Presentation on theme: "Blood-Borne Pathogens"— Presentation transcript:
1 Blood-Borne Pathogens Exposure Control PlanX District(This is the title page, and you can insert the name of your district where it says X District).
2 Occupational Safety and Health Law passed in 2001 requires public agencies in Missouri employing persons who might be occupationally exposed to blood-borne pathogens to prepare an exposure control plan equivalent to that required by the federal Occupational Safety and Health Administration(OSHA). Previously applied only to private agencies in Missouri.This inservice has been mandated by a law passed recently in MO that states that MO public institutions, including public schools, must now follow standard procedures set down by the Occupational Safety and Health Administration. Prior to this, MO was not considered an OSHA state. The OSHA standard however, has been in effect in private and parochial schools since 1991.
3 Missouri Law RSMo 191.640, passed in 2001 Rule promulgated in 2003: 19 CSRRule states that MO law will mirror the federal OSHA standard for blood-borne pathogensApplies to public schools as employers with employees at occupational riskOur law is located in the Revised Statutes, in the Chapter under Health and Welfare. The Dept. of Health and Senior Services first promulgated the rules governing this law in 2003, and we are now educating school districts about the rights and responsibilities of the district and the employees. The DHSS is assigned the implementation of the law.
4 What does that mean?Certain personnel in schools provide health services to children that involve exposure to blood-borne pathogens and other infectious agents, as part of their job.Generally speaking, we are talking about any personnel who give first aid for illness and injury, and those who perform special care procedures.
5 Who is at Risk? School nurse and health room aide Designated first aid and CPR responders, including secretarial staffSpecial education teachersTeacher aides with children who are developmentally disabledSpeech, OT and PTBus drivers for special educationThese are some of the individuals in our district that might be included in a list of those with expected occupational risk, based on their job duties.(Can add or subtract job classifications to fit your district)
6 Exposure Determination Reasonably anticipated exposure to skin, eye, mucous membrane or blood exposure during the course of employee’s duties without regard to whether the employee is using personal protective equipmentThis is the criteria for determining which employees might have an expected risk of exposure. (You can ask employees if they come into contact with blood or body fluids in the course of their job).
7 Requirements of Law Exposure Control Plan Staff Education Blood-borne DiseasesUniversal PrecautionsUse of Personal Protective EquipmentVaccination ProgramExposure Incident Follow-upRecord KeepingThis is what our district is required to do, under this law.The OSHA Law requires “universal precautions” not standard precautions. The difference is that this law only pertains to Blood & bloody body fluids and what they call other potentially infectious materials. It does not include feces, oral secretions, urine etc. unless they contain blood. Univ. Precautions came out before Standard precautions which means treat all moist body fluids and surfaces soiled with them as though they are infectious. Obviously Std. Precautions is a better approach but the law only pertains to bloodborne pathogens.
8 How do we protect employees Education of employeesBlood-borne pathogensMinimizing exposureEnforce use of universal precautionsProvide handwashing facilities and suppliesProvide personal protective equipmentThe intent of the legislation is to eliminate or reduce the possibility of exposure to blood that might be infected. To do that, we must look at how these events might occur, and change how things are done, provide the means for protection, provide any safeguards possible, and appropriately handle any materials with the risk for infection
9 How do we protect employees (continued) Appropriate sharps and waste disposalAppropriate housekeeping proceduresUse of bio-hazard labelingHepatitis B vaccine, when indicatedPlan for follow up in event of exposureThe overall law also applies to large institutions, like hospitals, where committees are assigned to look at work practices, needleless systems and various sharps disposal equipment. In the school, we must be sure we are providing an safeguards indicated.Nurses and maintenance staff must work together to assure appropriate cleaning procedures are in place.The hepatitis B vaccine may be administered on site, or in collaboration with private providers or local health agencies. It has to be at no cost to the employee, and be reasonably available.Employees must be advised of the procedures to follow if they have an unanticipated exposure.
