Summer Special

Corrective brows ove anothers work

Brows

Eyes

Brows

What my BBP class covers!! Learn it!!!

This is your BBP Manual!   Please print and keep for reference! 

Pathogenic microorganisms that are present in human blood and can cause disease in humans. These pathogens include among others hepatitis B virus (HBV), which causes hepatitis B; human immunodeficiency virus (HIV), which causes AIDS; hepatitis C virus and other pathogens, such as those that cause malaria. So pathogenic is disease causing and non pathogenic is non disease causing!

n     OSHA is federal law!!!!!!!!!

n     CDC is recommendation not law.

n     NIOSH is recommendation not law.

n     State law for OSHA over rules federal law when applicable in your state. AZ is State!

Sample of a shop that was shut down by OSHA!

n     No written exposure control plan

n     Not offering HBV vaccinations

n     Tossing all bio waste in regular trash

n     No bio or sharps labeling

n     No Hazard communication written plan like a chemical inventory list or MSDS sheets

n     Non labeled spray bottles

n     No exit signs

n     Non mounted fire extinguisher (no record of inspections annually or monthly spot test)

n     Circuit breakers not labeled or up to code

n     Electrical cords that did not have their grounded prongs

OSHA does NOT certify anyone!!  You are issued a certificate of completion as proof of annual training! Do not run any ads telling the public you are OSHA certified!

Occupational Safety and Health Administration = OSHA

Needle Stick Protocol

1.      Secure Needle

2. Remove gloves and wash area for one minute with antimicrobial soap and warm water.

3. Dry area and bandage the wound

4. Seek medical attention and take BBP manual with you

5. Report incident and fill our all appropriate paper work

6. Review incident and evaluate what went wrong and how to prevent

Breaking the chain of infection

One of the basic infection control principles is the chain of infection. Transmission of infection requires at least three elements: a source of infecting microorganisms, a susceptible host and a means of transmission for bacteria and viruses.

Source

Host

Transmission

Each link must be present and in sequential order for an infection to occur.

Washing hands and barrier protection best way to break the chain!!!

MRSA

n     A client gets and they will come back to blame you!

n     Why would they get if you follow all proper protocol?

1.      Dirty clothing

2.      Dirty car seat

3.      Dirty job (hospital to construction, etc.)

4.      Animals like cats and dogs

5.      Contaminated dirty sheets

6.      Un washed hands

7.      Poor hygiene, etc!

n     MRSA is commonly transmitted via person to person contact.

n     Can be from hands, contaminated sports equipment, clothing, skin, wounds, poor hygiene, etc.

n     It is not airborne

HBV Declination Sample

     I understand that due to my occupational exposure to blood or other potentially infectious materials I may be at risk for acquiring hepatitis B virus (HBV) infection. I have been given the opportunity to be vaccinated with hepatitis B vaccine, at no charge to myself. I decline hepatitis B vaccine vaccination at this time.  I understand by declining this vaccine, I continue to be at risk of acquiring hepatitis B, a serious disease. If in the future I continue to have occupations exposure to blood or other potentially infections materials and I want to be vaccinated with hepatitis B vaccine, I can receive this vaccination series at no charge to me.

Employee Name________________________________________

Employee SSN ____________________________________________

Employee Signature ______________________________________

Business Owner _________________________________________

Date _________________________________________________

If a client tells you they have HIV, can you turn them away?

Can I turn them away? NO! That is discrimination and part of the “American Disability Act”. However you have the right to ask for medical written clearance from their doctor for an elective tattoo. Be more worried about people that do not share or know.  This is why we do all that we do. In fact, not sure you can even ask a client about their HIV status. So assume all clients may be ill!

Every Shop Needs this and advised in a big red binder!

1.      MSDS sheets

2.      Chemical Inventory list

3.      All HBV records and declinations

4.      All training records

5.      Information of nearest medical facility and all info needed to take to hospital in a pre prepared envelop in back of book

6.      Emergency protocol and all contacts like sharps pick up, etc.

7.      First aid and blood spill kits

8.      Cleaning schedules

9.      Needle stick protocol

10. Sharps injury log

And anything else you can think of in a designated area of your shop! Make sure annually maintained and updates. Especially, first aid kits and blood spill kits and certain items do expire.

Gloves

It is advised to not wear latex gloves while tattooing but Nitrile!!!! Latex breaks down with ointment and water!

Material Safety Data Sheets MSDS SHEETS

Should have for all pigments, topical and ointments. Must have for any hazardous materials in your shop!

