1. http://www.cdc.gov/ 1 Bloodborne Pathogens Training 2013 29 CFR 1910:1030 UNDERSTANDING THE RISKS

2. http://www.cdc.gov/ 2 Introduction Approximately 5.6 million workers in healthcare and other facilities are at risk of exposure to bloodborne pathogens such as human immunodeficiency virus (HIV – the virus that causes AIDS), the hepatitis B virus (HBV) and the hepatitis C virus (HCV) OSHA’s 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 OSHA Acronym O- Occupational S – Safety H – Health A - Administration ¹OSHA Office of Training and Education

3. http://www.cdc.gov/ 3 What is the purpose of OSHA's Bloodborne Pathogens standard? The purpose of the standard is to minimize or eliminate occupational exposure to disease- carrying microorganisms or "pathogens" that can be found in human blood and body fluids

4. http://www.cdc.gov/ 4 What are the primary bloodborne pathogens? The primary bloodborne pathogens are: Hepatitis B Virus (HBV) Hepatitis C Virus (HCV) Human Immunodeficiency Virus (HIV) Other recognized pathogens transmitted by body fluids, usually blood, include: West Nile Virus (very rarely) Malaria Syphilis

5. http://www.cdc.gov/ 5 Initial Symptoms of HIV/AIDS What is HIV/AIDS? Human immunodeficiency virus, or HIV, is the virus that causes HIV infection – during HIV infection, the virus attacks and destroys the infection-fighting cells of the body’s immune system. – loss of these cells make it difficult for the immune system to fight infections Acquired immunodeficiency syndrome, or AIDS, is the most advanced stage of HIV infection

6. http://www.cdc.gov/ 6 Documented Cases of Occupational Transmission of HIV Between 1985 and December 1999, the CDC reported 56 documented cases of occupationally acquired HIV infections in health care workers and an additional 136 cases of possible occupational HIV transmissions

7. http://www.cdc.gov/ 7 Occupational Exposures and Hepatitis Hepatitis means "inflammation of the liver," and can be caused by a number of agents or conditions including drugs, toxins, autoimmune disease, and infectious agents including viruses The most common infectious causes of hepatitis are viruses

8. http://www.cdc.gov/ 8 Hepatitis B Virus (HBV) Hepatitis B virus (HBV) infection is the major infectious bloodborne occupational hazard to healthcare workers The Hepatitis Branch of the Centers for Disease Control (CDC) estimates that there are approximately 8,700 infections in healthcare workers with occupational exposure to blood and other potentially infectious materials in the United States each year These infections cause over 2,100 cases of clinical acute hepatitis, 400-440 hospitalizations and approximately 200 deaths each year in healthcare workers Death may result from both acute and chronic hepatitis

9. www.webmd.com 9 HBV Symptoms Many people with hepatitis B do not know they have it, because they do not have symptoms Most people with chronic hepatitis B have no symptoms If you do have symptoms, you may just feel like you have the flu Symptoms include: – feeling very tired – mild feverfever – headacheeadache – not wanting to eat – feeling sick to your stomach or vomitingstomachvomiting – belly pain – diarrhea or constipationiarrheaconstipation – muscle aches and joint pain – skin rashkin rash – yellowish eyes and skin (jaundice)eyesskinjaundice jaundice usually appears only after other symptoms have started to go away

10. http://www.cdc.gov/ 10 What Are HCV Symptoms? Typical symptoms include – jaundice – fatigue – abdominal pain – loss of appetite – intermittent nausea and vomiting.

11. http://www.cdc.gov/ 11 HBV Vaccine The use of hepatitis B vaccine, engineering and work practice controls, and personal protective equipment will prevent almost all of these occupational hepatitis B infections Efforts to reduce blood exposure and minimize puncture injuries in the workplace setting will reduce the risk of transmission of all bloodborne hepatitis viruses

12. http://www.cdc.gov/ 12 Who is covered by this standard? 1. By performing their job duties, EMPLOYEES could face contact with blood and other potentially infectious materials (OPIM) 2. “Good Samaritan” acts, such as a co-worker who assists with a nosebleed, would NOT be considered an occupational exposure

13. http://www.cdc.gov/ 13 Who is at risk? Physicians, nurses, medical assistants PT and OT Housekeeping personnel Law enforcement personnel Anyone providing first-response medical care This list names only a few at risk for exposure!

