Bloodborne Pathogens

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Natural Defenses

 Intact skin and mucous membranes in eyes, nose and mouth keeps germs out.

 Mucous membranes trap & force out germs.  Mucous membrane less effective than skin at keeping germs out of the body.

 Inside body germs detected & surrounded white blood cells, which release antibodies to fight infection.

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Natural Defenses

 Germs sub-classified as: - bacteria (tetanus) which are non-dependant & treated with antibiotics. - virus (measles) which are dependent & few medications available.

 Germs overwhelm immune system and infection develops.

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What is a BB Pathogen?

 Microorganisms (e.g., bacteria & viruses) carried in blood and causing diseases: - Malaria - Brucellosis - Syphilis - Hepatitis B(HBV) - Hepatitis C(HCV) - Human Immunodeficiency Virus (HIV) 4

Statistics and Standards

 Annually millions of workers at risk of exposure to bloodborne pathogens – human immunodeficiency virus (HIV – virus causes AIDS), hepatitis B virus (HBV), & hepatitis C virus (HCV)  OSHA’s Bloodborne Pathogens standard (1910.1030) prescribes exposure safeguards to reduce exposure risks.

 Hepatitis A not included, not carried in blood.  No MSHA or OSHA-Construction standard 5

Exposure Determination

 Employees “reasonably anticipated” in job performance to contact blood and other potentially infectious materials.

 Designated first-aid and CPR trained employees  “Good Samaritan” acts such as assisting a co worker with a nosebleed would not be considered occupational exposure.

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BB Pathogen Spread

 All four of the following must be met: - pathogen

P

resent, - pathogen

Q

uantity sufficient to cause disease, - pathogen through correct

E

ntry site, & - person

S

usceptible.

 PQES 7

Infection Risk

 Risk of infection from accidental bloodborne exposure varies with: - pathogen involved, - exposure type, - route of infection, - immune status of recipient, - amount of involved blood, - amount of virus in blood, & - ability of organism to produce disease.

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Pathogen Transmission

 Direct contact with infected human blood, unfixed tissues, & other potentially infectious bodily fluids such as: - Saliva - Vomit - Urine - Semen or vaginal secretions, - Blood transfusion, & - Bodily fluid visibly contaminated with blood.

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Pathogen Transmission

 Indirect contact with infected human blood, unfixed tissues, & other potentially infectious bodily fluids on: - soiled dressing, - equipment or working surfaces, - PPE, - other first-aid items.

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Pathogen Transmission

 HBV, HCV and HIV most commonly transmitted through: - sexual contact, - needles or other sharp instruments, - mothers to babies at/before birth, - contact between broken/damaged skin & infected bodily fluids, & - contact between mucous membranes & infected bodily fluids.

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Pathogen Transmission

 Infected blood or bodily fluid enters through: - open sores, - cuts, - abrasions, - acne, or - any sort of damaged or broken skin (e.g. sunburn or blisters).

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Pathogen Transmission

 Through mucous membrane of: - eyes, - nose, & - mouth.

 Example – blood/fluids splash to eyes.

 HBV, HCV & HIV share common transmission mode but risk differs.

 Most exposures do not result in infection.

 No evidence mosquitoes can transfer virus from person to person. 13

HBV Infection Risk

 No risk following receipt of vaccine & immunity development.

 Post exposure treatment 24 hours – 7 days.

 Susceptible person after cut exposure to blood: - single exposure 6-30%, & - positive antigen status means more virus.

 Possible risk from exposure of mucous membrane or nonintact skin.

 No known risk from exposure to intact skin.

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HCV Infection Risk

 Susceptible person after cut exposure to blood: - approximately 1.8%.

 Unknown following exposure to eyes, nose or mouth; believed to be very small.

 Reported infection from: - blood splash to eye, & - nonintact skin exposure.

 No known risk from exposure to intact skin.

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HIV Infection Risk

 After cut exposure to blood: - approximately 0.3%.

 After exposure to eyes, nose or mouth: - estimated on average at 0.1%.

 After exposure to nonintact skin: - less than 0.1%.

 From needle stick: - estimated on average at 0.3 – 0.4%.

 No cases with small blood amount on intact skin.

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Vaccinations

 HBV: - available since 1982, - series of 3 shots over 6 months, - provides protection for 9 or more years, - 70-88% effective within 1 week of exposure, & - 90-95% effective - chronic infection in 6% persons after age 5.

- death from liver disease in 15-25% of persons.