10 Agenda (Required Training) Overview of Exposure Control PlanIdentification of those at riskPotentially infectious agentsModes of transmission of infectious agentsStandard PrecautionsThis is the agenda for this inservice.
11 Agenda (continued) Personal Protective Equipment Housekeeping ProceduresHepatitis B VaccinationHandling an Exposure IncidentQuestions and AnswersPost-testYou will have an opportunity to ask questions at the end of the presentation. You will also be asked to complete a brief post-test to assure we have communicated the information adequately.
12 District Exposure Control Plan (Insert name of person in charge of plan) – Exposure Control OfficerDescribes the responsibility of both employer and employeeDistrict required to provide certain information, materials, etc.All employees must comply with plan requirements(On this slide, you need to insert the name of the person who has been given the responsibility for the ECP)
13 Purpose of District Plan To eliminate or minimize employee exposure to blood or other potentially infectious materials.To educate staff regarding methods of compliance to be implemented – personal responsibilityTo provide active protection to those at risk with hepatitis B vaccinationAll employees must be educated about the districts Exposure Control Plan, and all employees must understand their responsibility in avoiding exposure.
14 Training Objectives The employee will be able to: list the common blood-borne pathogens and other infectious agentsdescribe the modes of transmission of various agentsdemonstrate the principles of universal precautions and use of protective equipmentdescribe the appropriate action in the event of an exposure incidentcomply with Exposure Control PlanThese are the objectives for this presentation. We will discuss the various blood-borne pathogens of concern, and how they are transmitted.We will also review standard precautions, and the use of personal protective equipment at several levels of risk.You should know what to do if you think you have been exposed, particularly by a needlestick injury.
15 What do we need to worry about? Potential for exposure to blood-borne pathogensUsing safe practices to prevent exposureWe will talk about the blood-borne pathogens, and describe ways to prevent or reduce exposure.
16 What are blood-borne pathogens? Pathogens, or infectious agents, that are transmitted by exposure to infected blood through breaks in the skin or mucous membraneThis just means the pathogens, usually viruses, find a way into our blood stream.
17 Types of Blood-borne Pathogens Hepatitis B, C, and D virusesHuman Immunodeficiency Virus (HIV)These are the blood-borne pathogens we could see transmitted in schools.
18 Hepatitis Means inflammation of the liver – may be acute or chronic Can be caused by:VirusesBacterial invasionPhysical agents (gall bladder disease, cancer)Chemical agents (alcohol, certain drugs)Hepatitis simply means liver disease, and can be caused by various agents.
19 Forms of Hepatitis of Concern (Hepatitis A is not blood-borne)Hepatitis BHepatitis C and D can also be transmitted in the school settingWe will not discuss hepatitis A, as it is not blood-borne. It can be transmitted in schools, however.Hepatitis B is the most common type, about 30 x more likely to cause death than HIV.Hepatitis C is not related to other types of hepatitis infections, but usually becomes chronic. It is much less common now that blood donors are screened for Hep. C.Hepatitis D only occurs in individuals who also have hepatitis B.
20 Hepatitis B Virus (HBV) Spread by direct contact with infected body fluids (blood, semen, saliva), most commonly by sexual contact, needle sharing or needle stick injuryVirus can survive on surfaces for more than 7 days so transmission can occur through contact with contaminated objects/surfaces (including dried blood)Any EPA approved disinfectant will work as long as it has a label claim for hepatitis. Hepatitis B, HIV etc. are very easily killed. They are lipophilic viruses and even good detergents will kill them. Bleach when not used properly will damage floors, carpets, metals etc. so not recommended unless nothing else is available.
21 HBV (continued) Can cause chronic liver disease, may be fatal Fatalities much more common in HBV than HIV(in 2003, 428 HBV deaths compared to 124 AIDS deaths)Again, this can be a serious disease and can become chronic, or the individual could develop liver failure or cancer. About 90% of individuals who contract hepatitis B will be free of the virus within 6 months, but the remaining 10% become chronic carriers of the virus.
