Presentation on theme: "Infection Control and Bloodborne Pathogens Presented by Riverland Community College."— Presentation transcript:
Infection Control and Bloodborne Pathogens Presented by Riverland Community College
Objectives At the end of this training session, participants will be able to: Describe what laws and safety regulations cover Bloodborne Pathogens List and describe the diseases that cause the greatest concerns for providers and their symptoms Describe how to prevent disease transmission Describe post-exposure treatments and follow-up that may be provided Discuss the difference between significant vs reportable exposure
Things to Know if there is Risk of Exposure Counseling specific to exposure incident is available Post-exposure treatments and follow-up that may be provided. If you are exposed, confidential medical evaluation is to be made immediately available to you. 3
OSHA Bloodborne Pathogens Standard (29 CFR ) OSHAs Bloodborne Pathogens standard prescribes safeguards to protect workers against the health hazards from exposure to blood and other potentially infectious materials, and to reduce their risk from this exposure.
Who Needs OSHA BBP Training? All employees who could be reasonably anticipated as the result of performing their job duties to face contact with blood and other potentially infectious materials Good Samaritan acts such as assisting a co-worker with a nosebleed would not be considered occupational exposure 5
Employees Who May Be Exposed Physicians, nurses and emergency room personnel Orderlies, housekeeping personnel, and laundry workers Dentists and other dental workers Laboratory and blood bank technologists and technicians Maintenance workers in healthcare facilities Staff of nursing homes and long-term care facilities Firefighters/Law enforcement personnel First Responders/EMTs/Paramedics Medical waste treatment employees Employees of funeral homes & mortuaries Home healthcare workers 6
What are Bloodborne Pathogens? Bloodborne Pathogens are disease-causing microorganisms that may be present in human blood. They may be transmitted with any exposure to blood or OPIM. Hepatitis Viruses Hepatitis B (HBV) HBV Immunization Hepatitis C Virus Human Immunodeficiency Virus (HIV)
Other Potentially Infectious Materials (OPIM) Cerebrospinal Fluid Saliva (in dental procedures) Blood Pleural Fluid Pericardial Fluid Peritoneal Fluid Semen and Vaginal Secretions Amniotic Fluid Synovial Fluid Any fluid Containing visible blood.
How Exposures 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 9
How Exposures Occur Disease transmission is a two-way street. It is just as easy for you to infect a person with whom you come in contact as it is for that person to infect you. A pathogen is a disease-producing organism that enters the body; basically, a germ. The immune system relies heavily on the skin to keep the amount of pathogens that enter the body to a minimum. 10
How Infections Occur Chain of Infection Infectious Agent Reservoir Means of Exit Mode of Transmission Means of Entry Susceptible Host 11
How Infections Occur 12 Infectious Agent Reservoir Means of Exit Mode of Transmission Means of Entry Susceptible Host Chain of Infection
How Infections Occur Routes of Transmission: Direct contact Indirect contact Airborne transmission Vector-borne transmission 13
Direct Contact Reservoir to port of entry. (Person to person) Touching the body fluids from an infected person Kissing Sexual Contact Oral-Fecal Blood or other bodily fluids comes in contact with any port of entry.
