 Hello, I'm Secretary of Labor Lynn Martin. I'm here to introduce the Occupational Safety and Health Administration Standard on Blood Born Pathogens. The standard, which is effective as of March 6, 1992, is a pioneering step by the Department of Labor to protect all of us from blood-borne pathogens, such as the HIV virus and the hepatitis B virus. It covers an estimated 5.6 million workers, most in the health care industry, but others in businesses such as research laboratories, law enforcement departments, funeral homes, and fire and rescue operations. It is vital that we protect America's working men and women from the risks of blood-borne pathogens. The following presentation explains the new standard, tells how it will affect you and how it will help you do your job while dealing with these hazards. Hal Barakamu, a French novelist and Nobel Prize winner, used the plague as a metaphor. He explored how ordinary people act in times of uncertainty and risk. The most moving and most heroic parts of the story were about the health care workers and their professional responsibility. We need professional responsibility because very real and very deadly diseases have crashed down on our heads. According to the Centers for Disease Control, AIDS has already killed over 100,000 Americans. It's estimated that well over a million more are infected with a virus that causes AIDS. And the Centers estimates on hepatitis B are very sobering. Each year about 8,700 health care workers are infected with hepatitis B, and each year about 200 of them die from it. Hepatitis B and AIDS are called blood-borne diseases because the organisms that cause them are carried in blood. Blood-borne pathogens pose a special threat to health care workers and to other people who come in contact with blood and certain body fluids while doing their jobs. This program explains vital precautions you must use in the workplace to protect yourself. The precautions are targeted against all blood-borne pathogens. And there are several diseases that can be transmitted in blood and other potentially infectious materials, but two are especially dangerous. Hepatitis B and AIDS. Hepatitis B affects the liver, it is a very serious disease, and is the greatest infectious blood-borne hazard for health care workers. For some, hepatitis B often causes chronic, lifelong medical problems. In the worst case, the disease is fatal, and there is no cure. But there is a safe, effective vaccine against hepatitis B. Your employer is required to provide it at no cost to you. All occupationally exposed workers should be vaccinated. Defend yourself from hepatitis B, and avoid pain and illness. But there is no vaccine and there is no cure for the acquired immune deficiency syndrome. AIDS always kills. Both diseases are caused by tiny organisms called viruses. The virus that causes hepatitis B is called HBV. Even the tiniest traces of blood can be contaminated. One milliliter of blood may contain 100 million infectious doses of the hepatitis B virus. The virus that causes AIDS is called the Human Immunodeficiency Virus, or HIV. It's important to understand the distinction between the HIV virus and the disease AIDS. If a person is infected with HIV, medical tests will show that the person is HIV positive. That means that the person has antibodies to the HIV. It does not necessarily mean that the person has AIDS. A person who is HIV positive can feel completely normal. But sooner or later the HIV infection develops into the disease AIDS. And AIDS is a fatal illness. Essentially, HBV and HIV are transmitted the same way. Now let's look at the routes these blood-borne pathogens can travel to enter a person's body. The blood-borne pathogens are transmitted in human blood and other potentially infectious materials such as semen, vaginal secretions, and saliva in dental procedures. These blood-borne pathogens have not been shown to be transmitted by sweat, tears, urine, or feces. But remember, these substances can also be mixed with blood. For healthcare workers, the most common risk of exposure is by needle-stick injury. Exposure can also happen when blood or other potentially infectious materials touch the eyes, nose, or mouth. Finally, exposure can occur if contaminated blood or other potentially infectious materials come in contact with dermatitis, open sores, or nicks and cuts on the skin. Blood-borne pathogens pose very real life-threatening dangers, but there is no reason for panic. Consider this fact about AIDS. In the last decade, hundreds of thousands of healthcare workers have helped millions and millions of patients. Yet in 10 years, there are only about 65 reported cases of HIV infection related to occupational exposure. But the number of unknown cases in the general population is very sobering. For each patient actually diagnosed as HIV positive, there may be 40 undiagnosed people walking around. We do not know which individuals may have the virus. Because of the uncertainty, you must treat all blood or other potentially infectious materials as if it were infectious. We call this taking universal precautions. And universal precautions must become a part of how you do your job. For your own safety, treat all blood as if it contained blood-borne pathogens. Federal regulations have been issued by OSHA, the Occupational Safety and Health Administration. The regulations cover anyone who has reasonably anticipated skin, eye, mucus membrane, or parenteral contact with blood or other potentially infectious materials resulting from the performance of his or her duties. If your work brings you in contact with blood or other potentially infectious materials, you're covered by the Bloodborne Pathogen Standard, which is Title 29 of the Code of Federal Regulations, Part 1910.1030. It contains complete and comprehensive rules requiring such things as exposure control plans, free hepatitis B vaccinations for workers with occupational exposure, rules for training and record keeping, special rules for our research laboratories, and appropriate medical follow-up after an exposure incident. That's very important. If you do have an exposure incident, report it promptly to protect yourself. A confidential medical record separate from other personnel records must be developed for such incidents. The regulations ensure confidentiality and medical follow-up. One other thing you must know, these precautions are not just a good idea. These precautions are mandatory. These precautions are the law. Of course, it's our safety to make sure that the person that we just stopped isn't going to try and hurt