4What are bloodborne pathogens? Infectious microorganisms in human blood that can cause disease in humans.Include, but are not limited to, hepatitis B (HBV), hepatitis C and human immunodeficiency virus (HIV).Adapted from
5Who is at Risk?Workers in many occupations, including caregivers, housekeeping personnel, nurses and other healthcare personnel may be at risk of exposure to bloodborne pathogens.Adapted from
6Exposure Control Plan Must implement an exposure control plan Describe how an employer will use a combination of engineering and work practice controlsEnsure the use of personal protective clothing and equipmentProvide trainingMedical surveillanceHepatitis B vaccinationsSigns and labelsAmong other provisions…Adapted from
8What is HIV? Human immunodeficiency virus. The virus that can lead to acquired immune deficiency syndrome, or AIDS.
9What is HIV?HIV damage a person’s body by destroying specific blood cells, called CD4+ T cells, which are crucial to helping the body fight diseases
10SymptomsWithin a few weeks of being infected with HIV, some people develop flu-like symptoms that last for a week or two, but others have no symptoms at all.People living with HIV may appear and feel healthy for several years.However, even if they feel healthy, HIV is still affecting their bodies.
11SymptomsMay experience flu-like symptoms 2-6 weeks after becoming infectedChillsRashNight sweatsMuscle achesSore throatFatigueSwollen lymph nodesUlcers in the mouth
12StatisticsThe CDC estimates that about 56,000 people in the United States contracted HIV in 2006.Around 34 million people worldwide living with HIVOver 25 million have died since the first cases were reported in 1981
13AIDS AIDS is the late stage of HIV infection The person’s immune system is severely damaged and has difficulty fighting diseases and certain cancers.
14Progression to AIDSBefore the development of certain medications, people with HIV could progress to AIDS in just a few years.Currently, people can live much longer - even decades - with HIV before they develop AIDS. This is because of “highly active” combinations of medications that were introduced in the mid 1990s.
15Cardiovascular Health Hepatitis Opportunistic Infections HIV complicationsCardiovascular HealthHepatitisOpportunistic InfectionsOral Health Issues
18TransmissionHIV can be detected in several fluids and tissues of a person living with HIV.Finding a small amount of HIV in a body fluid or tissue does not mean that HIV is transmitted by that body fluid or tissue.These specific fluids must come in contact with a mucous membrane or damaged tissue or be directly injected into the blood-stream for transmission to occur.
19Which Body Fluids?These body fluids have been shown to contain high concentrations of HIV:BloodSemenVaginal fluidBreast milkOther body fluids containing blood
20Which Body Fluids?The following are additional body fluids that may transmit the virus that health care workers may come into contact with:Fluid surrounding the brain and the spinal cordFluid surrounding bone jointsFluid surrounding an unborn baby
21TransmissionIn the United States, HIV is most commonly transmitted through specific sexual behaviors (anal or vaginal sex) or sharing needles with an infected person.It is less common for HIV to be transmitted through oral sex or for an HIV-infected woman to pass the virus to her baby before or during childbirth or after birth through breastfeeding or by prechewing food for her infant.
22TransmissionIt is possible to acquire HIV through exposure to infected blood, transfusions of infected blood, blood products, or organ transplantationThis risk is extremely remote due to rigorous testing of the U.S. blood supply and donated organs.
23TransmissionSome healthcare workers have become infected after being stuck with needles containing HIV-infected blood or, less frequently, when infected blood comes in contact with a worker's open cut or is splashed into a worker's eyes or inside their nose.
24HIV is NOT spread by Air or water Insects, including mosquitoes Saliva, tears, or sweatCasual contact like shaking hands or sharing dishesClosed-mouth or “social” kissing
25The risk to direct care providers The risk of direct care provider being exposed to HIV on the job is very lowEspecially if they carefully follow standard precautionsCasual, everyday contact with an HIV-infected person does not expose direct care providers or anyone else to HIV.
26The risk to direct care providers For direct care providers on the job, the main risk of HIV transmission is through accidental injuries from needles and other sharp instruments that may be contaminated with the virusEven this risk is small.The risk of infection from a needle-stick is less than 1%.
28Antibody Screening Test Most common HIV test is the antibody screening test. This test can be performed with blood sample or oral fluid.This tests the antibodies your body produces to fight against HIV.Blood tests can detect HIV as soon as 3 weeks after being infected.
29Follow-up Diagnostic Tests Follow-up diagnostic test – these tests are performed after someone tests positive on his/her first test.HIV tests are usually very accurate, but a follow-up test is typically performed to confirm the results of the first test mostly for insurance/health care provider purposes.
