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Departmental Safety Representative (DSR) Session: Bloodborne Pathogens

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Departmental Safety Representative (DSR) Session: Bloodborne Pathogens Kellie Mayer Bloodborne Pathogens Coordinator * * * * * * Employee Responsibilities Reporting ... – PowerPoint PPT presentation

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Title: Departmental Safety Representative (DSR) Session: Bloodborne Pathogens


1
Departmental Safety Representative (DSR)
SessionBloodborne Pathogens
  • Kellie Mayer
  • Bloodborne Pathogens Coordinator

2
Bloodborne Pathogens
  • Any pathogenic microorganisms or OPIM (other
    potentially infectious materials) present in
    human blood that can cause disease in humans.
  • Goal eliminate or minimize occupational
    exposure to Hepatitis B virus (HBV), Human
    Immunodeficiency virus (HIV), Hepatitis C virus
    (HCV), and other bloodborne pathogens

3
We know blood and blood products are included in
this BBP scope, but what are Other Potentially
Infectious Materials (OPIM)?
4
OPIM includes the following
  • Synovial, pleural, pericardial, and peritoneal
    fluid
  • Cerebrospinal fluid
  • Semen
  • Vaginal secretions
  • Amniotic fluid
  • Saliva (in dental procedures)
  • Any unfixed tissue or organ from a human
  • Any body fluid visibly contaminated with blood
  • All body fluid where it is difficult to
    distinguish between body fluids
  • Cell or tissue cultures that were HIV or HBV
    infected

5
Job Duties with Possible Bloodborne Exposure
  • Drawing/processing blood/body fluids
  • Working in an area where HIV or HBV is produced
    or research is being performed
  • Cleaning glassware or disposing of waste
    contaminated with blood or OPIM
  • Transporting blood or OPIM
  • Working in a laboratory area where equipment or
    work benches can become contaminated either by a
    spill or accident
  • Handling laundry, spills or containers of
    infectious wastes
  • First aid, removing bandages

6
Job classifications in which employees may have
occupational exposure are
  • Athletic personnel
  • Instructors/Professors/ Faculty
  • Childcare Workers
  • Security Personnel
  • Laboratory Staff
  • Housekeeping
  • Facilities services staff
  • MDs, Residents, Interns, PAs
  • Veterinarians and vet staff
  • Nursing Staff RN's, LPN's, NA's
  • Scientific Department Personnel
  • Laundry staff
  • Housing and Resident Life

7
Bloodborne Pathogens Standard
  • 29 CFR 1910.1030, Occupational Exposure to
    Bloodborne Pathogens
  • Needlestick Safety and Prevention Act, P.L.
    106-430 2001 July 2001
  • Exposure Control Plan updated once a year with
    input from staff
  • Hepatitis B vaccine
  • Follow-up protocol after a bloodborne exposure
  • Safety devices and PPE

8
Bloodborne Pathogens Standard
  • The BBP Standard applies to all employers with
    employees with reasonably anticipated
    occupational exposure to blood or OPIM.
  • The Needlestick Safety and Prevention Act
    modified the Bloodborne Pathogens standard expand
    the requirement that employers identify,
    evaluate, and make use of effective safer medical
    devices

9
Modes of transmission of BBP
  • Percutaneous - the direct inoculation of
    infectious material by piercing through the skin
    barrier (needlestick or other accidental injury
    with a sharp, contaminated object)
  • Direct inoculation - exposure of blood or OPIM to
    pre-existing lesions, cuts, abrasions, or rashes
    (dermatitis) provides a route of entry into the
    body.
  • Mucous membrane contact - splashing blood or
    serum into an individual's unprotected eyes,
    nose, or mouth

10
Penetration by contaminated sharps is the most
common mode of transmission of bloodborne
pathogens in the workplace.
11
Hepatitis B Virus (HBV)
  • Hepatitis B is caused by a virus that attacks the
    liver and can cause lifelong infection,
    cirrhosis, liver cancer, liver failure, or death.
  • In 2003, an estimated 73,000 people were infected
    with HBV. People of all ages get hepatitis B and
    about 5,000 die per year of sickness caused by
    HBV.

12
Hepatitis B Virus
  • About 30 of infected persons have no sign or
    symptoms of HBV.
  • If symptoms occur, they usually begin to appear
    on the average of 12 weeks (range 9-21 weeks)
    after exposure to hepatitis B virus.
  • If you have symptoms, they might include
  • jaundice abdominal discomfort
  • dark urine clay-colored bowel movements
  • joint pain fatigue
  • loss of appetite nausea

13
HBV IS PREVENTABLE!A safe effective vaccine
is available.
  • If the vaccine is administered before infection,
    it prevents the development of the disease and
    the carrier state in almost all individuals.
  • Hepatitis B vaccine consists of a series of three
    injections initial, one a month later, and one
    six months from the first.
  • Available FREE of charge from employer for
    high-risk employees

14
HIV
  • HIV (human immunodeficiency virus) is the virus
    that causes AIDS (Acquired Immune Deficiency
    Syndrome). Once a person has been infected with
    HIV, it may be many years before AIDS actually
    develops.
  • HIV kills or damages cells in the bodys immune
    system, gradually destroying the bodys ability
    to fight infection and certain cancers.

computer generated art quality graphics of HIV
was done by Russell Kightley of Canberra,
Australia.
15
HIV
  • As of December 2001, occupational exposure to HIV
    has resulted in 57 documented cases of HIV
    seroconversion among healthcare personnel (HCP)
    in the US.
  • The average risk for HIV transmission after a
    percutaneous exposure to HIV-infected blood has
    been estimated to be approximately 0.3.
  • HIV does not survive well outside the body,
    making the possibility of environmental
    transmission remote.