Indirect Contact Touching objects that have been in contact with the body fluid of an infected person Door knobs Countertops Eating utensils Steering wheel Waterborne
Airborne Transmission Breathing in droplets that became airborne when an infected person coughs or sneezes Carried by current or ventilation systems
Airborne Transmission Large droplets that travel up to 3 feet. Coughing Sneezing Talking Lands on dust or surfaces Influenza Meninigitis Colds RSV
Vector-Borne Bite from an infected animal or insect Blood transfusions Organ transplant
What are the Infection Concerns? Both patients and healthcare workers are at an increased risk of infection Patients weakened immune systems injury Healthcare Personnel daily duties Consequences of infection
How Infections Occur Most infectious diseases are caused by one of five types of pathogens. The most common are viruses and bacteria. Viruses Bacteria Fungi Protozoa Parasites 20
How Infections Occur Viruses Hepatitis, Chicken Pox, HIV, etc. Bacteria Meningitis, Tuberculosis, food poisoning Fungi Athletes foot, ringworm Protozoa Malaria, dysentery Parasites Abdominal pain, anemia, etc. 21
Viruses Will use genetic make-up of host cell to replicated self. Hepatitis, Chicken Pox, HIV, Herpes, etc. Latent type of infection Cell reproduces both own and viruses genetic structure. (Herpes) Persistent Infection Hepatitis B
Bacteria Meningitis, Tuberculosis, food poisoning One-celled organisms Divide and multiply Produce enzymes and toxins Damage surrounding tissue Impair the bodys ability to defend itself
Transmission depends upon: The virulence of the pathogen. HBV vs. HIV The length of the exposure More time equals greater risk The route of entry Blood to blood Mucosal tissue Your general health Healthy & well-rested minimizes risk Your immunity Maintain your immunizations
The Bodys Means of Fighting off Organisms Vaccinations/Immunizations Healthy lifestyle Strong resistance High risk individuals HIV + Chronic health issues Surgery
The HIV virus can survive outside the host body for up to seven days in dried blood True False
Diseases that Cause Concern Human Immunodeficiency Virus (HIV) immune system Hepatitis B Virus (HBV) liver Other Pathogens
Human Immunodeficiency Virus (HIV) Blood and other body fluids AIDS no cure/no vaccine Auto-immune system suppressed Vulnerable to opportunistic diseases Environmental disinfection easy to kill
Human Immunodeficiency Virus Symptoms Certain symptoms & conditions may be associated with HIV/AIDS Fever Weight loss Swollen lymph nodes White patches in mouth (thrush) Certain cancers eg. Kaposis sarcoma, certain lymphomas Infections eg. pneumocystis pneumonia, TB, etc. 29
Hepatitis Viral Disease Inflammation of the liver Turn of the century identified as 2 types Enteric (food and water) Parenteral (blood and/or other bodily fluids) Currently-A, B, C, D, E, F & G
Hepatitis A (formerly called Infectious hepatitis) Foodborne illness Vaccine preventable More common in countries with underdeveloped sanitation systems Does not develop into chronic hepatitis or cirrhosis Can lead to acute liver failure and death In the News: 2009 outbreak in Illinois McDonalds
The Hepatitis B virus can survive outside the host body for days in dried blood. True False
Hepatitis B Virus (HBV) (formerly called Serum hepatitis) Parenteral Infection: blood and body fluids saliva Highly infectious diluted blood 1:100,000,000 viable in dried blood increase in sexually transmitted cases Immunization 3 shots
Hepatitis B Virus Symptoms Lethargy Loss of appetite Fever Vomiting Yellow skin & eyes (jaundice) Dark-colored urine. Light colored stool 34 DID YOU KNOW??? It is estimated that 4.9% of all Americans have been infected with HBV
Hepatitis C (HCV) Most common chronic bloodborne infection in the US. Transmitted through large or repeated direct exposures to blood such as: long term kidney dialysis, tattoos, sexual contact, parenteral infection In many cases, there are no symptoms until cirrhosis has developed. No vaccination available Can last in dried blood up to 3 weeks
Hepatitis C Symptoms Lethargy Loss of appetite Abdominal pain Nausea Vomiting Yellow skin & eyes (jaundice) Urine that is dark in color 36
Hepatitis D & E Hepatitis D (Delta Virus) Rare in most developed countries, and is mostly associated with intravenous drug use. Propagates only in the presence of the HBV virus. Hepatitis E Fecal-oral transmission route Seen more developing countries occur after heavy rainfalls because of their disruption of water supplies
Hepatitis F & G Hepatitis F Debate continues on its presence Hepatitis G Symptoms are non-existent Found in co-infections with other viruses, such as HCV and HIV
LESS RISK MORE RISK Sharing the toilet or shower Needlestick Blood contact with open wound Sharing eating utinsils Unprotected Sex Blood contact with gloved hands Open Mouthed Kissing Blood transfusion (infected blood) * * NOTE:The blood supply in the U.S. is now tested for HIV, and is considered safe. Sharing Drug Needles Blood contact with intact skin The Relative Risks
Reportable Incidents Incidents that involve the failure of barrier protection (glove failure), blood or OPIM contact with intact skin or conditions preventing the use of PPE Reportable Incident that must be reported to your supervisor before the end of your shift.