31TreatmentsMany people with HIV, including those who feel healthy, can benefit greatly from current medications used to treat HIV infection.These medications can limit or slow down the destruction of the immune system, improve the health of people living with HIV, and may reduce their ability to transmit HIV.
32Medications Can be expensive Can be very effective Complicated dosing schedulesIn some cases, virus develops a resistance to the medication
33Highly Active Anti-Retroviral Therapy HAARTHighly Active Anti-Retroviral Therapy
34Medications Class Description Examples Non-nucleoside reverse transcriptase inhibitors (NNRTIs)NNRTIs disable a protein needed by HIV to make copies of itself.efavirenz (Sustiva), etravirine (Intelence) and nevirapine (Viramune)Nucleoside reverse transcriptase inhibitors (NRTIs)NRTIs are faulty versions of building blocks that HIV needs to make copies of itself.Abacavir (Ziagen), and the combination drugs emtricitabine and tenofovir (Truvada), and lamivudine and zidovudine (Combivir)Protease inhibitors (PIs)PIs disable protease, another protein that HIV needs to make copies of itself. atazanavir (Reyataz), darunavir (Prezista), fosamprenavir (Lexiva) and ritonavir (Norvir)
35Medications Class Description Examples Entry or fusion inhibitors These drugs block HIV's entry into CD4 cellsenfuvirtide (Fuzeon) and maraviroc (Selzentry)Integrase inhibitorsWorks by disabling integrase, a protein that HIV uses to insert its genetic material into CD4 cellsraltegravir (Isentress)
36There is No Cure No one should become complacent about HIV and AIDS. While current medications can dramatically improve the health of people living with HIV and slow progression from HIV infection to AIDS, existing treatments need to be taken daily for the rest of a person’s life, need to be carefully monitored, and come with costs and potential side effects.At this time, there is no cure for HIV infection.
39Hepatitis BHepatitis B is a contagious liver disease that results from infection with the Hepatitis B virus.It can range in severity from a mild illness lasting a few weeks to a serious, lifelong illness.
40Hepatitis B Transmission Hepatitis B is spread when blood, semen, or other body fluid infected with the Hepatitis B virus enters the body of a person who is not infected.
41Hepatitis B Transmission From an infected mother to her baby during birthSex with an infected partnerSharing needles, syringes, or other drug-injection equipmentSharing items such as razors or toothbrushes with an infected personDirect contact with the blood or open sores of an infected personExposure to blood from needlesticks or other sharp instruments
42Acute or Chronic Acute Hepatitis B Short-term illness that occurs within the first 6 months after exposure.Can—but does not always—lead to chronic infection.Chronic Hepatitis BLong-term illness that occurs when the virus remains in a person’s body.Estimated 800,000 to 1.4 million persons have chronic Hepatitis B virus infection in the U.S.
43Hepatitis B VaccineThe Hepatitis B vaccine series is a sequence of shots that stimulate a person’s natural immune system to protect against HBV.After the vaccine is given, the body makes antibodies that protect a person against the virus.These antibodies are then stored in the body and will fight off the infection if a person is exposed to the Hepatitis B virus in the future.
44Hepatitis B Vaccine Safe and effective Usually given as 3-4 shots over a 6-month periodRecommended for health care workers (including caregivers) at risk for exposure to blood or blood-contaminated body fluids on the jobEmployers must offer at not cost if a job puts you at risk for exposure to blood or blood-contaminated body fluids on the job
46Hepatitis CA contagious liver disease that results from infection with the Hepatitis C virus.It can range in severity from a mild illness lasting a few weeks to a serious, lifelong illness.
47Can Be Acute or ChronicAcute Hepatitis C virus infection is a short-term illness that occurs within the first 6 months after someone is exposed to the Hepatitis C virus.For most people, acute infection leads to chronic infection.Chronic Hepatitis C is a serious disease than can result in long-term health problems, or even death.
48How is hepatitis C spread? Spread when blood from a person infected with the Hepatitis C virus enters the body of someone who is not infected.Today, most people become infected with the Hepatitis C virus by sharing needles or other equipment to inject drugs.Before 1992, when widespread screening of the blood supply began in the United States, Hepatitis C was also commonly spread through blood transfusions and organ transplants.
