Blood Borne Pathogens Training

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Blood Borne Pathogens Training

• Division of Public Health
• 2004

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Blood Borne Pathogens Training

• Overview of BBP Standard
• Types of pathogens
• Exposure Control Plan

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OSHA BBP Standard

• Reason Concern for employees who are
  occupationally exposed to blood and other body
  fluids and could acquire certain disease through
  exposure
• Purpose To minimize risk for employees with
  occupational exposure to blood and body fluids
• Location BCDP and BEOH, also at www.osha.gov
• Requires Exposure Control Plan

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Blood Borne Pathogens

• Human immunodeficiency virus (HIV)
• Hepatitis B virus (HBV)
• Hepatitis C virus (HCV)

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Blood Borne Pathogens

• Can acquire from
• blood
• body fluids containing visible blood
• other potentially infectious material (OPIM)
• cerebral spinal fluid (CSF), synovial fluid,
  pleural fluid, peritoneal fluid, amniotic fluid

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Blood Borne Pathogens

• Feces, nasal secretions, saliva (except in
  dental settings), sputum, sweat, tears, urine,
  and vomitus are not considered infected with
  blood borne pathogens unless they contain visible
  blood.

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Blood Borne Pathogens

• Occupational exposure occurs by
• percutaneous injury (needlestick or cut)
• contact with mucous membranes
• contact with non-intact skin
• in which there is blood, body fluids with
  visible blood, OPIM

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Blood Borne Pathogens

• HIV
• virus that causes AIDS
• incubation period 1
• to 3 months
• person is infectious from
• onset of infection throughout life
• all persons are susceptible

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Blood Borne Pathogens

• HIV
• risk of transmission
• needlestick 0.3
• splash/spray to mucuous
• membranes 0.09
• non-intact skin less than
• mucous membrane exposure

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Blood Borne Pathogens

• HBV
• virus that causes hepatitis B
• incubation period 45 to 180 days
• person is infectious if test for antigen (HBsAG)
  is positive
• unvaccinated persons are susceptible
• vaccination is recommended for persons with
  occupational exposure

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Blood Borne Pathogens

• HBV
• risk of transmission
• needlestick 22-31
• if source is HBeAG
• needlestick 1-6
• if source is HBeAG -
• direct or indirect contact with non-intact skin
  or mucous membranes is an important source of
  occupational exposure

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Blood Borne Pathogens

• HCV
• virus that causes hepatitis C
• incubation period 6 to 9 weeks
• most persons are infectious for life
• all are susceptible

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Blood Borne Pathogens

• HCV
• risk of transmission
• needlestick 1.8
• mucous membranes rare
• non-intact skin very rare

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DPH Exposure Control Plan

• universal/standard precautions
• hand hygiene
• PPE
• engineering controls
• work practice controls
• HBV vaccination
• post-exposure management
• training

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DPH Exposure Control Plan

• available to employees
• copies available in BCDP and BEOH
• reviewed, updated annually
• use of safe medical devices included

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DPH Exposure Control Plan

• Exposure Determination
• Any DPH employee who performs or may perform
  phlebotomies, fingersticks, administers
  immunizations (including smallpox vaccinations)
  has occupational exposure to blood borne
  pathogens

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Universal Precautions

• part of OSHA BBP standard
• used on ALL individuals
• used for ALL contact with
• blood, body fluids, OPIM
• mucous membranes
• non-intact skin
• to protect against blood borne pathogens

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Standard Precautions

• part of CDC guidelines on infection control
• used on ALL individuals
• blood, all body fluids, secretions,
  excretions(except sweat) considered infectious
  (regardless of visible blood)
• used to protect against all infectious agents

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Standard Precautions

• Hand hygiene
• use of personal protective equipment

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Hand Hygiene

• Wash hands
• after touching blood, body fluids, secretions,
  excretions, contaminated items, regardless if
  gloves are worn
• immediately after removing gloves
• before leaving work area
• whenever hands are dirty or contaminated

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Hand Hygiene

• Hand washing technique
• turn on faucets to comfortable water temperature
• wet hands, apply soap, lather
• rub with friction for at least 15 seconds, making
  sure to wash back of hands, fingers, fingertips,
  in between fingers
• rinse with fingertips pointing downward
• dry hands with paper towel
• discard paper towel and turn off faucets with
  clean paper towel

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Hand Hygiene

• Waterless alcohol gel
• may use if hands are not visibly soiled
• more effective against organisms
• convenient
• gentler to skin than soap, water, paper towels
• takes less time than soap
• and water wash

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Hand Hygiene

• Use of waterless gel
• press pump down completely
• to dispense appropriate amount
• dispense into palm of one hand
• rub palms, backs of hands,
• fingers, fingertips, between
• fingers until dry, about 30 seconds
• make sure hands are dry before
• resuming activities

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PPE

• gowns, gloves, surgical masks, face shields,
  goggles, shoe covers, aprons
• used when there is a reasonable anticipation of
  exposure to blood, body fluids, mucous membranes,
  non-intact skin
• provides protection for clothing, skin, eyes,
  mouth, nose

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PPE

• employer responsibilities
• provide in appropriate sizes
• make accessible
• require use by employees
• clean, launder, repair, replace as needed
• provide training

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PPE

• Employee responsibilities
• use appropriately
• dispose of appropriately

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PPE for DPH

• Gloves
• non-latex
• wear for phlebotomies, fingersticks, smallpox
  vaccinations
• remove between clients, wash hands
• select correct size
• have readily available at work station