Arizona

n     Effective Aug. 15, 2005, A.R.S. § 44-1342 requires a tattoo needle and any waste exposed to human blood that is generated in the creation of a tattoo to be disposed of in the same manner as biohazardous medical waste. Senate Bill 2679  , which created this requirement, via ADEQ.

n     44-1342. Tattoo needles and waste; disposal; civil penalty

n      A person who disposes of a tattoo needle or any waste generated in the creation of a tattoo in violation of this section is liable for a civil penalty of up to five hundred dollars for each violation.

n     REMEMBER every state, city and county may very above the standards that apply to all!! Biohazard is defined as free flowing. In AZ it is said even one drop of blood is bio! Quote from Steven Weber!

n     Your red bag medical waste companies usually also pick up your sharps. You can also use a mail in service for small containers.

n     An AZDEQ compliance officer  for waste management (Robert Phalen) says, “You can turn your sharps into a solid mass with plaster of paris or cement and mark treated and dispose of in regular trash”. As long as the container is rendered a solid mass and a needle stick is impossible! Must be encapsulated!

Robert Phalen, Solid Waste Specialist, (602) 771 4140

Sharps

According to NIOSH (recommendation) sharp containers may be wall mounted at different heights depending on the work station. The optimal are for standing workstations 52” to 56”. For sitting workstations 38” to 42” is optimal.

Washing your hands is the single best prevention of spreading disease!

n     Anti microbial soap on wet hands

n     Turn water on & off paper towel

n     Luke warm (tepid)

n     15 to 20 seconds or

n     Up to wrist and web of fingers

n     Pat dry

n     The simple act of washing your hands, for at least 15 to 20 seconds under tepid water with soap, will reduce the level of infectious agents by almost 95%.

n     PPE and barrier films (i.e. a plastic bag covering the tattoo machine) are considered clean, not sterile, that is to say they are new and fresh but have not been subjected to the processes needed to kill bacteria, fungi and viruses.

Tray Set up

Wrap it up!
Courtesy of Guy Aitchison

1. I use a small wheeled cart that can be positioned with the palette as close as possible to the tattoo.

2. The top of the cart is stainless and is cleaned after each session with Madacide.

3. It's wrapped in plastic wrap and paper towels to minimize any mess if there's a spill.

4. A garbage bag is taped hanging to the right in easy reach - no dirty trash can.

5. The power unit is wrapped in plastic and the clip cord is sleeved. Machines are bagged.

6. I have been using True Tubes, disposable tubes with steel tips, so we are technically autoclave free (still have the 'clave just in case).

7. Palette is on a plastic plate, which allows me to rotate and position it based on what color I'm using.

8. A second plate is kept under the first one to use as a cover if I need to step away.

9. Squirt bottle is wrapped.

10. I use two rinse cups, one for darks and the other for lights, which in this photo are covered temporarily.

11. Massage table and armrest (not pictured) are also wrapped; pillow is in a disposable pillowcase.

My rule (Jane) is anything on my tray is either disposable or barrier protected! If not must be sterilized. I have all clients sign off on single tray set up!  Thank you Guy for sharing!!!

*** You cannot tattoo over carpet!!!!!

NOOOO Food or drinks in work area!

n     No food or drinks anyplace there is a chance of blood particles or OPIM, like counter tops, etc!

Warning

n     Each work station needs to have an individual sharps container.

n     It is not acceptable to walk away from your station with contaminated tubes, etc.

n     Also keep in mind, that you can keep a liquid free covered stainless tray at station for used tubes and carry the container to your sterilization area.

n     All needles must be disposed of at arms length at each station. No exceptions!!

Liquid sterilizing solutions (Glutaraldehydes), such as Metricide, Cidex, etc. have no place in tattoo or piercing as a substitute for heat sterilization and should not be used.

Acceptable sterilization for tattoo and piercing means that after you have completed a cycle in your autoclave there is a probability of one microbe surviving on one million items.

Ultrasonic cleaners are used to dislodge fine particles that other cleaning methods may not be able to reach or remove.  Ultrasonics are not Washers. It would be contrary to manufacturer's instructions or expectations to try and clean grossly dirty instruments. Items to be ultrasoniced must be pre-cleaned. They do not clean gross debris!

Indicator marks on pouches and bags are usually printed with an ink that changes color during the sterilization process.  They do not indicate sterility since they usually are activated by heat level alone and not time, not pressure and the amount of saturated steam present.  They are useful to alert to failure for lots processed between biological testing and do not prove sterilization but alert to failure.  Only biological testing produces sterility assurance.

Integrators are placed inside the pouch and change color when steam processing has penetrated into the bag. Steam Integrators in conjunction with indicators and spore testing is the best way.

Spore Testing

n     Be sure to label all pouches, prior to sterilization.

n     *Last four digits of spore test lot #.

n     *Date done

n     * Date of expiration

n     * Initials of person doing

Steam versus Gas

n     When you autoclave your own implements how long are they sterile?  This will vary by manufacture of pouches (quality) and your state health department.  Some say 30 days (CA), 60 days (NV) others 90 days, etc.

n     EO pre-packaged needles remain sterile longer!  Why?  Stronger packaging.

