Bloodborne Pathogens: A Complete GuideDanielle Kelvas, MD
Do you work in a hospital, clinic, lab, or another setting where you may come in contact with bodily fluids? If so, you’re at risk of being exposed to bloodborne pathogens.
Bloodborne pathogens can cause several serious and potentially fatal diseases. To keep yourself and those around you safe from exposure, staying informed about what they are and how to avoid them is key.
According to the Centers for Disease Control and Prevention (CDC), 5.6 million health care workers in the U.S. face exposure to bloodborne pathogens every day (1). Exposure to infectious materials is part of your job, but so is protecting yourself and others from the potential diseases pathogen exposure can bring.
What are bloodborne pathogens, and what are your responsibilities in keeping your workplace safe from infection? Keep reading for a quick introduction.
What Are Bloodborne Pathogens?
Bloodborne pathogens (BBPs), by definition, are any disease-causing organisms that pass from one entity to another through blood or other potentially infectious materials (OPIM). These include (1):
- blood serum
- vaginal secretions
- cerebrospinal fluid
- pleural, peritoneal, and other joint capsule or organ fluids
- amniotic fluid
Bloodborne pathogen transmission isn’t well documented from samples of all bodily fluids. Saliva, urine, feces, and sweat are considered “low-risk” fluids from a BBP standpoint, though clinicians should always wear appropriate personal protective equipment (PPE) in the event the fluids mix with blood or carry other infectious diseases. Contact with semen or vaginal secretions is considered a high BBP risk during intercourse or when exposed to other mucous membranes.
Pathogens are microorganisms that cause disease in humans. These can be as simple as the common cold or as dangerous and virulent as the Ebola virus. Because pathogens have many modes of transmission, identifying how they spread is a key component in curing and preventing transmission.
Blood borne pathogens are diseases that spread through contact with blood and live in red blood cells. Some examples of blood borne pathogens include but are not limited to:
- Ebola and other hemorrhagic fevers
Let’s take a look at what makes these diseases different, how to treat them, and how to prevent their spread.
What are bloodborne pathogens?
These particular diseases live in blood but can cause a dramatic range of symptoms affecting every organ in the body. For instance, the hepatitis viruses cause liver inflammation, fevers, jaundice, weakness and in some cases can be fatal. They can be chronic or acute as well. Some are lifelong diseases that flare up, and some are short term and go away completely once cured.
What Are the Most Common Bloodborne Diseases?
The most common and devastating bloodborne pathogens include human immunodeficiency virus (HIV), hepatitis B (HBV), and hepatitis C virus (HCV) (2).
While HIV, HBV, and HCV are the best known bloodborne pathogens, you should also know that there are more than 20 other pathogens transmitted through the blood (2).
Some pathogens are bloodborne but aren’t classified this way. For example, malaria, West Nile virus, and Zika virus are all considered to be vector-borne diseases (mosquitos) even though you find the virus in an infected person’s blood. Unlike syphilis or HIV, these aren’t spread from person to person unless you get a transfusion from an infected person (3).
Instead, these vector-borne pathogens predominantly spread through other means. For example, malaria spreads via an infected female Anopheles mosquito (3).
What Is the OSHA Bloodborne Pathogens Standard?
OSHA, also known as the Occupational Safety And Health Administration, published the first bloodborne pathogens standard in 1991. This guideline requires employers to take initiative to minimize their employees’ bloodborne pathogens exposure. It was later updated in 2001 to incorporate the The Needlestick Safety and Prevention Act (4).
The mandates detail a description of individuals who are covered by the standard. It also includes the definition of words used in the document and sections that describe what is required of employers.
The OSHA bloodborne pathogens standard makes it mandatory for employers to do the following (5):
- Create a written “Exposure Control Plan” that’s updated each year.
- Enforce the use of universal (standard) protocol.
- Ensure the use of engineering precautions, including the operation of effective, safe medical equipment like sharps disposal bins, self-sheathing needles, and needleless operations.
- Make sure that work practices are performed to minimize exposure, such as proper practices for handling and discarding laundry and sanitizing infectious surfaces.
- Provide individual protective equipment like eye protection, gloves, gowns, and masks.
