2IntroductionOSHA 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
3Objectives Identify the pathogens that are transmitted via blood Identify modes of transmission of BBPIdentify risks of transmission in the workplaceIdentify appropriate use of PPEIdentify correct procedure to follow if exposedIdentify requirements of HBV seriesUnderstand importance of infectious waste disposalIdentify locations at both companies for decon and infectious waste disposal
4Objectives (cont’d) Identify those at risk for development of TB Differentiate between TB Disease and TB InfectionIdentify methods of diagnosing TBUnderstand treatment of TBUnderstand risks of rabies exposure to emergency responders
5Bloodborne Pathogens Hepatitis B,C,D,E,F,G HIV Viral Hemorrhagic Fevers (Ebola, Marburg)
6HepatitisHepatitis 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 )
7Hepatitis (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 cancerChronic infection with HCV occurs in 55-85% of infected persons and 70% of chronically infected persons go on to develop chronic liver diseaseThose with chronic HCV have a much higher risk of suffering from liver failure and liver cancer
8Hepatitis VaccineHBV series is a series of 3 shots over a period of 6 monthsOSHA 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
9Transmission 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
10HIVHuman 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 HIVAntiretroviral medications are used to treat HIV and have been shown to prolong the lifespan of those with HIV. There is no cure.
11HIV (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.
12HIV Transmission The three major routes of transmission of HIV are: Unprotected sexual intercourseContaminated needlesInfected mother to unborn child /breast milk to nursing infantScreening of blood products has virtually eliminated transmission via that route
13HIV 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
14HIV Symptoms (Late) Lack of energy, swelling or hardening of glands Weight loss, long bouts of diarrheaFrequent fevers & sweatsThrush accompanied by sore throatSevere or recurring yeast infectionsChronic pelvic inflammatory diseasePeriods of extreme & unexplained fatigueHeadaches, lightheadedness, dizzinessBruising easily
15What are the Chances? HBV –5-30 out of 100 HIV – 1 in 300 HCV – 1.8 in 100
16PrecautionsStandard 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.
18Personal Protective Equipment PPEGlovesGogglesMasks (N95 and surgical)Gowns/ApronsTyvek suitsBVM
19Post Exposure Follow up Report your exposure immediately to OICComplete Incident reportYou will be sent for a confidential medical evaluation (You have the right to refuse testing)
20Disposal of Infectious Waste & Decontamination Procedures Work area to be kept clean & sanitaryUse appropriate disinfectants and mix according to manufacturer’s directionsAll dressings & disposables must be bagged per infection Control policy in red biohazard bags.
21Company OneWhite 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 bayBiohazard shed kept locked at all times.
22Company TwoWhite biohazard containers located next to bay storage doors.Medical waste transported back to Company 1 medical waste shedContaminated gear & clothing transported to Company 1 for proper handling.
23Protecting 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.
24Tuberculosis 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.
25Symptoms of TB Feeling weak or sick Weight loss Fever Night Sweats Persistent CoughChest PainCoughing Up Blood
26Who is at Risk?People who share the same breathing space as someone with TB disease.Poor peopleHomeless PeopleForeign born people from countries with high incident of TBNursing Home ResidentsPrisonersAlcoholics and IV Drug abusersPeople with diabetes, certain types of cancer, and being underweightPeople with HIV
27TB Disease vs. TB Infection Person is sick with germs that are active in the bodyUsually have one or more symptoms of TBCan pass disease onPermanent body damage and death can occurMedicine is prescribed that can cure TBTB Infection:Person is healthyStrong immune systemNo SymptomsCannot spread the infectionCan develop TB disease in the futureMedicine prescribed to prevent development of TB disease
28Diagnosis of TB Skin Test Doctors Office or local Health Department If positive other tests will be done to see if you have infection vs. diseaseSmall needle used to implant tuberculin under the skinUsually done inside of your forearmTest is read in 48 to 72 hours to check for reactionSize of reaction is measuredLess than 10mm is negative
29Negative vs. Positive Negative Test: Usually means person is not infectedMaybe falsely negative if person has been recently infectedUsually takes 2 to 10 weeks after exposure for test to become positivePositive Test:Usually means the person has been infected with the TB germDoes not necessarily mean person has TB diseaseOther testing such as X-Ray or Sputum testing will be ordered
30Treatment of TB Compliance with medications is mandatory Common medications include INH and RifampinRoutine follow up Chest X-RaysRoutine follow up with Physician
31RabiesVirus 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
32People 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.
33Domestic PetsDogs, 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.
34How Does Rabies Work? Attacks brain cells & nerves Slowly & painfully kills its victim if not treated quickly.Prevention vaccine available for bite victimsIncubation period is 4-6 weeks
35Rabies VaccineInvolves a total of 5 shots over several days & 1 shot of Human Rabies Immune Globulin (HRIG) which is given immediately.
36On SceneFire & EMS personnel should be wary of stray or roaming animalsIf bitten, you must report it immediately & seek medical attention…untreated rabies can be & usually is fatal.
37TransmissionTransmitted through a bite, scratch, lick, and even petting.The virus is in the animal’s saliva.
38Myths All Rabid dogs froth at the mouth. A rabid dog will be vicious & snap at everythingA rabid dog will not drink water & will exhibit fear of waterIf a suspected dog acts friendly, its not rabid.The dog had his shots, it doesn’t have rabiesDogs 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.
39Avoiding 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
40Avoiding 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