Pathogen from Indirect Contact (3 ways is non needle stick)

1.      Vehicle borne – food, water or article

2.      Vector Borne – Rats, insects

3.      Airborne – dust, TB, sneeze etc

7 Keys of Asepsis

1. Knowing what is clean

2. Knowing what is contaminated

3. Knowing what is sterile

4. Keep clean, contaminated sterile items separate

5. Storage, opening sterile packs

6. Resolve contamination immediately

7. Beware of cross contamination & preventions

Bloodborne Pathogen Standards 1910.1030

http://www.osha.gov  Edited version can get entire document on this website!

Scope and Application. This section applies to all occupational exposure to blood or other potentially infectious materials.

Definitions

Assistant Secretary means the Assistant Secretary of Labor for Occupational Safety and Health, or designated representative.

Blood means human blood, human blood components, and products made from human blood.

Bloodborne Pathogens means pathogenic microorganisms that are present in human blood and can cause disease in humans. These pathogens include, but are not limited to, hepatitis B virus (HBV) and human immunodeficiency virus (HIV).

Clinical Laboratory means a workplace where diagnostic or other screening procedures are performed on blood or other potentially infectious materials.

Contaminated means the presence or the reasonably anticipated presence of blood or other potentially infectious materials on an item or surface.

Contaminated Laundry means laundry which has been soiled with blood or other potentially infectious materials or may contain sharps.

Contaminated Sharps means any contaminated object that can penetrate the skin including, but not limited to, needles, scalpels, broken glass, broken capillary tubes, and exposed ends of dental wires.

Decontamination means the use of physical or chemical means to remove, inactivate, or destroy bloodborne pathogens on a surface or item to the point where they are no longer capable of transmitting infectious particles and the surface or item is rendered safe for handling, use, or disposal.

Director means the Director of the National Institute for Occupational Safety and Health, U.S. Department of Health and Human Services, or designated representative.

Engineering Controls means controls (e.g., sharps disposal containers) that isolate or remove the bloodborne pathogens hazard from the workplace.

Exposure Incident means a specific 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.

Hand washing Facilities means a facility providing an adequate supply of running potable water, soap, and single-use towels or air-drying machines.

Licensed Healthcare Professional is a person whose legally permitted scope of practice allows him or her to independently perform the activities required. Hepatitis B Vaccination and Post-exposure Evaluation and Follow-up.

HBV means hepatitis B virus.

HIV means human immunodeficiency virus.

Occupational Exposure means reasonably anticipated skin, eye, mucous membrane, or parenteral contact with blood or other potentially infectious materials that may result from the performance of an employee's duties.

Other Potentially Infectious Materials (OPIM)  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 needle sticks, human bites, cuts, and abrasions.

Personal Protective Equipment (PPE) is specialized clothing or equipment worn by an employee for protection against a hazard. General work clothes (e.g., uniforms, pants, shirts or blouses) not intended to function as protection against a hazard are not considered to be personal protective equipment.

Production Facility means a facility engaged in industrial-scale, large-volume or high concentration production of HIV or HBV.

Regulated Waste means liquid or semi-liquid blood or other potentially infectious materials; contaminated items that would release blood or other potentially infectious materials in a liquid or semi-liquid state if compressed; items that are caked with dried blood or other potentially infectious materials and are capable of releasing these materials during handling; contaminated sharps; and pathological and microbiological wastes containing blood or other potentially infectious materials.

Research Laboratory means a laboratory producing or using research-laboratory-scale amounts of HIV or HBV. Research laboratories may produce high concentrations of HIV or HBV but not in the volume found in production facilities.

Sharps with engineered sharps injury protections means a non needle sharp or a needle device used for withdrawing body fluids, accessing a vein or artery, or administering medications or other fluids, with a built-in safety feature or mechanism that effectively reduces the risk of an exposure incident.

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.

Sterilize means the use of a physical or chemical procedure to destroy all microbial life including highly resistant bacterial endospores.

Universal Precautions is an approach to infection control. According to the concept of Universal Precautions, all human blood and certain human body fluids are treated as if known to be infectious for HIV, HBV, and other bloodborne pathogens.

Work Practice Controls means controls that reduce the likelihood of exposure by altering the manner in which a task is performed.

Exposure Control --Exposure Control Plan

Each employer having an employee(s) with occupational exposure shall establish a written Exposure Control Plan designed to eliminate or minimize employee exposure.

The Exposure Control Plan shall contain at least the following elements:

The schedule and method of implementation for paragraphs (d) Methods of Compliance, (e) HIV and HBV Research Laboratories and Production Facilities, (f) Hepatitis B Vaccination and Post-Exposure Evaluation and Follow-up, (g) Communication of Hazards to Employees, and (h) Record keeping, of this standard, and the procedure for the evaluation of circumstances surrounding exposure incidents as required.

