Transcript Tulane University Bloodborne Pathogens Training

Annual Blood Borne Pathogen
Training (Healthcare & Research version)
Environmental Health &
Safety Department
Jay Abbt
Daron White
• Annual update for PVAMU employees
with potential exposure to blood or other
potentially infectious materials (OPIM)
The following program meets the training requirements
set forth by the OSHA Bloodborne Pathogens Standard.
This training module is a self-study designed to provide a
review of the following:
• Bloodborne pathogens (BBP)
• Modes of transmission of BBP
• Exposure control principles and practices as they
relate to bloodborne pathogens
Bloodborne Pathogens Standard
• OSHA (1991)- “Occupational Exposure to
Bloodborne Pathogens” (29 CFR 1910.1030)
• Revised in 2001 in response to the
Needlestick Safety and Prevention Act
Goal: eliminate or minimize occupational
exposure to Hepatitis B virus (HBV), Human
Immunodeficiency virus (HIV), Hepatitis C
virus (HCV), and other bloodborne pathogens
What are Bloodborne Pathogens
(BBP)?
• Any pathogenic microorganisms or OPIM (other
potentially infectious materials) present in human
blood that can cause disease in humans.
• Primary focus in our setting is HBV, HCV, and
HIV- which will be detailed further in this
presentation.
• Other examples of BBP include microorganisms
that cause:
• malaria, syphilis, babesiosis, brucellosis, leptospirosis,
arboviral infections, relapsing fever, Creutzfeldt-Jakob
disease, HTLV-1, and viral hemorrhagic fever.
• We know blood and blood products are
included in this BBP scope, but what
are Other Potentially Infectious
Materials (OPIM)?
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
Let’s look at each of the
BBP of concern in detail
• HBV, HIV, HCV
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 2006, an estimated 46,000 people
were newly infected with HBV. It is
estimated that 1.25 million Americans
are chronically infected.
Hepatitis B Virus
• HBV infection is a well recognized occupational
risk for healthcare personnel.
• The average volume of blood inoculated during
a needlestick injury with a 22-gauge needle is
approximately 1 µl, a quantity sufficient to
contain up to 100 infectious doses of HBV.
• HBV can survive outside the body at least 7
days and still be capable of causing infection.
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
dark urine
joint pain
loss of appetite
•
•
•
•
abdominal discomfort
clay-colored bowel movements
fatigue
nausea
HBV IS PREVENTABLE!
A safe & effective vaccine is available.
• Hepatitis B vaccine prevents hepatitis B infection and
its serious consequences.
• 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 highrisk employees
What treatment is available for
HBV?
• In the occupational setting, multiple doses of
Hepatitis B Immune Globulin initiated within 1
week following percutaneous exposure to
hepatitis B surface antigen-positive blood
provides an estimated 75% protection from
HBV infection.
• There is no cure available for acute HBV
infection. There are antiviral drugs available
for the treatment of chronic HBV infection.
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
body’s immune system, gradually
destroying the body’s ability to fight
infection and certain cancers.
HIV
As of December 2001, occupational exposure to
HIV has resulted in 57 documented cases of HIV
seroconversion among healthcare personnel
(HCP) in the United States.
At the end of 2003, an estimated 1,039,000 to
1,185,000 persons in the United States were
living with HIV/AIDS, with 24-27% undiagnosed
and unaware of their HIV infection.
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.
HIV
• The average risk for HIV transmission
after a percutaneous exposure to HIVinfected blood has been estimated to
be approximately 0.3%.
• HIV does not survive well outside the
body, making the possibility of
environmental transmission remote.
HIV- no cure or vaccine
available
• Treatment protocols from the U.S. Public Health Service
have been developed using antiretroviral agents from
five classes of drugs to treat HIV infection. These
include:
• the nucleoside reverse transcriptase inhibitors,
nucleotide reverse transcriptase inhibitors,
nonnucleoside reverse transcriptase inhibitors,
protease inhibitors, and a single fusion inhibitor.
• The recommendations provide guidance to effectively
suppress the virus on the basis of HIV transmission risk
represented by the exposure.
