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Custodial Personnel Need to Understand Personal Protective Equipment and How Bloodborne Pathogens are Transmitted
What’s an OSHA & Why Does It Care ? Occupational Safety and Health Administration The Occupational Health and Safety Act The Final Rule – 1991 Approximately 5.6 million workers in health care and other facilities are at risk of exposure to bloodborne pathogens Purpose : “Limits occupational exposure to blood and other potentially infectious materials (OPIM) since any exposure could result in transmission of bloodborne pathogens which could lead to disease or death.” - OSHA 29CFR
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.
Administering first aid – needlesticks. Using a tool covered with dried blood? Cleaning the restrooms? – Feminine hygiene disposal – Cleaning toilet fixtures
“Bloodborne Pathogens (BBPs) means pathogenic microorganisms that are present in human blood and can cause disease in humans.” DEFINITION
Definitions: – Bloodborne – carried in the blood – Pathogens - disease causing microorganisms CFR specifically addresses: – HIV - Human Immunodeficiency Virus – HBV - Hepatitis B Virus – HCV – Hepatitis C Our presentation also covers other concerns you should understand.
HIV is a bloodborne virus that attacks the immune system rendering the body unable to fight disease.
At the end of 2009 (most current available), an estimated 1,039,000 to 1,185,000 persons in the United States were living with HIV/AIDS, with % undiagnosed and unaware of their HIV infection. – Number of new AIDS cases: 44,232 (2009) Go to : for the latest statistics in any state
Hepatitis B is a serious disease caused by a virus that attacks the liver. – The virus, which is called hepatitis B virus (HBV), can cause lifelong infection, cirrhosis (scarring) of the liver, liver cancer, liver failure, and death. The virus is found in body fluids, including; saliva, blood,urine; vaginal secretions; skin, tissue and cell cultures and other bodily waste and fluids.
Contact with infected blood & bodily fluids containing blood (saliva with blood, urine with blood) which penetrate the skin through scratches, cuts, bites or rashes may result in infection. HBV can also be spread by contaminated needles and syringes or exposure to any other objects which may contain small traces of human blood.
Number of new infections per year has declined from an average of 260,000 in the 1980s to about 73,000 in Highest rate of disease occurs in year-olds. Greatest decline has happened among children and adolescents due to routine hepatitis B vaccination. There are an estimated 1.25 million Americans chronically infected – 20-30% acquired their infection in childhood. – 6 – 10% show no symptoms
U.S.A. = 200,000 people/year infected 5,000 people = Die in U.S. /year 1 out of 20 U.S. people will get HBV in their lifetime.
HIV is spread by sexual contact with an infected person, by sharing needles with someone who is infected, or, less commonly (and now very rarely in countries where blood is screened for HIV antibodies), through transfusions of infected blood or blood clotting factors. Babies born to HIV-infected women may become infected before or during birth or through breast-feeding after birth.
In the health care setting, workers have been infected with HIV after being stuck with needles containing HIV-infected blood or, less frequently, after infected blood gets into a worker’s open cut or a mucous membrane (for example, the eyes or inside of the nose).
1. Weakness, headache, fever, diarrhea, sore throat, nausea, other “flu-like” symptoms. 2. Many infected people do not show symptoms for years after unprotected exposure.
Hepatitis B can survive in dried blood for a week or longer. Golly!
Hepatitis B is transmitted through blood and infected bodily fluids. This can occur through: – direct blood-to-blood contact – unprotected sex – unsterile needles – from an infected woman to her newborn during the delivery process. – Other possible routes of infection include sharing sharp instruments such as razors, toothbrushes or earrings. Body piercing, tattooing and acupuncture are also possible routes of infection unless sterile needles are used Hepatitis B is NOT transmitted casually. It cannot be spread through sneezing, coughing, hugging or eating food prepared by someone who is infected with hepatitis B.
Most people do not have noticeable symptoms when they are first infected. – Hepatitis B causes no symptoms in about 69 percent of infected people. – Approximately 30 percent of infected individuals think they just have the flu and ignore the symptoms
Common symptoms of hepatitis B infection include: – Fever, fatigue, muscle or joint pain – Loss of appetite – Mild nausea and vomiting Serious symptoms that require immediate medical attention and maybe even hospitalization: – Severe nausea and vomiting – Yellow eyes and skin ("jaundice") – Bloated or swollen stomach Up to10% of HBV infected people are “symptomless” chronic carriers.
Hepatitis C is also a virus that causes a disease of the liver.
HCV is the most common chronic bloodborne infection in the United States 80% of infected persons have no signs or symptoms. Number of new infections per year has declined from an average of 240,000 in the 1980s to about 30,000 in Estimated 3.9 million (1.8%) Americans have been infected with HCV, of whom 2.7 million are chronically infected. Chronic infection: 55%-85% of infected persons Chronic liver disease: 70% of chronically infected persons – Causes 8 – 10 Thousand deaths each year in the U.S. May triple within ten years, as people infected years ago are only now starting to show signs of serious liver damage and liver failure.