Each employer shall ensure that a copy of the Exposure Control Plan is accessible to employees in accordance with 29 CFR 1910.1020.

The Exposure Control Plan shall be reviewed and updated at least annually and whenever necessary to reflect new or modified tasks and procedures which affect occupational exposure and to reflect new or revised employee positions with occupational exposure. The review and update of such plans shall also:

Reflect changes in technology that eliminate or reduce exposure to bloodborne pathogens; and document annually consideration and implementation of appropriate commercially available and effective safer medical devices designed to eliminate or minimize occupational exposure.

An employer, who is required to establish an Exposure Control Plan, shall solicit input from non-managerial employees responsible for direct patient care who are potentially exposed to injuries from contaminated sharps in the identification, evaluation, and selection of effective engineering and work practice controls and shall document the solicitation in the Exposure Control Plan.

The Exposure Control Plan shall be made available to the Assistant Secretary and the Director upon request for examination and copying.

Exposure Determination.

1. A list of all job classifications in which all employees in those job classifications have occupational exposure;

2. A list of job classifications in which some employees have occupational exposure, and

3. A list of all tasks and procedures or groups of closely related task and procedures in which occupational exposure occurs and that are performed by employees in job classifications listed in accordance with the provisions of paragraph of this standard.

4. This exposure determination shall be made without regard to the use of personal protective equipment.

Methods of Compliance --

General. Universal precautions shall be observed to prevent contact with blood or other potentially infectious materials. Under circumstances in which differentiation between body fluid types is difficult or impossible, all body fluids shall be considered potentially infectious materials.

Engineering and Work Practice Controls.

Engineering and work practice controls shall be used to eliminate or minimize employee exposure. Where occupational exposure remains after institution of these controls, personal protective equipment shall also be used.

Engineering controls shall be examined and maintained or replaced on a regular schedule to ensure their effectiveness.

Employers shall provide hand washing facilities which are readily accessible to employees.

When provision of hand washing facilities is not feasible, the employer shall provide either an appropriate antiseptic hand cleanser in conjunction with clean cloth/paper towels or antiseptic towelettes. When antiseptic hand cleansers or towelettes are used, hands shall be washed with soap and running water as soon as feasible.

Employers shall ensure that employees wash their hands immediately or as soon as feasible after removal of gloves or other personal protective equipment.

Employers shall ensure that employees wash hands and any other skin with soap and water, or flush mucous membranes with water immediately or as soon as feasible following contact of such body areas with blood or other potentially infectious materials.

Contaminated needles and other contaminated sharps shall not be bent, recapped, or removed. Shearing or breaking of contaminated needles is prohibited.

Contaminated needles and other contaminated sharps shall not be bent, recapped or removed unless the employer can demonstrate that no alternative is feasible or that such action is required by a specific medical or dental procedure.

Such bending, recapping or needle removal must be accomplished through the use of a mechanical device or a one-handed technique.

Immediately or as soon as possible after use, contaminated reusable sharps shall be placed in appropriate containers until properly reprocessed. These containers shall be:

Eating, drinking, smoking, applying cosmetics or lip balm, and handling contact lenses are prohibited in work areas where there is a reasonable likelihood of occupational exposure.

Food and drink shall not be kept in refrigerators, freezers, shelves, cabinets or on countertops or bench tops where blood or other potentially infectious materials are present.

All procedures involving blood or other potentially infectious materials shall be performed in such a manner as to minimize splashing, spraying, spattering, and generation of droplets of these substances.

Specimens of blood or other potentially infectious materials shall be placed in a container which prevents leakage during collection, handling, processing, storage, transport, or shipping.

The container for storage, transport, or shipping shall be labeled or color-coded according to paragraph and closed prior to being stored, transported, or shipped. When a facility utilizes Universal Precautions in the handling of all specimens, the labeling/color-coding of specimens is not necessary provided containers are recognizable as containing specimens. This exemption only applies while such specimens/containers remain within the facility. Labeling or color-coding in accordance with paragraph is required when such specimens/containers leave the facility.

If outside contamination of the primary container occurs, the primary container shall be placed within a second container which prevents leakage during handling, processing, storage, transport, or shipping and is labeled or color-coded according to the requirements of this standard.

If the specimen could puncture the primary container, the primary container shall be placed within a secondary container which is puncture-resistant in addition to the above characteristics.

The employer shall ensure that this information is conveyed to all affected employees, the servicing representative, and/or the manufacturer, as appropriate, and prior to handling, servicing, or shipping so that appropriate precautions will be taken.

Personal Protective Equipment PPE

Provision. When there is occupational exposure, 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. Personal protective equipment will be considered "appropriate" only if it does not permit blood or other potentially infectious materials to pass through to or reach the employee's work clothes, street clothes, undergarments, skin, eyes, mouth, or other mucous membranes under normal conditions of use and for the duration of time which the protective equipment will be used.

