CENTRAL PIEDMONT COMMUNITY COLLEGE OSHA TRAINING FOR 1ST YEAR STUDENTS Revised 2014 LEARNING OBJECTIVES STUDENTS SHOULD BE ABLE TO UNDERSTAND; DISCUSS; INDENTIFY; AND IMPLEMENT OSHA.
Download ReportTranscript CENTRAL PIEDMONT COMMUNITY COLLEGE OSHA TRAINING FOR 1ST YEAR STUDENTS Revised 2014 LEARNING OBJECTIVES STUDENTS SHOULD BE ABLE TO UNDERSTAND; DISCUSS; INDENTIFY; AND IMPLEMENT OSHA.
CENTRAL PIEDMONT COMMUNITY COLLEGE OSHA TRAINING FOR 1ST YEAR STUDENTS Revised 2014 LEARNING OBJECTIVES STUDENTS SHOULD BE ABLE TO UNDERSTAND; DISCUSS; INDENTIFY; AND IMPLEMENT OSHA STANDARDS & REQUIREMENTS, INCLUDING CDC’S GUIDELINES FOR: TRAINING AND TERMINOLOGY EXPOSURE CONTROL PLAN EXPOSURE DETERMINATION/CATEGORY HAZARD WARNING LABEL & COMMUNICATION UNIVERSAL/STANDARD PRECAUTIONS AND CDC’S TRANSMISSION BASED PRECAUTIONS HAND HYGIENE DISEASE TRANSMISSION (e.g. Means of disease transmission, Hep. B/C, HIV/AIDS/TB, INFLUENZA) HEP. B VACCINATION PPE (personal protective equipment) HANDWASHING FACILITIES AND REQUIREMENTS SHARPS SAFETY LAUNDRY/HOUSEKEEPING MANAGEMENT OF BLOOD/BODY FLUID SPILLS MANAGEMENT OF EXPOSURE INCIDENTS MANAGEMENT OF REGULATED WASTE HAZARD COMMUNICATION STANDARD (hazardous chemicals) RECORDKEEPING REQUIREMENTS (e.g. training and medical records) OTHER (e.g. CPCC requirements) OSHA’S BLOODBORNE PATHOGENS STANDARD 29 CFR PART 1910.1030 OCCUPATIONAL SAFETY AND HEALTH ADMINISTRATION THE STANDARD INCLUDES: Definitions Exposure Control Plan Information & Training Including Disease Transmission (HIV/AIDS; Hep.; TB) Exposure Determination Universal & Standard Precautions Engineering & Work Practice Controls Post Evaluation & FollowUp Record Keeping Biohazard Communication Sharps Safety OSHA’S DEFINITIONS BLOOD = Human blood, human blood components, and products made from human blood. BLOODBORNE PATHOGENS = Pathogenic microorganisms that are present in human blood and can cause disease in humans. These pathogens include, but are not limited to Hep. B virus; Hep. C virus; and HIV. OSHA’S DEFINITIONS ENGINEERING CONTROLS = Controls (e.g. sharps disposal containers, self-sheathing needles, safer medical devices, such as sharps with engineered sharps injury protections and needleless systems) that isolate or remove the bloodborne pathogens hazard from the workplace. EXPOSURE INCIDENT = A specific eye, mouth, other mucous membrane, non-intake skin, or parenteral contact with blood or other potentially infectious materials that results from the performance of an employee’s duties. OSHA’S DEFINITIONS NEEDLELESS SYSTEM = A device that does not use needles for (1) the collection of bodily fluids or withdrawal of body fluids after initial venous or arterial access is established; (2) the administration of medication or fluids; or (3) any other procedure involving the potential for occupational exposure to bloodborne pathogens due to percutaneous injuries from contaminated sharps. OCCUPATIONAL EXPOSURE = Reasonably anticipated skin, eye, mucous membrane, or parenteral contact with blood or other potentially infectious materials that may result from the performance of an employee’s duties. PARENTERAL= Piercing mucous membranes or the skin barrier through such events as needlesticks, human bites, cuts, and abrasions. SHARPS WITH ENGINEERED SHARPS INJURY PROTECTIONS = A non-needle sharp or a needle device used for withdrawing body fluids, accessing a vein or artery, or administering medications or other fluids, with a built-in safety feature or mechanism that effectively reduces the risk of an exposure incident. OSHA’S DEFINITIONS SOURCE INDIVIDUAL = Any individual, living or dead, whose blood or other potentially infectious materials may be a source of occupational exposure to the employee. OSHA’S DEFINITIONS UNIVERSAL PRECAUTIONS = Is an approach to infection control. According to the concept of Universal Precautions, all human blood and certain human body fluids are treated as if known to be infectious for HIV, HBV, HCV, and other bloodborne pathogens/infectious diseases. WORK PRACTICE CONTROLS = Controls that reduce the likelihood of exposure by altering the manner in which a task is performed (e.g., prohibiting