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Blood-Borne Pathogens

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Presentation on theme: "Blood-Borne Pathogens"— Presentation transcript:

1 Blood-Borne Pathogens
Exposure Control Plan X 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 CSR Rule states that MO law will mirror the federal OSHA standard for blood-borne pathogens Applies to public schools as employers with employees at occupational risk Our 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 staff Special education teachers Teacher aides with children who are developmentally disabled Speech, OT and PT Bus drivers for special education These 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 equipment This 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 Diseases Universal Precautions Use of Personal Protective Equipment Vaccination Program Exposure Incident Follow-up Record Keeping This 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 employees Blood-borne pathogens Minimizing exposure Enforce use of universal precautions Provide handwashing facilities and supplies Provide personal protective equipment The 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 disposal Appropriate housekeeping procedures Use of bio-hazard labeling Hepatitis B vaccine, when indicated Plan for follow up in event of exposure The 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 Plan Identification of those at risk Potentially infectious agents Modes of transmission of infectious agents Standard Precautions This is the agenda for this inservice.

11 Agenda (continued) Personal Protective Equipment
Housekeeping Procedures Hepatitis B Vaccination Handling an Exposure Incident Questions and Answers Post-test You 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 Officer Describes the responsibility of both employer and employee District 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 responsibility To provide active protection to those at risk with hepatitis B vaccination All 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 agents describe the modes of transmission of various agents demonstrate the principles of universal precautions and use of protective equipment describe the appropriate action in the event of an exposure incident comply with Exposure Control Plan These 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 pathogens Using safe practices to prevent exposure We 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 membrane This just means the pathogens, usually viruses, find a way into our blood stream.

17 Types of Blood-borne Pathogens
Hepatitis B, C, and D viruses Human 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: Viruses Bacterial invasion Physical 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 B Hepatitis C and D can also be transmitted in the school setting We 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 injury Virus 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 hospitalization Symptoms may appear from days after exposure Vaccine now given to all babies at birth and to adolescents Potential for occupational exposure The 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 indicated Passive immunization (Hepatitis B immune globulin) can be administered upon exposure, if person is not vaccinated for HBV Vaccine is available for permanent protection Persons 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 available Some treatment available The 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 contact Best protection is avoiding exposure Hep B and C (acute and chronic) account for 4 of the 10 most common infections in Missouri The 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 schools Casual person-person contact poses no risk so exclusion not usually recommended Transmitted through blood, sexual contact Does not survive easily in environment No vaccine available; treatment is available The 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 blood 1 – 15 years from HIV infection to AIDS diagnosis Communicable from 6 – 12 weeks after exposure until death occurs Drug-resistant strains developing There 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 transmission HBV HIV Blood yes yes Semen yes yes Vaginal fluids yes yes Saliva Maybe no Target in body liver immune system This is just a quick look at the differences between HBV and HIV

29 Risk of Infection from Needlestick
HBV HIV Exposure to blood 6-30% 0.5% High Number of Virus in blood yes no Vaccine available yes no You 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 Incident Means 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 controls Personal protective equipment Work practice controls Universal precautions Handwashing Housekeeping guidelines Laundry handling As 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 Handwashing Most important technique to prevent transmission of disease Requires 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 toilet Diapering or assisting with personal care Any contact with blood, body fluid or soiled object, including facial tissues Removing gloves used as a barrier This 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 possible Use paper towels to turn off faucets Use paper towel to open restroom door, then discard It 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 available Have been shown to reduce infection Individual should use soap and water when hands are visibly soiled Should use soap and water as soon as possible after use of hand sanitizers Some 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 devices Work Practice Controls Reduces likelihood of exposure by altering manner in which task is performed Universal Precautions Assumes all persons might be infectious, and includes use of personal protective equipment and environmental practices Again, these are the means of reducing exposure.

37 Work Practice Controls
Universal Precautions Handwashing technique and facilities Guidelines for handling body fluids in school Proper sharps use and disposal Rules for personal hygiene and eating in workplace Work 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 cleaning Carpet cleaning Handling of contaminated waste/materials Communication 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 exposure Must not allow blood or potentially infectious material to pass through material to reach clothing, skin, mucous membrane Includes 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 sizes Hypoallergenic gloves must be available District responsible for cleaning and maintenance to assure PPE is used Responsibility of employee to use PPE if there is an expected risk of exposure Again, 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 punctured Utility gloves may be worn for cleaning purposes, can be decontaminated if intact Disposable 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 procedures Good practice for: Blood glucose monitoring Minor wound care, or dressing changes Catheterizations, diapering and toileting Applying topical medications Assisting with tooth brushing and oral care Emesis clean up This 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 secretions Feeding (oral or by gastrostomy tubes) Suctioning Changing personal hygiene pads Taking oral temperatures Used 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 containers Handling contaminated materials/containers Cleaning/sweeping up contaminated glass Handling contaminated laundry These 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, and dependent on adults for personal care needs This 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 present Diapering, toileting with gross contamination Wound care for combative child Handling contaminated laundry Disposing of grossly contaminated waste Caring 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 coughing History of spitting, vomiting Suctioning tracheostomy with copious secretions and forceful coughing Assisting with severe injury and spurting blood Cleaning up spills that may splatter Again, this will be a smaller category of employees.

48 Resuscitation Masks Use as a barrier from saliva, emesis or other potentially infectious materials during CPR Should be easily accessible for emergencies Must contain a one-way valve Must be properly cleaned for re-use Disposable, single-use masks available This 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 fluids Provision of required housekeeping materials (absorbent materials, germicides, etc.) Use of EPA approved agent Good 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 waste Warning labels for equipment The 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 Labels Red or red-orange with letters and symbols in contrasting color Disposal bags in red Items may be double-bagged, with red outer bag The 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 time Some contraindications to vaccine Very safe, given in upper deltoid muscle Very few side effects to this vaccine Aside 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 Vaccine Must be offered free, within 10 days of employment in a position of risk Not required to be tested to determine need for vaccine Employee must sign statement if declining vaccine, if recommended If boosters should be recommended, must be provided free of charge If 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 report Exposure Control Officer will document necessary information and make arrangements for medical follow-up May involve blood-testing of both employee and source individual All information kept confidential Affected employee will receive recommendations from health care provider This 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 evaluation Documentation of exposure Identification of source individual Results of blood testing of source individual Collection and testing of employee’s blood Post-exposure protection when indicated Counseling Evaluation of reported illnesses Copy of medical evaluation and recommendations This 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 Keeping All records kept confidential – not released without written consent of employee Records of employee training Records of hepatitis B vaccination Record of any exposure incident, including medical evaluation, testing results and follow-up The 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 Plan Identify those at occupational risk Provide education to all employees re risk of blood-borne pathogens Provide personal protective equipment Offer hepatitis B vaccine, if indicated Provide medical follow-up in the event of exposure incident These 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 handwashing Utilizing standard precautions and personal protective equipment when indicated Getting hepatitis B vaccine unless contraindicated Proper disposal of contaminated waste/sharps/laundry Immediate reporting of an exposure incident Compliance with follow-up of exposure Likewise, 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 responsibilities Employee’s personal responsibilities How 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.


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