HIV
• Side effects associated with the use of antiviral drugs can
be severe.
• The drug regimen is not a cure for AIDS, but it has greatly
improved the health of many people with AIDS and it
reduces the amount of virus circulating in the blood to
nearly undetectable levels.
• Researchers, however, have shown that HIV remains
present in hiding places such as the lymph nodes even in
people who have been treated.
HCV
• Hepatitis C virus is a liver disease
• After a needlestick or sharps exposure to
HCV positive blood , about 1.8%
healthcare workers will get infected with
HCV.
• Estimated 4.1 million (1.6%) Americans
have been infected with HCV, of whom 3.2
million are chronically infected.
HCV
Long term effects of HCV:
• Chronic infection: 75%-85% of infected
persons
• Cirrhosis: 20% of chronically infected
persons
• Deaths from chronic liver disease: 1%-5%
of infected persons may die
• Leading indication for liver transplant
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
HCV
• Currently, there is no cure for hepatitis C, and no
effective vaccine is currently available.
• National recommendations for the control of
occupational exposure to HCV rely more on the
prevention of transmission. In addition, several
blood tests that measure either antibodies to
HCV or HCV-RNA are available for hepatitis C
screening. These tests are useful in determining
current immune status and monitoring ongoing
infection.
How does a bloodborne
infection occur?
• How might I get exposed in the
workplace?
Chain of Infection
Infection Control = Break any link in the chain
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)
Penetration by contaminated sharps is the
most common mode of transmission of
bloodborne pathogens in the workplace.
Modes of transmission of BBP
• 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 in clinical
or laboratory settings poses a genuine risk
of infection.
Duties that might put you at risk
for an occupational exposure:
• Perform drawing of blood from human patients or
animals
• Process blood for experimentation
• Work with human or animal blood or body fluids
• Use unfixed tissue in preparations or
experimentation
• Work in an area where HIV or HBV research is
being performed or produced
• Clean glassware contaminated with blood or OPIM
Duties that might put you at risk
for an occupational exposure:
• Dispose of waste contaminated with blood or
OPIM
• Transport blood or OPIM
• Work in a laboratory where equipment or work
benches can become contaminated
• Handle containers of infectious wastes
• Clean blood spills, including dried blood
• Handle laundry that contains sharps or is soiled
with blood or OPIM
• Perform lifesaving procedures
Risk Factors for Infection
• Pathogenicity of organism
• Dose (how much blood or infectious agent)
• Route of entry (injection vs. contact with
mucous membrane or open wound)
• Host susceptibility
• Work practices
• Now that we have reviewed how
an exposure can occur, let’s look
at how to prevent exposure.
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, HBV vaccination, warning
signs or labels, and other provisions
described in this training section.
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
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
Employee Responsibilities
• Reporting exposure incidents to their
supervisor and assisting the supervisor in
completing First Report of Injury Form
• Pursuing follow-up care after an occupational
exposure
Failure to follow these policies could result
in disciplinary action.
Exposure Control Plan
• Written plan provided to eliminate or
minimize occupational exposure to BBP.
• PVAMU Safety Manual
• Can be obtained from EHS website.
• Reviewed annually.
Exposure Control Plan
Updates include:
• Changes in technology that reduce/eliminate
exposure (engineering controls)
• Annual documentation of consideration and
implementation of safer medical devices
• Input from non-managerial employees (who
are responsible for direct patient care) in
selecting and evaluating safer medical devices
Engineering Controls
• Sharps with Engineered Sharps Injury
Protection (SESIP)– a non-needle sharp or
needle with a built-in safety feature or
mechanism that effectively reduces the risk of
an exposure incident
Examples include:
Self-sheathing syringe
More Examples of Engineered
Sharps Safety Devices
In use
After use
Retractable needle technology
Add-ons (needle covers)
Retractable lancets
Self-blunting needles
Engineering Controls
• Needleless Systems = Device
that does not use a needle for:
• collection of body fluids
• administration of
medication/fluids
• any other procedure with
potential percutaneous
exposure to a contaminated
sharp
Work Practice Controls
• Contaminated needles/sharps shall not
be bent, recapped or removed unless
there is no feasible alternative or if
required by a specific medical procedure
• Such bending, recapping, or removal
must be done though use of mechanical
device or a one-handed technique
• Use puncture-resistant sharps
container for disposal of sharps
Work Practice Controls
• No food/drink/smoking, handling of contact
lenses, or application of cosmetics in work
area where there is potential for exposure
• Minimize splashing, spraying, spattering,
and generation of droplets
• No mouth pipetting
• Use secondary containment for transport,
shipping, or storage of containers
• Decontaminate surfaces and equipment
Handwashing
• Employees must wash their hands
immediately or as soon as feasible
after removal of gloves or other
personal protective equipment.
