OSHA Bloodborne Pathogen Standard
In December 1991, OSHA promulgated a standard entitled “Occupational Exposure to
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Bloodborne Pathogens” to eliminate or minimize occupational exposure to bloodborne pathogens 214. One component of this requirement is that all equipment and environmental and working surfaces be cleaned and decontaminated with an appropriate disinfectant after contact with blood or other potentially infectious materials. Even though the OSHA standard does not specify the type of disinfectant or procedure, the OSHA original compliance document 269 suggested that a germicide must be tuberculocidal to kill the HBV. To follow the OSHA compliance document a tuberculocidal disinfectant (e.g., phenolic, and chlorine) would be needed to clean a blood spill. However, in February 1997, OSHA amended its policy and stated that EPA-registered disinfectants labeled as effective against HIV and HBV would be considered as appropriate disinfectants “. . . provided such surfaces have not become contaminated with agent(s) or volumes of or concentrations of agent(s) for which higher level disinfection is recommended.” When bloodborne pathogens other than HBV or HIV are of concern, OSHA continues to require use of EPA-registered tuberculocidal disinfectants or hypochlorite solution (diluted 1:10 or 1:100 with water) 215, 228. Studies demonstrate that, in the presence of large blood spills, a 1:10 final dilution of EPA-registered hypochlorite solution initially should be used to inactivate bloodborne viruses 63, 235 to minimize risk for infection to health-care personnel from percutaneous injury during cleanup.
Emerging Pathogens (Cryptosporidium, Helicobacter pylori, Escherichia coli O157:H7, Rotavirus, Human Papilloma Virus, Norovirus, Severe Acute Respiratory Syndrome [SARS] Coronavirus)
Emerging pathogens are of growing concern to the general public and infection-control professionals. Relevant pathogens include Cryptosporidium parvum, Helicobacter pylori, E. coli O157:H7, HIV, HCV, rotavirus, norovirus, severe acute respiratory syndrome (SARS) coronavirus, multidrug-resistant M. tuberculosis, and nontuberculous mycobacteria (e.g., M. chelonae). The susceptibility of each of these pathogens to chemical disinfectants and sterilants has been studied. With the exceptions discussed below, all of these emerging pathogens are susceptible to currently available chemical disinfectants and sterilants 270.
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Cryptosporidium is resistant to chlorine at concentrations used in potable water. C. parvum is not completely inactivated by most disinfectants used in healthcare including ethyl alcohol 271, glutaraldehyde 271, 272, 5.25% hypochlorite 271, peracetic acid 271, ortho-phthalaldehyde 271, phenol 271, 272, povidone-iodine 271, 272, and quaternary ammonium compounds271. The only chemical disinfectants and sterilants able to inactivate greater than 3 log10 of C. parvum were 6% and 7.5% hydrogen peroxide 271. Sterilization methods will fully inactivate C. parvum, including steam 271, EtO 271, 273, and hydrogen peroxide gas plasma271. Although most disinfectants are ineffective against C. parvum, current cleaning and disinfection practices appear satisfactory to prevent healthcare-associated transmission. For example, endoscopes are unlikely to be an important vehicle for transmitting C. parvum because the results of bacterial studies indicate mechanical cleaning will remove approximately 104 organisms, and drying results in rapid loss of C. parvum viability (e.g., 30 minutes, 2.9 log10 decrease; and 60 minutes, 3.8 log10 decrease) 271.
Chlorine at ~1 ppm has been found capable of eliminating approximately 4 log10 of E. coli O157:H7 within 1 minute in a suspension test64. Electrolyzed oxidizing water at 23oC was effective in 10 minutes in producing a 5-log10 decrease in E. coli O157:H7 inoculated onto kitchen cutting boards274. The following disinfectants eliminated >5 log10 of E. coli O157:H7 within 30 seconds: a quaternary ammonium compound, a phenolic, a hypochlorite (1:10 dilution of 5.25% bleach), and ethanol53. Disinfectants including chlorine compounds can reduce E. coli O157:H7 experimentally inoculated onto alfalfa seeds or sprouts 275, 276 or beef carcass surfaces277.
Data are limited on the susceptibility of H. pylori to disinfectants. Using a suspension test, one study assessed the effectiveness of a variety of disinfectants against nine strains of H. pylori 60. Ethanol (80%) and glutaraldehyde (0.5%) killed all strains within 15 seconds; chlorhexidine gluconate (0.05%, 1.0%), benzalkonium chloride (0.025%, 0.1%), alkyldiaminoethylglycine hydrochloride (0.1%), povidone-iodine (0.1%), and sodium hypochlorite (150 ppm) killed all strains within 30 seconds. Both ethanol
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(80%) and glutaraldehyde (0.5%) retained similar bactericidal activity in the presence of organic matter; the other disinfectants showed reduced bactericidal activity. In particular, the bactericidal activity of povidone-iodine (0.1%) and sodium hypochlorite (150 ppm) markedly decreased in the presence of dried yeast solution with killing times increased to 5 – 10 minutes and 5 – 30 minutes, respectively.