22 HBV (continued)May appear as a mild flu-like illness, or be more severe, requiring hospitalizationSymptoms may appear from days after exposureVaccine now given to all babies at birthand to adolescentsPotential for occupational exposureThe symptoms of all the hepatitis diseases are vague, flu-like symptoms like muscle aches, nausea and vomiting, loss of appetite, joint pain and fatigue. Some individuals can recover and never know that they were infected. They just thought they had a bad case of the flu. Not all individuals with hepatitis diseases develop jaundice, which is often the first clue that they have the disease. It is at that point that the disease is infecting the liver to such an extent it is interfering with proper liver function.The good news is that there is vaccine for hepatitis B
23 HBV (continued)Not spread by casual contact so exclusion from school or work is not indicatedPassive immunization (Hepatitis B immune globulin) can be administered upon exposure, if person is not vaccinated for HBVVaccine is available for permanent protectionPersons with hepatitis B, if they feel well, can be at work and at school, since HBV is not spread by the type of casual contact you would have in a school setting.Persons, who are chronic carriers of the HBV, usually have no symptoms, and may not even know they have the virus in their system. That is one of the reasons we must assume any individual can be infectious, with any number of diseases, and is the basis for what we call standard precautions.Nela- replace standard precautions with universal precautions.
24 Hepatitis C (HCV)Usually occurs in persons with large or repeated exposure to infected blood, i.e., persons undergoing dialysis, history of blood transfusions (blood banks now test for this), exposure during tattooing and piercings, etc.No vaccine availableSome treatment availableThe symptoms of hepatitis C are like those for hepatitis A and B. Flu-like symptoms, general fatigue, lack of appetite, some nausea and/or vomiting.There is no vaccine for HCV, but there is some treatment that may be successful.
25 Other Hepatitis viruses Hepatitis D – occurs only in individuals with HBV - transmitted through blood and sexual contact.Hepatitis G – identified in 1996 – is transmitted through blood and sexual contactBest protection is avoiding exposureHep B and C (acute and chronic) account for 4 of the 10 most common infections in MissouriThe best protection for all the hepatitis viruses is to avoid exposure, and that would be practicing the standard precautions that I will describe in more detail later.
26 Human Immunodeficiency Virus First raised awareness of critical need for good personal hygiene in schoolsCasual person-person contact poses no risk so exclusion not usually recommendedTransmitted through blood, sexual contactDoes not survive easily in environmentNo vaccine available; treatment is availableThe HIV infection taught us some good lessons about the need to pay attention to personal hygiene. Later, we found out how HIV was spread, but individuals did become more aware of the potential for infection in the school setting. We now know that HIV is not spread by casual contact, so we see individuals working and attending schools with HIV, without threat to others. It is now considered a chronic infectious disease.Hepatitis B and HIV are equally fragile in the environment. It just depends upon how much protein material surrounds them as to how long they survive in the environment. As stated previously, bleach is not necessary.
27 HIV (continued) Treatment continues to be effective in prolonging life May take 6-12 weeks to appear in blood1 – 15 years from HIV infection to AIDS diagnosisCommunicable from 6 – 12 weeks after exposure until death occursDrug-resistant strains developingThere are new treatments all the time for HIV, and new information on how to keep an individual with HIV healthier and less at risk from other diseases.
28 Comparison of HBV and HIV Mode of transmissionHBV HIVBlood yes yesSemen yes yesVaginal fluids yes yesSaliva Maybe noTarget in body liver immunesystemThis is just a quick look at the differences between HBV and HIV
29 Risk of Infection from Needlestick HBV HIVExposure to blood 6-30% 0.5%High Number ofVirus in blood yes noVaccine available yes noYou can see that HBV is a more serious threat from a needlestick injury than HIV because the level of the virus is the blood is much higher..