recapping of needles by a two-handed technique, handwashing, etc.) OSHA’S DEFINITIONS REGULATED WASTE = MEANS LIQUID OR SEMILIQUID BLOOD OR OTHER POTENTIALLY INFECTIOUS MATERIALS. MEANS CONTAMINATED ITEMS THAT WOULD RELEASE BLOOD OR OTHER POTENTIALLY INFECTIOUS MATERIALS IN A LIQUID OR SEMILIQUID STATE IF COMPRESSED. MEANS ITEMS THAT ARE CAKED WITH DRIED BLOOD OR OTHER POTENTIALLY INFECTIOUS MATERIALS AND ARE CAPABLE OF RELEASING THESE MATERIALS DURING HANDLING. MEANS CONTAMINATED SHARPS. MEANS PATHOLOGIC AND MICROBIOLOGIC WASTES CONTAINING BLOOD OR OTHER POTENTIALLY INFECTIOUS MATERIALS. EXPOSURE CONTROL PLAN THE EXPOSURE CONTROL PLAN IS THE EMPLOYER’S WRITTEN EXPLANATION ON HOW THE FACILITY COMPLIES WITH OSHA’S BLOODBORNE PATHOGENS. STANDARD. THE PLAN MUST BE MADE AVAILABLE TO ALL EMPLOYEES AT RISK OF EXPOSURE. TRAINING MUST TAKE PLACE WITHIN 10 DAYS OF STARTING JOB MUST HAVE ANNUAL TRAINING THEREAFTER TRAINER MUST BE PRESENT TO ANSWER QUESTIONS REQUIREMENTS TRAINING DISEASE TRANSMISSION PPE HANDWASHING FACILITIES SHARPS SAFETY LAUNDRY/HOUSEKEEPING BLOOD/BODY FLUID SPILLS EXPOSURES REGULATED WASTE HAZARD COMMUNICATION RECORDKEEPING OTHER OSHA REQUIREMENTS NEW ENGINEERING REQUREMENTS TO AGGRESSIVELY MOVE TOWARDS THE USE OF NEEDLESS IV SYSTEMS AND PROTECTED NEEDLE DEVICES. POST-EXPOSURE EVALUATION INCORPORATES CDC’S GUIDELINES ON POST-EXPOSURE EVALUATION AND FOLLOW-UP FOR HIV, HEP. B, HEP. C VIRUS. OSHA REQUIREMENTS REGULATED MEDICAL WASTE CONTAINERS MUST BE LABELED WITH THE BIOHAZARD SYMBOL TO WARN EMPLOYEES WHO MAY HAVE CONTACT WITH THE CONTAINERS OF THE POTENTIAL HAZARD POSED BY THEIR CONTENTS. OSHA REQUIREMENTS REQUIRES EFFECTIVE TRAINING AND EDUCATION FOR EMPLOYEES WHENEVER SAFER DEVICES ARE IMPLEMENTED. OSHA REQUIREMENTS EMPLOYEES MUST BE TRAINED IN HOW TO REMOVE A BLOOD CONTAMINATED PULL-OVER SCRUB TOP WITHOUT ALLOWING SKIN CONTACT. OSHA REQUIREMENTS HAND TO HAND TRANSFER OF SHARPS SHOULD BE ELIMINATED WHENEVER POSSIBLE. OSHA REQUIREMENTS ANNUAL REVIEW OF EXPOSURE CONTROL PLAN TO ENSURE THAT THE PLAN REFLECTS CONSIDERATION AND USE OF COMMERICALLY AVAILABLE SAFER MEDICAL DEVICES. EMPLOYER MUST MONITOR ENGINEERING CONTROLS TO ENSURE THEIR EFFECTIVENESS. EXPOSURE DETERMINATION TASK/CATEGORY I: Employees/students will perform tasks/duties that will put them at risk for exposure to blood and other potentially infectious materials, therefore, Universal/Standard Precautions required. EXPOSURE DETERMINATION TASK/CATEGORY II: Employees/students will perform tasks/duties that normally do not put them at risk but they could be asked to perform tasks/duties that would put them at risk, therefore, Universal/Standard Precautions required. EXPOSURE DETERMINATION TASK/CATEGORY III: Employees/students will perform tasks/duties that will not put them at risk for exposure to blood and other potentially infectious materials, therefore, Universal/Standard Precautions are not required. BIOHAZARD WARNING COMMUNICATION PERSONAL PROTECTIVE EQUIPMENT (PPE) AND OTHER REQUIREMENTS MASK GLOVES EYE OUTER PROTECTION GARMENT HEAD & CPR NIOSH-N95 DEVICES APPROVED SHOE RESPIRATOR COVERS FOR TB MEANS FOR HAND WASHING PPE; RESPIRATOR MASK; CPR RESCUE BREATHING DEVICE; MEANS TO PERFORM HAND HYGIENE UNIVERSAL PRECAUTIONS –VSSTANDARD PRECAUTIONS OSHA = UNIVERSAL PRECAUTIONS CDC = STANDARD PRECAUTIONS OSHA’S UNIVERSAL PRECAUTIONS APPLY TO: BLOOD SEMEN/VAGINAL SECRETIONS CEREBROSPINAL FLUID SYNOVIAL FLUID AMNIOTIC FLUID PERICARDIAL FLUID PERITONEAL FLUID OSHA’S UNIVERSAL PRECAUTIONS APPLY TO: INFECTED BREAST MILK ANY BODY FLUID WITH VISIBLE BLOOD ANY UNIDENTIFIABLE BODY FLUID SALIVA (ALL DENTAL PROCEDURES) UNFIXED TISSUE/ORGANS CULTURES: HIV/HEP. INFECTED OSHA’S UNIVERSAL PRECAUTIONS APPLY TO: BLOOD, ORGANS, TISSUES FROM EXPERIMENTAL ANIMALS INFECTED WITH HIV/HEP. UNLESS BLOOD IS PRESENT OSHA’S UNIVERSAL PRECAUTIONS DO NOT APPLY TO: FECES NASAL SECRETIONS SPUTUM SWEAT TEARS URINE VOMITUS CDC’S STANDARD PRECAUTIONS APPLY TO: ALL BODY FLUIDS WHETHER THERE IS VISIBLE BLOOD OR NOT. THE ONLY EXCEPTION IS SWEAT: SWEAT IS THE ONLY BODY FLUID NOT CONSIDERED INFECTIOUS. STANDARD PRECAUTIONS IS THE COMBINATION OF UNIVERSAL