Significant Exposures Follow your organizations Exposure Reporting Policy. Needlesticks Needlesticks Blood/OPIM contact with non-intact skin Blood/OPIM contact with non-intact skin Blood/OPIM contact with mucosal tissue Blood/OPIM contact with mucosal tissue
OSHA Office of Training and Education42 What to do if an exposure occurs? Wash exposed area with soap and water Flush splashes to nose, mouth, or skin with water Irrigate eyes with water or saline Report the exposure Direct the worker to a healthcare professional
43 Post-Exposure Follow-Up Employer will: document routes of exposure and how exposure occurred record injuries from contaminated sharps in a sharps injury log, if required obtain consent from the source individual and the exposed employee and test blood as soon as possible after the exposure incident provide risk counseling and offer post- exposure protective treatment for disease when medically indicated in accordance with current U.S. Public Health Service guidelines
The Ryan White Act Requires Health Care Providers (hospitals, nursing homes, primary care facilities) to notify ALL personnel who may have been exposed to infectious/communicable diseases.
Labels and Signs
Labeling Regulated Waste Refers to the following categories of waste that require special handling at a minimum: Liquid or semi-liquid blood or OPIM Items contaminated with blood or OPIM & would release these substances in a liquid if compressed Caked with dried blood or OPIM Contaminated sharps Pathological & microbiological wastes containing blood or OPIM
When Labeling Regulated Waste is Necessary On containers of regulated waste or on refrigerators or freezers that are used for storage Equipment being sent to another facility for servicing or decontamination Must be labeled with biohazard label Even if your facility considers all of its waste to be regulated, it still must bear the label
Biohazard Labels Biohazard labels may be attached to bags containing potentially infectious materials Labels must be fluorescent orange or orange-red with letters or symbols in contracting color or color-coded for your facility Attached to any container that is used to store or transport potentially infectious materials
Contaminated Sharps OSHA Definitionany contaminated object that can penetrate the skin, including, but not limited to, needles, scalpels, broken capillary tubes, and exposed ends of dental wires.
Contaminated Sharps Reusable sharps Must be placed in a clearly labeled puncture- resistant, leakproof container asap after use Acceptable sharps containers Closable Puncture resistant Leakproof on sides & bottom Labeled or color-coded in accordance with the Standard
Sharps Containers Must be easily accessible to personnel and located as close to immediate area as possible. Sharps containers mounted onto walls should be 52 to 56from the floor. Maintained in an upright position Reusable containers (those used to transport contaminated sharps for cleaning) shall not be opened, emptied, or cleaned manually which would expose employees to risk of injury
52 Sharps Injury Log Employers must maintain a sharps injury log for the recording of injuries from contaminated sharps The log must be maintained in a way that ensures employee privacy and must contain, at a minimum: Type and brand of device involved in the incident Location of the incident Description of the incident
Disinfection You can clean without disinfecting or sterilizing......but you cannot disinfect or sterilize without cleaning.
Disinfection is a Process Step 1 - Cleaning If foreign material/soil is visible (i.e., body fluids), remove by cleaning prior to disinfection Soil can keep the disinfection process from working Step 2 - Disinfecting Disinfection is a process that eliminates many or all microorganisms except spores
Universal Precautions Treat all human blood & certain body fluids as if they are known to contain HIV, HBV, HCV or other bloodborne pathogens regardless of the perceived risk of the source.
Personal Protective Equipment Gloves blood or body fluids mucous membranes skin with open cuts or sores contaminated items or surfaces Gown or Apron Mask Dont Forget Eye Protection!