Use. The employer shall ensure that the employee uses appropriate personal protective equipment unless the employer shows that the employee temporarily and briefly declined to use personal protective equipment when, under rare and extraordinary circumstances, it was the employee's professional judgment that in the specific instance its use would have prevented the delivery of health care or public safety services or would have posed an increased hazard to the safety of the worker or co-worker. When the employee makes this judgement, the circumstances shall be investigated and documented in order to determine whether changes can be instituted to prevent such occurrences in the future.

Accessibility. The employer shall ensure that appropriate personal protective equipment in the appropriate sizes is readily accessible at the worksite or is issued to employees. Hypoallergenic gloves, glove liners, powderless gloves, or other similar alternatives shall be readily accessible to those employees who are allergic to the gloves normally provided.

Cleaning, Laundering, and Disposal. The employer shall clean, launder, and dispose of personal protective equipment required by paragraphs and of this standard, at no cost to the employee.

Repair and Replacement. The employer shall repair or replace personal protective equipment as needed to maintain its effectiveness, at no cost to the employee.

If a garment(s) is penetrated by blood or other potentially infectious materials, the garment(s) shall be removed immediately or as soon as feasible.

All personal protective equipment shall be removed prior to leaving the work area.

When personal protective equipment is removed it shall be placed in an appropriately designated area or container for storage, washing, decontamination or disposal.

Gloves. Gloves shall be worn when it can be reasonably anticipated that the employee may have hand contact with blood, other potentially infectious materials, mucous membranes, and non-intact skin; when performing vascular access procedures except as specified in paragraph and when handling or touching contaminated items or surfaces. LATEX is not acceptable for tattooing. Use NITRILE!

Disposable (single use) gloves such as surgical or examination gloves, shall be replaced as soon as practical when contaminated or as soon as feasible if they are torn, punctured, or when their ability to function as a barrier is compromised.

Disposable (single use) gloves shall not be washed or decontaminated for re-use.

Utility gloves may be decontaminated for re-use if the integrity of the glove is not compromised. However, they must be discarded if they are cracked, peeling, torn, punctured, or exhibit other signs of deterioration or when their ability to function as a barrier is compromised.

When the employee has cuts, scratches, or other breaks in his or her skin;

When the employee judges that hand contamination with blood may occur, for example, when performing phlebotomy on an uncooperative source individual, tattooing, etc!

Masks, Eye Protection, and Face Shields. Masks in combination with eye protection devices, such as goggles or glasses with solid side shields, or chin-length face shields, shall be worn whenever splashes, spray, spatter, or droplets of blood or other potentially infectious materials may be generated and eye, nose, or mouth contamination can be reasonably anticipated.

Gowns, Aprons, and Other Protective Body Clothing. Appropriate protective clothing such as, but not limited to, gowns, aprons, lab coats, clinic jackets, or similar outer garments shall be worn in occupational exposure situations. The type and characteristics will depend upon the task and degree of exposure anticipated.

Surgical caps or hoods and/or shoe covers or boots shall be worn in instances when gross contamination can reasonably be anticipated.

Housekeeping

General. Employers shall ensure that the worksite is maintained in a clean and sanitary condition. The employer shall determine and implement an appropriate written schedule for cleaning and method of decontamination based upon the location within the facility, type of surface to be cleaned, type of soil present, and tasks or procedures being performed in the area.

All equipment and environmental and working surfaces shall be cleaned and decontaminated after contact with blood or other potentially infectious materials.

Contaminated work surfaces shall be decontaminated with an appropriate disinfectant after completion of procedures; immediately or as soon as feasible when surfaces are overtly contaminated or after any spill of blood or other potentially infectious materials; and at the end of the work shift if the surface may have become contaminated since the last cleaning.

Protective coverings, such as plastic wrap, aluminum foil, or imperviously-backed absorbent paper used to cover equipment and environmental surfaces, shall be removed and replaced as soon as feasible when they become overtly contaminated or at the end of the work shift if they may have become contaminated during the shift.

All bins, pails, cans, and similar receptacles intended for reuse which have a reasonable likelihood for becoming contaminated with blood or other potentially infectious materials shall be inspected and decontaminated on a regularly scheduled basis and cleaned and decontaminated immediately or as soon as feasible upon visible contamination.

Broken glassware which may be contaminated shall not be picked up directly with the hands. It shall be cleaned up using mechanical means, such as a brush and dust pan, tongs, or forceps.

Reusable sharps that are contaminated with blood or other potentially infectious materials shall not be stored or processed in a manner that requires employees to reach by hand into the containers where these sharps have been placed.

