Labor & Industries (L&I), Washington State

Bloodborne Pathogens Chapter 296-823, WAC

Effective Date: 09/01/04

 

WAC 296-823-140  Control Employee Exposure

For printing

Your Responsibility:

To use feasible controls to eliminate or minimize occupational exposure to blood or other potentially infectious materials (OPIM)

IMPORTANT:

If occupational exposure remains after implementing these controls, personal protective equipment must be used. See WAC 296-823-150, Personal Protective Equipment.

You must

Use appropriate equipment and safer medical devices to eliminate or minimize occupational exposure WAC 296-823-14005 Handle contaminated sharps properly and safely WAC 296-823-14010 Handle reusable sharps properly and safely WAC 296-823-14015 Minimize splashing, spraying, splattering and generation of droplets WAC 296-823-14020 Make sure items are appropriately labeled WAC 296-823-14025 Make sure employees clean their hands WAC 296-823-14030 Prohibit food, drink, and other personal activities in the work area WAC 296-823-14035 Prohibit pipetting or suctioning by mouth WAC 296-823-14040 Place specimens in an appropriate container WAC 296-823-14045 Examine and label contaminated equipment WAC 296-823-14050 Make sure your worksite is maintained in a clean and sanitary condition WAC 296-823-14055 Handle regulated waste properly and safely WAC 296-823-14060 Handle contaminated laundry properly and safely WAC 296-823-14065

 

WAC 296-823-14005

Use feasible controls, including appropriate equipment and safer medical devices, to eliminate or minimize occupational exposure

You must

• Use appropriate equipment and safer medical devices to eliminate or minimize employee exposure.
• Use work practices designed to eliminate or minimize employee exposure.
• Examine and maintain or replace equipment and safer medical devices on a regular schedule to make sure they remain effective.

Note: Examples of appropriate equipment include: – Sharps containers – Biosafety cabinets – Splash guards – Centrifuge cups – Specimen storage and transport containers. Examples of safer medical devices include: – Sharps with engineered sharps injury protections (SESIP) – Needleless systems – Blunt suture needles – Plastic capillary tubes. Examples of work practices include: – No-hands procedures in handling contaminated sharps – No hand-to-hand instrument passing.

Definition: Sharps with engineered sharps injury protections (SESIP) is a nonneedle 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.

WAC 296-823-14010

Handle contaminated sharps properly and safely

You must

• Make sure that you don't bend, recap, or remove contaminated needles or other contaminated sharps unless you can demonstrate that there is no feasible alternative or that it's required by a specific medical or dental procedure.

  – Bending, recapping or needle removal must be done by using a mechanical device or a one-handed technique.

  Note: Demonstrating that no alternative to bending, recapping, or removing contaminated sharps is feasible, may be accomplished through written justification, supported by reliable evidence, in your exposure control plan.

You must

• Make sure you don't shear or break contaminated needles.

WAC 296-823-14015

Handle reusable sharps properly and safely

You must

• Place contaminated reusable sharps immediately, or as soon as possible after use, in appropriate containers until properly decontaminated. Containers must be all of the following:

  • – Puncture resistant
  • – Labeled or color-coded as described in this chapter
  • – Leakproof on the sides and bottom
  • – Meet the same requirements as the container for disposable sharps, except they don't need to be closable.
• Store or process contaminated reusable sharps so employees aren't required to reach into the container or sink by hand.
• Make sure reusable sharps containers aren't opened, emptied, or cleaned manually or in any other manner that would expose employees to contaminated sharps.

Reference: Requirements for appropriate labels and color-coding are found in WAC 296-823-14025.

WAC 296-823-14020

Minimize splashing, spraying, splattering, and generation of droplets

You must

• Make sure all procedures involving blood or OPIM are performed so splashing, spraying, spattering, and generation of droplets are minimized.
• – Examples include:

  • Appropriate operation and use of recommended controls for surgical power tools, lasers and electrocautery devices
  • Use of personal protective equipment when contact with blood or OPIM is reasonably anticipated
  • Making sure cleaning procedures don't generate unnecessary splashes, spraying, spattering, or generation of droplets.

WAC 296-823-14025

Make sure items are appropriately labeled

Exemption: The following are exempt from the labeling requirements of this chapter: - Individual containers placed in an appropriately labeled secondary container. -Regulated waste that has been decontaminated. - Containers of blood, blood components, or blood products that are labeled with their contents and have been released for transfusion or other clinical use. - Extracted teeth, gallstones, kidney stones, or other tissues and body substances that are given to patients.

You must

• Attach appropriate labels to:

• - Containers used to store, transport, or ship blood or other potentially infectious materials (OPIM) including:
• Refrigerators
• Freezers
• – Sharps containers
• – Contaminated equipment
• – Laundry bags and containers
• – Specimen containers
• – Regulated waste containers.
• Make sure that labels:

  – Include the following symbol:

BIOHAZARD

• – Are all or mostly fluorescent orange or orange-red with lettering and symbol in a contrasting color
• – Are attached to the container by string, wire, adhesive, or other method so they can't become lost or accidentally removed.