us as well as the traffic out here in 95, being in this interstate highway. The main thing I do is keep my distance to keep myself from getting hurt. It's very important for the trooper or police officer to place some sort of protection onto his hands, the potential to come into contact with an HIV-infected person's body fluids or blood. Also, hepatitis B or HBV is also very prevalent and, as a matter of fact, is much more contagious. The backseat passenger had an open warrant from New York. Due to them being placed under arrest, a search of the car was conducted for any type of narcotics or weapons. We search any people that were placed under arrest. We use rubber gloves. One, we try to check all their pockets in case they have any type of needles or anything in there. Also, when we check down through their body on their skin and everything, in case they have any type of diseases or anything that can be contracted. We're on an emergency call. The first thing that has to go through your mind is safety. And the best way to start safety practices is by having set established procedures so that you don't have to think every time you go on a call. It should become commonplace for you to protect yourself, putting on your gloves, your face shield, your mask, and preparing for the worst when every incident, as if it were a communicable disease on every single call that we handle. When we're on an accident scene where there's a lot of glass or possibly drug paraphernalia that you could stick yourself with while surveying a patient, the best protection we have is common sense so that we don't approach the scene too rapidly. When we survey a patient, the reason we do the PAT search is to try to seek out further patient injuries. We want to be especially careful around concealed areas like the pocket for any sharps or contaminated objects. Sometimes, and most of the time, the case is that we'll cut the clothing away so that we don't have to expose our hands to that kind of a possible danger. As per federal and local guidelines, we document the names of all members responding to emergency calls. This allows us to retrace our steps and notify everyone in the event that we find out later a communicable disease was involved. The universal precautions are always on our mind on the scene of an accident or something like that. When we have a structure fire, we are aware of the universal precautions we need to take. However, we are mostly covered, our body is completely covered by the protection gear that we wear to protect ourselves from the smoke and heat inside of a structure fire. Our number one priority is always to rescue any victims that would be trapped inside of the house. And then we would immediately remove them to the outside of the structure where the proper EMS personnel will take care of them from there. In the delivery room, we do several things to protect ourselves against blood-borne pathogens. After we scrub our hands, we take a towel and dry ourselves well and then we self-gown for the position is usually the only one gowned in the delivery. Then we put the gloves on in such a fashion that our hands do not touch the outside of the gloves at any time. We then draw the edge of the glove up over the white cuff so as to prevent seepage of blood through the porous white cuff. We put on the hat of our head. We wear a mask that has a face shield that protects both from the side and the front. Our eyes and the mucous membranes of our eyes against blood splashing, especially with deliveries because the cord sometimes can wave around a bit or just during the delivery everything happens very quickly. We also wear boots on our feet because the gown only covers below our knees and this protects both our shoes and our angles and shins, so on. The idea being that we can take everything off as we leave the delivery room thereby not taking anything outside the delivery room. We place a drape under the patient that has a pocket that allows all the blood to flow into the pocket. At the end of each suture, when you're done with it, we take the needle, we cut off the suture and we place the needle into either a cuff or somewhere separate so we can identify at the end of the case. And at the very end of the case, we as the physicians are held responsible for making sure the needles are all placed into the red containers. The AIDS epidemic has been a painful thing for our society. There's a near plague mentality out in the community at least. The sophisticated and seasoned healthcare worker feels otherwise and has become comfortable with working with the AIDS patients, hepatitis patients, but take the appropriate precautions. The CDC reports that some healthcare workers a year contract the hepatitis from their work and some 200 of them die. On the other hand, in 10 years of the AIDS epidemic, the CDC only has a handful of healthcare workers who they believe contracted the disease on the job. So hepatitis B is where the action is and it has been there all along. I guess the AIDS epidemic has just enhanced our concentration on it. We provide vaccination for all employees as the major precaution. That is number one, plus the universal precautions that we've been discussing. Beginning with the specimens at the end of the laboratory in a very strongly constructed container in such a manner that if dropped, the specimen will be certainly contained. The gloves are worn in laboratory to act as a barrier against infection. The gloves are either made of latex or vinyl and when dawn should be inspected for tears or other imperfections and changed periodically in between tasks. As they become soiled or spattered with specimens, they should be changed also. Gloves should not be washed while they're on your hands or at any other time to be reused. A laboratory coat with long sleeves should be worn at all times. Now this laboratory coat should be either removed or changed when the laboratory worker leaves the laboratory. Goggles and masks are worn again when spattering or splashing is anticipated, particularly when stoppers are being removed from tubes. In addition to this, a gauze pad is used by laying it across the top of the tube and with a gentle twist, the stopper is removed. There are special precautions to be used when working with a centrifuge. The tubes should be remained either stopper or capped as they are placed in the centrifuge. They should be inspected. The centrifuge should be loaded by balancing and never open while it's running. The appropriate method to use to clean up a blood spill in a laboratory is to first cover it with