PRECAUTIONS AND BODY SUBSTANCE ISOLATION AND ARE STRICTER THAN OSHA’S REQUIREMENT. SHARPS SAFETY EVALUATION AND USE OF SAFER SHARPS DEVICES REQUIRED BY OSHA. MUST BE PART OF THE EXPOSURE CONTROL PLAN. IF NEEDLES MUST BE RECAPPED USE ONE-HANDED SCOOP METHOD OR RECAPPING SAFETY DEVICE. SHARPS SAFETY EVALUATION AND USE OF SAFER SHARPS DEVICES FOR DENTAL:THE DENTIST SHOULD RECAP AND RELOAD CONTAMINATED SYRINGES IF OFFICE USES SAFETY NEEDLES STUDENT SHOULD RECEIVE TRAINING AND INSTRUCTIONS PRIOR TO USE SHOULD A SHARPS INJURY OCCUR A SEPARATE SHARPS INJURY REPORT FORM MUST BE FILLED OUT CDC’S TRANSMISSION BASED PRECAUTIONS AIRBORNE PRECAUTIONS AIRBORNE-NIOSH APPROVED RESPIRATOR/HEPA MASK REQUIRED (E.G. TB/SARS PATIENTS) AIRBORNE (ALL OTHER PATIENTS WITH AIRBORNE TRANSMITTED DISEASES): SURGICAL MASK REQUIRED CDC’S DROPLET PRECAUTIONS DROPLET PRECAUTIONS: SPREAD THROUGH AIR WITHIN 3 FEET OF SOURCE. REQUIRES SURGICAL FACE MASK. CDC’S CONTACT PRECAUTIONS CONTACT PRECAUTIONS: REQUIRES PPE (E.G. GLOVES & GOWNS) OTHER TRANSMISSION PRECAUTIONS AS ESTABLISHED BY FACILITY: (E.G. IMMUNOCOMPROMISED PRECAUTIONS) RECORDKEEPING TRAINING RECORDS: MUST BE KEPT FOR 3 YEARS FROM DATE OF TRAINING. RECORDKEEPING MEDICAL RECORDS: MUST BE KEPT FOR LENGTH OF EMPLOYMENT PLUS 30 YEARS. HAND HYGIENE HAND HYGIENE THE MOST COMMON MODE OF TRANSMISSION OF PATHOGENS IS VIA THE HANDS DO NOT “TOP-OFF” PARTIALLY EMPTY DISPENSERS DO NOT USE PRODUCT BEYOND EXPIRATION DATE DO NOT WEAR HAND/ARM JEWELRY DO NOT WEAR ARTIFICIAL NAILS/NAIL POLISH FINGERNAILS Natural nail tips should be kept to ¼ inch in length Artificial nails should not be worn when having direct contact with high-risk patients Guideline for Hand Hygiene in Health-care Settings. MMWR 2002; vol. 51, no. RR-16. FINGERNAILS HAND HYGIENE DEFINITIONS HAND HYGIENE – Performing handwashing, antiseptic handwash, alcohol-based handrub, surgical hand hygiene/antisepsis HANDWASHING – Washing hands with plain soap and water ANTISEPTIC HANDWASH – Washing hands with water and soap or other detergents containing an antiseptic agent Guideline for Hand Hygiene in Health-care Settings. MMWR 2002; vol. 51, no. RR-16. HAND HYGIENE DEFINITIONS ALCOHOL-BASED HANDRUB – Rubbing hands with an alcohol-containing preparation SURGICAL HAND HYGIENE/ANTISEPSIS – Handwashing or using an alcohol-based handrub before operations by surgical personnel Guideline for Hand Hygiene in Health-care Settings. MMWR 2002; vol. 51, no. RR-16. INDICATIONS FOR HAND HYGIENE When hands are visibly dirty, contaminated, or soiled, wash with non-antimicrobial or antimicrobial soap and water. If hands are not visibly soiled, use an alcoholbased handrub for routinely decontaminating hands. Guideline for Hand Hygiene in Health-care Settings. MMWR 2002; vol. 51, no. RR-16. RECOMMENDED HAND HYGIENE TECHNIQUE HANDRUBS – Apply to palm of one hand, rub hands together covering all surfaces of hands and fingers until dry – Volume: based on manufacturer recommendations HANDWASHING – Wet hands with water, apply soap, rub hands and fingers together for at least 20 seconds – Rinse and dry with disposable towel – Use towel to turn off faucet Guideline for Hand Hygiene in Health-care Settings. MMWR 2002; vol. 51, no. RR-16. RECOMMENDED SURGICAL HAND HYGIENE TECHNIQUE Use either an antimicrobial soap or alcohol-based handrub Antimicrobial soap: scrub hands, fingers, and forearms for length of time (2-6 min.) recommended by manufacturer Alcohol-based handrub: Follow manufacturer’s recommendations. Before applying, pre-wash hands and forearms with antimicrobial soap followed by an alcohol-based surgical hand-scrub product with persistent activity. Guideline for Hand Hygiene in Health-care Settings. MMWR 2002; vol. 51, no. RR-16. UNRESOLVED ISSUES Routine use of nonalcohol-based handrubs Wearing rings in healthcare settings Guideline for Hand Hygiene in Health-care Settings. MMWR 2002; vol. 51, no. RR-16. ALCOHOL AND FLAMMABILITY Alcohols are flammable Alcohol-based handrubs should be stored away from high temperatures or flames. FIRE CODES APPLY U.S.: one report of a nurse’s hands burned (static electricity) U.S.: one report of flash fire