Note: Red bags or red containers may be substituted for labels as long as they're: – Covered in the exposure control plan – Communicated to all affected employees (including employees of laundry services, disposal services, and transport companies) whether they're your employees or not. - The label doesn't always need to be attached to each individual container. - For example, a cart carrying specimen containers could be labeled, rather than each individual container.

WAC 296-823-14030

Make sure employees clean their hands

You must

1) Provide handwashing facilities that are readily accessible to employees, wherever feasible. If handwashing facilities aren't feasible, provide either one of the following:

• Antiseptic towelettes
• Antiseptic hand rub product along with clean cloth/paper towels.

2) Make sure employees clean their hands as soon as feasible after removing gloves and whenever there is the potential for contact with blood or other potentially infectious materials (OPIM). Do one of the following:

• Wash with soap and water
• Use an appropriate waterless antiseptic hand rub product or towelettes, provided there are no signs of visible contamination
• Use an appropriate waterless antiseptic hand rub product or towelettes followed by washing with soap and water as soon as possible, when hands are visibly contaminated and handwashing facilities aren't immediately available.

Note: An appropriate waterless antiseptic hand rub product is one that contains a 60-95% alcohol solution (isopropanol or ethanol).

You must

3) Make sure employees wash any skin with soap and water, or flush mucous membranes with water as soon as feasible following contact with blood or OPIM.

WAC 296-823-14035

Prohibit food, drink, and other personal activities in the work area

You must

• Make sure eating, drinking, smoking, applying cosmetics or lip balm, and handling contact lenses are prohibited in work areas where there is occupational exposure.
• Make sure food and drink aren't kept in refrigerators, freezers, shelves, cabinets, or on countertops or benchtops where there is a potential for exposure to blood or other potentially infectious materials (OPIM).

WAC 296-823-14040

Prohibit pipetting or suctioning by mouth

You must

• Prohibit mouth pipetting or suctioning of blood or other potentially infectious materials (OPIM).

 

WAC 296-823-14045

Place specimens in an appropriate container

You must

• Place specimens of blood or other potentially infectious materials (OPIM) in an appropriate container that prevents leakage during collection, handling, processing, storage, transport, or shipping.
• Make sure the container is properly labeled or color-coded and closed before being stored, transported, or shipped.

  – If outside contamination of the container occurs, the container must be placed inside a second container that prevents leakage and is properly labeled or color-coded

  – If the specimen could puncture the container, the container must be placed inside a second container that:

  • Is puncture-resistant

  • Prevents leakage during handling, processing, storage, transport, or shipping
  • Is properly labeled or color-coded.

Exemption: When your facility handles all specimens using universal precautions or other equivalent infection control systems, you don't have to label/color-code specimens as long as the containers can be recognized as containing specimens. This exemption only applies while these specimens/containers remain within the facility. Proper labeling or color-coding is required when specimens/containers leave the facility.

Reference: Requirements for appropriate labels and color-coding are found in WAC 296-823-14025.

Helpful Tool: Guidance on the Handling of Criminal Evidence This tool contains information about the handling and storage of criminal evidence. Criminal evidence contaminated with blood or OPIM is considered a specimen under the scope of this chapter. You can find a copy of this tool in the Resource section of this chapter.

WAC 296-823-14050

Examine and label contaminated equipment

You must

• Examine equipment which could become contaminated with blood or other potentially infectious materials (OPIM) before servicing or shipping.

  – Decontaminate this equipment and its parts as necessary unless you can demonstrate that decontamination isn't feasible

  – Attach an easily seen biohazard label to the equipment stating which portions remain contaminated.

Reference: Requirements for appropriate labels and color-coding are found in WAC 296-823-14025.

You must

• Make sure that information on contaminated equipment is communicated to all affected employees, the servicing representative, and the manufacturer as appropriate, prior to handling, servicing, or shipping so that appropriate precautions will be taken.

 

WAC 296-823-14055

Make sure your worksite is maintained in a clean and sanitary condition

You must

1) Develop an appropriate written schedule for cleaning and decontamination based upon the following:

• The location within the facility
• Type of surface to be cleaned
• Type of contamination present
• Tasks or procedures being performed in the area.

2) Clean and decontaminate environmental and working surfaces and all equipment after contact with blood or other potentially infectious materials (OPIM).

• Decontaminate work surfaces with an appropriate disinfectant at these times:

  – After completion of a procedure
  – Immediately or as soon as possible when surfaces are clearly contaminated or after any spill of blood or OPIM
  – At the end of the workshift if the surface could have become contaminated since the last cleaning.

• Remove and replace protective coverings, such as plastic wrap, aluminum foil, or imperviously backed absorbent paper used to cover equipment and environmental surfaces, as soon as possible when they:

  – Clearly become contaminated

  or

  – At the end of the workshift if they could have become contaminated during the shift.

