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Caring for the Worker Potentially Exposed to Bloodborne Pathogens

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liver disease: 15-25% of chronic inf. Immunity: Protective antibody. response identified ... liver disease: 3% of chronic inf. Immunity: No protective antibody ... – PowerPoint PPT presentation

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Title: Caring for the Worker Potentially Exposed to Bloodborne Pathogens


1
Caring for the Worker Potentially Exposed to
Bloodborne Pathogens
  • Lawrence D. Budnick, MD, MPH
  • Associate Professor of Medicine
  • Director, Occupational Medicine Service
  • New Jersey Medical School
  • University of Medicine Dentistry of New Jersey
  • December 10, 2001

2
Objectives
  • Risks of exposure to blood and body fluids (BBFs)
  • Current regulatory environment regarding
    bloodborne pathogens (BBPs)
  • Prevention methods
  • Clinical management
  • - Assessment - Treatment
  • - Counseling - Follow-up

3
Health Care Workers
gt10 million persons in the US
  • Paid and unpaid persons whose activities involve
  • Working in a health care setting
  • Contact with patients
  • Contact with potentially infectious materials
    from patients in a health care setting
  • May include, but not limited to
  • Patient care nurses, physicians, EMS personnel,
    part-time staff, temporary contractors, students
  • Non-patient care volunteers, dietary, clerical,
    janitorial, maintenance, housekeeping

4
Potential Bloodborne Pathogens
  • B virus (Herpesvirus simiae) Blastomycosis
    Brucellosis Creutzfeld-Jakob disease
  • Cyptococcosis Cytomegalovirus Diphtheria
    Ebola fever Gonorrhea (cutaneous) Hepatitis B
    Hepatitis C Herpes Human
    immunodeficiency virus Leptospirosis
  • Malaria Mycobacteriosis Rocky Mtn Spotted
    FeverMycoplasmosis Prion
    Sporotrichosis Scrub Typhus
    Sporotrichosis Staphylococcus aureusStreptococcu
    s Syphilis Toxoplasmosis
    Tuberculosis

5
Hepatitis B Virus
  • Hepadnavirus
  • 42 nm double-
  • stranded DNA
  • 27 nm
  • nucleocapsid
  • core (HBcAg)
  • Outer lipoprotein
  • coat contains
  • surface antigen
  • (HBsAg)
  • 4 major subtypes

6
Hepatitis B - Clinical Features
Incubation period Average 9-13
weeks Range 6-26 weeks Clinical
illness 70 Chronic infection 2-8 Death
from chronic liver disease 15-25 of chronic
inf. Immunity Protective antibody
response identified
7
Hepatitis B Epidemiology
  • Incidence 80,000 cases/year
  • Was 450,000 in the 1980s
  • Prevalence 1.25 million are chronically infected
  • In 1994, 1000 health care workers developed HBV
    infection
  • Approx. 200 HCWs died each year

Source CDC, 1991 1997
8
Risk Factors for Acute Hepatitis B, US, 1992-93
Heterosexual (41)
Injecting Drug Use (15)
Homosexual Activity (9)
Household Contact (2)
Health Care Employment (1)
Unknown (31)
Other (1)
Includes sexual contact with acute cases,
carriers, and multiple partners. Source CDC
Sentinel Counties Study of Viral Hepatitis
9
Hepatitis C Virus
  • Hepapavirus
  • Enveloped RNA
  • virus
  • 90 subtypes

10
Hepatitis C - Clinical Features

Incubation period Average 6-9
weeks Range 2-28 weeks Clinical
illness 20-40 Chronic hepatitis 70-85 Death
from chronic liver disease lt3 of chronic
inf. Immunity No protective antibody
response identified
11
Hepatitis C Epidemiology
  • Incidence 40,000 cases/year
  • Was 240,000 in the 1980s
  • Prevalence 3.9 million or 1.8 persons have been
    infected with HCV
  • 2.7 million are chronically infected

Source CDC, 1991 1997
12

Click for larger picture
13
Occupational Transmission of HCV via NSI
14
Human Immunodeficiency Virus
  • Retrovirus
  • Core of diploid RNA
  • Spherical lipid
  • envelope
  • 2 major types

15
Acute HIV - Clinical Features
  • Incubation period Avg 2-4 weeks, range 1-12 wks
  • Acute antiretroviral syndrome
  • 50, 1-2 weeks duration
  • Most common symptoms
  • - Fever - Lethargy - Pharyngitis
  • - Lymphadenopathy - Maculopapular rash
  • - Myalgia - Arthralgia
  • Immunity No protective Ab response identified
  • AIDS incidence 50 in 10 years without Rx