Preventing Disease Transmission Wash hands! if visibly soiled before and after restroom before and after eating after taking off gloves
Hand Washing Recommendations Hand Hygiene Indications Visibly soiled hands - traditional wash Hand Hygiene Technique Traditional Handwash Wet hands first mL of product Wash for at least 15 seconds Rinse Dry - use towel to turn off faucet
Tips for a Traditional Wash Proper Handwashing: Wet hands BEFORE adding soap Dime-sized amount of soap is plenty Use warm, not HOT water Rinse thoroughly Dry thoroughly
New Guideline Recommendations Hand Hygiene Indications If hands are not soiled, use alcohol: Before and after gloving Before and after patient contact intact skin non-intact skin, wound dressings (no visible soil) between contaminated and clean body sites
Considerations Use caution when handling items that may contain sharps Do not eat, drink, apply cosmetics or handle contact lenses in areas where exposure is likely to occur Place soiled linen in an impermeable bag Clean, disinfect or sterilize contaminated equipment between uses
Blood Spills Spills of blood or body fluids should be cleaned up promptly Use an appropriate disinfectant (HIV and HBV effective) OSHA considers tuberculocidal agents (bleach, phenol) HIV and HBV effective OSHA now considers quats EPA registered as effective against HIV and HBV effective
n Prions (vCJD) n Bacterial spores Not High Sterilization n (Bacillus, Clostridium spp.) Numbers n MycobacteriumIntermediateHigh-Level n (M. tuberculosis) DisinfectionDisinfection n Nonlipid or n small viruses Check n (Poliovirus, HAV) Label n Fungi n (Candida sp.) n Vegetative bacteriaLow-Level n (S. aureus, MRSA, VRE) Disinfection n Lipid or medium- n sized viruses n (Herpes simplex, HBV, HIV) Descending Order of Resistance
Choosing a Disinfectant for Blood Spills Sodium Hypochlorite (bleach) Phenolic HBV Effective Quaternary Ammonium Compound
Sodium Hypochlorite Pros history of disinfection economical Cons surface compatibility stability safety cleaning ability
Phenol Pros broad kill range, including TB cleaning ability resistance to hard water and organic soil Cons surface compatibility toxicity
HBV Effective Quaternary Ammonium Compounds Pros cleaning ability broad spectrum of kill resistance to hard water and organic soil surface compatibility safety Cons not tuberculocidal, unless combined with another chemical
Final Points to Remember Basic Steps to Prevent Infection use appropriate cleaning and disinfectant procedures wash your hands thoroughly practice good skin care use personal protective equipment HBV Vaccination know the exposure control plan
Infectious disease cause by the bacterium, Mycobacterium tuberculosis. Spread by airborne droplets, droplet nuclei, which may be generated when a person with TB disease coughs, sneezes, speaks or sings.
Occurrence Nearly one-third of the worlds population is infected with TB, which kills almost 3 million people per year.
Why Is TB Increasing? Multiple contributing factors: Homelessness Intravenous drug use Overcrowding in institutional settings HIV infection Drug-resistant strains of TB Reduced TB control and treatment resources Immigration from high TB prevalence areas
Where Is TB Found in the Workplace? Healthcare Facilities Correctional Institutions Homeless Shelters Long-term Care Facilities for the Elderly Drug Treatment Centers
What Does it Mean to You? Your employer must provide training in recognizing high-risk patients and procedures. Employers must provide fit-tested and N95 masks for all employees. Employees must receive free skin test (Mantoux test) upon hiring and at least annually thereafter.
Employer must provide evaluation and management of symptomatic employees with history of positive skin tests. Employer must maintain complete records of all training, skin tests and exposures. What Does it Mean to You?
Tuberculosis signs and symptoms Persistent productive cough (lasting 2 weeks or more) Weight loss Loss of appetite Night sweats and/or fever General weakness or lethargy Hemoptysis (coughing up blood)
Tuberculosis Screening Healthcare Workers have increased risk of TB Frequency of Screening is dependent on the number of active cases within facility
TB Skin Test (Mantoux) Injection of purified protein derivative (PPD) under skin Injection is then checked for reaction in 48 to 72 hours
TB and Respiratory Protection The primary means to control occupational diseases caused by breathing contaminated air is through the use of feasible engineering controls such as enclosures, confinement of operations, ventilation or substitution of less toxic materials. When these controls are not feasible, or while they are being instituted, appropriate respirators shall be used.
When to Wear the Respirator ( N95 masks) When entering a TB isolation area During contact with a patient with suspected or confirmed active TB During high risk procedures on high risk patient groups A respirator may be re-used by the same person until it becomes wet or damaged.
Respirator Limitations Do not wear a respirator unless cleared Do not put respirator on patient N95 masks or H.E.P.A. respirators do not protect from hazardous chemicals Do not wear in oxygen deficient atmosphere Do not share respirators
Accident Prevention Signs and Tags In accordance with (f)(8), a warning shall be posted outside the respiratory isolation or treatment room or a message referring one to the nursing station for instruction may be posted (f)(4) requires that a signal word or biological hazard symbol may be presented as well as a major message.
Accident Prevention Signs and Tags (Continued) Employers are also required to use biological hazard tags on air transport components which identify TB hazards to employees associated with working on air systems that transport contaminated air.
References OSHA Office of Training & Education American Academy of Orthopedic Surgeons, Bloodborne Pathogens Fourth Edition