.4Our
advice is to buy good quality, powder-free, non-latex gloves, and plenty of
them.
The next most common piece of PPE used is eye protection. Protective eyewear
or face shields are worn to prevent exposure of mucous membranes of the mouth,
nose, and eyes during activities or procedures that are likely to generate
droplets of blood or body fluids. These types of activities are most common
in the laboratory, for instance performing autopsies or preparing and analyzing
specimens, but they can also be encountered in the field during investigations
and evidence collection. So carry all types, eye glasses, goggles, and face
shields, just in case.
After the golden rule of always assuming fluids as infectious and preventing
exposure with appropriate, quality barriers, the final part of Universal Precautions,
is avoiding injuries and accidents caused by needles, scalpels, and other sharp
instruments or devices. Be extremely careful whenever handling these “sharps.” Never
recap needles and always have sharps disposal containers available.
Vince McLeod is a Certified Industrial Hygienist by the American Board
of Industrial Hygiene and the senior IH with the University of Florida’s
Environmental Health and Safety Division. He has 15 years of experience in
all facets of occupational health and safety and specializes in hazard evaluation
and exposure assessments.
Glenn Ketcham is a Certified Industrial Hygienist
with 20 years experience in the health and safety field. He is currently
the Risk Manager for the University of Florida. He has worked as a USDOL/OSHA
compliance
officer and has program management experience in general OSHA compliance,
laboratory and chemical safety, workplace ergonomics, loss prevention, disaster
preparedness,
and classical industrial hygiene.