16
HIV
  • Some infected with HIV have no symptoms for up to
    ten years.
  • Within a month or two after exposure to the virus
    some experience flu-like illness such as
  • fever, headache, fatigue, weight loss, diarrhea,
    night sweats, enlarged lymph nodes
  • These symptoms usually disappear within a week to
    a month and are often mistaken for those of
    another viral infection. During this period, the
    individual is very infectious.

17
HCV
  • Hepatitis C virus (HCV) is a liver disease
  • After a needlestick or sharps exposure to HCV
    positive blood , about 1.8 healthcare workers
    will get infected with HCV.
  • Recent studies suggest that HCV may survive on
    environmental surfaces at room temperature at
    least 16 hours, but no longer than 4 days.

18
HCV
80 of persons infected have no signs or symptoms
for HCV. When present, symptoms may include
  • jaundice
  • fatigue
  • dark urine
  • abdominal pain 
  • loss of appetite
  • nausea

19
Occupational Exposure Prevention
  • The risk of occupational exposure can be
    minimized or eliminated using a combination of
    engineering and work practice controls, personal
    protective clothing and equipment, training,
    medical surveillance, warning signs or labels,
    and other provisions described in this next
    section.  

20
Standard Precautions
  • Guidelines to decrease the risk of occupational
    exposure to blood or body fluids
  • A system of infection control which assumes that
    every direct contact with body fluids is
    infectious and requires every employee exposed to
    direct contact with body fluids to be protected
    as though such body fluids were infected with a
    bloodborne pathogen
  • Provides adequate protection against bloodborne
    infections from both humans and animals

21
  • Engineering Controls means controls (e.g., sharps
    disposal containers, self-sheathing needles or
    shielded needle devices, needleless devices,
    blunt needles, plastic capillary tubes) that
    isolate or remove the bloodborne pathogens
    hazards from the workplace.
  • Work Practice Controls means controls that reduce
    the likelihood of exposure by altering the manner
    in which a task is performed such as prohibiting
    recapping of needles by a two-handed technique.

22
Engineering and Work Practice Controls
  • The employer must
  • Evaluate available engineering controls (safer
    medical devices)
  • Train employees on safe use and disposal
  • Implement appropriate engineering controls/devices

23
Personal Protective Equipment
  • Gloves (latex or nonlatex)
  • When to use them
  • when there is reasonable anticipation
  • of employee hand contact with blood, OPIM,
    mucous membranes, or non-intact skin
  • when handling or touching contaminated surfaces
    or items.

24
Latex Allergies
  • Latex gloves have proven effective in preventing
    transmission of many infectious diseases to
    health care workers. However, for some workers,
    exposures to latex may result in allergic
    reactions.
  • For further reading
  • http//www.cdc.gov/niosh/topics/latex/
  • http//www.osha.gov/SLTC/latexallergy/index.html

25
Personal Protective Equipment
  • Gowns, aprons, fluid-resistant clothing
  • Face shields, eye protection (safety glasses,
    goggles)
  • Surgical mask and/or N-95 respirator
  • Surgical caps, shoe covers

26
Even though the use of PPE is very important in
controlling exposure to BBPs, it is your last
line of defense against exposure if engineering
and work practice controls fail.
  • Do not rely only on PPE for protection.

27
Housekeeping Sharps Disposal
  • Keep sharps container upright,
  • readily available in the work area
  • Never place sharps into the regular trash
  • Use a leak-proof, puncture-resistant
  • sharps container labeled with the biohazard
    symbol
  • Do not overfill - dispose of sharps container as
    biohazard waste when it is 2/3 full

28
Training
  • OSHA standards require that all employees with
    occupational exposure participate in a training
    program. 
  • Training must be provided at the time of initial
    assignment to tasks where occupational exposure
    may take place and at least annually thereafter. 

29
Warning Signs and Labels
  • Fluorescent orange or orange-red label
  • with word Biohazard and biohazard symbol in
    contrasting color must be provided on
  • Containers of regulated waste
  • Refrigerators/freezers used to store blood/OPIM
  • Containers used to store, transport, or ship
    blood/OPIM
  • Contaminated equipment
  • Red bags may be substituted for biohazard labels
    on biohazardous waste bags.

