Transcript Bloodborne Pathogens

Bloodborne Pathogens Standard
Requirements
TOSHA believes the information in this presentation
to be accurate and delivers this presentation as a
community service. As such, it is an academic
presentation which cannot apply to every specific
fact or situation; nor is it a substitute for any
provisions of 29 CFR Part 1910 and/or Part 1926
of the Occupational Safety and Health Standards
as adopted by the Tennessee Department of Labor
and Workforce Development or of the
Occupational Safety and Health Rules of the
Tennessee Department of Labor and Workforce
Development.
Bloodborne Pathogens
 Pathogenic micro-
organisms present
in human blood that
can lead to diseases
 Human immunodeficiency virus (HIV)
 Hepatitis B (HBV)
 Hepatitis C (HCV)
Hepatitis A
http://www.hepatitisfoundation.org/HEPATITIS/Hepatitis-A.html
 Hepatitis A is the most common of the two transmitted hepatitis viruses
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(hepatitis A virus and hepatitis E virus) in the U.S. and is one of the two
vaccine-preventable hepatitis infections (hepatitis A and B).
In children the infection is usually mild and without symptoms.
In adults the severity generally increases with increasing age. Nonetheless,
full recovery is expected in about 99% of all infections. HAV infection
usually resolves on its own over several weeks, but occasionally relapses
occur. Hepatitis A does not lead to chronic hepatitis.
Spread primarily through person-to-person contact, or via food or water
contaminated by feces from an infected person. In rare cases, it can be
spread through contact with infected blood.
Basic precautions like washing hands with soap and water following
bowel movements and before food preparation can reduce the incidence.
Hepatitis A is prevented through vaccination. The Centers for Disease
Control and Prevention (CDC) recommend hepatitis A vaccination for
children aged 12 to 23 months and for adults who are at high risk for
infection. Following the initial dose, a booster dose is given 6-12 months
later.
Hepatitis B
http://www.hepatitisfoundation.org/HEPATITIS/Hepatitis-B.html
 Hepatitis B is a vaccine-preventable bloodborne infection.
It is a serious viral disease that infects the liver
 In the U.S. the disease is spread predominantly through sex
with an infected person, from mother to child during
childbirth, (regardless if the delivery is vaginal or through
Caesarean section), and through contact with infected
blood or body secretions among injection drug users,
health care workers, first-responders, and others at risk of
exposure
 For the treatment of chronic hepatitis B two oral drugs –
tenofovir and entecavir – and an injected drug, pegylated
interferon are available and considered first-line options
Hepatitis C
http://www.hepatitisfoundation.org/HEPATITIS/Hepatitis-C.html
 Hepatitis C causes inflammation of the liver, with an estimated 80% of
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those infected developing chronic hepatitis. Many people infected with
hepatitis C also can develop cirrhosis (scarring of the liver), and some
may also develop liver cancer.
spread primarily through contact with infected blood. Less commonly,
it can spread through sexual contact
prevent the disease is to reduce the risk of exposure to the virus.
Reducing exposure means avoiding behaviors like sharing drug
needles or personal items such as toothbrushes, razors, and nail
clippers with an infected person.
HCV is not spread through kissing or casual contact.
Symptoms may be very mild and flu-like: nausea, fatigue, loss of
appetite, fever, headaches, and abdominal pain
The challenge of recurrent
hepatitis C virus in liver transplant
recipients.
 Marotta PJ.
 Source
 Multi-Organ Transplant Program, London
Health Sciences Centre, London, Canada.
 Abstract
 Hepatitis C virus (HCV) has become the
leading indication for liver transplantation
Hepatitis D
http://www.hepatitisfoundation.org/HEPATITIS/Hepatitis-D.html
 Hepatitis D (HDV) is spread through contact with
infected blood. This disease only occurs as a coinfection with hepatitis B, or in anyone who are
already infected with hepatitis B.
 Not everyone infected with the hepatitis D virus
will develop symptoms. You may develop a
sudden fever, extreme tiredness, nausea, lack of
appetite, abdominal or stomach pain, and
yellowing of the skin or whites of the eyes.
 Vaccination against HBV will prevent HDV
Hepatitis E
http://www.hepatitisfoundation.org/HEPATITIS/Hepatitis-E.html
 Acute hepatitis E is uncommon in the United
States and very rarely results in chronic hepatitis,
particularly in solid organ transplant recipients,
patients with cirrhosis, and those on
immunosuppressive therapies.
