Transcript Excellence Through Training Fermilab Fire Department 2009

Fermilab Fire Department
Excellence Through Training
January 2009
Bloodborne
Pathogens
Awareness
Objectives 1 of 2
• Identify the laws relating to Bloodborne
Pathogens (BBP)
• Identify the definition of BBP
• Identify local procedures for BBP and
exposures to BBP
• Identify precautions and PPE relating to
BBP
Objectives 2 of 2
• Identify Facts and Characteristics of BBP
• Identify Methods BBP can be spread
• Identify high risk behaviors/practices
associated with BBP
OSHA 1910.1030
Occupational Exposure to
Bloodborne Pathogens
(Mandated Federal Law)
Adopted by reference in Illinois (IDOL)
“Bloodborne Pathogens”
Defined . . .
Pathogenic microorganisms that
are present in human blood and
can cause disease in humans.
“Bloodborne Pathogens”
Examples . . .
Human Immunodeficiency (HIV)
Hepatitis B (HBV)
Hepatitis C (HCV)
“Regulated Waste”
Defined . . .
• Liquid or semi-liquid blood or other potentially
infectious materials;
•Contaminated items that would release blood or
other potentially infectious materials in a liquid or
semi-liquid state if compressed;
•Contaminated sharps;
•Pathological and microbiological wastes
containing blood or other potentially infectious
materials (OPIM).
“Other Potentially
Infectious Materials”
Defined . . .
(1) The following human body fluids: semen,
vaginal secretions, cerebrospinal fluid, synovial
fluid, pleural fluid, pericardial fluid, peritoneal
fluid, amniotic fluid, saliva in dental procedures,
any body fluid that is visibly contaminated with
blood, and all body fluids in situations where it is
difficult or impossible to differentiate between
body fluids;
OSHA 1910.1030
Effective March 6, 1992
Applies to ALL Employers With
Employees “Reasonably
Anticipated”to Have Occupational
Exposure to Blood and Other
Potentially Infectious Materials
Requirements of OSHA 1910.1030
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Exposure determination
Exposure control plan
Annual awareness training
Implementation of engineering and work
practice controls
Requirements of OSHA 1910.1030
• Proper labeling of blood or other
potentially infectious materials
• Free HBV vaccinations
• Free medical evaluations for incidents of
exposure
Persons who may be exposed . . .
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Firefighter / EMTs
Firefighter / Paramedics
Fire Lieutenants
Fire Chiefs
Day Care Workers
Medical Department
Tasks involving potential exposure . . .
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Rescue / Extrication
Fire Suppression
BLS / ALS procedures (EMS)
Handling of deceased persons
Disinfecting / Decontaminating
procedures
How does exposure occur?
Most common: needlesticks
Cuts from other contaminated sharps (scalpels,
broken glass, etc.)
Contact of mucous membranes (for example, the
eye, nose, mouth) or broken (cut or abraded) skin
with contaminated blood
OSHA Office of Training and Education
5
FERMILAB
Exposure Control Plan
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Engineering & work practices
Hepatitis B Vaccination
Post-exposure evaluation & follow-up
Bio-hazard labeling
Record keeping
Information & training
AIDS
Acquired Immunodeficiency Syndrome
Caused by HIV
Human Immunodeficiency Virus
HIV
Outcome of infection with the virus varies:
• Some have no symptoms.
• Some have less severe symptoms than those
with AIDS.
• AIDS results from destruction of the immune
system which allows diseases to threaten life or
health.
How Widespread Is HIV ?
Worldwide
• CDC estimates that 33.6 million people
worldwide are living with HIV / AIDS.
(32.4 million adults) 2008
• Approx. 5.6 million new HIV infections were
reported in 2006. More than 15,000 infections
each day.
• One in every 100 adults aged 15 to 49 is HIVinfected.
How Widespread Is HIV ?
United States
• CDC estimates that 650,000 to 900,000 US
residents are currently living with HIV
infection, of whom more than 200,000 are
unaware of their infection.
• Approx. 43,000 new HIV infections were
reported in 2006
• 711,344 cases of AIDS have been officially
reported to the CDC as of June 30, 2005
You Cannot “Catch” HIV:
• Through the air
• Through casual, everyday contact
– (sharing bathrooms, kitchens, etc.)
• Through nonsexual social situations
• Through insects or mosquitoes
• Through urine, feces, nasal secretions, sputum,
vomitus, saliva, sweat or tears from an infected
person
What Personal Behaviors/Practices
Put You at Risk ?