- Provide free hepatitis B vaccinations to workers within 10 days of assignment.
- Provide free post-exposure exams per the CDC guidelines after any occupational exposure accident for employees.
- Educate employees about hazards via bloodborne pathogen training, signage, and labels.
- Document injuries and maintain the medical records for injured employees.
After the original standard was published in 1991, OSHA issued a revised bloodborne pathogens standard on January 18th, 2001. The revision included changes that Congress detailed in the Needlestick Safety and Prevention Act. It also detailed additional requirements for employers to follow, such as (4,5):
- Maintaining a sharps injury log.
- Documenting non-managerial workers for ID, evaluation, and selection of devices.
- Expanded terms and definitions of engineering controls.
- Ensuring that exposure control protocols included changes in technology that minimize exposure to bloodborne pathogens.
Examples of Bloodborne Pathogens
There are many unique diseases caused by bloodborne pathogens. Even so, only three of them are a primary concern in U.S. healthcare settings.
Hepatitis B, caused by the Hepatitis B Virus (HBV), is one of five different types of hepatitis. Hepato- refers to the liver,and -itis refers to an inflammatory condition. Thus, hepatitis is an inflammation of the liver (6).
Hepatitis B comes in two forms: acute, in which infection lasts up to six months before complete recovery, and chronic, in which the infection lingers for over six months to years. An HBV infection can be a life-long struggle for people with a compromised immune system (6).
The symptoms of hepatitis B include (6):
- joint pain
- abdominal discomfort
- a decrease in appetite and/or weight loss
- dark-colored urine
- Jaundice (yellowing of the skin)
If the condition is chronic, long-term inflammation and damage can lead to liver cancer, liver failure, and cirrhosis (6).
There are two reasons hepatitis B is so dangerous to healthcare workers. First, it’s highly infectious, with an estimated 6-30% chance of infection after only a single needle stick. Second, because most people do not develop symptoms until 1-4 months after infection (and young children may not get symptoms at all), your patients may not know they’re infected (7).
There is a vaccination to prevent HBV infection, but there is no cure once infected (7).
Hepatitis C is the other bloodborne type of liver inflammation, caused by the Hepatitis C Virus (HCV). Like Hepatitis B, it’s an acute disease that can also become chronic (8,9).
The CDC estimates that as of 2016, 2.4 million Americans were living with an HCV infection. The symptoms of both diseases are similar, and unfortunately, it is possible to be infected with both hepatitis B and C viruses at the same time. Even so, some people with HCV never develop symptoms (8,9).
There’s no vaccination to prevent hepatitis C, but due to expanding research, there are effective treatments available. Known as direct-acting antivirals, these drugs can help people overcome the infection in as few as twelve weeks. Some people will recover completely while others may deal with a lifelong infection (8,9).
HIV and AIDS
Human Immunodeficiency Virus (HIV) is the bloodborne pathogen responsible for Acquired Immunodeficiency Syndrome (AIDS). Once infected, a person will test positive for HIV for the rest of their life (10,11).
This virus acts by killing white blood cells known as T-cells or CD4 Lymphocytes. These cells are essential for helping your immune system fight pathogens. When the number of T-cells in your body drops, you’re vulnerable to opportunistic infections—pathogens that can take hold due to your already compromised immune system (10,11).
AIDS, the advanced form of HIV infection, can take up to 2-10 years to develop. Today, antiretroviral therapy can help your body fight HIV’s effects well enough to prevent AIDS from developing for an extended amount of time (10,11).
Many viral hemorrhagic fevers (VHF) are also the result of bloodborne pathogens. While these aren’t common in the United States, they can be found in some parts of Africa and the Middle East where their non-human host species live. Examples of VHF include Ebola virus disease, Lassa fever, Marburg, and Dengue (12).
How Do BBPs Spread?
As we already discussed, bloodborne pathogens spread when an uninfected person comes in contact with an infected person or animal’s blood or OPIM. But how much contact is required for actual transmission to occur?
Sexual contact and sharing hypodermic needles—usually associated with illicit drug use—are the two main methods of transmission. Contact between mucous membranes of the mouth, eyes, nose, or genital regions even outside of traditional sex can also pass diseases. Infected mothers can transmit some BBPs to their babies while pregnant, but the risk increases during birth when they’re no longer protected by the placental barrier.