 People most likely to be exposed to the hepatitis E
virus include international travelers, particularly
those traveling to developing countries where
hepatitis E is endemic, those who come in contact
with swine, and those who ingest pork products
and venison.
Other Bloodborne Pathogens
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Syphilis
 Malaria
 Brucellosis
 Babesiosis
 Leptospirosis
 Arborviral Infections
 Relapsing Fever
 Creutzfeld-Jacobs Disease--Mad-cow
 Viral Hemorrahgic Fever--Ebola
Potentially Infectious Materials –All
Can Transmit Hepatitis B, C, and HIV
Blood
 Semen
 Vaginal secretions
 Cerebrospinal fluid
 Pleural fluid
 Pericardial fluid
 Peritoneal fluid
 Amniotic fluid
 Saliva in dental proc.
 Any visibly
contaminated body
fluid
 Any body fluid where
differentiation is
difficult
 Any unfixed tissue or
organ
 Aqueous and vitreous
humors in the eyes
Other Body Fluids
 These body fluids do NOT have enough virus in
them to transmit disease UNLESS they are
contaminated with blood
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Urine
Feces
Tears
Sweat
Vomitus
Spit
Modes of Transmission
 Stick or Cut
 Splash to mucous membranes of the eyes,
nose, mouth
 Non-intact skin exposure
Universal Precautions
 Must be observed
 All blood and body fluids are treated as if
known to be infected with HIV, HBV, HCV,
etc.
 Do not come into contact with another
person's blood or body fluids
Exposure Control Plan
 Employer's plan describing how compliance with
the standard is achieved
 Describes what employees are covered
 Describes tasks that are covered
 Describes post-exposure follow-up procedures
 Must be reviewed and updated annually
 Must be accessible to employees
– Every employee should know the procedure to
follow to obtain a copy
Exposure Control Plan
 Safer Medical Devices
– The Exposure Control Plan must be updated every
12 months to reflect evaluation, consideration, and
selection of appropriate devices
– Document in the plan the devises evaluated and
those currently used
– Front line employees must be involved in the
selection of devices
Handwashing
 The single most important aspect of
infection control
 Wash hands when contaminated with blood
or body fluids and after removing personal
protective equipment
 Use antiseptic hand cleaner clean
paper/cloth towels or antiseptic towelettes
when "in the field"
 Wash hands with soap and water asap
Needles/Sharp Objects
 Use sharps with sharps injury prevention or needleless
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systems for all procedures involving sharps
Place in puncture resistant, labeled, leak-proof containers for
transport, storage, and/or disposal
Keep the container closed
Do not bend, break, recap, or remove needles
Do not pick up contaminated broken glass directly with the
hands
Do not reach by hand into containers where contaminated
sharps are placed
Do not overall sharps containers
Eating/Drinking
 Do not eat or drink in
areas where there is
exposure to blood or
body fluids
 Do not store food in
refrigerators, freezers,
cabinets, on shelves or
countertops where
blood or other body
fluids are present
Personal Protective Equipment
(PPE)
 Wear PPE to prevent blood or body fluids
from getting on your clothes, skin,
underclothes, etc.
 Must be provided at no cost to the employee
 Employer must enforce the use
 Must be removed prior to leaving the work
area and placed in designated area
PPE
 Parental exposure
– stick or cut
 gloves
 Mucous membrane
– splash
 glasses/ goggles
 Non-intact skin
– spill or splash
 pocket masks
 gowns
 masks
 shoe covers
Decontamination
 Clean and decontaminate all equipment and
environmental and working surfaces after
contact with blood and/or body fluids
 Decontaminate with appropriate disinfectant
– EPA registered tuberculocidal disinfectant
– EPA registered disinfectant with label stating it
is effective against HIV and HBV
– Household bleach, diluted 1:10-1:100, made
fresh daily
Contaminated Laundry
 Remove contaminated clothing when it
becomes contaminated
 Place immediately in bag or container that
is labeled
 Prevent leakage
Regulated Waste
 Sharps containers
– Needles
– Blades
– Broken glass
 Red bags
– Liquid or semi-liquid blood or
OPIM
– Items caked with dried blood
or OPIM
– Items that could release blood
or OPIM
– Pathological waste
– Microbiological waste
Hepatitis B Vaccination
 the HBV vaccination must be offered after
the employee has received training and
within 10 working days of job assignment
– At no cost
– Provided by PLHCP
– According to US Public Health Service most
current recommendations
• “Immunization of Health Care Workers:
Recommendations of ACIP and HICPAC,” MMWR,
Vol. 46, No. RR-18
HBV Vaccination
 Employees who do not take the shots must sign a
declination statement
 Highly recommended
 Few contraindications
 Three-shot series—titer 1-2 months after last shot
 No booster currently recommended
 Each person must have a health care professional's
written opinion
– A copy must be provided to the employee within 15
days of completion of the evaluation
 An employee can decline now, take the shots later
Written Opinion
 Each person must have a health care
professional's written opinion for hepatitis B
vaccination
– A copy must be provided to the employee
within 15 days of completion of the evaluation
VACCINES TO PREVENT
 Hepatitis A and B can be prevented through
immunization. Awareness of the importance of
immunizing against these diseases is growing, and
new initiatives are capitalizing on this interest.
