'Borne free

     Personal safety is always the EMS provider's first priority. Because of bloodborne pathogens, every patient contact is a threat to EMS provider safety. This article reviews the Occupational Safety and Health Administration (OSHA) bloodborne pathogens standard, bloodborne pathogens encountered by EMS providers, use of personal protective equipment and reporting exposure incidents.

     The OSHA bloodborne pathogens standard, which was developed to reduce and prevent workplace exposures to infectious diseases among healthcare workers, has several important and relevant components for EMS providers. It outlines the elements for an exposure control program to protect healthcare workers, workplace engineering practices to reduce exposures, provisions for employers to offer hepatitis B vaccinations, elements of employee training in preventing bloodborne pathogen exposure, and record-keeping for exposure incidents. To view the standard, search the Internet for OSHA bloodborne pathogens standard. The standard applies to all employees who could be "reasonably anticipated" to have contact with blood or other potentially infectious materials while performing their duties.

     Bloodborne pathogens are pathogenic microorganisms present in human blood that can cause disease in humans. They include the hepatitis B and C viruses, syphilis and human immunodeficiency virus (HIV).

     EMS providers also want to limit their exposure to other potentially infectious materials, defined as "human body fluids; any body fluid that is visibly contaminated with blood; all body fluids in situations where it is difficult or impossible to differentiate between body fluids; any unfixed tissue or organ from a human and 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."¹ Gloves, instruments, cots, linens, clothing and other equipment can become contaminated during patient assessment, treatment and transport. "Contaminated," the standard says, "means the presence or the reasonably anticipated presence of blood or other potentially infectious materials on an item or surface."¹

     If blood or other potentially infectious material is present or potentially present on a surface or item, decontamination is needed. Decontamination is the "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."¹

     EMS providers have many potential exposures that may result from performance of their duties. They can be exposed to bloodborne pathogens and other infectious materials by needlesticks, rescue breathing, bleeding control and airway management, as well as through cleaning up blood after an incident.

     The most common occupational exposure to bloodborne pathogens comes through needlesticks. It is estimated that 600,000–800,000 needlesticks happen every year in the U.S. Other exposures involve cuts from contaminated sharps and contact with mucous membranes or broken skin by contaminated blood. An exposure incident is "a specific eye, mouth, other mucous membrane, nonintact skin or parenteral contact with blood or other potentially infectious materials that results from the performance of an employee's duties."¹

     Standard precautions teach us to treat all human blood and certain body fluids as if we know they're infectious. This section reviews common bloodborne pathogens encountered by EMS.

     Hepatitis B is the primary bloodborne pathogen hazard for EMS providers. Hepatitis B is a serious disease that attacks the liver. It can cause lifelong infection, cirrhosis or scarring of the liver, liver cancer, liver failure and death. The hepatitis B virus "is efficiently transmitted by percutaneous or mucous membrane exposure to infectious blood or body fluids that contain blood."⁶ Populations at high risk for hepatitis B infection include: