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OSHA/Infection Control Annual Update Training - 2008

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Title: OSHA/Infection Control Annual Update Training - 2008


1
OSHA/Infection Control Annual Update Training -
2008
2
Disease Numbers 2006-2007
  • 2006
  • AIDS 36,817
  • Hepatitis B 4,713
  • Hepatitis C 766
  • Syphilis 9,758
  • TB 13,779
  • WNV 5,269
  • 2007
  • AIDS 38,151
  • Hepatitis B 4,519
  • Hepatitis C 845
  • Syphilis 11,466
  • TB 13,299
  • WNV 3,404

  • CDC, MMWR, August 22, 2008

3
Local Disease Stats-
  • AIDS -
  • Hepatitis B -
  • Hepatitis C
  • TB
  • Syphilis-
  • WNV -
  • MMWR, August 22, 2008

4
Exposures - 2007
  • Bloodborne -
  • Airborne -

5
Ryan White CARE Act
  • P.L. 101-381 (1990)
  • Subpart II- Notification of Possible Exposure to
    Infectious Diseases
  • April 20, 1994 Effective Date
  • December 9, 2006 Repeal Date
  • (P.L. 109-415)

6
What does this mean ?
  • Training DICOs is even more important
  • OSHA offers some assistance

7
Why This Law Is Needed
  • Requires all emergency response employers to have
    a designated infection control officer
  • Provides coverage for state and local governments
    in states without OSH plans
  • Provides coverage for volunteers
  • Forces medical facilities to provide source
    patient disease status info in timely manner

8
RYAN WHITE LAW
  • Current efforts
  • working with congressman Waxmans office
  • working with CDC representative
  • NAEMSP/IAFF, NAEMT/NASEMO

9
Update November 2008
  • Ryan White Law to be back in 2009!

10
Refresher/Reminders

11
Defining Exposure - Bloodborne Pathogens
  • A contaminated Needlestick Injury
  • Blood/OPIM in contact with the surface of the
    eye, inner surface of the nose or mouth

12
Defining Exposure- Bloodborne Pathogens
  • Blood/OPIM in contact with an open area of the
    skin
  • Cuts with sharp objects covered with blood/OPIM
  • Human bites (bloody)

13
Define - Other Potentially Infectious Materials
-OPIM
  • CSF
  • Synovial fluid
  • Pleural fluid
  • Amniotic fluid
  • Peritoneal fluid
  • Any body fluid containing gross visible blood

14
Non -Risk Body Fluids, HIV, HBV,HCV
  • Tears
  • Saliva
  • Urine
  • Stool
  • Sweat
  • Vomitus
  • Nasal Secretions
  • Sputum
  • CDC, May 15, 1998, June 29, 2001, Sept. 2005

15
Adult Recommendations
  • Updated recommendations for adult vaccination
    published
  • December 8, 2006
  • All unvaccinated adults

December 8, 2006
16
HBV Infection Rate- US
  • 0.4

CDC, September, 2008
17
Update
  • HBV infection in police officers, firefighters
    and corrections officers has been lower that that
    of the general population

CDC, Dec. 8, 2006
18
Hepatitis B Vaccine
  • Offers protection via immunologic memory
  • There is NO formal requirement or recommendation
    for a booster
  • Titer 1-2 months after completion of vaccine
    series is required- OSHA enforcing
  • CDC, 1992,1997, June 29, 2001, December 2006

19
Hepatitis B Vaccine Titers
  • If titer not never performed, DO NOT go back and
    do one
  • Titer would be done if an exposure occurs
  • Once you have a positive titer, you never have to
    titer test again even if an exposure occurs
  • CDC, 1997, June 29, 2001, Dec. 2006

20
Hepatitis C Cases
  • Incident rate continues to decline
  • Rate in US- 1.3
  • September, 2008

21
CDC- Tattoos Body Art
  • CDC has published info on website
  • www.cdc.gov/Features/BodyArt

22
AxSYM Anti HCV
  • New rapid test for HCV
  • Takes 23 mins.
  • More accurate than other antibody tests
  • Performed on the source !
  • Cost 65.00

23
Reminder -
  • If you are exposed to a hepatitis C positive
    patient, you should have a blood test in 4- 6
    weeks
  • HCV-RNA (blood test)

24
Hepatitis C Early Treatment
  • Studies Germany France
  • HCV-RNA positive begin treatment
  • 24 weeks clear viral load

25
Hepatitis C Post-Exposure
  • No vaccine available
  • No post- exposure prophylaxis available
  • CDC, June 29, 2001

26
HIV Origin Confirmed
  • Wild Chimpanzee

J. Science, May 26, 2006
27
Infected Healthcare Workers- Occupational
Infection-HIV
  • 1978 - December 2006
  • 57 documented cases
  • 0 in fire/EMS personnel
  • 49 were sharps related exposures

HIC, Jan., 2007(CDC)
28
No new cases since 2000
29
HIV/AIDS
  • North America Western Europe
  • Cases have remained the same

Infectious Disease News, January 2007
30
HIV/AIDS
  • Cases are increasing in Russia and China

31
Rapid HIV Tests
  • Rapid HIV Test - currently available
  • OraQuick
  • Reveal
  • Uni-Gold
  • Multispot
  • Clearview

CDC January 2007
32
OSHA Rapid HIV Testing
  • OSHA states that an employers failure to use
    rapid HIV testing when testing is required by
    paragraph (f)(3)(ii)(A) would usually be
    considered a violation of that provision

OSHA Letter, Jan. 7, 2007
33
Testing Issues - Post Exposure
  • If source patient is negative with rapid testing
    no further testing of health-care worker
  • Use of rapid testing will prevent staff from
    being placed on toxic drugs for even a short
    period of time
  • CDC, May , 1998, CDC June 29, 2001, September 2005

34
Question
  • How long do BBP organism live in a deceased
    person?

35
Answer
  • In unrefrigerated bodies, HIV generally survives
    up to 24-36 hours after death. However in
    refrigerated bodies, the survival time of HIV is
    significantly increased.
  • In one study, in bodies that were stored at 6
    degrees Celsius (42.8 degrees Fahrenheit), HIV
    was still viable for up to 6 days.
  • In another study, bodies refrigerated at 2
    degrees Celsius (35.6 degrees Fahrenheit) were
    found to have infectious HIV for up to 16.5
    days.

HIV/AIDS Resources, April 27, 1998
36
Syphilis Cases
  • Continue to rise in the U.S.
  • Post exposure follow up if source is HIV positive
    or Hepatitis C positive
  • Low risk

37
Highest States for cases - 2007
  • District of Columbia
  • California
  • Maryland
  • Georgia
  • Texas

38
CDC - Plan
  • Update plan to eliminate syphilis by 2015

39
Tuberculosis
40
Risk Assessment
  • Based on new formula
  • Three listings
  • Low risk
  • Medium risk
  • Potential for on-going transmission

41
Risk Assessment
  • Based on number of active-untreated TB patients
    transported in the past year

42
Risk Assessment
  • Low Risk
  • Transported less than 3 TB patients
  • Medium Risk
  • Transported more than 3 TB patients

43
Department TB Risk Assessment
  • 2007

44
2005 CDC Guidelines
  • EMS personnel should be included in the
    follow-up contact investigations of patient with
    infectious TB disease. The Ryan White
    Comprehensive AIDS Resources Emergency Act of
    1990 ( Public Law 101-381) mandates notification
    of EMS personnel after they have been exposed to
    a patient with suspect or confirmed infectious TB
    disease. (Title 42 U.S. Code 1994)

45
New Requirements for TB Testing
  • Persons administering 10 hours
    training/observation check off
  • Persons Reading 10 hours training observation
    with an observation check off

CDC, December 30, 2005
46
Fire Department TB Testing- Mississippi
  • 9 firefighters tested positive on 2-step testing
  • NIOSH study conducted
  • Blood test negative
  • Skin testing not read properly
  • Follow CDC risk assessment for need for testing
    yearly

CDC, December 21, 2007
47
Lesson Learned Mississippi Study
  • Evidence based practice is important
  • Blood test is more accurate
  • Annual testing when not needed is not a benefit

48
TB Skin Testing
  • On hire
  • 2 step testing is required
  • 2nd test given 1-2 weeks after the first

49
CDC Recommendation TSTs
  • To reduce errors if using skin testing
  • Interpret TST results 48-72 hours after
    administration to avoid false-negative results
  • Avoid switching brands of tuberculin as this
    could create potential interpretation errors and
    false-positive results
  • Read tests in millimeters along the horizontal
    axis of the forearm to ensure consistency among
    TST readers

50
Reduce TST Reading Errors
  • Follow manufacturers guidelines for storage and
    use of tuberculin products
  • Document lot number, brand name, and manufacturer
    for the product being used
  • Receive training to distinguish induration from
    erythema
  • If higher numbers of positive results than
    expected occur, investigation should be
    conducted. False-positive results increase costs
    and expose medical personnel to unnecessary
    medication that can have serious side effects.

CDC, 2008
51
New Version TB Blood Test
  • QFT-T (In-tube)
  • FDA approved October 2007
  • Less time consuming to perform
  • More accurate

52
Multi-Drug Resistant TB
  • Another airline alert
  • December, 2007
  • Responsibility of Customs Border Protection

53
Transmission - Plane
  • TB is generally not spread by casual contact,
    but typically requires relatively prolonged
    contact in shared air space. The environment on
    long flights in commercial aircraft, particularly
    those of 8 or more hours in length, has been
    previously implicated in TB transmission,
    especially to passengers seated in close
    proximity

Dr. Cetron, US Public Health, July,2007
54
West Nile Virus - Update
  • Cases 2007 3,404

55
West Nile Virus - 2007
  • Cases moved westward
  • Highest cases
  • Colorado
  • California
  • North Dakota
  • Wyoming
  • Texas
  • Mississippi
  • Oklahoma

CDC, Dec. 11, 2007
56
Flu Vaccine - Annual
  • Direct patient care
  • All healthcare workers

57
CDC Take 3 for the Flu Season.
1. Take time to get vaccine
2. Take everyday actions to stop germs like
frequent hand washing and covering coughs and
sneezes. 3. Take antiviral drugs if your doctor
says you need them.
58
FluMist Nasal Spray
  • For healthy persons ages
  • 5 49 (2-5yrs.)
  • Does not need to be stored frozen
  • Do not take if pregnant live virus vaccine
  • No thimerisol
  • Is egg based
  • Cost reduced

59
CDC Flu Vaccine Program
  • Employers must offer
  • Employers must pay
  • Employees who decline - sign a declination form

CDC, February 24, 2006/2008
60
Department Flu Vaccine Participation
  • Percent

61
Flu Vaccine Program Rationale
  • Reduce annual illness in staff
  • Increase protection from flu viruses
  • Reduction of Flu will assist in identification of
    a pandemic

62
Mask Use and the Flu
  • Health-care Personnel
  • A surgical or procedure mask should be worn by
    health-care personnel who are in close contact
    (i.e., within 3 feet) with a patient who has
    symptoms of a respiratory infection, particularly
    if fever is present, as recommended for standard
    and droplet precautions. These precautions should
    be maintained until the patient has been
    determined to be noninfectious or for the
    duration recommended for the specific infectious
    agent.

CDC, 2008
63
Vaccine for 2008/09
  • A-Brisbane/59
  • A-Brisbane/10
  • B-Florida

CDC, MMWR, July 17, 2008
64
Work Restriction
  • Restrict ill workers from the workplace
  • use sick time
  • protect co-workers
  • protect patients

65
MRSA Basic Issues

66
MRSA
  • Soft tissue infection

67
MRSA
  • Often confused with a spider bite

68
MRSA Community Cases
  • Outbreaks
  • Close contact sports
  • Injection drug users
  • Inmates
  • Group home residents
  • Men who have sex with men
  • Gyms

69
Risk the 5 Cs
  • Crowding
  • Contact skin to skin
  • Compromised skin
  • Contaminated surfaces
  • Cleanliness

Dr. William Basco
70
New Quick Test
  • FDA approved on 1/2/08
  • BD GeneOhm StaphSR Assay
  • Blood test

71
MRSA
  • Organism -
  • Grows more slowly than other organisms
  • Make take up to 18 hours or more

72
Prevention for HCWs
  • Handwashing -
  • after touching blood/body fluids
  • after touching contaminated objects
  • after glove removal

73
MRSA Treatment
  • Colonization with MRSA is not treated
  • Infection with MRSA is treatable with several
    antibiotics
  • Vancomycin
  • Synercid
  • Tygacil

74
Issues - MRSA
  • Open areas on skin should be covered with a
    dressing- too large- limit work tasks
  • Do not share PPE or fire gloves or clothing

75
Issues - MRSA
  • Use a barrier between skin and exercise equipment
  • Clean exercise equipment daily (1100 b/w)

76
Laundry Issues - MRSA
  • Launder clothing as usual
  • No special temp (120 160) normal washing temp
  • No special solution needed

77
Snake Oil Buyer Beware
  • No special solution is needed to kill MRSA
  • Use bleach/water or any EPA approved disinfection
    cleaning solution

78
Remember to Clean Your Workplace
  • Nothing beats plain old cleaning

79
Compliance Monitoring
  • Check for compliance with cleaning routines

80
Avian Flu
81
No Rapid Human to Human Transmission Cases
  • Have been documented

September, 2008
82
Avian Flu
  • Outbreak in Vietnam January 2007
  • Outbreak in S. Japan January 2007
  • Outbreak in England February 2007
  • Outbreak in Germany August 2007
  • Outbreak in Egypt December 2007
  • Outbreak So. Korea, 2008

January, 2008, WHO
83
Human Cases
  • Majority of human cases
  • Indonesia

84
Prevention
  • Travel history on patient assessment especially
    with respiratory symptoms

85
CDC Clarifies Vaccines/Immunizations
  • For Disaster Responders

86
CDC Recommends
  • Hepatitis B Vaccine for persons performing direct
    patient care activities
  • Tetanus- booster if not immunized in past 10
    years
  • Td or Tdap can be used

CDC, Emergency Preparedness Response 9/3/08
87
OSHA Most Common BBP Citations - 2007
  • Failure to have an Exposure Control Plan
  • Failure to update Exposure Control Plan annually
  • Failure to offer new hire training at no cost and
    during work hours
  • Failure to use engineering/work practice controls
  • Failure to offer HBV vaccine within 10 days of
    hire
  • Failure to have a sharps injury log
  • Failure to discard sharps into sharps containers
    ASAP
  • Failure to have employee input to selection of
    needle safe devices
  • Failure to reflect review of technology in the
    ECP
  • Failure to offer annual training

OSHA Jan. 2008
88
Questions Answers
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