Transcript BLOODBORNE PATHOGENS TRAINING

OSHA / WISHA
BLOODBORNE
PATHOGENS TRAINING
by: Lanette Dyer
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Overview
• Review of BBP
• Exposure Control Plan
• Hepatitis B Vaccination
• Control Measures
• Personal Protective Equipment
• Waste Management
• Post Exposure Management
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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 didn’t call you”
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BLS Sick
On exam,
Slurring words, coughing
“Beat It, I didn’t call you”
VS: HR 98, BP 142/P, RR
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Lungs: scattered rhonci
Tender to R ant chest
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BLS Sick
What’s wrong with this
“Barney?”
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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)
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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.
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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.
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TB Masks
– Wear it
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Malaria or West Nile?
USA Malaria: About 1,000 cases are reported annually
Worldwide prevalence of Malaria:Each year, 300 to 500 million people develop malaria and
1.5 to 3 million–mostly children–die, according to the World Health Organization (WHO).
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Malaria or West Nile?
2004 West Nile Virus Activity in the United States
(reported to CDC as of October 12, 2004)*
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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.
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BLOODBORNE PATHOGENS
• Pathogenic microorganisms that are
present in human blood or OPIM and can
cause disease in humans.
– Examples include HBV, HCV, HIV
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Other Potentially Infectious Materials
(OPIM)
• Human body fluids
– Semen, vaginal secretions (not at work!)
– CSF, amniotic
– any body fluid visibly contaminated with
blood
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NOT Infectious
– Feces, snot, saliva, sputum, sweat, tears,
vomitus, and urine
• Unless blood-stained
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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
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BBP TRANSMISSION
Overview
• Sexual contact
• Sharing needles or syringes
• From infected mother to baby
• Blood transfusion
• Organ transplant
• Not transmitted through casual contact
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Average Risk of Transmission after
Percutaneous Injury
Source
HIV
Hepatitis C
Hepatitis B
Risk (%)
0.3
1.8
30.0
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Viral Hepatitis
About 50,000 reported cases per year
60% hepatitis A
25% hepatitis B
15% hepatitis C
<1% unspecified…not enough to count
CDC estimates 500-750,000 actual new cases
15,000 deaths per year
4,000,000 carriers
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Viral Hepatitis—Overview
TYPES OF HEPATITIS
A
Source of
virus
Route of
transmission
Chronic
infection
Prevention
B
C
D
E
feces
blood/
blood/
blood/
blood-derived blood-derived blood-derived
body fluids
body fluids
body fluids
feces
fecal-oral
Fast food
Percutaneous, Percutaneous, Percutaneous,
mucosal
mucosal
mucosal
fecal-oral
no
yes
pre/postexposure
immunization
pre/postexposure
immunization
yes
yes
blood donor
pre/postscreening;
exposure
risk behavior immunization;
modification risk behavior
modification
no
ensure safe
drinking
water
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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.
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HBV SYMPTOMS
• About 30% of persons
have no signs or
symptoms.
• Signs and symptoms are
less common in children
than adults.
 jaundice
 fatigue
 abdominal
pain
 loss of
appetite
 nausea,
vomiting
 joint pain
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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.
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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/fact.htm
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HCV SYMPTOMS
• 80% of persons have no
signs or symptoms.
 jaundice
 fatigue
 dark urine
 abdominal
pain
 Long hair
 Bad acting
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The Fire Service Controversy
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The Fire Service Controversy
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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.
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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.
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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.
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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
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MRSA
Methicillin-resistant Staphylococcus Aureus
• 20-30% Healthcare worker’s 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
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Preventing Transmission of
Bloodborne Viruses in HealthCare 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 bloodcontaminated materials
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EXPOSURE CONTROL PLAN
• Written Document
• Accessible to all personnel
• Update at least annually
– Or when alterations in procedures create new
occupational hazards
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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.
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EXPOSURE CONTROL PLAN
• KEY ELEMENTS
– Recordkeeping/compliance methods
• Engineering/work practice controls
• Personal protective equipment (PPE)
• Housekeeping
– Procedures for postexposure evaluation and followup
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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
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PROGRAM
• Communicate hazards
• Identify/control hazards
• Preventive measures
– Hepatitis B vaccine
– Engineering controls
– Safe work practices
– PPE
– Housekeeping
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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.
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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.
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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.
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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
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PPE
“You got what!?”
• Know where yours is
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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
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GLOVES
• Per SOP’s 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”.
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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.
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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.
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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
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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.
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Postexposure Management:
Wound 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.
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Postexposure Management
Notification
• Report Immediately
• Exposed individual must be directed to a
qualified health-care professional.
– Antiretroviral drugs (if indicated) should be
administered immediately!
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Postexposure Management:
The Exposure Report
• Date and time of exposure
• Procedure details…what, 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
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Postexposure Management:
Assessment of Infection Risk
• Type of exposure
–
–
–
–
Percutaneous
Mucous membrane
Non-intact skin
Bites resulting in blood
exposure
• Body substance
• Source evaluation
–
–
–
–
Presence of HBsAg
Presence of HCV antibody
Presence of HIV antibody
If source unknown, assess
epidemiologic evidence
– Blood
– Bloody fluid
– Potentially infectious
fluid or tissue
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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
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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.
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How to live long?
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The Healthy Way
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