Application is key: Let It Dry! Guideline for Hand Hygiene in Health-care Settings. MMWR 2002; vol. 51, no. RR-16. ALCOHOL-BASE HANDRUBS Require less time More effective for standard handwashing than soap More accessible than sinks Reduce bacterial counts on hands Improve skin condition Guideline for Hand Hygiene in Health-care Settings. MMWR 2002; vol. 51, no. RR-16. ALCOHOL-BASE HANDRUBS CANNOT BE USED IF HANDS ARE VISIBLY SOILED EMOLLIENTS MAY BUILD-UP (SOME RECOMMEND AFTER 10 HANDWASHINGS WITH ALCOHOL –BASED HANDRUBS THAT HANDS SHOULD BE WASHED WITH ANTIMICROBIAL SOAP) Guideline for Hand Hygiene in Health-care Settings. MMWR 2002; vol. 51, no. RR-16. ALCOHOL-BASE HANDRUBS LATEX GLOVES: REMINDERS NATURAL RUBBER LATEX CONTAINS OVER 260 PLANT-BASED PROTEINS (1 DOZEN ARE ALLERGENIC) OVER 200 CHEMICALS ARE ADDED TO NRL AND SYNTHETIC RUBBER GLOVES OTHER CHEMICALS MAY PERMEATE GLOVES (E.G. GLUTARALDEHYDE, BONDING AGENTS, RESINS) LOW-PROTEIN NRL GLOVES ARE NOT OK FOR USE BY HEALTHCARE WORKERS ALLERGIC TO NRL AS THRESHOLDS ARE NOT YET WELL DEFINED CDC’S HAND HYGIENE GUIDELINES AND OTHER WEBSITES http://www.cdc.gov/handhygiene/materials.htm http://www.cdc.gov http://www.cdc.gov/ncidod/hip/enviro/guide.htm BLOODBORNE DISEASES HIV/AIDS HEPATITIS B HEPATITIS C HIV/AIDS HIV is spread by sexual contact with an infected person, by sharing needles and/or syringes (primarily for drug injection) with someone who is infected, or, 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. In the health care setting, workers have been infected with HIV after being stuck with needles containing HIV-infected blood or, less frequently, after infected blood gets into a worker’s open cut or a mucous membrane (for example, the eyes or inside of the nose). There has been only one instance of patients being infected by a health care worker in the United States; this involved HIV transmission from one infected dentist to six patients. Investigations have been completed involving more than 22,000 patients of 63 HIV-infected physicians, surgeons, and dentists, and no other cases of this type of transmission have been identified in the United States. HIV/AIDS PREVENTION FOR HCW Healthcare personnel should assume that the blood and other body fluids from all patients are potentially infectious. They should therefore follow infection control precautions at all times. These precautions include: The routine use of barriers (such as gloves and/or goggles) when anticipating contact with blood or body fluids Washing hands and other skin surfaces immediately after contact with blood or body fluids, and The careful handling and disposing of sharp instruments during and after use. HIV/AIDS PREVENTION FOR HCW Safety devices have been developed to help prevent needlestick injuries. If used properly, these types of devices may reduce the risk of exposure to HIV. Many percutaneous injuries are related to sharps disposal. Strategies for safer disposal, including safer design of disposal containers and placement of containers, are being developed. Although the most important strategy for reducing the risk of occupational HIV transmission is to prevent occupational exposures, plans for postexposure management of health care personnel should be in place. CDC has issued guidelines for the management of HCP exposures to HIV and recommendations for postexposure prophylaxis (PEP). FDA approves home HIV test kit This is a screening test only, if positive further testing is necessary OraQuick test uses a swab of the oral cavity Test results will take 20-40 minutes and a (+) test still requires confirmation testing by physician Concerns about home test: 1 in 5,000 will have false (+) 1 in 12 will have false (-) ORA QUICK TEST FOR HIV HEPATITIS B Concentration of Hepatitis B Virus in Various Body Fluids High: blood; serum; wound exudates Moderate: semen; vaginal fluid; saliva Low/Not Detectable: urine; feces; sweat; tears; breastmilk HBV is transmitted by percutaneous or permucosal exposure to infectious blood or body fluids from persons who have either acute or chronic HBV infection. The highest concentrations of virus are in blood and serous