“The employer shall make available the hepatitis B vaccine and vaccination series to all employees who have occupational exposure, and post-exposure evaluation and follow-up to all employees who have had an exposure incident.” The vaccination series may be started AFTER an exposure incident – the sooner the better You may decline the vaccination series, but you must sign a declination form. You may change your mind.
Must make available, free of charge at a reasonable time and place, to all employees with occupational exposure within 10 working days of initial assignment unless: – employee has had the vaccination – antibody testing reveals immunity The vaccination must be performed by a licensed healthcare professional.
IV drug use; blood or blood product transfusions; kidney dialysis; accidental needlesticks (healthcare workers; unprotected sexual activity; sharing items that may have infected blood on them such as razors, toothbrushes, etc.; ear and body piercing with contaminated instruments; from mother to child at birth
Symptoms include: jaundice, fatigue, abdominal pain, loss of appetite, intermittent nausea, vomiting May lead to chronic liver disease and death
MRSA is not a virus, but is an increasing threat to health that often involves blood or body fluids. It is “ Methicillin-Resistant Staphylococcus Aureus,” a bacteria.
C. diff is an especially important concern in assisted living, healthcare, hospital and general restroom settings.
“… means reasonably anticipated skin, eye, mucous membrane, or parenteral contact with blood or (OPIM) that may result from the performance of an employee’s duties.” “Parenteral means piercing mucous membranes or the skin barrier through such events such as needle sticks, human bites, cuts, and abrasions.”
29 CFR says: – “Each employer having an employee(s) with occupational exposure… shall establish a written Exposure Control Plan designed to eliminate or minimize employee exposure.”
Identifies job and tasks that occupational exposure to blood or other infectious materials may occurs Describes how employer will: – Use engineering & work practice controls & Ensure use of appropriate PPE – Provide training & medical surveillance – Provide hepatitis B vaccinations – Use signs & Labels
Exposure records Training records Name of responsible person
# 1. Universal Precautions – Assume contamination – Treat all blood and body fluids as if they are known to be infected – “Universal Paranoia” Treat every surface as if it is known to be contaminated – The Hepatitis B virus has been shown to live on a dry surface for 10 days to two weeks
# 2. Engineering and Work Practice Controls – Sharps disposal containers; Self-sheathing needles; Safer medical devices ( Needless systems & Sharps with engineered sharps injury protection. – Changing the way tasks are done to eliminate or minimize occupational exposure – Handwashing...
# 3. Good Housekeeping Practices – “All equipment and working surfaces shall be cleaned and decontaminated after contact with blood or OPIM.” – Containers that are to be reused which have a reasonable likelihood for coming into contact with blood or OPIM… shall be decontaminated on a regularly scheduled basis.
Industrial accident Giving First Aid Post-accident cleanup Maintenance and Janitorial work
“Treat any body fluid as if it were labeled DANGER! ” BLOODBORNE PATHOGENS AWARENESS
To better protect ourselves and to reduce disease transmission, we need to understand “fomites”
Organism Examples (Vector): Tick, mosquito, flea The Mosquito that Kept the French from Completing the Panama Canal Object Examples (Fomite) Keyboards, handles, buttons Object Examples (Fomite) Sheets, uniforms, towels
Fomite A fomite is an object that facilitates the transfer of disease from one human host to a new one. HostFomite Host
Cross-contamination is the process of infectious microorganisms being moved from a host to a fomite and picked up again by a new host. Cross-Contamination
Restroom fixtures Gym Equipment Door Handles Bedding Counters Lockers Elevator Panels Desktops Railings
Viruses are so small they can even enter through chapped skin, eyes, mouth or other mucous membranes. They travel in other cells, even inside bacteria.
Large Bacteria 4 microns Virus.025 microns (needs cell to live) Large Mold 12 microns AEROSOL PARTICLE A VIRUS MIGHT TRAVEL ON LOOK
INFECTED INDIVIDUAL HANDS, BODY FLUIDS OR OPEN WOUND FOMITE (INANIMATE SURFACE) HANDS OR SKIN PORTAL OF ENTRY (MUCOUS MEMBRANE)
You can have the greatest impact on disease transmission in a building by applying this principle: Interrupt the Cross – Contamination Cycle! Interrupt the Cross-Contamination Cycle
1.Block off the area 2.Put on appropriate personal protective equipment 3.Apply absorbent material 4.Pick up absorbent and dispose into a red bag if your facility has a red-bag program, if not use a double trash bag 5.Decontaminate the area 6.Decontaminate non-disposable tools 7.Dispose of single-use PPE – decontaminate re-usable PPE 8.Wash hands 9.Dispose of waste properly
Goggles, Aprons, Gloves and Masks are all Appropriate PPE
Gloves are front-line defense for any potential contact with Bloodborne Pathogens.
