BLOODBORNE PATHOGENS TRAINING

1
OSHA / WISHA BLOODBORNE PATHOGENS TRAININGby
Lanette Dyer
2
Overview

• Review of BBP
• Exposure Control Plan
• Hepatitis B Vaccination
• Control Measures
• Personal Protective Equipment
• Waste Management
• Post Exposure Management

3
BLS Sick

• Called for a 48 year old alcoholic fallen off a
  stool
• C/C rib pain from fall
• Pt coughing
• Denies LOC, neck/back/abd pain, dizziness, nausea
• Recently had flu

Get Lost, I didnt call you
4
BLS Sick

• On exam,
• Slurring words, coughing
• VS HR 98, BP 142/P, RR 24
• Lungs scattered rhonci
• Tender to R ant chest

Beat It, I didnt call you
5
BLS Sick

• Whats wrong with this Barney?

6
TB Numbers

• 2 billion infected worldwide
• 250 new cases in WA last year
• 5 in Thurston Co
• 18 in Pierce
• Risk factors
• HIV/IVDA
• Homeless
• Prisoners (including nursing homes, dorm slugs)
• Immigrant (S. Central America, Africa, SE Asia)

7
TB Testing

• TB Testing shall be
•    Made available free of charge to members
• Offered at a reasonable time and place
•       Performed under the supervision of
  someone smart
• Administered according to the standard
  recommendations for medical practice current at
  the time of testing
• a) The department shall not make TB testing
  mandatory.
•  
• b) The department shall ensure that members who
  decline to accept TB testing sign a denial form.
•  

8
TB protection

• Patient gets a particulate mask (unless needing
  real O2!)
• If possible move the patient outside to fresh
  air.
• Respirators shall be donned by all members of the
  Emergency Medical Team.
• Windows opened and exhausted fans shall be
  operating.
• Nebulizers should be pointed downward and away
  from personnel.
• Coach the patient to cover mouth/nose with
  his/her hand or tissue during coughing episodes.

9
TB Masks

• Wear it

10
Malaria or West Nile?
USA Malaria About 1,000 cases are reported
annually   Worldwide prevalence of MalariaEach
year, 300 to 500 million people develop malaria
and 1.5 to 3 millionmostly childrendie,
according to the World Health Organization (WHO).
11
Malaria or West Nile?
2004 West Nile Virus Activity in the United
States(reported to CDC as of October 12, 2004)
12
OCCUPATIONAL EXPOSURE

• Reasonably anticipated skin, eye, mucous
  membrane, or puncture wound (parenteral) contact
  with blood or OPIM (Other Potentially Infectious
  Materials) that may result from the performance
  of employee duties.

13
BLOODBORNE PATHOGENS

• Pathogenic microorganisms that are present in
  human blood or OPIM and can cause disease in
  humans.
• Examples include HBV, HCV, HIV

14
Other Potentially Infectious Materials (OPIM)

• Human body fluids
• Semen, vaginal secretions (not at work!)
• CSF, amniotic
• any body fluid visibly contaminated with blood

15
NOT Infectious

• Feces, snot, saliva, sputum, sweat, tears,
  vomitus, and urine
• Unless blood-stained

16
HBV, HCV and HIV

• Bloodborne viruses
• Can produce chronic infection
• Transmissible in health-care settings
• Data from multiple sources (e.g., surveillance,
  observational studies, serosurveys) used to
  assess risk of occupational transmission

17
BBP TRANSMISSIONOverview

• Sexual contact
• Sharing needles or syringes
• From infected mother to baby
• Blood transfusion
• Organ transplant
• Not transmitted through casual contact

18
Average Risk of Transmission after Percutaneous
Injury
Risk ()
Source
0.3 1.8 30.0
HIV Hepatitis C Hepatitis B
19
Viral Hepatitis

• About 50,000 reported cases per year
• 60 hepatitis A
• 25 hepatitis B
• 15 hepatitis C
• lt1 unspecifiednot enough to count
• CDC estimates 500-750,000 actual new cases
• 15,000 deaths per year
• 4,000,000 carriers

20

Viral HepatitisOverview
TYPES OF HEPATITIS
A
B
D
C
E
Source of
feces
blood/
blood/
blood/
feces
virus
blood-derived
blood-derived
blood-derived
body fluids
body fluids
body fluids
Route of
fecal-oral Fast food
Percutaneous,
Percutaneous,
Percutaneous,
fecal-oral
transmission
mucosal
mucosal
mucosal
Chronic
no
yes
yes
yes
no
infection
Prevention
pre/post-
pre/post-
blood donor
pre/post-
ensure safe
exposure
exposure
screening
exposure
drinking
immunization
immunization
risk behavior
immunization
water
modification
risk behavior
modification
21
HBV TRANSMISSION

• Occurs when blood or body fluids from an infected
  person enters the body of a person who is not
  immune.
• HBV is spread through
• sexual contact with an infected person,
• sharing needles/syringes,
• needle sticks or sharps exposures on the job, or
• from an infected mother to her baby during birth.