49How is hepatitis C spread? People can become infected with the Hepatitis C virus during such activities as:Sharing needles, syringes, or other equipment to inject drugsNeedlestick injuries in health care settingsBeing born to a mother who has Hepatitis C
50How is hepatitis C spread? Less commonly, a person can also get Hepatitis C virus infection through:Sharing personal care items that may have come in contact with another person’s blood, such as razors or toothbrushesHaving sexual contact with a person infected with the Hepatitis C virus
51Is there a vaccine?At this time there is not a vaccine for hepatitis C.Vaccines are available only for Hepatitis A and Hepatitis B.Research into the development of a vaccine is under way.
53Diabetes and Hepatitis CDC has investigated multiple outbreaks of viral hepatitis among residents in long-term-care (LTC) communitiesAttributed to shared devices and other breaks in infection-control practices related to blood glucose monitoring
54Diabetes and Hepatitis Insulin pens and insulin cartridgesDo not use to administer to multiple residentsNot designed for, and are not safe for, use on more than one person
55Diabetes and Hepatitis GlucometersAssigned to individual residentsDecontaminate regularly and any time contamination is suspectedMaintain supplies and equipment within individual resident rooms if possible
56Diabetes and Hepatitis Unused supplies and medications taken to the bedside should not be used for another residentNever share fingerstick samplingSelect single-use lancets that permanently retract upon punctureDispose of in sharps container
57Diabetes and Hepatitis Any trays or carts used to deliver medications or supplies to individual residents should remain outside resident rooms.Do not carry supplies and medications in pockets.
58Diabetes and Hepatitis Prepare medications in a centralized medication areaMultiple dose insulin vials should be assigned to individual residents and labeled appropriately.Store unused and used diabetes equipment and supplies separatelyNever reuse needles, syringes, or lancets.
61At home…In your personal life the best way to protect yourself from bloodborne pathogens is to avoid engaging in activities that lead to their transmission, such as unprotected sex.
62At work…At work you can protect yourself by applying the principles of standard precautions during any activity that may lead to exposure to blood or other potentially infectious body fluids
63If you are exposed…If you experienced a needlestick or sharps injury or were exposed to the blood or other body fluid of a resident during the course of your work, immediately follow these steps:
64If you are exposed… Wash needlesticks and cuts with soap and water Flush splashes to the nose, mouth, or skin with waterIrrigate eyes with clean water, saline, or sterile irrigantsReport the incident to your supervisorImmediately seek medical treatment
66Standard Precautions Replaced Universal Precautions Includes elements of Universal Precautions and Body Substance Isolation
67Should be applied to all residents, regardless of infectious status Standard PrecautionsTwo key elements:All blood, body fluids, secretions, excretions except sweat, nonintact skin, and mucous membranes may contain transmissible infectious agentsShould be applied to all residents, regardless of infectious status
68Standard Precautions Applies to all: Blood Body fluids Secretions Excretions (except sweat)Nonintact skinMucous membranes
69Should be applied to all residents, regardless of infectious status Standard PrecautionsTwo key elements:All blood, body fluids, secretions, excretions except sweat, nonintact skin, and mucous membranes may contain transmissible infectious agentsShould be applied to all residents, regardless of infectious status
71Standard Precautions Hand Hygiene: When Before having direct contact with residentsAfter contact with blood, body fluids or excretions, mucous membranes, nonintact skin, or wound dressingsAfter contact with a resident’s intact skinIf hands will be moving from a contaminated-body site to a clean-body site during resident careAfter contact with inanimate objects (including medical equipment) in the immediate vicinity of the residentAfter removing gloves
72Standard Precautions Hand Hygiene: Visibly Soiled When hands are visibly dirty, contaminated with proteinaceous material, or visibly soiled with blood or body fluidsWash hands with either a nonantimicrobial soap and water or an antimicrobial soap and water
73Standard Precautions Hand Hygiene: Not Visibly Soiled If hands are not visibly soiled, or after removing visible material with nonantimicrobial soap and water, decontaminate handsThe preferred method of hand decontamination is with an alcohol-based hand rubAlternatively, hands may be washed with an antimicrobial soap and water.