Regulated Waste

Contaminated Sharps Discarding and Containment

Contaminated sharps shall be discarded immediately or as soon as feasible in containers that are: Closeable, Puncture resistant, leak proof and properly labeled

Easily accessible to personnel and located as close as is feasible to the immediate area where sharps are used or can be reasonably anticipated to be found (e.g., laundries);

Maintained upright throughout use; and

Replaced routinely and not be allowed to overfill.

When moving containers of contaminated sharps from the area of use, the containers shall be:

Closed immediately prior to removal or replacement to prevent spillage or protrusion of contents during handling, storage, transport, or shipping;

Placed in a secondary container if leakage is possible. The second container shall be:

Closable;

Constructed to contain all contents and prevent leakage during handling, storage, transport, or shipping; and

Labeled or color-coded according to paragraph of this standard.

Reusable containers shall not be opened, emptied, or cleaned manually or in any other manner which would expose employees to the risk of percutaneous injury.

Other Regulated Waste Containment

Regulated waste shall be placed in containers which are:

Closable;

Constructed to contain all contents and prevent leakage of fluids during handling, storage, transport or shipping;

Labeled or color-coded in accordance with paragraph this standard; and

Closed prior to removal to prevent spillage or protrusion of contents during handling, storage, transport, or shipping.

If outside contamination of the regulated waste container occurs, it shall be placed in a second container. The second container shall be: Closable

Constructed to contain all contents and prevent leakage of fluids during handling, storage, transport or shipping;

Labeled or color-coded in accordance with paragraph of this standard; and

Closed prior to removal to prevent spillage or protrusion of contents during handling, storage, transport, or shipping.

Disposal of all regulated waste shall be in accordance with applicable regulations of the United States, States and Territories, and political subdivisions of States and Territories.

Laundry

Contaminated laundry shall be handled as little as possible with a minimum of agitation.

Contaminated laundry shall be bagged or containerized at the location where it was used and shall not be sorted or rinsed in the location of use.

Contaminated laundry shall be placed and transported in bags or containers labeled or color-coded in accordance with paragraph of this standard. When a facility utilizes Universal Precautions in the handling of all soiled laundry, alternative labeling or color-coding is sufficient if it permits all employees to recognize the containers as requiring compliance with Universal Precautions.

Whenever contaminated laundry is wet and presents a reasonable likelihood of soak-through of or leakage from the bag or container, the laundry shall be placed and transported in bags or containers which prevent soak-through and/or leakage of fluids to the exterior.

The employer shall ensure that employees who have contact with contaminated laundry wear protective gloves and other appropriate personal protective equipment. It is not acceptable to use any material not disposable via tattooing!

When a facility ships contaminated laundry off-site to a second facility which does not utilize Universal Precautions in the handling of all laundry, the facility generating the contaminated laundry must place such laundry in bags or containers which are labeled or color-coded in accordance with paragraph. NOT Applicable for tattooing!

Standard Microbiological Practices. All regulated waste shall either be incinerated or decontaminated by a method such as autoclaving known to effectively destroy bloodborne pathogens. CANNOT GO IN REGULAR TRASH?? EPA violation

Laboratory coats, gowns, smocks, uniforms, or other appropriate protective clothing shall be used in the work area and animal rooms. Protective clothing shall not be worn outside of the work area and shall be decontaminated before being laundered.

Special care shall be taken to avoid skin contact with other potentially infectious materials. Gloves shall be worn when handling infected animals and when making hand contact with other potentially infectious materials is unavoidable.

All spills shall be immediately contained and cleaned up by appropriate professional staff or others properly trained and equipped to work with potentially concentrated infectious materials. MUST HAVE A BLOOD SPILL KIT

A spill or accident that results in an exposure incident shall be immediately reported to the responsible person.

A biosafety manual shall be prepared or adopted and periodically reviewed and updated at least annually or more often if necessary. Personnel shall be advised of potential hazards, shall be required to read instructions on practices and procedures, and shall be required to follow them.

Containment Equipment

Each shop shall contain a facility for hand washing and an eye wash facility which is readily available within the work area.

The surfaces of doors, walls, floors and ceilings in the work area shall be water resistant so that they can be easily cleaned. Penetrations in these surfaces shall be sealed or capable of being sealed to facilitate decontamination.

Each work area shall contain a sink for washing hands and a readily available eye wash facility. The sink shall be foot, elbow, or automatically operated and shall be located near the exit door of the work area.

Access doors to the work area or containment module shall be self-closing.

An autoclave for decontamination of regulated waste shall be available within or as near as possible to the work area.

Hepatitis B Vaccination and Post-exposure Evaluation and Follow-up

The employer shall make available the hepatitis B vaccine and vaccination series to all employees who have occupational exposure, and post-exposure evaluation and follow-up to all employees who have had an exposure incident.