fluids; lower concentrations are found in semen, vaginal fluid, and saliva. Therefore, blood exposure and sex contact are relatively efficient modes of transmission. Saliva can be a vehicle of transmission through bites; however, transmission has not been documented to occur as a result of other types of exposure to saliva, including kissing. HBsAg has also been detected in low concentrations in other body fluids, including tears, sweat, urine, feces, breast milk, cerebrospinal fluid, and synovial fluid; however, these fluids have not been associated with transmission. HEPATITIS B Hepatitis B Virus Modes of Transmission: Sexual Parenteral Perinatal In the United States, the most important route of HBV transmission is by sex contact, either heterosexual or homosexual, with an infected person. Direct parenteral inoculation of HBV by needles during injecting drug use is also an important mode of transmission. Transmission of HBV may also occur by other percutaneous exposures, including tattooing, ear piercing, and acupuncture, and by needlesticks or other injuries from sharp instruments sustained by medical personnel; however, these exposures account for only a small proportion of reported cases in the United States. In addition, transmission can occur perinatally from a chronically infected mother to her infant, most commonly by contact of maternal blood to the infant’s mucous membranes at the time of delivery. HEPATITIS B VACCINE SAFETY •Medical, scientific and public health communities strongly endorse using hepatitis B vaccine as a safe and effective way to prevent disease and death. •Scientific data show that hepatitis B vaccines are very safe for infants, children, and adults. •There is no confirmed evidence which indicates that hepatitis B vaccine can cause chronic illnesses. •To assure a high standard of safety with vaccines, several federal agencies continually assess and research possible or potential health effects that could be associated with vaccines. HEPATITIS B VACCINE •Vaccination Schedule: Initial first dose; 1 month later second dose; 6 months from first dose third dose. •Post-vaccination testing should be completed 1-2 months after the third vaccine dose for results to be meaningful. A protective antibody response is 10 or more milliinternational units (>=10mIU/mL). HEPATITIS C Exposures Known to be Associated With HCV Infection in the United States: •Injecting drug use •Transfusion, transplant from infected donor •Occupational exposure to blood - Mostly needle sticks •Iatrogenic (unsafe injections) •Birth to HCV-infected mother •Sex with infected partner - Multiple sex partners HEPATITIS C Occupational Transmission of HCV •Inefficient by occupational exposures •Average incidence 1.8% following needle stick from HCV-positive source •Associated with hollow-bore needles •Case reports of transmission from blood splash to eye; one from exposure to non-intact skin •Prevalence 1-2% among health care workers •Lower than adults in the general population •10 times lower than for HBV infection HEPATITIS C HCW to Patient Transmission of HCV •Rare •In U.S., none related to performing invasive procedures •Most appear related to HCW substance abuse •Reuse of needles or sharing narcotics used for self-injection •No restrictions routinely recommended for HCV-infected HCWs HEPATITIS C HCV Testing Routinely Recommended Based On Increased Risk For Infection: •Ever injected illegal drugs •Received clotting factors made before 1987 •Received blood/organs before July 1992 •Ever on chronic hemodialysis •Evidence of liver disease Based On Need For Exposure Management: •Healthcare, emergency, public safety workers after needle stick/mucosal exposures to HCV-positive blood •Children born to HCV-positive women HEPATITIS C Postexposure Management for HCV: •IG, antivirals not recommended for prophylaxis •Follow-up after needlesticks, sharps, or mucosal exposures to HCV-positive blood •Test source for anti-HCV •Test worker •Confirm all anti-HCV results with RIBA •Refer infected worker to specialist for medical evaluation and management RAPID BLOOD TEST FOR HCV OraQuick Rapid HCV Results Available In 20 