• Inspect and clean (on a regularly scheduled basis) all bins, pails, cans, and similar receptacles intended for reuse that have a reasonable likelihood for becoming contaminated with blood or OPIM.

  – Clean and decontaminate these types of receptacles immediately or as soon as possible when they are visibly contaminated.

• Use a brush and dustpan, tongs, forceps, or other mechanical means to clean up broken glassware that may be contaminated.
  

Note: An appropriate disinfectant is one that is effective against tuberculosis or HBV and HIV such as: – Diluted bleach solution (1:10 or 1:100). Use the 1:10 bleach solution for spills and the 1:100 bleach solution for routine cleaning – You can make your own bleach solution. Using household bleach (5.25% sodium hypochlorite) follow these directions: For a 1:100 solution add 2 teaspoons (10 ml) to a container, then add water to make a quart (946 ml). For a 1:10 solution, add 1/3 cup (79 ml) and 1 tablespoon (15 ml) in a container, then add water to make a quart (946 ml) – EPA registered: tuberculocidals (List B) Sterilants (List A) Products registered against HIV/HBV (List D). Any of the above products are considered effective when used according to the manufacturers' instructions. Higher level disinfection may be required depending on the agent or level of decontamination.

Link: These lists are available from the EPA Office of Pesticides, antimicrobial pesticides website at http://www.epa.gov/oppad001/chemregindex.htm.

WAC 296-823-14060

Handle regulated waste properly and safely

Definition: Regulated waste is any of the following: – Liquid or semiliquid blood or other potentially infectious materials (OPIM) – Contaminated items that would release blood or OPIM in a liquid or semiliquid state, if compressed – Items that are caked with dried blood or OPIM and are capable of releasing these materials during handling – Contaminated sharps – Pathological and microbiological wastes containing blood or OPIM.

You must

• Discard contaminated sharps immediately, or as soon as possible, in containers that are all of the following:
• – Closable
• – Puncture resistant
• – Leakproof on sides and bottom
• – Appropriately labeled or color-coded
• – Easily accessible to personnel
• – Located as close as feasible to the immediate area where sharps are used or areas sharps can be reasonably anticipated to be found (for example, laundries)
• – Maintained upright throughout use
• – Replaced routinely and not allowed to overfill.
  

Exemption: Work areas such as correctional facilities, psychiatric units, pediatric units, or residential homes may have difficulty placing sharps containers in the immediate use area. In such situations, alternatives such as using lockable containers or bringing containers in and out of the work area may be used.

Note: For additional information on placement and use of sharps containers see Selecting, Evaluating, and Using Sharps Disposal Containers, NIOSH Publication 97-111, January 1998. You can obtain a copy of this publication by calling 1-800-35-NIOSH or get an electronic version in PDF at http://www.cdc.gov/niosh/publistd.htm.

You must

• Make sure when you move containers of contaminated sharps, the containers are:
• – Closed prior to removal or replacement to prevent spilling or protrusion of contents during handling, storage, transport, or shipping;
  

  and

  – Placed in a secondary container, if leaking is possible. The second container must be:

• Closable
• Constructed to contain all contents and prevent leakage during handling, storage, transport, or shipping
• Appropriately labeled or color-coded.

• Make sure regulated waste other than sharps is placed in containers that are all of the following:
• – Closable
• – Constructed to contain all contents and prevent leakage of fluids during handling, storage, transport, or shipping
• – Closed prior to removal to prevent spillage or protrusion of contents during handling, storage, transport, or shipping
• – Placed in a second container if outside contamination of the primary regulated waste container occurs.
  • The second container must meet these requirements.
  – Appropriately labeled or color-coded.

• Dispose of all regulated waste according to applicable state and county regulations.

 

WAC 296-823-14065

Handle contaminated laundry properly and safely

You must

• Handle laundry contaminated with blood or other potentially infectious material (OPIM) as little as possible and with a minimum of agitation.
• Bag contaminated laundry or put it into a container at the location where it was used

  – Don't sort or rinse at the location of use

  – Place and transport contaminated laundry in bags or containers that are properly labeled or color-coded

  – If your facility ships contaminated laundry off-site to a second facility that doesn't use an infection control or isolation system when handling all of their soiled laundry, your facility must place the laundry in red bags or containers that are appropriately labeled.

Note: If your facility uses an infection control or isolation system in the handling of all soiled laundry, you can use alternative labeling or color-coding so employees recognize that the containers need to be handled using these precautions.

Reference: Requirements for appropriate labels and color-coding are found in WAC 296-823-14025 of this chapter.

You must

• Place and transport wet contaminated laundry that is likely to soak through or leak to the outside, in bags or containers that will prevent such leakage.

Reference: You need to follow additional requirements to make sure that employees who have contact with contaminated laundry wear protective gloves and other personal protective equipment (PPE) as appropriate, see WAC 296-823-150, Personal Protective Equipment.