30 Exposure IncidentMeans a specific eye, mouth, other mucous membrane, non-intact skin or parenteral contact with blood or other potentially infectious materials that result from the performance of an employee’s duties.Does not include body-fluid clean up or exposure to blood when protected by PPE or intact skin (wearing gloves)This is the definition of an exposure incident what it is and is not..
31 Methods to Reduce Exposure Engineering controlsPersonal protective equipmentWork practice controlsUniversal precautionsHandwashingHousekeeping guidelinesLaundry handlingAs you can see, there are a variety of ways we can reduce the risk of exposure.Engineering controls simply refers to items designed to reduce exposure, like the self-sheathing needles used in Epi-pens, or the sharps disposal systems.Work practice controls refers to prohibiting the practice of re capping needles. Instead, they are to be placed in a sharps disposal container, or following procedures to reduce the risk of contamination.Different procedures will require different PPE, based on level of risk.Housekeeping and laundry procedures reduce risk by activities such as double-bagging contaminated materials, handling soiled laundry with gloves, using bio-hazard bags to alert someone the material inside may be infectious.Nela – handwashing, Housekeeping guidelines and laundry handling, and universal precautions are work practice control.
32 HandwashingMost important technique to prevent transmission of diseaseRequires soap, water and vigorous scrubbing of hands - front, back and between fingers for seconds(time it takes to sing one verse of Old Macdonald, or Happy Birthday twice)The ten most common ways to spread an infection are our ten fingers!We can’t emphasize enough the importance of good handwashing practices.
33 Handwashing (continued) Should wash hands before eating,And after:Using the toiletDiapering or assisting with personal careAny contact with blood, body fluid or soiled object, including facial tissuesRemoving gloves used as a barrierThis is when we must wash our hand, and every time we wash our hands, other than these times, we are reducing our risk as well. That is why it is recommended to wash hands frequently during cold and flu season. Every surface we touch, like phones and door knobs can transmit viruses.It is important to protect others by washing your hands as soon as possible after covering your nose or mouth after sneezing or coughing unexpectedly.
34 Handwashing (continued) Use warm water and soap whenever possibleUse paper towels to turn off faucetsUse paper towel to open restroom door, then discardIt is important to wash hands thoroughly, and then protect yourself from other sources of contamination of your clean ands by not touching faucets and door handles.
35 Alcohol-based Hand Sanitizers Have been deemed “acceptable” by CDC when soap and water not availableHave been shown to reduce infectionIndividual should use soap and water when hands are visibly soiledShould use soap and water as soon as possible after use of hand sanitizersSome schools have gone exclusively to alcohol-based gels, but they are intended as a substitute until hands can be washed.
36 Control of Exposure Engineering Controls Isolate or remove the blood-borne pathogens from the work place, i.e., sharps disposal, auto-injection devicesWork Practice ControlsReduces likelihood of exposure by altering manner in which task is performedUniversal PrecautionsAssumes all persons might be infectious, and includes use of personal protective equipment and environmental practicesAgain, these are the means of reducing exposure.
37 Work Practice Controls Universal PrecautionsHandwashing technique and facilitiesGuidelines for handling body fluids in schoolProper sharps use and disposalRules for personal hygiene and eating in workplaceWork practice controls are policies and procedures that include these areas. All individuals must take personal responsibility to use good work practices.
38 Work Practice Controls (Cont.) Equipment cleaningCarpet cleaningHandling of contaminated waste/materialsCommunication of hazards (labels, red containers)All custodial staff must have education on how to handle contaminated surfaces and clean up waste materials.
39 Personal Protective Equipment (PPE) Appropriate for assignment, expected exposureMust not allow blood or potentially infectious material to pass through material to reach clothing, skin, mucous membraneIncludes use of gloves, face masks, gowns, goggles, resuscitation masks, etc.The type of PPE you will need will depend on the type of exposures that might be expected. At the very least, disposable gloves must be readilly available. In some schools, staff that cover the playground wear a fanny pack with disposable gloves and first aid supplies.