Min. HEPATITIS C AIRBORNE/DROPLET DISEASES TUBERCULOSIS: AIRBORNE PANDEMIC INFLUENZA TUBERCULOSIS TB, or tuberculosis, is a disease caused by bacteria called Mycobacterium tuberculosis. The bacteria can attack any part of your body, but they usually attack the lungs. TB disease was once the leading cause of death in the United States. TUBERCULOSIS TB is spread through the air from one person to another. The bacteria are put into the air when a person with TB disease of the lungs or throat coughs or sneezes. People nearby may breathe in these bacteria and become infected. People who are infected with latent TB do not feel sick, do not have any symptoms, and cannot spread TB. But they may develop TB disease at some time in the future. People with TB disease can be treated and cured if they seek medical help. Even better, people who have latent TB infection but are not yet sick can take medicine so that they will never develop TB disease. TUBERCULOSIS When a person breathes in TB bacteria, the bacteria can settle in the lungs and begin to grow. From there, they can move through the blood to other parts of the body, such as the kidney, spine, and brain. TB in the lungs or throat can be infectious. This means that the bacteria can be spread to other people. TB in other parts of the body, such as the kidney or spine, is usually not infectious. TUBERCULOSIS In most people who breathe in TB bacteria and become infected, the body is able to fight the bacteria to stop them from growing. The bacteria become inactive, but they remain alive in the body and can become active later. This is called latent TB infection. People with latent TB infection: Have no symptoms Don't feel sick Can't spread TB to others Usually have a positive skin test reaction Can develop TB disease later in life if they do not receive treatment for latent TB infection Many people who have latent TB infection never develop TB disease. In these people, the TB bacteria remain inactive for a lifetime without causing disease. But in other people, especially people who have weak immune systems, the bacteria become active and cause TB disease. TUBERCULOSIS TB bacteria become active if the immune system can't stop them from growing. The active bacteria begin to multiply in the body and cause TB disease. Some people develop TB disease soon after becoming infected, before their immune system can fight the TB bacteria. Other people may get sick later, when their immune system becomes weak for some reason. TUBERCULOSIS Symptoms of TB depend on where in the body the TB bacteria are growing. TB bacteria usually grow in the lungs. TB in the lungs may cause: A bad cough that lasts longer than 2 weeks Pain in the chest Coughing up blood or sputum (phlegm from deep inside the lungs) TUBERCULOSIS Other symptoms of TB disease are: Weakness Or Fatigue Weight Loss No Appetite Chills Fever Sweating At Night TUBERCULOSIS Latent TB Infection: Have no symptoms Do not feel sick Cannot spread TB to others Usually have a positive skin test Chest x-ray and sputum test normal TB Disease SYMPTOMS INCLUDE: A bad cough that lasts longer than 2 weeks Pain in the chest Coughing up blood or sputum Weakness or fatigue Weight loss No appetite Chills Fever Sweating at night May spread TB to others Usually have a positive skin test May have abnormal chest x-ray, And/or positive sputum smear or Culture CDC’S INFLUENZA PANDEMIC OPERATION PLAN http://www.cdc.gov/flu/pandemic/cdcplan.htm NORTH CAROLINA’S INFLUENZA PANDEMIC OPERATION PLAN http://www.pandemicflu.gov/plan/states/northca rolina.html INFLUENZA PANDEMIC All personal protective equipment cleared by FDA must be able to block the passage of small particles the size of most infectious materials. FDA is not aware of any studies that specifically test PPE with any influenza virus, and no such data have been submitted to FDA by manufacturers. Thus neither FDA, nor a manufacturer, knows to what extent PPE will protect you against bird flu. Keep in mind that other infection control practices, such as hand-washing, isolating sick patients, and using appropriate coughing etiquette, are also important to minimize your risk of