• Wash as soon as possible if gross
contamination occurs
• Alternate methods:
– Antiseptic towelettes
– Waterless handwashing gels
Personal Protective Equipment
(PPE)
PPE is appropriate only if it does not
permit blood/OPIM to pass through
and/or reach the employee’s
clothing, skin, eyes, mouth, or other
mucous membranes under normal
use.
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 performing vascular access procedures
• when handling or touching contaminated surfaces
or items.
– Remove prior to leaving the work area and discard as
biohazard waste
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
Personal Protective Equipment
• Gowns, aprons, fluid-resistant
clothing
• Face shields, eye protection
(safety glasses, goggles)
• Respirators
• Surgical caps, shoe covers
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.
Training
• Training is required:
– at the time of initial employment and assignment
(or transfer) to job tasks where occupational exposure may
occur
– within one year of the employee's previous training and
annually thereafter (if the employee remains in an at-risk
position)
– when changes such as modification of tasks or procedures
or institution of new tasks or procedures affect the
employee's potential for occupational exposures, and as
new standards for safe work practices evolve.
HBV Vaccination
• FREE to employee - paid for by your department
if you are at high-risk for exposure
• If you initially refuse the vaccine, you may
change your mind later and still receive it.
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.
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
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.
Where do I go and
what must I do if I am
exposed?
What to Do: Post-Exposure
• Wash exposed area with soap and water for 5 minutes
– if eye or mucous membrane contact, flush with sterile water or saline
for 5 minutes
• Report the incident to your supervisor, EHS AND
Health Center immediately.
• Complete First Report of Injury Form
• Report to Health enter for medical evaluation
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). You should not use your personal insurance
when receiving care for an occupational
injury/exposure.
• Don’t delay in reporting for
medical care - early treatment can
mean the difference between life
and death!
Recordkeeping
• Injury Log
– Maintained by Human Resources in cooperation
with Environmental Health & Safety Department.
– 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
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
REMEMBER:
Don't wait.
Immediately report all exposures.
You may have to make a quick decision about
starting an antiretroviral agent as prophylaxis. The
time frame for beginning this treatment is critical.
Reporting is also essential for establishing a claim
for Workers' Compensation benefits.
PVAMU’s Workers’ Compensation Specialist can be
reached at (936) 261-1728
Summary of Post-Exposure
Employee Responsibilities
1.
Wash/flush exposed injury area for 5 minutes.
2.
Promptly report the incident to your supervisor
and the Bloodborne Pathogens Coordinator.
3.
Complete the First Report of Injury forms.
4.
Report to Health Clinic for medical evaluation.
*Reminder*
• PVAMU encourages you to contact you’re
the Health Center, Environmental Health &
Safety or supervisor for questions,
comments, or suggestions.
Health Center
(936) 261-1400
Env. Health & Safety
(936) 261-1745 or 1746
Workers Compensation
(936) 261-1728
Why was this training so vital?
• Healthcare and research personnel are at
a great risk for occupational exposure to
bloodborne pathogens.
• Through information and awareness
PVAMU aims to minimize any risk to our
employees and continue the commitment
to safety in the workplace.
Quiz required for Training credit
• Thank you for completing the self-study
review session. Please click below to
assess your learning and receive credit
for participation.
• Take Quiz