40 PPE (continued) Must be provided without cost to employee Must be accessible, and in correct sizesHypoallergenic gloves must be availableDistrict responsible for cleaning and maintenance to assure PPE is usedResponsibility of employee to use PPE if there is an expected risk of exposureAgain, it falls back on the employee taking personal responsibility to use the right PPE if they anticipate an exposure.The district must make the materials available.
41 Gloves Disposable gloves – can’t be washed or decontaminated Discard if torn or puncturedUtility gloves may be worn for cleaning purposes, can be decontaminated if intactDisposable gloves protect both the individual and the caregiver.Utility gloves are used by custodial staff.
42 Level I Protection Indications for Glove Use Injections and intravascular proceduresGood practice for:Blood glucose monitoringMinor wound care, or dressing changesCatheterizations, diapering and toiletingApplying topical medicationsAssisting with tooth brushing and oral careEmesis clean upThis is the first level of risk requiring the use of gloves. The law only covers the use of gloves for injections and IV procedures. We know that it is a good practice to use gloves when performing the rest of these tasks.
43 Glove Use (continued) Changing ostomy bags Cleaning nose/mouth secretionsFeeding (oral or by gastrostomy tubes)SuctioningChanging personal hygiene padsTaking oral temperaturesUsed when caregiver has open lesion on hand(s) – cuts, rashes, etc.These are some more procedures where it is considered good practice to wear gloves, but these procedures are not covered in the OSHA standard for bloodborne pathogens.
44 Use of Utility Gloves Cleaning up body spills Emptying trash cans Handling sharps containersHandling contaminated materials/containersCleaning/sweeping up contaminated glassHandling contaminated laundryThese are guidelines for custodial staff for when to wear gloves to prevent exposure.
45 Level II Protection (Use of Gloves and Other PPE) Routine exposure expected during assignment (usually with children with special health care needs). This group is more likely to be at increased risk of exposure to blood-borne pathogens due to:vulnerability to injury,special medical needs, anddependent on adults for personal care needsThis level probably affects only those individuals giving direct personal care.
46 Level II Protection (Use of Gloves and Other PPE) Changing pads with body fluids presentDiapering, toileting with gross contaminationWound care for combative childHandling contaminated laundryDisposing of grossly contaminated wasteCaring for children with little or no impulse control (diapering, feeding, suctioning, etc.)These are some of their tasks.
47 Level III Protection (Requires additional PPE) May be exposure to face, nose, or eyes (use of masks)Feeding a child with forceful coughingHistory of spitting, vomitingSuctioning tracheostomy with copious secretions and forceful coughingAssisting with severe injury and spurting bloodCleaning up spills that may splatterAgain, this will be a smaller category of employees.
48 Resuscitation MasksUse as a barrier from saliva, emesis or other potentially infectious materials during CPRShould be easily accessible for emergenciesMust contain a one-way valveMust be properly cleaned for re-useDisposable, single-use masks availableThis protection must be available to anyone expected to perform CPR. Some personnel in schools carry a disposable face mask with the gloves they have in their playground pack or on buses.
49 Housekeeping Routine cleaning Decontamination after contact with blood and other body fluidsProvision of required housekeeping materials (absorbent materials, germicides, etc.)Use of EPA approved agentGood housekeeping procedures protect everyone in the school environment. We are counting on them to do the right type of disinfecting, since viruses cannot be seen.They must have the information and materials they need to properly clean up spills, and it is the responsibility of the Exposure Control Officer to oversee this area., to be sure they know what to do, and have what they need.
50 Communication of Hazards Information and training at time of employment regarding hazardous materials, labeling, etc.Warning labels or red containers for wasteWarning labels for equipmentThe bio-hazard labeling and red bags and containers are designed to alert individuals that the container might hold infectious waste and should be handled carefully.
51 Biohazard LabelsRed or red-orange with letters and symbols in contrasting colorDisposal bags in redItems may be double-bagged, with red outer bagThe bio-hazard symbol is the one on the lower right hand corner of each of these slides. It is usually red or orange, with black lettering.
