1. Bloodborne Pathogens/TB
An OSHA Mandated Drill

2. Introduction
OSHA mandates that upon hire each individual who works in a high-risk environment must received bloodborne pathogens training.
OSHA also mandates that this topic be reviewed annually

3. Objectives Identify the pathogens that are transmitted via blood
Identify modes of transmission of BBP
Identify risks of transmission in the workplace
Identify appropriate use of PPE
Identify correct procedure to follow if exposed
Identify requirements of HBV series
Understand importance of infectious waste disposal
Identify locations at both companies for decon and infectious waste disposal

4. Objectives (cont’d) Identify those at risk for development of TB
Differentiate between TB Disease and TB Infection
Identify methods of diagnosing TB
Understand treatment of TB
Understand risks of rabies exposure to emergency responders

5. Bloodborne Pathogens Hepatitis B,C,D,E,F,G HIV
Viral Hemorrhagic Fevers (Ebola, Marburg)

6. Hepatitis
Hepatitis is an infection that occurs in the liver after exposure to the virus through blood.
Symptoms of hepatitis include: jaundice, fever, weight loss, loss of appetite, fatigue, dark urine, joint pain, abdominal pain, diarrhea, nausea, and vomiting.
Incubation periods vary depending on the type.
HBV average is 120 days (ranges from days)
HCV average is 45 days (ranges from )

7. Hepatitis (cont’d)
Death from chronic liver disease occurs in 15-25% of chronically infected persons.
People with chronic HBV infection have a much greater risk of developing liver failure & liver cancer
Chronic infection with HCV occurs in 55-85% of infected persons and 70% of chronically infected persons go on to develop chronic liver disease
Those with chronic HCV have a much higher risk of suffering from liver failure and liver cancer

8. Hepatitis Vaccine
HBV series is a series of 3 shots over a period of 6 months
OSHA mandates that all employees in a high-risk setting must be offered the vaccine free of charge.
If you decline the vaccine, you must sign a waiver.
31-60 days after receiving the 3rd shot you should have a titre drawn to check for immunity.
There is no vaccine for HCV

9. Transmission of Hepatitis
HBV is found in blood and certain body fluids. It is spread through these fluids from an infected person to a non-immune person.
Spread via unprotected sex, sharing needles, exposure to needlesticks/sharps in the workplace, and from an infected mother to her child during birth

10. HIV
Human Immunodeficiency Virus is a retrovirus that causes Acquired Immune Deficiency Syndrome (AIDS).
The Immune system progressively deteriorates leading to opportunistic infections that ultimately leads to death.
There is no vaccine for HIV
Antiretroviral medications are used to treat HIV and have been shown to prolong the lifespan of those with HIV. There is no cure.

11. HIV (cont’d)
HIV was first discovered on December 1, Since that time the World Health Organization (WHO) estimates that AIDS has killed more than 25 million people.
In 2005 AIDS claimed million lives of which, more than 570,000 were children.
It is one of the most destructive pandemics in recorded history.

12. HIV Transmission The three major routes of transmission of HIV are:
Unprotected sexual intercourse
Contaminated needles
Infected mother to unborn child /breast milk to nursing infant
Screening of blood products has virtually eliminated transmission via that route

13. HIV Symptoms (Early)
Many people do not develop symptoms when first infected.
Some people develop flu-like symptoms within 3-6 weeks of exposure (Acute HIV Syndrome). There may also be enlargement of lymph nodes during this phase of illness.
This phase usually lasts a week to a month & is often mistaken for another viral infection

14. HIV Symptoms (Late) Lack of energy, swelling or hardening of glands
Weight loss, long bouts of diarrhea
Frequent fevers & sweats
Thrush accompanied by sore throat
Severe or recurring yeast infections
Chronic pelvic inflammatory disease
Periods of extreme & unexplained fatigue
Headaches, lightheadedness, dizziness
Bruising easily

15. What are the Chances? HBV –5-30 out of 100 HIV – 1 in 300
HCV – 1.8 in 100

16. Precautions
Standard Precautions- combines major features of universal precautions and body substance isolation (BSI). Applies to all body fluids, secretions, and excretions regardless of whether or not they contain visible blood.

17. Transmission-Based Precautions
Airborne – TB, Chickenpox
Droplet – Whooping cough, measles, SARS, flu
Contact – MRSA, VRE, C-Diff

18. Personal Protective Equipment
PPE
Gloves
Goggles
Masks (N95 and surgical)
Gowns/Aprons
Tyvek suits
BVM

19. Post Exposure Follow up
Report your exposure immediately to OIC
Complete Incident report
You will be sent for a confidential medical evaluation (You have the right to refuse testing)

20. Disposal of Infectious Waste & Decontamination Procedures
Work area to be kept clean & sanitary
Use appropriate disinfectants and mix according to manufacturer’s directions
All dressings & disposables must be bagged per infection Control policy in red biohazard bags.

21. Company One
White biohazard containers located by EMS room.(Lids must be on at all times)
Contaminated equipment cleaned in decon shower at far end of bay in decon shower.
Contaminated gear & clothing washed in machines under stairwell at far end of bay
Biohazard shed kept locked at all times.