74Standard Precautions Hand Hygiene: Spores Wash hands with non-antimicrobial soap and water or with antimicrobial soap and water if contact with spores (e.g., C. difficile or Bacillus anthracis) is likely to have occurred
76Standard Precautions Respiratory Hygiene Cover the mouth/nose when coughing or sneezing
77Standard Precautions Respiratory Hygiene Post signs at entrances and in strategic places
78Standard Precautions Respiratory Hygiene Provide tissues and no-touch receptacles for disposal of tissues
79Standard Precautions Respiratory Hygiene Provide resources and instructions for performing hand hygiene in or near common areas
80Standard Precautions Respiratory Hygiene During periods of increased prevalence of respiratory infections in the community, offer masks to coughing residents and other symptomatic persons
81Standard Precautions Resident Placement Include the potential for transmission of infectious agents when selecting a resident's room/apartmentPlace residents who pose a risk for transmission to others (e.g., uncontained secretions, excretions or wound drainage) in a single-resident room when available
84Standard Precautions CLEANING DISINFECTING SANITIZING Removes germs Kills germsLowers # of germsRemoves germs, dirt, and impurities from surfaces or objectsUses soap (or detergent) and waterPhysically remove germs from surfacesDoes not necessarily kill germsUses chemicals to kill germs on surfaces or objectsDone after cleaningWorks by either cleaning or disinfecting surfaces or objects to lower the risk of spreading infection
85Standard Precautions Clean in disinfect properly: Always follow label directionsWash surfaces with a general household cleaner to remove germsRinse with waterFollow with an EPA-registered disinfectant to kill germs
86Standard Precautions Bleach is a good alternative: Add 1 tablespoon of bleach to 1 quart (4 cups) of water. For a larger supply of disinfectant, add ¼ cup of bleach to 1 gallon (16 cups) of waterApply the solution to the surface with a clothLet it stand for 3 to 5 minutesRinse the surface with clean water
88Regulated waste“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; items that are caked with dried blood or other potentially infectious materials and are capable of releasing these materials during handling; contaminated sharps; and pathological and microbiological wastes containing blood or other potentially infectious materials.”
89Standard Precautions Sharps containers Contaminated sharps shall be discarded immediately or as soon as feasible in containers that are:Puncture resistantLeakproof on sides and bottomLabeled or color-coded
90Standard Precautions Sharps containers, during use: Easily accessible to personnelLocated as close as is feasible to the immediate area where sharps are used or can be reasonably anticipated to be found (e.g., laundries)Maintained upright throughout useReplaced routinely and not be allowed to overfill.
91Regulated waste Regulated Waste Regulated waste shall be placed in containers which are:ClosableConstructed to contain all contents and prevent leakage of fluids during handling, storage, transport or shippingLabeled or color-codedClosed prior to removal to prevent spillage or protrusion of contents
93Personal Protective Equipment "Personal Protective Equipment" is specialized clothing or equipment worn or used by an employee for protection against a hazard.General work clothes (e.g., uniforms, pants, shirts or blouses) not intended to function as protection against a hazard are not considered to be personal protective equipment.
94Personal Protective Equipment GlovesFor touching blood, body fluids, secretions, excretions, contaminated itemsFor touching mucous membranes and nonintact skin
95Personal Protective Equipment GownWhen contact of clothing/exposed skin with blood/body fluids, secretions, and excretions is anticipated
96Personal Protective Equipment Mask/Eye ProtectionDuring procedures and activities likely to generate splashes or sprays of blood, body fluids, secretions, and excretions
105What is Tuberculosis?Abbreviated as TB for tubercle bacillus or Tuberculosis.TB bacteria usually attacks the lungs, but can attack any part of the body including the kidney, spine, and brain.
106What is Tuberculosis?Research shows that TB is the second most common cause of death worldwide.If untreated, or not treated effectively, tuberculosis can be fatal.
107CausesTuberculosis is caused by the infectious agent known as Mycobacterium tuberculosis (Mtb).Discovered by Dr. Robert Koch in 1882.
108Risk FactorsFor someone to develop active TB disease, the following two events must take place:The bacteria enters the body and causes an Mtb infection.The immune system cannot stop the TB bacteria from growing and spreading after the initial infection.
109What’s the difference? Active vs. Latent There are two types or forms of TB:ActiveLatentWhat’s the difference?
110Transmission Tuberculosis is primarily an airborne disease. According to the CDC, “The TB bacteria are put into the air when a person with active TB disease of the lungs or throat coughs, sneezes, speaks, or sings.”
111Transmission A person CANNOT get TB by: Touching bed linens or toilet seatsShaking someone’s handSharing food/drinkSharing toothbrushKissing
112SymptomsThe symptoms of TB can range from no symptoms or very mild illness (latent TB) to significant symptoms with massive involvement (active TB).TB may also lie dormant for years and reappear after the initial infection is contained.
113Symptoms Early symptoms of active TB can include: Cough Loss of appetiteShortness of breathPalenessWeight lossJoint painFatigueChillsFeverSwollen glandsNight sweatsAbdominal swellingGeneral discomfort
114Diagnostic TestWhat is PPD and what other test may be performed to detect or diagnose TB?
