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Bloodborne Pathogens Awareness and safe practices for employees and responders who may come into contact with blood or other potentially infectious materials.

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Presentation on theme: "Bloodborne Pathogens Awareness and safe practices for employees and responders who may come into contact with blood or other potentially infectious materials."— Presentation transcript:

1 Bloodborne Pathogens Awareness and safe practices for employees and responders who may come into contact with blood or other potentially infectious materials.

2 INTRODUCTION (C) 2011 EMS Safety BBPIntroduction2

3 Bloodborne Pathogens (BBP) Learning Objectives Understand risks associated with BBP in the workplace Understand how to minimize risks and potential for exposure at work Determine proper action if exposure occurs Demonstrate skill of soiled glove removal Key Concepts 3.3 million workplace injuries and illnesses OSHA developed standard for employers (1910.1030) Purpose: reduce risk of occupational exposure to BBP Microorganisms cause bloodborne diseases Includes needle safety protocols (C) 2011 EMS Safety BBPIntroduction3

4 You will learn What bloodborne pathogens are and why they are dangerous Basic information on HIV, hepatitis B (HBV) and hepatitis C (HCV) Routes of exposure, techniques to reduce risk of exposure, and use of personal protective equipment (PPE) Resources available to employees How to respond safely to an emergency at work Post-exposure actions (C) 2011 EMS Safety BBPIntroduction4

5 Why me? Why do you need this training? –To provide care to an injured or ill person –To handle contaminated sharps –To clean a blood or body fluid spill –To learn what to do if you’re exposed to BBP You should know: –Risks of workplace duties that might involve blood or body fluid exposure –Routes of entry for BBP –Protective and preventive measures for handling blood or other body fluids (C) 2011 EMS Safety BBPIntroduction5

6 Who is covered by the BBP Standard? Employees who could come into contact with blood or Other Potentially Infectious Materials (OPIM) while performing their jobs –A coworker coming to the aid of a bleeding victim –Public safety, correctional officers, first responders –Healthcare or dental workers –Custodial or maintenance workers –Workers in labs, tissue or blood banks, laundries or mortuaries –Workers handling medical equipment or regulated waste –Workers who provide body art (C) 2011 EMS Safety BBPIntroduction6

7 What is a bloodborne pathogen? Disease-causing microorganism present in human blood Transmitted through exposure to the blood or certain body fluids of an infected person Most serious types: HIV, HBV, HCV What are Other Potentially infectious fluids (OPIM)? –Human body fluids –Unfixed tissue or organs from a human –Any cell, culture, fluid, tissue or organ containing the HIV or hepatitis B virus (C) 2011 EMS Safety BBPIntroduction7

8 What is an Exposure Incident? Defined by OSHA “A specific eye, mouth, or other mucous membrane, non-intact skin, or parenteral contact with blood or other potentially infectious materials that results from the performance of an employee’s duties” Exposure incidents are reported after initial care and decontamination (C) 2011 EMS Safety BBPIntroduction8


10 HIV: Key Concepts Breaks down immune system – Kills T-Cells that help fight against infection >1M cases of HIV in U.S. – 20% unaware of infection – 56,000 new cases annually No known cure or vaccine AIDS is most advanced stage of HIV infection – Allows opportunistic illnesses – Common cold becomes fatal pneumonia (C) 2011 EMS Safety BBPIntroduction10 The HIV Virus

11 How is HIV transmitted? Must have a route of entry Primary methods of transmission: –Unprotected sex with infected partner –Sharing needles during injection drug use Can pass disease without knowing you’re infected (C) 2011 EMS Safety BBPIntroduction11

12 What body fluids transmit HIV? Blood (any fluid contaminated w/ blood) Semen, vaginal secretions Breast milk or amniotic fluid (from a mother’s pregnancy) Saliva (usually bloody) from dental procedures Cerebrospinal fluid (brain and spinal column) Synovial fluid (surrounding joints) Pleural fluid (around lungs) Peritoneal fluid (in abdomen) Pericardial fluid (around heart) (C) 2011 EMS Safety BBPIntroduction12