30
Housekeeping Decontamination
Work surfaces should be decontaminated with an
appropriate disinfectant such as 10 bleach
solution or an EPA approved disinfectant after
completion of procedures, immediately or as soon
as feasible when surfaces are overtly
contaminated or after any spill, and at the end
of the work shift.
31
What is the difference between cleaning and
disinfecting?
  • Cleaning and disinfecting are not the same thing.
    In most cases, cleaning with soap and water is
    adequate. It removes dirt and most of the germs.
  • You should disinfect areas where there are both
    high concentrations of dangerous germs and a
    possibility that they will be spread to others.
  • Disinfectants, including solutions of household
    bleach, have ingredients that destroy bacteria
    and other germs.

32
Exposure Control Plan
  • The ECP must be updated annually to include
  • changes in technology that reduce/eliminate
    exposure
  • annual documentation of consideration and
    implementation of safer medical devices
  • solicitation of input from non-managerial
    employees

33
Employee Responsibilities
  • Completing training/orientation as required
  • Following the Exposure Control Plan and the
    Standard Precautions Policy
  • Using work practices, engineering controls, and
    personal protective equipment as outlined in the
    Exposure Control Plan
  • Obtaining the HBV vaccine or signing the
    declination form

34
Employee Responsibilities
  • Reporting exposure incidents to their supervisor
    and assisting the supervisor in completing First
    Report of Injury/Illness and EPINet Forms
  • Pursuing follow-up care after an occupational
    exposure

Failure to follow these policies could result in
disciplinary action.
35
Recordkeeping
  • Sharps Injury Log
  • Maintained by Office of Environmental Health
    Safety (OEHS) independently from OSHA 300 Log
  • Contains necessary documented information for
    each needlestick/sharp related incident
  • type and brand of device involved
  • department or area of incident
  • description of incident
  • Training records 3 years

36
Recordkeeping
  • Confidential medical records duration
  • of employment 30 years
  • EPINet (Exposure Prevention Information Network)
    forms
  • helps to track trends, problem areas, types of
    medical devices, etc. related to BBP occupational
    exposure incidents and injuries
  • First Report of Injury and Illness Form

37
Where do I go and what must I do if I am exposed?
38
What to Do Post-Exposure
  • Wash exposed area with soap and water for 5
    minutes
  • if at TNPRC, please use one of the bite kits that
    are available in each work area for your 15
    minute scrub using betadine
  • if eye or mucous membrane contact, flush with
    sterile water or saline for 5 minutes
  • Report the incident to your supervisor.
  • Complete First Report of Occupational
    Injury/Illness Form
  • Report for medical evaluation (please review the
    next few slides for places to report)

39
Where to Go Post-Exposure General Medical
Surveillance
  • Any bloodborne pathogens exposure incident is an
    event for which immediate attention must be
    sought, as the effectiveness of prophylaxis
    depends on the immediacy of its delivery.
  • Seek medical attention in the same manner that it
    would be sought should any occupational injury
    occur (e.g., emergency room, physician's office,
    urgent care clinic).

40
Where to Go Post-Exposure Injuries Sustained at
TNPRC (Tulane National Primate Research Center)
  • Go to Employee Health (B- Bldg) at TNPRC for
    medical evaluation during business hours.
  • Report to Employee Health at TNPRC for follow-up
    visits
  • If an exposure incident occurs after hours or on
    the weekend, your supervisor will notify the
    veterinarian on call and page the nurse at
  • (985) 966-6515 for further instructions.

41
Where to Go Post-Exposure Injuries Sustained
while on Rotation at Another Facility
  • If on rounds at another hospital, report there
    for initial visit but you must still notify the
    Bloodborne Pathogen Coordinator at (504) 988-6608.

42
It is VERY important to bring the patients
source blood (if available) with you when you
report for initial evaluation. Your care is
dependant on the HIV, HBV, and HCV status of the
source patient to whom you were
exposed.Similarly, when dealing with nonhuman
primates it is important to note which monkey was
the source for the bite/scratch to allow for
proper evaluation of infection in the source
animal.
Failure to do this can result in delayed or
unnecessary treatment for you.
43
Summary of Post-Exposure Employee Responsibilities
  • Wash/flush exposed injury area for 5 minutes (15
    minutes if at TNPRC for possible B virus
    exposure).
  • 2. Promptly report the incident to your
    supervisor.
  • 3. Complete the First Report of Injury and EPINet
    forms.
  • 4. Report to appropriate clinic/emergency
    department (depending on your location) for
    medical evaluation.

44
You can always reach the Bloodborne Pathogens
Coordinator 24 hours a dayby work cell phone
(504)419-1391 or call (504)988-5486 and press 1.
45
  • Tulane UniversityOffice of Environmental Health
    Safety (OEHS)Please contact the BBP
    Coordinator for questions, comments, and/or
    interactive discussion. Kellie C. Mayer
    (504-419-1391) kmayer_at_tulane.edu
  • If unable to proceed to quiz, type the link below
    into your browser
  • https//pandora.tcs.tulane.edu/ehs/enterssn.cfm?te
    stnum25

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