• Sexual contact with an infected person
• Sharing infected needles
• Infected woman to her child at birth
• Blood transfusion*
*The blood supply is thoroughly screened so that the risk of infection
from transfusion is extremely small.
How Can You Prevent HIV
Transmission in Your Personal Life?
Refrain from:
• Vaginal or oral sex with someone who uses IV drugs
• Sex with someone you don’t know well
• Sex with someone who has multiple sex partners
• Sex without a condom - with an infected person
• Sharing IV drug needles
Occupational Acquired HIV
Infection & AIDS
Of the 427,795 infected adults reported to the CDC where the
type of job was known, 21,760 were health care workers.
Of those, 74% have died.
Occupational Acquired HIV
Infection & AIDS
There has only been one documented case
of patients being infected by a health
care worker in the United States.
This involved HIV transmission from one
infected Dentist to six patients.
Protect yourself from HIV on the job by avoiding
contact with blood and potentially infectious
body fluids that can transmit the virus
Blood
The single most prominent source of HIV
in the occupational setting
The risk of HIV infection through
contact with feces, nasal secretions,
saliva, sputum, sweat, tears, urine
and vomitus is extremely low or
nonexistent.
Workers May Be Exposed Through:
• Needle stick
– 47 of the 55 reported health care workers
who seroconverted to HIV after exposure
were exposed through punctures / cuts.
• Mucous membranes of the eyes, nose or mouth
• Broken or non-intact skin
Risk of HIV Infection:
• Needle stick: 0.3% following needle stick
contaminated with blood from a known
infected person.
• Chapped / broken skin or mucous
membranes: less, but not definitively
known
HIV Antibodies
• Antibodies to HIV in an infected person’s
blood can be detected by a test.
• Persons usually develop antibodies within
6 to 12 weeks after becoming infected.
How Can You Protect Yourself?
• Use Body Substance Isolation (BSI)
procedures & equipment.
• No preventative vaccine exists at the
present time.
What Is Hepatitis B?
• Caused by the Hepatitis B Virus (HBV).
• Damages the liver, causing symptoms that
range from mild or unapparent to severe or
fatal.
• 25% of infected individuals develop acute
hepatitis.
• 6% to 10% become HBV carriers. Carriers
can develop liver disease and are infectious to
others.
Hepatitis B . . .
• 12,000 health care workers become infected
through occupational exposure each year.
• 500-600 infected health-care workers are
hospitalized each year.
• 200-300 infected health-care workers die each
year with associated diseases.
What Personal Behaviors Put You at
Risk for HBV Infection ?
• Sexual contact with an infected person
• Sharing drug needles and syringes with
infected person
• Since blood supply is screened for HBV, the
chance of being infected through transfusion is
extremely small.
What Occupational Exposures Put a
Worker at Risk for HBV Infection ?
Contact with blood or potentially infectious body
fluids through:
• Needle stick
• Broken or non-intact skin
• Mucous membranes of eyes, nose and mouth
Saliva injected through a human bite can also
transmit HBV.
Body Substance Isolation
(BSI)
The same BSI equipment &
procedures that will protect against
exposure to HIV will protect the
worker against HBV.
Blood tests are available to detect
antibodies for HBV in an infected
person.
Vaccines provide protection against
HBV infection (90% protection for 7 or
more years)
Vaccines are 70% to 80% effective when
given within 1 week of exposure
Personal Protective Equipment
Gloves
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Disposables protect against blood and fluids
Normally provide no protection against sharps
Must be changed if soiled or torn
Must be changed between handling of different
people
Personal Protective Equipment
Masks, Eyewear & Gowns
• Not necessary unless blood or other potentially
infectious fluids are or could be present
• Masks & eyewear should be worn together if
splashes are anticipated
• Gowns or aprons are worn to avoid soaking of
clothes
There are no reported cases of
HBV or HIV transmission
from mouth-to-mouth
resuscitation.
Because other diseases can be transmitted
this way, protective devices should be
used:
bag-valve-mask devices
pocket masks
mechanical resuscitators
How Can You Protect Yourself
Against HIV & HBV ?
• If you perform tasks that put you in contact
with blood, or other potentially infectious body
fluids, you should be vaccinated against HBV.
• Practice BSI if blood or other potentially
infectious fluids are present.
• Have PPE readily available.
HIV cannot live in a dry environment for more
than a few hours
HBV can live in a dry environment for at least
7 days
Once the virus is dead - it’s dead. You cannot
“reactivate” it by adding water.