14. http://www.cdc.gov/ 14 How does an exposure occur? Most common are needlesticks Other events include – cuts from scalpels, broken glass or other contaminated sharps – contact of mucous membranes eyes nose mouth cut or abraded skin with contaminated blood

15. http://www.cdc.gov/ 15 Wright State Physicians (WSP) Exposure Control Plan Identifies jobs and tasks where occupational exposure to blood or other potentially infectious material (OPIM) It also will identify how WSP will – use engineering and work practice controls – ensure use of personal protective equipment – provide training – provide medical surveillance – provide hepatitis B vaccinations – use signs and labels

16. http://www.cdc.gov/ 16 Exposure Control Plan OSHA has determined employers can minimize or even eliminate occupational bloodborne hazards by developing and enforcing a combination of exposure control strategies which work for all bloodborne diseases. It is not enough for an employer to provide bloodborne pathogens annual training; they must also have a formal exposure control plan documented and implemented.

17. http://www.cdc.gov/ 17 Exposure Control Plan This plan must be 1. a written plan 2. reviewed at least annually 3. accessible to employees I’ve seen the control plan but I can’t remember where? Where’s my department’s plan?

18. http://www.cdc.gov/ 18 WSP Exposure Control Plan Location Check with your supervisor to find an onsite plan or Log into Paycor and find the plan at: Paycor Online Services

19. http://www.cdc.gov/ 19 Universal Precautions Treat all human blood and certain body fluids as if they are infectious potential Observe universal precautions in all situations where there is a potential for contact with blood or other potentially infectious materials

20. http://www.cdc.gov/ 20 Engineering and Work Practice Controls Reduce Employee exposure by removing or isolating the worker Examples include – sharps disposal containers – self-sheathing needles – safe medical devices needleless systems sharps with engineered sharps injury protections

21. http://www.cdc.gov/ 21 Safer Medical Devices Include Needleless systems – devices that do not use needles for collection or withdrawal of body fluids Sharps with engineered sharps injury protections – a non-needle sharp or a needle device used for withdrawing body fluids

22. http://www.cdc.gov/ 22 Work Practice Controls Reduce Likelihood of exposure by altering how a task if performed Examples include – washing hands after removing gloves and as soon as possible after exposure – not bending or breaking sharps – eliminating food in work areas

23. http://www.cdc.gov/ 23 What is eye and face protection? Eye and face protection is protective equipment such as spectacles, goggles, face shields, or welding shields that are designed to protect the wearer against a variety of hazards

24. http://www.cdc.gov/ 24 How can I protect my skin? Gloves, gowns, caps can be worn when you anticipate exposure to you skin

25. http://www.cdc.gov/ 25 Contaminated Waste Apply universal precautions Use appropriate Personal Protective Equipment Contaminated Waste shall be placed in containers clearly marked with this label – potential leaks are placed in a second labeled receptacle

26. http://www.cdc.gov/ 26 Contaminated Laundry Handle as little as possible Bag or contained at location Do not sort/rinse in location of use Please in red bags and following procedure for Standard Precautions

27. http://www.cdc.gov/ 27 Hand Washing All employees shall wash their hands following every incident of potential exposure to blood, body fluids, or other potentially infectious material. Hands must be washed using an approved disinfectant soap. Handwashing is one of the most important elements of the Infection and Exposure Control Plan

28. http://www.cdc.gov/ 28 Hand Washing CDC recommendations for basic handwashing are as follows: 1. When washing hands with soap and water, wet hands first with water, apply soap and rub hands together vigorously for at least 20 seconds, covering all surfaces of the hands and fingers, including underneath rings and fingernails 2. Rinse hands with water and dry thoroughly with a disposable towel. Use the towel to turn off the faucet