Healthcare workers and other at-risk professionals should be most aware of the methods of accidental exposure. These include (1,4):
- needle sticks
- punctures from medical sharps or broken glass
- inhalation of contaminated aerosols, such as when a patient coughs up bloody sputum
- accidental blood or OPIM contact with a mucous membrane (eyes, nose, mouth)
- accidental blood or OPIM contact with damaged or broken skin
Contact with healthy, undamaged skin holds the lowest risk of infection but should still be avoided at all times. Even if you aren’t treating a patient in-person, a puncture from a contaminated object or cleaning up infected fluids can still result in transmission.
Direct contact with infected blood is a primary mode of transmission. This means anyone who shares needles with other people are at significant risk for contracting a blood borne pathogen, the most common in these cases being hepatitis C. Most blood borne pathogens can also be spread through contact with feces and through sexual contact as well. Transmission through unclean tattoo parlors is also a possibility, though health departments across the world have strict guidelines for professional tattoo parlors that make infection far less likely.
How long can blood borne pathogens live outside the body?
Most blood borne pathogens can live for up to a week outside the body. In fact, dried blood can still transmit hepatitis B and C; a very small amount of contact is all that’s necessary to contract these viruses.
How Do You Stop Them From Spreading?
The best way to prevent bloodborne pathogens from spreading is to follow universal precautions. In short, this means treating all blood and OPIM as if they were carrying BBPs.
These precautions begin with engineering controls like installing authorized sharps and biohazard disposal containers. At-risk persons should also wear appropriate PPE including gloves, masks, eye protection, face shields, and gowns. Employers of at-risk persons must label hazardous items/areas and offer the hepatitis B vaccine.
To reduce risks, all re-used items and surfaces should be disinfected between uses. All policies and procedures should also be safety-focused to minimize exposures.
Anyone who is at risk of accidental exposure to BBPs, whether or not they’re a healthcare worker, should undergo training and pass a bloodborne pathogens test. The list of professions that should go through BBP training includes (1,2,4):
- doctors, nurses, and other direct patient care providers
- paramedics, EMTs, firemen, and other first responders
- medical laboratory teams and researchers
- rehab, nursing home, and home health care providers
- dentists, hygienists, and dental assistants
- law enforcement
- janitorial, laundry, and housekeeping teams
- blood and tissue bank staff and blood drive volunteers
- medical equipment technicians
- teachers, school nurses, and school employees
- morticians and funeral home employees
- tattoo and piercing artists
This is not an exhaustive list. Anyone whose job could cause them to come in contact with blood, OPIM, or potentially contaminated items (like needles and syringes) should take an accredited BBP course.
Ensure that you never use the same intravenous needle as someone else. If you’re getting a tattoo, get it from a credible tattoo parlor and make sure they are using gloves, sterile needles, and best safety practices to avoid contamination. Do not take sexual risks, always use protection, and be selective of your partners. If you come across blood — wet or dry — ensure proper cleaning protocol, including using something like bleach to destroy any pathogens that might be present.
How to Handle Exposure to Bloodborne Pathogens
Despite our best efforts at following safety precautions, accidental BBP exposures do happen. Statistics show that more than 50% of nurses will suffer a needle stick accident at least once in their careers, and other medical professionals are at risk of BBP exposure as well (4).
If you do get exposed, it’s vital to act quickly. If the exposure happens at work, follow your workplace’s established exposure control plan. OSHA requires employers to offer post-exposure evaluation and follow-up appointments to their at-risk employees at no cost.
After an accidental contact or needle stick, immediately wash the area with soap and water. Flush mucous membranes with copious amounts of water. If the fluid comes in contact with your eyes, irrigate them with sterile water or saline.
After cleaning the area thoroughly, seek prompt medical attention. Make sure to document and report the incident according to your workplace’s policy.
Whether you come into contact with blood as an occupational hazard or through sheer happenstance, treat it with extreme caution. Blood borne diseases are often significantly more dangerous than those transmitted through the air, and in the case of HIV or hepatitis C, can be chronic, lifelong conditions. Treat all blood as thought it could be hazardous and avoid touching it or interacting with it unless you first treat it with bleach or clinically formulated hydrogen peroxide.