Engineering Practices
&
Control
Universal Precautions
• Consider everything contagious
• Personal Protective Equipment (PPE)
– MUST be provided free of charge
• PPE is carried on all EMS apparatus
• Fire fighting gear offers little or no
protection
Contaminated Equipment
• If possible, use as much disposable
equipment as possible.
• Reusable equipment should be
decontaminated with a germicidal solution
as soon as possible / practical.
• Consider patient’s clothing / belongings as
contaminated if soiled.
Needles & Sharps Disposal
• Needles should not be recapped or
manipulated by hand.
• Disposable blades and other sharps should
be placed in a puncture-resistant container.
• Puncture-resistant containers should be
readily available at all times.
• Scissors, glass, lancets should be considered.
Hand Washing
• Wash hands upon arrival at hospital or
returning to quarters.
• Use utility or designated sink -- not the
food preparation area.
• Wash thoroughly with soap & water or
germicidal cleanser.
• Antiseptic hand cleaners should be
available for special situations.
Cleaning & Decontaminating
Spills of Blood:
• Wear gloves and clean with disposable
towels. Place soiled linens in a red plastic
bag.
• Wear eye & face protection if splashing is a
possibility.
• Wear shoe covers if amount of blood is great.
Cleaning & Decontaminating
Spills of Blood:
• Decontaminate with tuberculocidal solution
or 10:1 solution of bleach. Wipe area with
clean towels and let air dry.
• Waste/unused cleaning solution should only
be poured down sanitary drains. Sinks shall
be disinfected after use.
• Remove contaminated items, shoe coverings,
etc. and place in a red plastic bag for proper
disposal. Remove gloves last. Wash hands
after removing gloves.
Laundry
• Handle soiled items as little as possible.
• If possible, remove soiled linens at
place of use and place in red plastic
bags that prevent leakage.
Labeling
Record Keeping
Records MUST BE kept for the
duration of employment
plus 30 years.
Exposure Reporting
Exposures MUST BE reported
as soon as possible so the postexposure documentation can
be completed and the postexposure evaluation
procedures initiated.
What is a Significant Exposure?
Refers to an exposure which
carries the potential for
transmission of HIV
(AIDS Virus).
“Significantly Exposed” means . . .
Sustained a contact which carries a
potential for a transmission of HIV, by
one or more of the following:
1) Transmission, into a body orifice or onto mucous
membrane of blood; semen; vaginal secretions;
cerebrospinal, synovial, pleural, peritoneal,
pericardial or amniotic fluid; or other body fluid
that is visibly contaminated with blood.
Guidelines & Procedures
1. Pre-hospital providers should have on
record their past medical history
• Tetanus
• Hepatitis B Vaccination
Guidelines & Procedures
2. Each ambulance should have a hand
washing product and surface cleaner
available at all times.
• Most EPA approved germicidals OK
• 10% bleach may be substituted but
some equipment could be bleach
sensitive.
Guidelines & Procedures
3. Hand Washing should be done before &
after contact with patient
4. Gloves should be worn when there is any
risk with bodily fluids
5. Masks, gowns and protective eyewear
should be worn when there is any risk of
splattering or spraying of infectious
material
Guidelines & Procedures
10. Soiled clothing – linens should be placed into
leak proof bag, sealed and transported to ER.
Rescuer clothing laundered ASAP.
11. Sharps should be handled with extreme
caution. DO NOT RECAP, BEND or CUT
USED NEEDLES. Use appropriate puncture
resistant containers.
Guidelines & Procedures
12. Where possible, disposable equipment
should be used on all patients. Where not
possible equipment should be cleaned
immediately with a commercial disinfectant
or bleach solution.
13. CPR should use appropriate protection, avoid
mouth-to-mouth, clean & disinfect if not
disposable.
Guidelines & Procedures
14. Exposure to blood or body substance, should:
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Fill out “Exposure form”
Verbal report
Evaluation by ED within one hour
Follow-up determined by ED in accordance with
Policy
Provider reports incident to Employer
Guidelines & Procedures
15. Exposure to eyes should necessitate
immediate irrigation & evaluation by
Fermilab Office or ED if off hours.
16. Exposure to skin should necessitate washing
with warm soap & water or commercial
agent, & seek evaluation by Fermilab
Medical Office or ED if off hours.
THE FERMILAB
EXPOSURE CONTROL PLAN
FESHM CHAPTER #5072
The End