paper towels and then saturate the paper towels with an appropriate disinfectant. Take your gloved hands and place the paper towels in a container that will be either cinerated or autoclaved. Cover the area again with the disinfectant and clean up thoroughly. And the housekeeping staff prepares a room for patients. It's recommended that we follow a seven-step procedure. First of all, we high dust, then low dust, making sure that we not place our hands in corners or other areas that we can't see behind because there may be a contaminated needle or other shop object accidentally left behind. Next, we strip the bed and place some soil in it in a laundry bag, which is later taken to the laundry room. During the sanitizing and cleaning procedure, heavy gloves are always worn as a protection against cleaning agents and protection from contaminated blood or other unknown fluids. Then the trash bags are removed from the containers. Now when we carry these bags, it's real important that we hold the trash bag away from our body in case there might be a sharp object inside. Then the floor is dusted, then sanitized, and the bathroom is also thoroughly sanitized. And the last step is to inspect the room to ensure that everything is cleaned and sanitized and ready for the next patient. The universal precautions are important to the housekeeping staff because we come in contact with all different contaminated fluids. We clean, spill, and we handle soil linens so we wear gloves and we follow the recommended procedures to ensure our own health and safety. The sharps containers are removed from the rooms between patients, but before we remove them from the wall, the cap at the top is securely locked. Then a key is used to remove the container from the wall. Then we take the biohazard label from the bottom, peel it off and place it across the top of the container. Then it's taken to the soil utility room and placed in the proper container to be disposed of. Our infection waste, or medical waste, if you will, is put in a red liner, which is a 3-mil thickness, placed inside of a cardboard box that is located in a dock area that is labeled Infectionist Waste as well. It's sealed, and at that time a vendor comes and picks up the cardboard container and take it and have it incinerated. Some of the safety precautions we have in place here, we instruct our people when putting the bag into the box that they do not push down on the bag with their hands. Also, that they do not carry the bag close to their body. When folding the liner into the bag, we make sure that it is properly closed where there are no airborne germs can be placed out. Also, we have them in proper protective clothing, and the regular general hygiene type things, wash your hands prior to eating, and anytime you're leaving the area, wear your gloves, etc. In the dental office, even with our young patients, we still have to take the same universal precautions to protect ourselves, our staff, and other patients from blood-borne pathogens such as hepatitis B and HIV. There are several things we do to protect ourselves. We wear masks and eye protection to keep particles from getting into our eyes, nose, and mouth. We have to, as much as possible, use some type of barrier technique, such as the rubber dam we are using with this patient, which cuts down on the amount of saliva that comes out of our mouth. We even use high-volume suction in trying to evacuate saliva as much as possible and to decrease the number of airborne particles. Between patients, we must disinfect and sterilize everything we use. Many items are used once and then thrown away. Items not easily disinfected or discarded, such as switches are covered with a throwaway film. The hepatitis B virus and the HIV virus may be present in saliva mixed with blood. Because we have our hands in the patient's mouth, it's very easy to get infected. The gums usually bleed, so if you have a microcrack or cut in your hands, the potential for infection is present. Wearing gloves is very important. We don't wash or reuse the gloves. They are thrown away after each patient. And if we leave the work area for a moment, we must rewash our hands and put on fresh gloves. We wash our hands thoroughly between patients, cleaning any debris from under the nails. We must treat every patient as if they are infected with the hepatitis B or HIV virus, whether it's true or not. The history may not show it, and the patient may not know. Therefore, we must take the same precautions as if the patient is infected with the HIV virus or the hepatitis B. The new OSHA regulations are the law because it is so important to protect your health and safety on the job. You must observe the important universal precautions. So from this moment on, day in and day out, treat all blood and other potentially infectious material as if they were infectious. Taking universal precautions must become a routine part of your job. Get the hepatitis B vaccination. The vaccine is safe, effective and available at no cost. Get the vaccination. Always protect yourself with appropriate barriers such as gloves, masks and goggles. Do not wash or reuse disposable gloves. Hand those sharp instruments carefully. Do not recap, remove or bend needles unless it's required by a medical procedure. If recapping or removal is required, you must use a mechanical device or a one-handed technique. Put all regulated waste into color-coded bags or containers with biomedical warning labels and handle the bags or containers carefully. Clean up blood and fluid spills as soon as possible. Disinfect carefully and safely using gloves and an appropriate disinfectant. Remember that all of the protective measures we've talked about are required under the law. Comprehensive training on blood-borne pathogens and the requirements of the standard are also required and records of this training must be kept. Every few minutes an innocent new life begins. Precious, sweet and vulnerable. But if that child's blood is infected, then you are vulnerable. You must treat all blood or other potentially infectious materials as if it were infectious. Make universal precautions a routine part of your job. In his novel about the plague, Albert Camus used a health care worker as the storyteller. So have we. And you have seen other parallels too. Caring for patients, human compassion, professional responsibility. Everybody knows that pestilences have a way of recurring in the world. Yet somehow we find it hard to believe in ones that crash down on our heads from a blue sky. The thing was to do your job as it should be done.