infection. INFLUENZA PANDEMIC CDC (Centers for Disease Control and Prevention), not FDA, makes recommendations for infection control practices, including recommendations specific to influenza. As part of its overall infection control recommendations, CDC recommends that healthcare workers wear the following personal protective equipment during the care of a patient with suspected or confirmed flu (influenza): surgical masks medical gloves surgical gowns INFLUENZA PANDEMIC WHAT YOU SHOULD KNOW FROM THE CDC For more information about CDC’s recommendations for controlling the spread of the flu http://www.cdc.gov/flu CDC’s RECOMMENDATIONS Seasonal flu vaccine should be administered to all people age 6 months and older unless medically contraindicated All healthcare workers should be vaccinated unless medically contraindicated, some healthcare facilities may make this mandatory Must develop new way of producing flu vaccine that will be faster than the current use of culturing in eggs TYPES OF INFLUENZA • Influenza Viruses are either 1) Swine (pig) related or 2) Avian (birds/bucks) related • Seasonal Influenza are type A and B with different strains • Most seasonal influenza can be prevented by vaccination • The most common strain of seasonal influenza virus is H1N1 • When new strains of influenza are detected concerns are raised for pandemic potential Must develop new way of producing flu vaccine that will be faster than the current use of culturing in eggs OTHER CONCERNS: H3N2v H3N2v is a Swine Virus associated with prolonged exposure to pigs, especially at State Fairs There has been no sustained transmssion but CDC continues to monitor OTHER CONCERNS: H5N1 H5H1 is a highly pathogenic Avian Influenza Virus but has not had much sustainability It is considered an Avian Disease although there is some evidence of limited human-to-human transmission Global effort is underway to control or eradicate it in poultry and prevent human exposure in an attempt to avoid a deadly pandemic Ducks play a role in transmitting the virus to other birds and has been found in some pigs, cats, dogs (have had human cases in 15 countries in Asia, Africa, the Pacific, Europe, the near East, and in 2014 one reported case in Canada) H5N1 has been contained CDC will continue to monitor this strain of influenza Mortality rates in human cases are 60% These cases have been the result of close contact with infected poultry and wild birds Efforts to produce pre-pandemic vaccine for humans that would be effective against avian influenza A (H5N1) viruses are ongoing. However, no H5N1 vaccines are currently available for human use. NEW CONCERNS: H7N9 In 2013 a new strain of flu (H7N9) was discovered in China To date there has been no evidence of sustained transmission Infected birds do not always display signs/symptoms of infection and may not appear to be sick/ill CDC is concerned about pandemic potential of this virus and will be working on developing a vaccine should one be needed CDC WEBSITES Interim Guidance For IFC With H1N1 Virus In Healthcare Settings: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5823a2.htm Additional Guidance For Laboratory Workers: http://www.cdc.gov/h1n1flu/guidance_ems.htm *SPECIAL NOTE: One should monitor CDC’s H1 N1 website daily for updates as guidance from the CDC may change rapidly http://www.cdc.gov/flu CDC WEBSITES CDC Home page: http://www.cdc.gov CDC Division of Health-Care Quality: http://www.cdc.gov/ncidod/hip CDC Morbidity and Mortality Weekly: http://www.cdc.gov/mmwr CDC Recommendations/Guidelines: http://www.phppo.cdc.gov/cdcRecommends/Adv SearchV.asp CDC’s National institute for Occupational Safety and Health: http://www.cdc.gov/niosh/homepage.html CDC’S Hand Hygiene Guidelines: http://www.cdc.gov/handhygiene/materials.htm CDC’s Environmental Guidelines: http://www.cdc.gov/ncidod/hip/enviro/guide.htm CPCC STUDENT MANAGEMENT OF AN EXPOSURE INCIDENT FIRST AID FIRST AID MEASURES SCRUB FOR MINIMUM OF 5 –10 MINUTES APPLY ANTISEPTIC IF APPROPRIATE OBTAIN OTHER FIRST AID IF NECESSARY (e.g. Td booster, sutures, etc.) EYES AND MUCOUS MEMBRANES MUST BE FLUSHED WITH PLENTY OF RUNNING WATER 5-15 