29. http://www.cdc.gov/ 29 CDC Hand Hygiene 2002 Guidelines In 2002, the CDC released new hand hygiene guidelines – advise the use of alcohol based hand rubs to protect patients and workers in health care settings Recent data show alcohol cleaners are more effective than hand washing for two reasons: – health care personnel are more inclined to use alcohol based hand rubs because they are convenient. – alcohol hand rubs reduce the number of bacteria on hands more effectively than soap and water It is important to remember that if hands are visibly soiled, they should be cleaned with soap and water before using an alcohol cleaner

30. http://www.cdc.gov/ 30 New Emphasis on Preventing Needlestick Injuries During the past decade many different medical devices have been developed or re- engineered to reduce the risk of needle-stick and other sharps injuries Despite these advances, health are workers continue to suffer high rates of needle-sticks and sharps injuries

31. http://www.cdc.gov/ 31 Hepatitis B vaccine The vaccine is generally thought to be 95-97% effective in producing antibodies against hepatitis B It is usually administered as a series of 3 injections over 6 months No serious adverse reactions to the vaccine have been reported The vaccine is available at no cost to eligible employees

32. http://www.cdc.gov/ 32 Post Exposure Prophylaxis, Evaluation & Follow-up HBV infection is the major infectious risk that occurs from these exposures, and needlesticks from Hepatitis B positive individuals will infect 7% to 30% of susceptible healthcare workers Pre-exposure vaccination is the most effective method for preventing such infection However, it can be expected that some individuals, who initially decline vaccination, will experience an exposure incident Fortunately, effective post-exposure prophylaxis exists for HBV exposures if appropriate protocols are followed

33. http://www.cdc.gov/ 33 Exposure to HCV (Hepatitis C Virus) Risk to acquire Hep C is higher than the risk to acquire HIV – the risk is increased in part because the frequency of HCV in the population is greater than the frequency of HIV according to the CDC, 3.9 million Americans have been infected with HCV (MMWR October 16, 1998, 1-39) the number of people living with HIV is estimated to be between 650,000 and 900,000 (CDC Update, "How Many People Have HIV & AIDS," May 1999) – more efficiently transferred as well Therefore, health care workers face a greater risk of encountering a patient with HCV than a patient with HIV Of the total acute Hepatitis C infections that occurred in 1995, the CDC estimates that 2%-4%, or 720-1400, were in health care workers exposed to blood in the workplace. (MMWR October 16, 1998, 1-39).

34. http://www.cdc.gov/ 34 How is Hepatitis C Transmitted? Hepatitis C is caused by the hepatitis C virus (HCV). HCV is most efficiently transmitted by large or repeated percutaneous exposures to blood, such as blood transfusions from infectious donors and needle sharing among IV drug abusers. The risk factors for HCV transmission to health care workers are not well defined but the most likely related cause is blood exposure

35. http://www.cdc.gov/ 35 I’ve been exposed! NOW WHAT?

36. http://www.cdc.gov/ 36 Steps to Take After an Exposure Report your exposure to your supervisor immediately and obtain medical treatment You will be sent to an occupational healthcare center for medical care You will incur NO expense related to this care – WSP will cover the costs! – do not give your insurance information out!

37. http://www.cdc.gov/ 37 Steps to Take Complete an incident report Your supervisor will ask the patient (source individual) to consent to have their blood tested You will receive a follow up report regarding the status of your test and the status of the patient’s test

38. http://www.cdc.gov/ 38 Stay Safe Wright State Physicians provides you with resources to stay safe. Follow all policies and use personal protective equipment (PPE) when you anticipate you could be exposed. If you have any questions about your protection, contact your supervisor or the Compliance Director.

39. http://www.cdc.gov/ 39 Questions? Contact: Marta Kennedy, Compliance Director (937) 245-7130 marta.kennedy@wrightstatephysicians.org