22
HBV SYMPTOMS

• jaundice
• fatigue
• abdominal pain
• loss of appetite
• nausea, vomiting
• joint pain

• About 30 of persons have no signs or symptoms.
• Signs and symptoms are less common in children
  than adults.

23
HCV TRANSMISSION

• HCV is spread through
• Unsafe sexual practices
• sharing needles/syringes,
• needlesticks or sharps exposures on the job, or
• from an infected mother to her baby during birth.

24
HCV TRENDS/STATISTICS

• Number of new infections per year has declined
  from an average of 240,000 in the 1980s to about
  25,000 in 2001.
• Most infections are due to illegal injection drug
  use.
• Transfusion-associated cases occurred prior to
  blood donor screening now occurs in less than
  one per million transfused unit of blood.
• Estimated 3.9 million (1.8) Americans have been
  infected with HCV, of whom 2.7 million are
  chronically infected.

http//www.cdc.gov/ncidod/diseases/hepatitis/c/fac
t.htm
25
HCV SYMPTOMS

• 80 of persons have no signs or symptoms.

• jaundice
• fatigue
• dark urine
• abdominal pain
• Long hair
• Bad acting

26
The Fire Service Controversy
27
The Fire Service Controversy
28
HIV STATISTICS

• United States
• Through December 2001, a total of 816,149 cases
  of AIDS had been reported to the CDC.
• 57 proven cases amongst Health Care workers
• Another 138 maybe
• Worldwide 65 million people since beginning.
• At the end of 2002, an estimated 42 million
  people were living with HIV infection or AIDS.

29
HIV TRANSMISSION

• HIV is spread by
• sexual contact with an infected person,
• sharing needles/syringes,
• Needle sticks or sharps exposures on the job.
• Less commonly (and now very rarely in countries
  where blood is screened for HIV antibodies),
  through transfusions of infected blood or blood
  clotting factors.
• Babies born to HIV-infected women may become
  infected before or during birth or through
  breast-feeding after birth.

30
HIV SYMPTOMS

• Many people do not have any symptoms when they
  first become infected with HIV. Some people,
  however, have a flu-like illness within a month
  or two after exposure to the virus.
• These symptoms usually disappear within a week to
  a month and are often mistaken for those of
  another viral infection. During this period,
  people are very infectious, and HIV is present in
  large quantities in genital fluids.

31
HIV/AIDS SYMPTOMS

• Varying symptoms
• No symptoms to flu-like symptoms
• Fever, lymph node swelling, rash, fatigue,
  diarrhea, joint pain
• Many people who are infected with HIV do not have
  any symptoms at all for many years.
• Will develop AIDS
• Weight loss, night sweats, diarrhea, loss of
  appetite, rash, lymph node swelling
• Lack of resistance to disease

32
MRSA
Methicillin-resistant Staphylococcus Aureus

• 20-30 Healthcare workers nostrils
• Lots of nosocomial spread
• Normally found in bed-ridden long term care
  patients
• Main transmission via direct contact
• So wash hands, wear gloves
• If needed, gown/mask

33
Preventing Transmission of Bloodborne Viruses in
Health-Care Settings

• Promote hepatitis B vaccination
• Treat all blood as potentially infectious
• Use barriers to prevent blood contact
• Prevent percutaneous injuries
• Safely dispose of sharps and blood-contaminated
  materials

34
EXPOSURE CONTROL PLAN

• Written Document
• Accessible to all personnel
• Update at least annually
• Or when alterations in procedures create new
  occupational hazards

35
EXPOSURE CONTROL PLAN

• KEY ELEMENTS
• Identification of job classifications/tasks where
  there is exposure to blood/OPIM.
• Schedule of how/when provisions of standard will
  be implemented.
• Methods of communicating hazards to staff.
• Need for Hepatitis B vaccination.
• Post exposure evaluation and follow-up.

36
EXPOSURE CONTROL PLAN

• KEY ELEMENTS
• Recordkeeping/compliance methods
• Engineering/work practice controls
• Personal protective equipment (PPE)
• Housekeeping
• Procedures for postexposure evaluation and
  follow-up

37
TRAINING

• Initial training
• Provided at time of initial assignment to tasks
  with occupational exposure or when job tasks
  change.
• Annual refresher training
• Employer has record keeping responsibility

38
PROGRAM

• Communicate hazards
• Identify/control hazards
• Preventive measures
• Hepatitis B vaccine
• Engineering controls
• Safe work practices
• PPE
• Housekeeping

39
HEPATITIS B VACCINATION

• Effective in preventing hepatitis B
• 95 develop immunity
• 3-dose vaccination series
• Test for antibodies to HBsAg 1 to 2 months after
  3-dose vaccination series completed.
• Re-vaccinate those who do not develop adequate
  antibody response.