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PPE for DPH

• Gowns
• protect skin, prevent soiling of clothing
• do not re-use disposable gowns
• wash hands after removing
• use when cleaning spills
• of blood/body fluids

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PPE for DPH

• Over shirts
• use if desired at STD clinics
• and HIV testing sites
• remove immediately if saturated with blood/body
  fluids
• place in designated laundry bags for professional
  cleaning

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PPE for DPH

• Lab coats
• disposable lab coats used by vaccinators
• at smallpox clinics
• remove and dispose
• of before leaving
• vaccination station,
• wash hands

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PPE for DPH

• Surgical masks with eye protection/face shields
• cover eyes, nose, and mouth when anticipating
  splash or spray to face
• eye glasses are not protective

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PPE Removal

• 1) Remove gloves by grasping outside of gloved
  hand with other gloved hand and peel off. Hold
  removed glove
• in gloved hand.
• 2) Slide fingers of
• ungloved hand under
• remaining glove.
• Discard gloves.

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PPE Removal

• 3) Remove any PPE from face next, handling by
  head bands, ear pieces, or ties. Discard.
• 4) Remove gown by pulling away from neck and
  shoulders, touching inside of gown only. Turn
  gown inside out. Discard.

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PPE Removal

• Wash hands!

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Engineering Controls

• Safety devices on sharps needles, lancets
• must be used if available
• evaluated by staff
• Shearing, breaking, bending, re-capping of
  contaminated sharps is prohibited
• Do not remove needle from used tube holder after
  phlebotomy

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Engineering Controls

• Place used sharps in disposal containers
  immediately after use
• Sharps containers
• puncture resistant
• leakproof
• labeled or red in color
• stabilized if portable

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Engineering Controls

• Sharps containers
• Replace sharps containers when 2/3 full
• The users of the containers are responsible for
  replacing when necessary

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Work Practice Controls

• Do not eat, drink, apply make-up, handle contact
  lenses, or smoke in areas with likely exposure to
  blood or OPIM
• testing areas
• areas where specimens located
• Do not store food or beverages in refrigerators,
  freezers, coolers, shelves, cupboards where
  specimens are located

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Work Practice Controls

• Do not place hands into used sharps containers
• Use a brush and dustpan or tongs or forceps to
  pick up broken glass or other sharp items

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Waste Disposal

• Infectious waste
• sharps
• disposable items that are saturated with blood or
  OPIM to the point where such material can be
  squeezed, poured, dripped, or flaked off the
  items
• for DPH, most infectious waste will be sharps

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Waste Disposal

• Infectious waste
• place in red biohazard bags, seal to prevent
  spillage during handling
• store in designated areas for collection by waste
  haulers
• Central Health Clinic biohazard collection room
• Madison???

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Waste Disposal

• Document waste disposal
• date removed
• amount
• where shipped
• by whom
• send completed forms to ICE

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Laundry

• handle with minimal agitation
• place dry laundry in bags at point of use
• laundry that is wet from blood or OPIM is placed
  in plastic bags
• send to professional cleaners
• over shirts
• personal clothing visibly soiled with blood or
  OPIM

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Labels

• Infectious waste red bag with biohazard label
• Sharps containers
• biohazard label
• blood specimens
• biohazard labeled storage
• bags, storage containers
• refrigerators, coolers where blood or OPIM is
  stored biohazard label

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Specimens

• label with appropriate information
• wrap in material to prevent breakage
• place in plastic biohazard bag
• place paperwork in outside pouch of bag
• do not place specimens back into clean collection
  kits
• store or ship appropriately

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Cleaning/Disinfection

• Clean first, then disinfect all equipment and
  environmental surfaces after contact with blood
  or OPIM
• use EPA registered disinfectant with activity
  against HIV, HBV, HCV or 110 bleach
• follow instructions on disinfectant label

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Handling Blood Spills

• Procedure for Cleaning Blood Spills
• wear PPE gown, gloves, goggles
• wet cloth with the disinfectant
• wipe item/area with wet cloth
• spray disinfectant on item/area
• wipe with clean cloth, let air dry

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Hepatitis B Vaccination

• Any one with occupational exposure to blood or
  OPIM should be vaccinated
• recommended unless
• employee has documentation of receipt of series
• antibody testing shows immunity
• employee has medical contraindications

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Hepatitis B Vaccination

• available within 10 working days of work start
  date
• if employee declines, must sign statement of
  declination
• employee may request the series later

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Hepatitis B Vaccination

• Safety
• very safe vaccine
• US as of 2000 more than 100 million adults have
  received vaccine with few side effects
• serious reactions are rare
• mild symptoms may occur soreness at injection
  site, low-grade fever
• may be given during pregnancy

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Hepatitis B Vaccination

• Effectiveness
• at least 90 of adults are immune after
  completing the three doses of vaccine
• since 1985, 90 reduction of number of HCW
  infected with HBV, largely due to vaccine

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Hepatitis B Vaccination

• vaccine provided at ??????
• administered by deep intramuscular injection
• 3 doses given 1st two doses 1 month apart, last
  dose is given 5 months after second dose
• SLH will test antibody levels at 1-2 months after
  last dose to test for immunity
• non-responders will be-revaccinated

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Post Exposure Management

• 1) Clean the site
• percutaneous injuries
• wash with soap and water
• mucous membranes
• rinse copiously with water
• 2) Go to the nearest
• Concentra clinic for evaluation.
• If none in area, report to nearest ER

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Post Exposure Management

• 3) Notify supervisor, who will notify the
• ICE
• 4) Medical evaluation
• documentation of route of exposure
• document source person
• source and exposed will be tested
• results given to exposed persons provider
• counseling