13 NOT transmitted through casual contact No transmission from saliva or tears No known transmission from sharing –Food and drink –Towels, tools, eating utensils –Restroom facilities Very weak virus outside the body –Can only live about 5 min in a drop of blood on the ground (C) 2011 EMS Safety BBPIntroduction13

14 What are the symptoms of HIV? Initially flu-like symptoms that dissipate May have no other signs and symptoms for years Common symptoms of HIV infection include: –Anorexia, weight loss –Fatigue, weakness –Persistent cough, swollen lymph nodes –Diarrhea, abdominal discomfort –Mouth lesions, dark skin blemishes –Afternoon fevers, night sweats, chills –Memory loss, neurological disorders (C) 2011 EMS Safety BBPIntroduction14


16 Key Concepts Hepatitis is inflammation of the liver –Usually caused by a viral infection –Hepatitis B (HBV) and Hepatitis C (HCV) are the most serious workplace exposures Hepatitis can cause: –Cirrhosis (scarring) of the liver –Liver cancer –Liver failure –Death –Chronic liver infections Hepatitis is very contagious –Strong virus, even outside the body –HBV can live in drop of dried blood for up to 2 weeks (C) 2011 EMS Safety BBPIntroduction16

17 Comparing HBV and HCV HBV 38,000 new cases in 2008 90% patient recovery 5 -10% develop chronic liver infection 30-50% of infected children become chronic carriers 1.4 million Americans have chronic HBV More easily transmitted than HIV or HCV Vaccine preventable HCV 18,000 new cases in 2008 Can cause acute or chronic (life-long) infection 75-85% develop chronic infection, which can cause – Chronic liver disease – Death 3.2 million Americans with chronic HCV (C) 2011 EMS Safety BBPIntroduction17

18 Transmission of HBV and HCV Contracted through direct contact with infected blood or OPIM Transmission is most commonly from: –Needlesticks or other contaminated sharps exposures –Sharing needles during injection drug use –Infected mother to her baby during birth –Unprotected sex with an infected person (rarely HCV) Can transmit HBV or HCV w/o having signs or symptoms (carrier) Not spread through casual contact (working, studying, or playing) No known transmission from: –Sharing food/drink –Sharing restroom facilities –Insects (C) 2011 EMS Safety BBPIntroduction18

19 Signs and Symptoms of HBV/HCV Jaundice –Yellowing of the skin –Yellowing sclera around the eyes Fatigue Loss of appetite, nausea and vomiting Abdominal pain, diarrhea, dark urine Joint pain (HBV) Many infected people may not have any signs or symptoms (C) 2011 EMS Safety BBPIntroduction19

20 WORKPLACE TRANSMISSION (C) 2011 EMS Safety BBPIntroduction20

21 Transmission from Infected to Non-Infected Workplace transmission of a BBP can occur when –Responding to an emergency –Handling a contaminated sharp –Cleaning a blood or body fluid spill BBP must have a route of entry Mucous membranes –Unprotected eyes, mouth, nose –Unprotected sex Skin breakdown –Cut or open wound –Fresh scab –Rash –Hangnail Puncture –Needlesticks –Handling contaminated sharp objects –Sharing needles during injection drug use (C) 2011 EMS Safety BBPIntroduction21

22 Protection from Infection Get vaccinated against HBV Avoid unprotected sex with infected persons or multiple partners Do not share items possibly contaminated with blood or OPIM: –Needles from injection drug use –Razors –Toothbrushes Use universal precautions when there is risk of exposure to blood or body fluids (We’ll discuss later) Use personal protective equipment (PPE) to protect routes of entry Follow your organization’s Exposure Control Plan (C) 2011 EMS Safety BBPIntroduction22

23 Suspect Exposure? Get Tested. Report possible exposure See your doctor for a blood test There may be no signs or symptoms A blood test is required for diagnosis Early diagnosis is important to: –Ensure appropriate and early care –Avoid spreading the disease to others (C) 2011 EMS Safety BBPIntroduction23