The employer shall ensure that all medical evaluations and procedures including the hepatitis B vaccine and vaccination series and post-exposure evaluation and follow-up, including prophylaxis, are:

Made available at no cost to the employee;

Made available to the employee at a reasonable time and place;

Performed by or under the supervision of a licensed physician or by or under the supervision of another licensed healthcare professional; and

The employer shall ensure that all laboratory tests are conducted by an accredited laboratory at no cost to the employee.

Hepatitis B Vaccination.

Hepatitis B vaccination shall be made available after the employee has received the training required in paragraph and within 10 working days of initial assignment to all employees who have occupational exposure unless the employee has previously received the complete hepatitis B vaccination series, antibody testing has revealed that the employee is immune, or the vaccine is contraindicated for medical reasons.

The employer shall not make participation in a prescreening program a prerequisite for receiving hepatitis B vaccination.

If the employee initially declines hepatitis B vaccination but at a later date while still covered under the standard decides to accept the vaccination, the employer shall make available hepatitis B vaccination at that time.

The employer shall assure that employees who decline to accept hepatitis B vaccination offered by the employer sign the statement in Appendix A.

If a routine booster dose(s) of hepatitis B vaccine is recommended by the U.S. Public Health Service at a future date, such booster dose(s) shall be made available in accordance.

Post-exposure Evaluation and Follow-up. Following a report of an exposure incident, the employer shall make immediately available to the exposed employee a confidential medical evaluation and follow-up, including at least the following elements:

Documentation of the route(s) of exposure, and the circumstances under which the exposure incident occurred;

Identification and documentation of the source individual, unless the employer can establish that identification is infeasible or prohibited by state or local law;

The source individual's blood (dead or alive) shall be tested as soon as feasible and after consent is obtained in order to determine HBV and HIV infectivity. If consent is not obtained, the employer shall establish that legally required consent cannot be obtained. When the source individual's consent is not required by law, the source individual's blood, if available, shall be tested and the results documented.

When the source individual is already known to be infected with HBV or HIV, testing for the source individual's known HBV or HIV status need not be repeated.

Results of the source individual's testing shall be made available to the exposed employee, and the employee shall be informed of applicable laws and regulations concerning disclosure of the identity and infectious status of the source individual.

Collection and testing of blood for HBV and HIV serological status;

The exposed employee's blood shall be collected as soon as feasible and tested after consent is obtained.

If the employee consents to baseline blood collection, but does not give consent at that time for HIV serologic testing, the sample shall be preserved for at least 90 days. If, within 90 days of the exposure incident, the employee elects to have the baseline sample tested, such testing shall be done as soon as feasible.

Post-exposure prophylaxis, when medically indicated, as recommended by the U.S. Public Health Service;

Evaluation of reported illnesses

Information Provided to the Healthcare Professional.

The employer shall ensure that the healthcare professional responsible for the employee's Hepatitis B vaccination is provided a copy of this regulation. www.osha.gov

The employer shall ensure that the healthcare professional evaluating an employee after an exposure incident is provided the following information:

1. A copy of this regulation;

2. A description of the exposed employee's duties as they relate to the exposure incident;

3. Documentation of the route(s) of exposure and circumstances under which exposure occurred;

4. Results of the source individual's blood testing, if available; and

5. All medical records relevant to the appropriate treatment of the employee including vaccination status which are the employer's responsibility to maintain.

Healthcare Professional's Written Opinion. The employer shall obtain and provide the employee with a copy of the evaluating healthcare professional's written opinion within 15 days of the completion of the evaluation.

The healthcare professional's written opinion for Hepatitis B vaccination shall be limited to whether Hepatitis B vaccination is indicated for an employee, and if the employee has received such vaccination.

The healthcare professional's written opinion for post-exposure evaluation and follow-up shall be limited to the following information:

That the employee has been informed of the results of the evaluation; and

That the employee has been told about any medical conditions resulting from exposure to blood or other potentially infectious materials which require further evaluation or treatment.

All other findings or diagnoses shall remain confidential and shall not be included in the written report.

Medical Record keeping. Medical records required by this standard shall be maintained in accordance with paragraph of this section.

Communication of Hazards to Employees

Labels and Signs

Warning labels shall be affixed to containers of regulated waste, refrigerators and freezers containing blood or other potentially infectious material; and other containers used to store, transport or ship blood or other potentially infectious materials.

Labels required by this section shall include the following legend:

These labels shall be fluorescent orange or orange-red or predominantly so, with lettering and symbols in a contrasting color.

Labels shall be affixed as close as feasible to the container by string, wire, adhesive, or other method that prevents their loss or unintentional removal.

Red bags or red containers may be substituted for labels.

Individual containers of blood or other potentially infectious materials that are placed in a labeled container during storage, transport, shipment or disposal are exempted from the labeling requirement.

Labels required for contaminated equipment shall be in accordance with this paragraph and shall also state which portions of the equipment remain contaminated.