Bloodborne Pathogens Training Topics
There are specific topics that should be covered during pathogen training. The course must educate employees on how to minimize exposure by doing the following (1,2,4,5):
- Adhering to safe workplace precautions.
- Using personal protective gear and equipment.
- Following proper housekeeping practices.
- Using basic safety precautions, such as treating every blood sample as if it’s infectious.
- Using engineering controls such as self sheathing needles and sharps disposal bins.
Healthcare workers should also be taught the details of their specific facility’s exposure control plan. The OSHA bloodborne pathogen standard mandates employers to implement their control plans as the foundation for preventing infectious diseases.
Bloodborne Pathogens Training Records
All employee training records are required to stay on file for at least three years from the worker’s training date. Furthermore, the documentation must be easily accessible by the employer in the event that OSHA performs an audit. In order to comply with the OSHA bloodborne pathogens standard training requirements, records most detail (4,5):
- The date of the training session.
- The names and educational qualification of the course instructors who conducted the training.
- The name and job title of all employees who are trained.
- A summary of the course session.
Bloodborne pathogen training does not have to be provided in a classroom setting. OSHA does allow video on-demand courses and online, video-based training.
However, the program content must include all pertinent information required by OSHA. It’s also a good idea for employers to use a training course that is specific to their industry.
Getting Trained on Bloodborne Pathogens
Bloodborne pathogens and OPIM cause a wide range of serious diseases. To keep both others and yourself safe from infection, it’s vital to have adequate BBP training.
If you or your medical team needs training, HIPAA Exams has all of the courses you need to get started. Our hour-long course and exam cover all the information touched on in this article in greater detail, along with deeper instruction on OSHA regulations and work practice. To sign up for this affordable, comprehensive course and get a competitive group rate, visit our website today.
- Bloodborne Pathogens and Needlestick Prevention. OSHA. Retrieved Oct 4, 2022 from https://www.osha.gov/bloodborne-pathogens/hazards.
- Bloodborne Pathogens. National Occupational Research Agenda, CDC. Retrieved Oct 6, 2022 from https://www.cdc.gov/nora/councils/hcsa/stopsticks/bloodborne.html.
- Vector-borne diseases. World Health Organization. Published March 2, 2020. Retrieved Oct 6, 2022 from https://www.who.int/news-room/fact-sheets/detail/vector-borne-diseases.
- The Bloodborne Pathogens Standard and the Needlestick Safety & Prevention Act: Not Just for OSHA Compliance. Safety Partners Inc. Published Nov 5, 2020. Retrieved Oct 6, 2022 from https://www.safetypartnersinc.com/the-bloodborne-pathogens-standard-and-the-needlestick-safety-prevention-act-not-just-for-osha-compliance.
- Bloodborne Pathogens and Needlestick Prevention. Retrieved Oct 4, 2022 from https://www.osha.gov/bloodborne-pathogens/enforcement.
- Hepatitis B. CDC. Published Oct 12, 2021. Retrieved Oct 6, 2022 from https://www.cdc.gov/hepatitis/hbv/index.htm.
- Hepatitis B. World Health Organization. Published June 24, 2022. Retrieved Oct 6, 2022 from https://www.who.int/news-room/fact-sheets/detail/hepatitis-b.
- Hepatitis C. CDC. Published July 28, 2020. Retrieved Oct 6, 2022 from https://www.cdc.gov/hepatitis/hcv/index.htm.
- Hepatitis C. WHO. Published June 24, 2022. Retrieved Oct 6, 2022 from https://www.who.int/news-room/fact-sheets/detail/hepatitis-c.
- CDC. Published Aug 31, 2022. Retrieved Oct 6, 2022 from https://www.cdc.gov/hiv/basics/index.html.
- WHO. Published July 27, 2022. Retrieved Oct 6, 2022 from https://www.who.int/news-room/fact-sheets/detail/hiv-aids.
- Viral Hemorrhagic Fevers (VHFs). CDC. Published Sept 2, 2021. Retrieved Oct 6, 2022 from https://www.cdc.gov/vhf/index.html.