MINUTES IMMEDIATELY REPORT INCIDENT FILL-OUT FORMS (CPCC MUST RECEIVE A COPY OF THE INCIDENT REPORT) CPCC STUDENT REPORTING IMMEDIATELY REPORT EXPOSURE TO THE AFFILIATING FACILITY AND CPCC’S CLINICAL SUPERVISIOR REPORT EXPOSURE TO PROGRAM CHAIR; DIVISION DIRECTOR; CPCC’S HEALTH & SAFETY OFFICER: 704-330-5492 Or 330-400-9951 Or 704-330-6580 CPCC INCIDENT REPORT FOLLOW WRITTEN INSTRUCTIONS FOR COMPLETING THE INCIDENT REPORT PACKET SUPPLY NECESSARY GENERAL INFORMATION GIVE DETAILED DESCRIPTION OF INCIDENT COMPLETE SHARPS INJURY FORM IF APPLICABLE SUMMARY OF ACTION TAKEN STUDENT CONSENT/DECLINATION FORMS SOURCE PATIENT INFORMATION SOURCE PATIENT CONSENT FORM NOTIFY CPCC’S HEALTH & SAFETY OFFICE AT: 704-330-5492/330-400-9951/704-330-6580 SHARPS INJURY REPORT CASE REPORT NUMBER DATE OF INCIDENT DIVISION AND PROGRAM NAME TYPE AND BRAND OF DEVICE USED LOCATE OF FACILITY COMMENTS/EXPLANATION OF HOW INCIDENT OCCURRED SUMMARY OF ACTION TAKEN POST-EXPOSURE EVALUATION AND FOLLOW-UP: STUDENT $$$ EXPENSES $$$ OSHA DOES NOT CONSIDER STUDENTS EMPLOYEES. CPCC AND CLINICAL SITES/FACILITIES ARE NOT RESPONSIBLE FOR THE EXPENSES ASSOCIATIATED WITH EXPOSURE INCIDENTS. STUDENTS MUST OBTAIN HEALTH INSURANCE. POST-EXPOSURE EVALUATION AND FOLLOW-UP: STUDENT IF A STUDENT SHOULD EXPERIENCE A HIGH-RISK EXPOSURE, IT IS IMPORTANT TO SEEK MEDICAL CARE WITHIN ONE HOUR OF THE INCIDENT. THERE IS A “WINDOW OF OPPORTUNITY” THAT MUST BE MET FOR POST-EXPSOURE MEDICATION TO BE THE MOST EFFECTIVE. POST-EXPOSURE EVALUATION AND FOLLOW-UP: STUDENT IMMEDIATELY CALL NOVANT URGENT CARE TO NOTIFY THE STAFF OF THE INCIDENT AND ARRANGE FOR FOLLOW-UP WITHIN 1-2 HOURS OF THE INCIDENT (NO LATER THAN 24 HOURS) 704-316-1050 BRING COPY OF INCIDENT REPORT CPCC EXPOSURE MANAGEMENT PROVIDER: NOVANT URGENT CARE 1918 RANDLOPH ROAD CHARLOTTE, NC 704-316-1050 OPEN 7 DAYS A WEEK (Call For Hours) CONTACT PERSON: ROSA OMER IDENTIFY SELF AS CPCC STUDENT IN HEALTH PROGRAM MUST TAKE EXPOSURE INCIDENT REPORT CPCC EXPOSURE MANAGEMENT PROVIDER: NOVANT URGENT CARE 9600 E. INDEPENDENCE BLVD. MATTHEWS, NC 704-316-1050 OPEN 7 DAYS A WEEK (Call For Hours) IDENTIFY SELF AS CPCC STUDENT IN HEALTH PROGRAM MUST TAKE EXPOSURE INCIDENT REPORT POST-EXPOSURE EVALUATION AND FOLLOW-UP: STUDENT AFTER BASELINE TESTING: FOLLOW-UP TESTING TAKES PLACE AT 6 WEEKS, 12 WEEKS (3 MONTHS), AND 6 MONTHS POST-EXPOSURE FOLLOW U.S. PUBLIC HEALTH SERVICE’S RECOMMENDATIONS FOR POST-EXPOSURE PROPHYLAXIS POST-EXPOSURE EVALUATION AND FOLLOW-UP ALL FEDERAL AND STATE LAWS APPLY THE STUDENT AND SOURCE PATIENT MUST RECEIVE PRE AND POST TEST COUNSELING TESTING AT BASELINE INCLULDES HIV; HEP. B; HEP. C (OTHER TEST IF INDICATED) SOURCE PATIENT ONLY TESTED ONCE SOURCE PATIENT SOURCE PATIENT MUST BE TESTED ACCORDING TO NORTH CAROLINA STATE LAW FACILITY MUST INFORM PATIENT MUST BE TESTED FOR HEP. B, C, HIV (Other testing as indicated) TESTING IS THROUGH NOVANT URGENT CARE VII. NORTH CAROLINA STATE STATUES: 15A NCAC 19A.0202(4) Control Measures HIV 15A NCAC 19A.0203(b)(3) Control Measures Hepatitis When a health care worker sustains an exposure incident (in North Carolina), the source patient must be tested with or without written consent. If a person refuses to comply with the rules/requirement for testing, the local health director, who is charged with ensuring compliance with the rules shall be notified. The local health director may be able to gain compliance through discussion or by an official public health ordinance by obtaining a court order. Blood should not be forcibly obtain. However, if blood is stored in a laboratory, it may be used if the patient cannot be located or does not comply with the public health ordinance. A person who violates a provision of these laws or the rules adopted by the Health Commission or a local board of health shall be guilty of a misdemeanor. HEALTHCARE PROVIDER’S WRITTEN OPINION MUST BE RECEIVED WITHIN 15 DAYS MUST BE LIMITED TO IT’S CONTENTS Contact Your Program Chair, Clinical Faculty Supervisor, Division Director, Or CPCC’s Health & Safety Office Should You Have Any Questions Or Need Help With What To Do Should You Experience An Exposure Incident. THE END-THANK YOU!