25 Personal Protective Equipment (PPE) Protects potential routes of entry from exposure Employer provides PPE –For employees at risk of exposure to a BBP –Responders, housekeepers, lab workers… Standard PPE Includes: –Gloves (disposable, watertight) –Protective clothing: gowns, aprons, lab coats, shoe covers –Face shields or face masks –Eye protection –CPR barrier masks or bag masks for rescue breathing (C) 2011 EMS Safety BBPIntroduction25

26 PPE Preparation Requires training for proper use –Must fit correctly –Be appropriate for each situation Practice selecting, donning and removing PPE before a real emergency PPE Location –Store at each workstation –First aid kits –Any site where there is a potential for exposure to BBP (C) 2011 EMS Safety BBPIntroduction26

27 PPE Disposal Remove PPE as soon as possible after an exposure, before leaving the scene Contaminated PPE must be disposed of properly as regulated waste –Not with regular trash –Use plastic red bag or other leak-proof, container –Label as biohazard Uncontaminated PPE may be discarded in the regular trash Wash your hands thoroughly after removing PPE (C) 2011 EMS Safety BBPIntroduction27

28 PPE Practice Discuss: Where is your PPE? Disposable glove removal – Pinch base of glove, peel off slowly – Hold in other hand – Slip finger(s) inside other glove – Carefully peel off so that it is inside out – Dispose in proper, leak- proof container Practice disposable glove removal (C) 2011 EMS Safety BBPIntroduction28

29 EXPOSURE CONTROL PLAN A written plan for management of bloodborne pathogens in the workplace… (C) 2011 EMS Safety BBPIntroduction29

30 Key Concepts Developed by employer Must be accessible to employees Identifies –Workplace specific BBP issues –Employees at risk for exposure –How to determine if an exposure has occurred –Response to an exposure Reviewed annually –New or modified activities or jobs that may result in exposure to BBP –New technology, devices or procedures that could decrease risk of exposure –Employee input –Includes engineering controls and work-practice controls (C) 2011 EMS Safety BBPIntroduction30

31 Workplace ‘Controls’ of Exposure Control Plan Engineering Controls: Items or hardware that isolate or remove BBP hazards from the workplace –Sharps disposal containers –Needleless injection systems –Self-sheathing needles –Blunt-tip suture needles for less-dense tissue –Specially marked bags for contaminated (regulated) waste Work-practice Controls: Systems or everyday practices in the workplace that reduce risk and exposure to BBP. –Company policy that says to use watertight gloves when responding to emergencies. (C) 2011 EMS Safety BBPIntroduction31

32 Elements of an Exposure Control Plan Sharps management Spill clean-up Regulated waste Contaminated laundry Labeling Hand washing Hygiene Maintenance and housekeeping HBV vaccination Postexposure follow-up and treatment (C) 2011 EMS Safety BBPIntroduction32

33 Discussion Where is your Exposure Control Plan Who is covered by the plan Name one engineering control –Item or hardware Name one work-practice control –System, policy or practice (C) 2011 EMS Safety BBPIntroduction33

34 MANAGEMENT OF SHARPS A contaminated sharp is any object contaminated with blood or OPIM that can penetrate the skin (C) 2011 EMS Safety BBPIntroduction34

35 Key Concepts Contaminated sharp is object contaminated with blood or OPIM that can penetrate skin –Needles, scalpels –Broken glass or capillary tubes –Exposed ends of dental wires Needlesticks –Most common cause of occupational exposure to BBP –800,000 needlesticks annually in the U.S (C) 2011 EMS Safety BBPIntroduction35

36 Sharps Injury Log Part of the Exposure Control Plan The employer is required to track sharps injuries Tracks how sharps injuries occur at workplace Helps future prevention efforts Confidential between the employer and employee Must include: –Type and brand of device used in the incident –Location of the incident –Description of the incident (C) 2011 EMS Safety BBPIntroduction36

37 Safe Handling of Shar ps Use a mechanical means to pick up contaminated sharps (tongs, broom, dust pan) Wear PPE Dispose of sharps in proper container Review sharps policies annually or as needed –New technology –New products –Employee input on sharps use Follow your state’s needle safety legislation Labs and healthcare settings: –Use a needleless system or other advanced technology –DO NOT Recap needles –DO NOT Self-blunt (bend/break) needles (C) 2011 EMS Safety BBPIntroduction37