115preventionWhat is the BCG vaccine and who is recommended to receive this vaccine?What are the risk factors involved?
116Treatments What are the common challenges regarding TB treatments? Long-term antibiotic therapyRisk of liver damageCostsCo-morbid conditions such as mental illness
117Strategies to Ensure Quality of Care for Our Residents
118Strategies to ensure quality of care Successful treatment of tuberculosis has benefits both for the individual resident and the community in which the resident resides.The goals for treatment are:To minimize the transmission of TB to other personsTo cure the individual resident of TB
119Strategies to ensure quality of care What are some ways we can ensure quality of care for our residents?
120Strategies to ensure quality of care AwarenessIt is important that people are aware that TB is not an ancient disease as it is often considered to be. TB is killing more people than ever before in history and remains one of the world’s deadliest infectious diseases. Healthcare workers, organizations, community members all need to assist in raising awareness.
121STOP TB OSHA Requirements Implement effective control programs to minimize exposure to Tuberculosis which include:Early IdentificationIsolationTreatmentSTOPTB
122Policies and Procedures One essential strategy to ensure quality of care for our residents is to develop and implement effective policies and procedures in our assisted living and residential care communities.
123Staff TrainingEffective staff training is the key to providing the highest quality of care to our residents.Educate staff to be aware of the causes and risksThe use of protective equipmentInjury and illness preventionResident rights and confidentiality
124Strategies to Ensure Confidentiality and Personal Rights
125Strategies to Ensure Confidentiality Confidentiality is not an option, it’s a requirement!
126Confidentiality/Personal Rights ResidentWhat are the resident’s personal rights?How can we ensure highest quality of care while maintaining confidentiality and resident rights?
127Confidentiality/Personal Rights Care StaffIdentify how to respond when care staff are diagnosed with HIV or have latent TB.
130Question #1 HIV is transmitted in ________________. Air, water, and some foodsBlood and some bodily fluidsBlood onlyNone of the above
131Question #1 HIV is transmitted in ________________. Air, water, and some foodsBlood and some bodily fluidsBlood onlyNone of the above
132Question #2Hepatitis B is a non-contagious liver disease that results from infection with the Hepatitis B virus.TrueFalse
133Question #2Hepatitis B is a non-contagious liver disease that results from infection with the Hepatitis B virus.TrueFalse
134Question #3Personal protective equipment only includes: gloves and masks.TrueFalse
135Question #3Personal protective equipment only includes: gloves and masks.TrueFalse
136Question #4When a resident’s equipment has been contaminated with blood or other bodily fluids, you must first:Rinse with waterCleanDisinfectNone of the above
137Question #4When a resident’s equipment has been contaminated with blood or other bodily fluids, you must first:Rinse with waterCleanDisinfectNone of the above
138Question #5 Sharps or Needlesticks injuries can occur ____________. When a person uses themDuring disassemblyDue to improper disposalAll of the above
139Question #5 Sharps or Needlesticks injuries can occur ____________. When a person uses themDuring disassemblyDue to improper disposalAll of the above
140Question #6 HIV is NOT spread by: Saliva, tears or sweat Casual everyday contact with an HIV-infected personCasual contact like shaking hands or sharing dishesAll of the above
141Question #6 HIV is NOT spread by: Saliva, tears or sweat Casual everyday contact with an HIV-infected personCasual contact like shaking hands or sharing dishesAll of the above
142Question #7An exposure control plan must include information regarding how an employer will use a combination of engineering and work practice controls to prevent or reduce occupational exposure to bloodborne pathogens.TrueFalse
143Question #7An exposure control plan must include information regarding how an employer will use a combination of engineering and work practice controls to prevent or reduce occupational exposure to bloodborne pathogens.TrueFalse
144Question #8TB is a life-threatening infection that primarily affects the:BrainBloodLungsHeart
145Question #8TB is a life-threatening infection that primarily affects the:BrainBloodLungsHeart
146Question #9According to the CDC, “The TB bacteria are put into the air when a person with active TB disease of the lungs or throat _______________.”CoughsSneezesSpeaksAll of the above
147Question #9According to the CDC, “The TB bacteria are put into the air when a person with active TB disease of the lungs or throat _______________.”CoughsSneezesSpeaksAll of the above
148Question #10 Symptoms of active TB include: Cough Weight loss Night sweatsAll of the above
149Question #10 Symptoms of active TB include: Cough Weight loss Night sweatsAll of the above
150Evaluation If you have not completed your evaluation please take time to complete when time permits, your feedback is greatly appreciated.