22. Company Two
White biohazard containers located next to bay storage doors.
Medical waste transported back to Company 1 medical waste shed
Contaminated gear & clothing transported to Company 1 for proper handling.

23. Protecting Yourself On Scene
USE YOUR HEAD!!!
Take an extra few seconds to survey the scene for potential exposure hazards & choose your PPE accordingly.
Be efficient but don’t rush. (Fools rush in!)
You are ultimately accountable for your own protection.

24. Tuberculosis Tuberculosis is spread by the airborne route.
Primarily associated with the lungs, but can be found in other parts of the body such as the kidney and the bone.
It is reportable to the CT DPH by law.
There are specific laws that dictate how it should be managed.

25. Symptoms of TB Feeling weak or sick Weight loss Fever Night Sweats
Persistent Cough
Chest Pain
Coughing Up Blood

26. Who is at Risk?
People who share the same breathing space as someone with TB disease.
Poor people
Homeless People
Foreign born people from countries with high incident of TB
Nursing Home Residents
Prisoners
Alcoholics and IV Drug abusers
People with diabetes, certain types of cancer, and being underweight
People with HIV

27. TB Disease vs. TB Infection
Person is sick with germs that are active in the body
Usually have one or more symptoms of TB
Can pass disease on
Permanent body damage and death can occur
Medicine is prescribed that can cure TB
TB Infection:
Person is healthy
Strong immune system
No Symptoms
Cannot spread the infection
Can develop TB disease in the future
Medicine prescribed to prevent development of TB disease

28. Diagnosis of TB Skin Test Doctors Office or local Health Department
If positive other tests will be done to see if you have infection vs. disease
Small needle used to implant tuberculin under the skin
Usually done inside of your forearm
Test is read in 48 to 72 hours to check for reaction
Size of reaction is measured
Less than 10mm is negative

29. Negative vs. Positive Negative Test:
Usually means person is not infected
Maybe falsely negative if person has been recently infected
Usually takes 2 to 10 weeks after exposure for test to become positive
Positive Test:
Usually means the person has been infected with the TB germ
Does not necessarily mean person has TB disease
Other testing such as X-Ray or Sputum testing will be ordered

30. Treatment of TB Compliance with medications is mandatory
Common medications include INH and Rifampin
Routine follow up Chest X-Rays
Routine follow up with Physician

31. Rabies
Virus spread by warm blooded mammals (raccoons, skunks, foxes, coyotes, woodchucks and bats.
A Bat’s teeth & claws are so small that a bite may not bleed or even hurt

32. People sleeping in a room where a bat is found, or children who may have been alone in a room with a bat, should see a doctor. If possible the bat should be saved for testing, but never handle it without protective gloves.

33. Domestic Pets
Dogs, cats, ferrets & farm animals can act as a bridge between wild animals and people.
If pets appear to have been in a fight, use caution, and handle with gloves. Cover pet with fluid impervious material & see Vet.

34. How Does Rabies Work? Attacks brain cells & nerves
Slowly & painfully kills its victim if not treated quickly.
Prevention vaccine available for bite victims
Incubation period is 4-6 weeks

35. Rabies Vaccine
Involves a total of 5 shots over several days & 1 shot of Human Rabies Immune Globulin (HRIG) which is given immediately.

36. On Scene
Fire & EMS personnel should be wary of stray or roaming animals
If bitten, you must report it immediately & seek medical attention…untreated rabies can be & usually is fatal.

37. Transmission
Transmitted through a bite, scratch, lick, and even petting.
The virus is in the animal’s saliva.

38. Myths All Rabid dogs froth at the mouth.
A rabid dog will be vicious & snap at everything
A rabid dog will not drink water & will exhibit fear of water
If a suspected dog acts friendly, its not rabid.
The dog had his shots, it doesn’t have rabies
Dogs afflicted by 2 types..dumb paralytic, drools constantly, tongue hangs out, frothy appearance 20% of cases only.
Dog with furious type might. At first will snap at non-existent objects. If dog is loose, will run for miles, snapping at anything it encounters until it eventually becomes paralyzed & dies.
Humans infected with rabies suffer painful muscle spasms when swallowing, rabid dogs do not & can drink large quantities of water.
Infected dogs will undergo mood shifts. In addition, an infected dog can transmit the diseae 3-5 days prior to exhibiting Sx.
Two types of rabies vaccine. One lasts for one year, the other for three years. Never take it by word of mouth. Ask for a a vet’s written certificate as proof of properly administered/up to date vaccination.

39. Avoiding Rabies Avoid being bitten
Treat any animal bite as a potential rabies exposure.
If bitten, immediately wash area with soap & warm water then wash wound with 1% providone-iodine.
Capture/confine the animal

40. Avoiding Rabies cont’d
Suspect strays should be destroyed & tested by health officials.
Pets who’s owner can’t provide proof of vaccine should be confined for 10 days.
All animal corpses should be treated as HIV contaminated (Use PPE when handling)
Notify proper authorities of any suspected rabid animal

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