Regulated waste that has been decontaminated need not be labeled or color-coded.

Signs

The employer shall post signs at the entrance to work areas specified, Example; Clean Room, Sterilization Room, Staff Only, Restroom, Not an Exit, etc.

(Name of the Infectious Agent)
(Special requirements for entering the area)
(Name, telephone number of the laboratory director or other responsible person.)

These signs shall be fluorescent orange-red or predominantly so, with lettering and symbols in a contrasting color.

Information and Training

The employer shall train each employee with occupational exposure in accordance with the requirements of this section. Such training must be provided at no cost to the employee and during working hours. The employer shall institute a training program and ensure employee participation in the program.

Training shall be provided as follows:

1. At the time of initial assignment to tasks where occupational exposure may take place;

2. Annual training for all employees shall be provided within one year of their previous training.

3. Employers shall provide additional training when changes such as modification of tasks or procedures or institution of new tasks or procedures affect the employee's occupational exposure. The additional training may be limited to addressing the new exposures created.

4. Material appropriate in content and vocabulary to educational level, literacy, and language of employees shall be used.

The training program shall contain at a minimum the following elements:

·        An accessible copy of the regulatory text of this standard and an explanation of its contents;

·        A general explanation of the epidemiology and symptoms of bloodborne diseases;

·        An explanation of the modes of transmission of bloodborne pathogens;

·        An explanation of the employer's exposure control plan and the means by which the employee can obtain a copy of the written plan;

·        An explanation of the appropriate methods for recognizing tasks and other activities that may involve exposure to blood and other potentially infectious materials;

·        An explanation of the use and limitations of methods that will prevent or reduce exposure including appropriate engineering controls, work practices, and personal protective equipment;

·        Information on the types, proper use, location, removal, handling, decontamination and disposal of personal protective equipment;

·        An explanation of the basis for selection of personal protective equipment;

·        Information on the hepatitis B vaccine, including information on its efficacy, safety, method of administration, the benefits of being vaccinated, and that the vaccine and vaccination will be offered free of charge;

Information on the appropriate actions to take and persons to contact in an emergency involving blood or other potentially infectious materials;

·        An explanation of the procedure to follow if an exposure incident occurs, including the method of reporting the incident and the medical follow-up that will be made available;

·        Information on the post-exposure evaluation and follow-up that the employer is required to provide for the employee following an exposure incident;

·        An explanation of the signs and labels and/or color coding required.

·        An opportunity for interactive questions and answers with the person conducting the training session. Via phone, email, in person or on-line chat.

·        The person conducting the training shall be knowledgeable in the subject matter covered by the elements contained in the training program as it relates to the workplace that the training will address.

·        The employer shall assure that employees demonstrate proficiency in standard microbiological practices and techniques and in the practices and operations specific to the facility before being allowed to work with HIV or HBV.

·        The employer shall assure that employees have prior experience in the handling of human pathogens or tissue cultures before working with HIV or HBV.

·        The employer shall provide a training program to employees who have no prior experience in handling human pathogens. Initial work activities shall not include the handling of infectious agents. A progression of work activities shall be assigned as techniques are learned and proficiency is developed. The employer shall assure that employees participate in work activities involving infectious agents only after proficiency has been demonstrated.

Record keeping

Medical Records

The employer shall establish and maintain an accurate record for each employee with occupational exposure, in accordance with 29 CFR 1910.1020.

This record shall include:

1. The name and social security number of the employee;

2. A copy of the employee's hepatitis B vaccination status including the dates of all the hepatitis B vaccinations and any medical records relative to the employee's ability to receive vaccination as required.

3. A copy of all results of examinations, medical testing, and follow-up procedures as required.

4. The employer's copy of the healthcare professional's written opinion as required.

5. A copy of the information provided to the healthcare professional as required.

6. Confidentiality. The employer shall ensure that employee medical records required.

7. Kept confidential; and not disclosed or reported without the employee's express written consent to any person within or outside the workplace except as required by this section or as may be required by law.

The employer shall maintain the records required by paragraph for at least the duration of employment plus 30 years in accordance with 29 CFR 1910.1020.

Training Records

Training records shall be maintained for 3 years from the date on which the training occurred. Part employee file.

Sharps injury log

The employer shall establish and maintain a sharps injury log for the recording of percutaneous injuries from contaminated sharps. The information in the sharps injury log shall be recorded and maintained in such manner as to protect the confidentiality of the injured employee. The sharps injury log shall contain, at a minimum:

·        The type and brand of device involved in the incident,

·        The department or work area where the exposure incident occurred, and

·        An explanation of how the incident occurred.

The requirement to establish and maintain a sharps injury log shall apply to any employer who is required to maintain a log of occupational injuries and illnesses under 29 CFR 1904.

The sharps injury log shall be maintained for the period required.

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