16
HIV Epidemiology in the U.S.
  • HIV AIDS
  • Incidence 42,156 cases/year
  • Prevalence 450,151 persons are living with
    HIV/AIDS

Source CDC,2001
17
U.S. HCWs with Occupationally Acquired AIDS/HIV,
to October 2001
Documented N 57
Possible N 138

Other Dental worker, dentist, EMT/paramedic,
housekeeper, health aide, other technician
18
Potential for Transmission of HIVAfter
Percutaneous Exposure
19
Potential for Transmission of Bloodborne Pathogens
CDC. MMWR 2001.
20
Concentrations of Hepatitis B Virus in Various
Body Fluids

Low/Not
High
Moderate
Detectable
blood
semen
urine
serum
vaginal fluid
feces
wound exudates
saliva
sweat
tears

breast milk
21
Needlestick Injuries
  • 6-800,000 annually in US
  • 16,000 (2) of these are likely to be
    contaminated by HIV
  • Up to 80 of all unintentional exposures to blood
    are caused by needlestick injuries

22
Needlestick/Sharps Reports Among Health Care
Workers
  • Exposure Prevention Information Network
  • 1993-95
  • 77 hospitals
  • 10 639 cases
  • 91 medical students

23
Type of Sharps as Cause of Percutaneous Injuries,
NaSH Hospitals, 6/95-7/99
N4951
24
Items Most Frequently Causing Sharp-Object
Injuries, 1995
Adapted from Ippolito et al, 1997
Click for larger picture
25
Reported Cause of Percutaneous Injuries, NaSH
Hospitals, 6/95-7/99
N3057
26
When Do Needlesticks Happen?
27
Centers for Disease Control and Prevention
  • 11/99 NIOSH Alert Preventing Needlestick Injuries
    in Health Care Settings
  • DHHS (NIOSH) Publ 2000-108
  • 6/29/01 Updated USPHS Guidelines for the
    Management of Occupational Exposures to HBV, HCV,
    and HIV and Recommendations for Postexposure
    Prophylaxis
  • MMWR v 50, RR-11

28
NIOSH Alert - Employers
  • Improved engineering controls in a comprehensive
    program involving workers
  • Eliminate the use of needles where possible
  • Implement the use of devices with safety features
    and evaluate their use for effectiveness and
    acceptability
  • Analyze injuries to identify hazards and injury
    trends
  • Set priorities and strategies for prevention
  • Training
  • Modify work practices that pose a hazard
  • Promote safety awareness
  • Reporting and timely follow-up
  • Evaluate program effectiveness and provide
    feedback

29
NIOSH Alert -Health Care Workers
  • Avoid needles where safe effective alternatives
    available
  • Help employer select and evaluate safety devices
  • Use safety devices
  • Avoid recapping needles
  • Plan for safe handling and disposal before
    procedure
  • Dispose of used needles promptly in sharps
    disposal containers
  • Report all sharps-related injuries promptly
  • Tell your employer about hazards
  • Participate in training and follow recommended
    infection prevention practices

30
OSHA General Duty Clause
  • Section 5 (a) (1) of the OSH Act
  • Each employer shall furnish to each of his
    employees employment and a place of employment
    which are free from recognized hazards that are
    causing or are likely to cause death or serious
    physical harm to his employees.

31
OSHA Guidelines
  • Management commitment
  • Employee involvement
  • Worksite analysis
  • Hazard prevention and control
  • Engineering design
  • Administrative controls
  • Personal protective equipment
  • Medical management
  • Prevention
  • Early identification
  • Systematic evaluation
  • Conservative treatment
  • Training and education
  • Recordkeeping

32
OSHA BloodbornePathogens Actions
  • 12/6/91 - Occupational Exposure to BBP Final
    Rule. 29 CFR 1910.1030
  • 1988, 1990, 1992, 1999, 2001 - OSHA Instruction
    Enforcement Procedures for the Occupational
    Exposure to BBP, CPL-2-2.69
  • 11/6/00 - Needlestick Safety and Prevention Act
  • 1/18/01 - Revised BBP Standard
  • 1/18/01 - Recording and Reporting Occupational
    Injuries and Illnesses. 29 CFR 1904
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