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Vaccinations

 HCV: - treatment thru medications* and therapy, and - no vaccine currently available.

 HIV: - treatment thru medications, and - no vaccine currently available.

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Hepatitis B (HBV)

 Durable virus, able to survive in dried blood up to 7 days.

 Initial inflammation of the liver, but can lead to serious conditions (e.g., cirrhosis & cancer).  1 – 9 months before symptoms are noticeable.

 Mild flu symptoms – fatigue, appetite loss, nausea, joint pain & stomach pain.

 Progresses to jaundice & darkening of urine.

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Hepatitis B (HBV)

 300,000 U.S. individuals (8,700 health care workers) infected annually; 1 – 2% fatal  Infection does non prevent infection of HAV or HCV.

 Medications available for chronic HBV; only work for some patients.

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Hepatitis C (HCV)

 Most common chronic bloodborne infection in the United States.

 Acute or Chronic  Chronic – insidious, slow & without symptoms for 2 or more decades.

 Symptoms include: jaundice, fatigue, abdominal pain, loss of appetite, intermittent nausea, vomiting.

 May lead to chronic liver disease, transplant & death.

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Human Immunodeficiency Virus (HIV)

 HIV virus leading to AIDS.

 Depletes immune system (white blood cells).

 Opportunistic infections (e.g., TB, pneumonia).

 Very fragile & not survive long outside body.

 Primary concern to individuals providing first air or medical care involving fresh blood or potentially infectious materials.

 No threat of contraction through casual contact.

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Infection Prevention

 Universal Precautions: - Treat all blood and bodily fluids as infectious, - Use of proper PPE, - Personal hygiene, - Proper cleanup and decontamination, & - Proper disposal of all contaminated material.

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Engineering & work Practice Controls & PPE

 Engineering & work practice controls primary methods used for transmission control (e.g., sharps containers),  Work practices: - Blood and bodily fluids treated as infectious, - Remove jewelry, - Personal hygiene, & - etc.

 PPE used in conjunction with engineering & work place controls. 24

Personal Hygiene

 Important factor in minimizing exposure  Confine loose clothing or hair  Maintain nail length < ¼ inch long  Hand washing is one of the most important practices in transmission prevention. 25

Hand Washing

 Wash hands immediately after removing PPE.

 Use a soft antibacterial soap  Min. 15 sec. including nails  Rinse thoroughly  Antiseptic cleanser, 70% ethyl alcohol, but wash with soap and water ASAP.

 Frequently sanitize hands and exposed skin.

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PPE

 Anything protecting a person from exposure  Gloves (latex, nitrile) - double glove  Face shields  Eye protection  Mask or Respirator  Mouthpieces & resuscitation devices 27

PPE Rules to Remember

 Ensure always available  Always wear in exposure situations or when there are skin openings (breaks, cuts).

 Check for age, defects or tears before using  Remove & replace if torn or defective, or lost ability to function as barrier.

 Remove ASAP to prevent contamination.

 Cover skin openings prior to donning.

 Remove properly & do not reuse 28

Recommended PPE

Recommended PPE Against HBV, HCV & HIV Transmission Activity/ Task Bleeding w/ spurting blood Disposable Gloves Yes Gown Yes Disposable Mask Yes Protective Eyewear Yes Bleeding w/ minimal blood Handle/Clean contaminated items Yes Yes No No, unless soiling No No No No

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Glove Removal Technique

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Glove Removal Technique

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Exposure Incident

 Flush site of blood or OPIM contact (e.g., splash to nose, mouth, or skin).

 Irrigate eyes with water or saline  Note specifics of contact with blood or OPIM  Notify supervisor and Safety  No infiltrations of mucous membranes or open skin surfaces, not considered exposure.  Medical evaluation within 1 to 2 hours according to current medical guidelines!

 Post-exposure medical evaluations 32

Post-exposure Evaluation

 Confidential medical evaluation  Document route of exposure  Identify source individual  Hepatitis B vaccination status  Test source individuals blood  Provide results to exposed employee 33

Summary

 OSHA’s Bloodborne Pathogens standard prescribes safeguards to protect against blood and OPIM exposures, & reduce their risk from this exposure.

 Implementation will not only will prevent HBV cases, but also significantly reduce risk of contracting HIV, HCV, or bloodborne diseases.

 Given our line of work, first aid and CRP responders are potentially exposed. 34

Conclusions

 BB pathogen rules in place for your health  Precautions use will remove 1 of 4 PEQS transmission conditions.

 Condition missing, infection not occurring 35