38 Sharps Containers Features –Closeable –Puncture-resistant and leak-resistant –Properly labeled as a biohazard Keep visible and within easy reach –Avoid bending, stretching or straining to discard sharps –Plainly visible to the workers, including how full it is Do not overfill –Change when 2/3 full –Avoid injury from discarding sharps into full container (C) 2011 EMS Safety BBPIntroduction38

39 BLOOD SPILLS (C) 2011 EMS Safety BBPIntroduction39

40 Key Concepts Follow Exposure Control Plan Goal of clean-up is to disinfect area of potentially infectious materials Use EPA-registered germicidal for disinfection If no germicide is available, use chlorinated bleach –Mix one part chlorinated bleach to 10 - 100 parts water (1:10 to 1:100) –Solution concentrations vary depending on the size and type of spill –Change bleach/water solutions daily (C) 2011 EMS Safety BBPIntroduction40

41 Cleaning a Blood Spill 1. Clear immediate area, reduce further contamination or foot tracking 2. Locate BBP spill kit 3. Put on appropriate PPE 4. Clean area of visible blood and OPIM with paper towels or an absorbent powder 5. Disinfect at least 10 minutes 6. Dispose of soiled clean-up materials and PPE in proper container 7. Wash hands (C) 2011 EMS Safety BBPIntroduction41 Follow Exposure Control Plan

42 LABELING (C) 2011 EMS Safety BBPIntroduction42

43 Key Concepts Items contaminated with BBP need to be properly labeled as a bio-hazard for disposal, containment, or transport (C) 2011 EMS Safety BBPIntroduction43

44 Regulated Waste Soiled material from clean-up Any discarded item contaminated with blood or OPIM Examples –Bloody gauze –Heavily soiled gloves –Shoe covers contaminated with blood or OPIM Special handling and disposal –Proper biohazard container –Disposal by a medical waste company Containers –Closeable –Leak-proof –Labeled or color-coded to indicate a biohazard (C) 2011 EMS Safety BBPIntroduction44

45 Contaminated Laundry Handle as little as possible Place in container –Properly labeled –Closeable –Leak-proof container Cleaned by a professional service that provides pick-up (C) 2011 EMS Safety BBPIntroduction45

46 Warning Labels Must be attached to: –Container: Regulated waste, contaminated laundry, used sharps –Refrigerators and freezers containing blood or OPIM –Any container used to ship, store or transport blood or OPIM Biohazard label requirements –Color: fluorescent orange or orange-red –Symbol: biohazard symbol in contrasting colors –Attached so that cannot be accidentally removed or fall off If a biohazard label is unavailable –Use a red bag or other red container as a temporary substitute Post warning Signs –At the entrance to HIV and HBV research and production facilities –As otherwise specified by the Standard (29 CFR 1910.1030) (C) 2011 EMS Safety BBPIntroduction46


48 Key Concepts Hand washing & hygiene prevent exposure –Prevents touching mucous membranes with contaminated hands –Prevents transfer of BBP from environmental surfaces to other people Wash hands as soon as possible after potential exposure to BBP –Providing first aid –Cleaning a blood spill –Handling regulated waste or contaminated laundry (C) 2011 EMS Safety BBPIntroduction48

49 Hand Washing Technique Wet hands with warm water and apply soap – Liquid soap reduces bacteria associated with bar soap Rub hands together vigorously on all surfaces – Under nail beds – Between fingers Create friction to dislodge and remove germs Continue scrubbing for at least 20 seconds Rinse well with warm water and dry hands (C) 2011 EMS Safety BBPIntroduction49

50 If hand washing facility is not available Use hand sanitizer that contains at least 60% alcohol –Temporary solution until hand washing facility is available –Not a substitute for hand washing Wash hands properly at the earliest opportunity (C) 2011 EMS Safety BBPIntroduction50

51 Hygiene In areas where BBP may be present, DO NOT: –Store food –Apply makeup –Apply lip balms –Smoke –Eat or drink –Handle contact lenses Be careful around potentially infectious materials –Use PPE at all times –Minimize splashing or splattering of droplets of blood or OPIM when cleaning (C) 2011 EMS Safety BBPIntroduction51