Remove gloves when they become: 1. CONTAMINATED, 2. DAMAGED, 3. OR BEFORE LEAVING THE CLEAN-UP AREA.
PEEL ONE GLOVE OFF FROM TOP TO BOTTOM HOLD IT IN THE GLOVED HAND. PEEL THE SECOND GLOVE FROM THE INSIDE. TUCK THE FIRST GLOVE INSIDE THE SECOND. RED BAG THE BUNDLE PROMPTLY. WASH HANDS THOROUGHLY. FIRST GLOVE INSIDE SECOND TAKE CARE! DON’T TOUCH OUTSIDE OF SECOND GLOVE WITH FINGERS!
AVOID SHARP ITEMS BY PICKING THEM UP WITH A DUST PAN OR GRABBER ARM.
Spray the area with Disinfectant Cleaner and let it “dwell” for the prescribed time on the label. Make sure the product protects against the pathogens discussed in this presentation.
Use the powder in the Bodily Fluid Spill Control kit to make a mound of powder around the blood then work toward the center to absorb the fluid.
After the powder absorbs the liquid it can be scooped up and placed in the disposable bag.
Spray the area again with Disinfectant Cleaner to perform a final cleaning and disinfection of the surface. Maintain dwell time.
Dispose of the scraper and scoop with used absorbent into the red plastic bag from the kit – if your facility has a red-bag program. Used towels and PPE can be disposed of in the provided plastic bag. Wash hands with towelettes and put used towelettes into bag.
AFTER DISINFECTING ALL SURFACES INVOLVED AND SURROUNDING THE SPILL: RED BAG ALL MATERIALS USED IN THE CLEANUP.*
Liquid or semi-liquid blood or OPIM (other potentially infectious materials) Contaminated items that would release blood or OPIM when compressed Items caked with dried blood or OPIM that are capable of releasing such Contaminated sharps Pathological and microbiological waste containing blood or OPIM
Fluorescent Orange or Orange-Red All waste must be labeled or be in RED bags (if your facility has a red-bag program)
Hand washing is the single most important hygienic practice that can reduce the chance that a susceptible person will be dangerously exposed to infectious agents in blood or other body fluids.
“When a provision of handwashing facilities is not feasible – The employer shall provide either an appropriate antiseptic hand cleanser with clean cloth/paper towels – Or antiseptic towelettes. When antiseptic hand cleansers or towlettes are used, hands shall be washed with soap and running water as soon as feasible.”
“Eating, drinking, smoking, applying cosmetics or lip balm, and handling contact lenses are prohibited in work areas where there is a reasonable likelihood of occupational exposure.”
The employer pays for cleaning, laundering, disposal, repair, and replacement as needed. If PPE is penetrated it shall be removed immediately or as soon as feasible. All PPE shall be removed prior to leaving the work area. When removed, it shall be placed in an appropriately designated area or container.
Contaminated laundry = handle with minimum agitation. “Contaminated laundry = bag or containerize at the use location & not sorted or rinsed in the location of use.” Must be placed & transported in labeled or color-coded containers.
If facility uses Universal Precautions = soiled laundry, alternative labeling or color coding is sufficient if it all employees recognize the containers as requiring compliance with Universal Precautions.”
Wet laundry = In leak proof bags or containers. The employer = Provide PPE for those who handle contaminated laundry. If contaminated laundry sent off-site to a second facility which does not utilize Universal Precautions in the handling of all laundry… must be labeled or color coded…”
“Following a report of an exposure incident, the employer shall make immediately available to the exposed employee a confidential medical evaluation and follow- up, including at least the following elements: – Documentation of the route(s) of exposure – The circumstances under which the exposure incident occurred;…”
“…Identification and documentation of the source individual, unless the employer can establish that identification is infeasible or prohibited by state or local law; The source individual’s blood shall be tested as soon as feasible and after consent is obtained in order to determine HBV and HIV infectivity…”
1 RESPOND 2 BLOCK 3 CLEAN 4 CALL* RESPOND TO INJURY OR INCIDENT AFTER PUTTING ON APPROPRIATE PPE. BLOCK OFF THE AREA (TO PROTECT OTHERS) AS SOON AS POSSIBLE. CLEAN THE PHYSICAL AREA AS SOON AS POSSIBLE AFTER SPILL. OR CLEAN YOURSELF FIRST IF ACCIDENTALLY EXPOSED TO FLUIDS. CALL TO REPORT ANY EXPOSURES TO APPROPRIATE SUPERVISOR.
“Treat any body fluid as if it were labeled DANGER! ” BLOODBORNE PATHOGENS AWARENESS