52 Hepatitis B Vaccine Requires three immunizations Protection lasts at least 13 years, but no booster is recommended at this timeSome contraindications to vaccineVery safe, given in upper deltoid muscleVery few side effects to this vaccineAside from the environmental and work practices, this is another major way we can protect employees who might be exposed to blood-borne pathogens.How many of you have already been vaccinated for hepatitis B? People have been vaccinated for a variety of reasons, and if you have had a complete series, you would not have to receive the vaccine again.It is a very safe vaccine, and the most common side effect is redness at the site of injection.
53 Hepatitis B VaccineMust be offered free, within 10 days of employment in a position of riskNot required to be tested to determine need for vaccineEmployee must sign statement if declining vaccine, if recommendedIf boosters should be recommended, must be provided free of chargeIf you haven’t received the vaccine, you are eligible to receive it free. You can refuse the vaccine if you wish, but this law requires you to sign a statement refusing the vaccine, which would be filed with the district’s records for compliance with the law. If you change your mind later, you can still get the vaccine.
54 Handling Exposure Incident Employee with exposure must reportExposure Control Officer will document necessary information and make arrangements for medical follow-upMay involve blood-testing of both employee and source individualAll information kept confidentialAffected employee will receive recommendations from health care providerThis is what to do if you think you have had an exposure. Again, we are not talking about an incident where you followed the procedures, were wearing gloves while you cared for a bloody injury, removed the gloves, and washed your hands.We are talking about an unexpected exposure, which could include a needlestick, exposure to mucous membranes from blood splatters, etc. It is an exposure you did not expect, and were not prepared for, with the proper PPE.You would report the incident, and the Exposure Control Officer would work through the process with you for the necessary follow-up. The medical follow-up would be at no cost to you as the employee.
55 Post-exposure Evaluation Employee is provided a medical evaluationDocumentation of exposureIdentification of source individualResults of blood testing of source individualCollection and testing of employee’s bloodPost-exposure protection when indicatedCounselingEvaluation of reported illnessesCopy of medical evaluation and recommendationsThis is what is entailed in a post-exposure evaluation. The process is confidential, and the counseling is built into the process because it could be a scary thing to think you might contract one of these blood-borne diseases.
56 Record KeepingAll records kept confidential – not released without written consent of employeeRecords of employee trainingRecords of hepatitis B vaccinationRecord of any exposure incident, including medical evaluation, testing results and follow-upThe law requires a lot of record keeping by the district including all the training you might attend, and what information you were given. The records have to include whether or not you received the vaccine, and certainly any actions taking following a suspected exposure.
57 Employer’s Responsibilities Develop Exposure Control PlanIdentify those at occupational riskProvide education to all employees re risk of blood-borne pathogensProvide personal protective equipmentOffer hepatitis B vaccine, if indicatedProvide medical follow-up in the event of exposure incidentThese are the district’s responsibilities in reducing your risk of exposure.It includes specific education, PPE, vaccine and assistance if you do get exposed to a blood-borne pathogen.
58 Employee’s Responsibility Proper handwashingUtilizing standard precautions and personal protective equipment when indicatedGetting hepatitis B vaccine unless contraindicatedProper disposal of contaminated waste/sharps/laundryImmediate reporting of an exposure incidentCompliance with follow-up of exposureLikewise, you have a personal responsibility to avoid exposure, and these are some of the ways you can do that.Again, good handwashing is the number one way to protect yourself against blood-borne pathogens and any other type of pathogens that might be found in the school setting.
59 Questions and Answers Opportunity to clarify any concerns Employer responsibilitiesEmployee’s personal responsibilitiesHow to obtain copy of district Exposure Control Plan(Answer questions to clarify information)Explain how they can obtain a copy of the total Exposure Control Plan. Would not recommend making copies for everyone, but they might want the agenda, the objectives and a copy of the Appendix B – the rule. The statute is probably more information than they will want.