 No vaccine to prevent hepatitis C is available.
http://www.cdc.gov/idu/hepatitis/vaccines.pdf
Post-Exposure Follow-up
 After exposure incident
– Stick or cut
– Splash
– Non-intact skin exposure
 At no cost
 Begin ASAP after exposure incident
 Report exposure incident to your supervisor
or designated personnel immediately
Post-Exposure Follow-up
 Investigation of the incident
 ID source individual, obtain consent, and
test their blood to determine HBV, HCV,
and HIV infectivity ASAP
 Results of source individual's test given to
exposed person
 Obtain and test exposed person's blood for
HBV, HCV, and HIV serological status
Post-Exposure Follow-up
 Post-exposure prophylaxis as indicated by CDC
– “Updated U.S. Public Health Service Guidelines for
the Management of Occupational Exposures to
HBV, HCV, and HIV and Recommendations for
Postexposure Prophylaxis” June 29, 2001, Vol 50,
No. RR-11
– “Updated U.S. Public Health Service Guidelines for
the Management of Occupational Exposures to HIV
and Recommendations for Postexposure
Prophylaxis,” September 30, 2005, Vol 54, RR-09
 Counseling and Evaluation of reported illnesses
Written Opinion
 The employee must be provided a copy of
the Health Care Professional's Written
Opinion for Post-Exposure Follow-up
within 15 days of completion of the
evaluation
Labels
 Containers with
contaminated items
 Can substitute red
Training
 For all employees listed in the Exposure
Determination
 At no cost to employees
 During working hours
 At the time of initial assignment
 Annually--within 1 year of last training date
 Must be opportunity for interactive questions and
answers
 Train employees on adopted safer needle devices
before implementation
Training
 Five Easy Questions
– What is universal precautions?
– What do you do when there is a blood spill?
• Personal protection
• Clean-up and disposal procedures
• Disinfection (hazard communication applies)
– What do you do with contaminated sharps and
laundry?
– Have you been offered the HBV vaccination free
of charge?
– Where is the Exposure Control Plan?
Additional Training
 Copy of the BBP standard, 29 CFR 1910.1030, must be
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accessible to you
Explanation of methods of recognizing tasks that may
involve exposure to blood and/or body fluids
Information on types, use, location, removal, handling,
decontamination, and disposal of ppe
Basis of selection of ppe
Actions to take and persons to contact in a bloodborne
emergency that you do not know how to handle
Procedure to follow if exposure incident occurs
Opportunity for interactive Q & A
Records
 Medical records
– Name and social security number
– HBV vaccination status
– Results of exposure incident follow-up
– Health care professional's written opinions
– Info provided to health care professional
– Confidential
Records
Training
– Dates
– Contents
– Names and qualifications of trainers
– Names and titles of persons attending
Records
Sharps Injury Log
– Per the Tennessee Sharps Injury
Prevention law
– Keep a log of all sharps injuries with
• Type and brand of device involved in the
incident
• Department or work area where the incident
occurred
• Explanation of how the incident occurred
Resources
 www.osha.gov
www.tennessee.gov/labor-wfd/tosha
 www.cdc.gov
 www.cdc.gov/niosh
 Memphis Office
 Jackson Office
 Nashville Office
 Knoxville Office
 Kingsport Office
 Chattanooga
 Consultative Services
901-543-7259
701-423-5641
615-741-2793
1-800-249-8510
865-594-6180
423-224-2042
423-634-6424
1-800-325-9901