52 Workspace Housekeeping Maintain a safe work area Clean & disinfect at beginning and end of each shift Remove and replace equipment coverings that have been exposed to BBP Clean spills immediately Pick up sharps properly and discard ASAP Use the proper containers for: –Contaminated or used sharps –Regulated waste –Contaminated laundry Handle infectious materials as little as possible Ensure containers have biohazard symbol (C) 2011 EMS Safety BBPIntroduction52

53 HBV VACCINATION (C) 2011 EMS Safety BBPIntroduction53

54 Key Concepts Most effective method to reduce risk of HBV transmission Provides 95% immunity to HBV Safe for adults and children Series of three shots Given under supervision of a licensed physician or another healthcare professional At-risk employees are eligible for HBV vaccination –Given at no cost to employee –Within 10 days of being classified as “at-risk” –After an exposure incident, employer should offer post- vaccination testing for immunity (C) 2011 EMS Safety BBPIntroduction54

55 Who should receive the HBV vaccination? Employees who are “at-risk” for exposure to BBP Persons whose lifestyle or environment puts them at increased risk for exposure All infants and children under 19 years of age Employee has right to refuse vaccination –Must sign a declination form –May choose to have vaccination at any time, even if refused initially (C) 2011 EMS Safety BBPIntroduction55

56 RESPONDING TO EMERGENCIES (C) 2011 EMS Safety BBPIntroduction56

57 Key Concepts Responding to emergencies creates risk of exposure to BBP Put your own safety first Use Universal Precautions to prevent transmission of BBP (C) 2011 EMS Safety BBPIntroduction57

58 Universal Precautions Designed to prevent transmission of BBP when providing medical aid Universal Precautions say to treat blood and body fluids as infectious For additional protection, use Standard Precautions and treat every body fluid as potentially infectious –Regardless if bloody or not –Includes non-intact skin, mucous membranes –Exception: sweat Body fluids may not carry BBP, but may contain other infectious microorganisms (C) 2011 EMS Safety BBPIntroduction58

59 Guidelines for Emergency Response Assume all moist body substances are infectious Wash hands thoroughly before and after each patient contact Put on PPE before providing medical aid Use CPR barrier devices for rescue breathing Follow your workplace Exposure Control Plan for cleaning and disposal of blood and OPIM (C) 2011 EMS Safety BBPIntroduction59

60 WHAT IF YOU’RE EXPOSED ON THE JOB? (C) 2011 EMS Safety BBPIntroduction60

61 Key Concepts Immediate Actions –Wash hands and exposed areas immediately –Flush splashes to nose, mouth, or skin with water –Irrigate eyes thoroughly with water or saline Follow Exposure Control Plan Dispose of contaminated PPE, clothing or objects Ensure the clean-up of any blood spill (C) 2011 EMS Safety BBPIntroduction61

62 Reporting an Exposure General Reporting Report immediately to your supervisor Date and time of exposure Body part exposed Job classification Work site location Engineering controls being used Work practices being followed Activity performed at time of exposure incident Previous training for activity Sharps Reporting Did sharp have engineered sharps injury protection mechanism? Did incident occur before or after mechanism was activated? If no protection mechanism, could engineered protection have prevented injury? Could other engineering control, work-practice control, or policy have prevented injury? (C) 2011 EMS Safety BBPIntroduction62

63 Postexposure Evaluation & Follow Up Provided by the employer, no cost to employee Within 3-4 hours after the exposure: –Document routes and circumstances of exposure –Identify & document source individual (unless prohibited by law) –Confidential medical evaluation by a qualified physician –Laboratory testing of the source individual and person exposed with follow-up testing as needed Treat exposure –Postexposure medications as needed –Employee counseling Continued follow-up as needed (C) 2011 EMS Safety BBPIntroduction63

64 CONCLUSION, SCENARIOS & TESTING (C) 2011 EMS Safety BBPIntroduction64

65 Conclusion DISCUSS: What if you’re exposed on the job? IDENTIFY and DISCUSS: Workplace scenarios TEST: Written Exam (C) 2011 EMS Safety BBPIntroduction65

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