40
HEPATITIS B VACCINATION

• Safe, effective, and long-lasting
• Booster doses of vaccine and periodic serologic
  testing to monitor antibody concentrations after
  completion of the vaccine series are not
  necessary for vaccine responders.

41
CONTROL MEASURES

• Engineering and work practice controls
• Needle less systems
• Sharps containers/shuttles
• PPE required when occupational exposure to BBP
  remains after instituting these controls.

42
EXPOSURE CONTROL PLAN Summary

• Employers must implement safer medical devices
• Appropriate, commercially available, and
  effective
• Appropriate
• Based on reasonable judgment in individual cases,
  will not jeopardize patient/employee safety or be
  medically compromised
• Effective
• Based on reasonable judgment, will reduce the
  likelihood of an exposure incident involving a
  contaminated sharp

43
PPE
You got what!?

• Know where yours is

44
PPE

• Gloves
• Surgical mask
• Long-sleeved protective apparel (e.g., bunker)
• Protective eyewear with solid side shields
• Chin-length face shield worn with a surgical mask

45
GLOVES

• Per SOPs wear gloves on all pt contacts.
• Remove gloves after caring
• for a patient.
• Do not wear the same pair of gloves for the care
  of more than one patient.
• Removal grasp at wrist and strip off
  inside-out.

46
EYEWEAR/FACE SHIELD

• Wear when splash, spray, or spatter is
  anticipated.
• Eyewear must have solid side shields.
• Remove by headband or side arms.
• Do not touch shield or lens area.
• May be decontaminated and reused.
• A chin-length face shield may be worn with a mask
  if additional protection is desired.

47
PROTECTIVE APPAREL

• Long sleeves required by OSHA if worn as PPE.
• Wear when splash, spray, or spatter is
  anticipated.
• Remove immediately if penetrated by blood/OPIM.
• Use tie strings to remove and peel off.
• Minimize contact during removal.
• If reusable, place in marked laundry container.

48
PPE

• Employer responsibility
• Will provide, maintain, and replace
• Ensure accessibility in appropriate sizes
• Provide alternative products (e.g., latex-free
  gloves, powderless gloves, glove liners)
• Will ensure employee use
• Launder or discard if appropriate

49
HOUSEKEEPING

• Employer must ensure clean/sanitary workplace.
• Work surfaces, equipment, and other reusable
  items must be decontaminated upon completion of
  procedure when contaminated with blood/OPIM.
• Barriers protecting surfaces/equipment must be
  replaced when contaminated or at end of the work
  shift.

50
Postexposure ManagementWound Care

• Clean wounds with soap and water.
• Flush mucous membranes with water.
• No evidence of benefit for
• application of antiseptics or disinfectants.
• squeezing (milking) puncture sites.
• Avoid use of bleach and other agents caustic to
  skin.

51
Postexposure ManagementNotification

• Report Immediately
• Exposed individual must be directed to a
  qualified health-care professional.
• Antiretroviral drugs (if indicated) should be
  administered immediately!

52
Postexposure ManagementThe Exposure Report

• Date and time of exposure
• Procedure detailswhat, where, how, with what
  device
• Exposure details...route, body substance
  involved, volume/duration of contact
• Information about source person
• Information about the exposed person
• Exposure management details

53
Postexposure Management Assessment of Infection
Risk

• Source evaluation
• Presence of HBsAg
• Presence of HCV antibody
• Presence of HIV antibody
• If source unknown, assess epidemiologic evidence

• Type of exposure
• Percutaneous
• Mucous membrane
• Non-intact skin
• Bites resulting in blood exposure
• Body substance
• Blood
• Bloody fluid
• Potentially infectious fluid or tissue

54
Postexposure Management Unknown or Untestable
Source

• Consider information about exposure
• Where and under what circumstances
• Prevalence of HBV, HCV, or HIV in the population
  group
• Testing of needles and other sharp instruments
  not recommended
• Unknown reliability and interpretation of
  findings
• Hazard of handling sharp

55
Postexposure Management Evaluating the Source

• If the HBV, HCV, and/or HIV status of the source
  is unknown, testing should be done.
• Testing should be performed as soon as possible.
• Consult your laboratory regarding most
  appropriate test to expedite obtaining results.
• Informed consent should be obtained in accordance
  with state and local laws.

56
How to live long?
57
The Healthy Way