Personal Protective Equipment & Bloodborne Pathogens
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Objectives At the end of this program, participants will be able to… identify who’s responsibility worker safety is review OSHA requirements for workplace practices review Bloodborne Pathogens and standard precautions list the appropriate measures for protecting yourself and your staff
Worker Safety Is An Important Aspect of any Employer’s Responsibility There are numerous Federal, State, and Local rules and Regulations addressing safe work place practices. These agencies carry the force of law behind them.
Develops engineering control rules and work place practices control. Seeks to provide a safe environment for the worker. Eliminate exposure of healthcare workers (HCWs) to any infectious materials. Enforcement of rules and regulations
Engineering Control Rules Disposal of needles and sharps in special, puncture-proof containers. Providing hand washing facilities. Providing eye wash stations or showers. Providing appropriate work attire in controlled environments. Environmental Controls
Eliminate Exposure Both engineering controls and work place practice are designed to eliminate exposure of the healthcare worker to infectious materials or to reduce the effects of accidental exposure to infectious materials.
The Use of Personal Protective Equipment (PPE) When there is occupational exposure, the employer shall provide, at no cost to the employee, appropriate PPE. Specialized clothing or equipment worn by an employee for protection against a hazard: gloves, masks, goggles or face shields, imperious gowns, surgical caps, hoods, shoe covers, and respirators when appropriate. The code of Federal Regulations 1910.1030
The Use of Personal Protective Equipment (PPE) The employer has the obligation to ensure the healthcare worker uses the PPE. One of the ways to ensure that employees use PPE is to have them accessible. The requirement includes having latex free gloves for those persons who have latex sensitivities. The employer, under certain circumstances, can force the employee to wear PPE.
Gloves Gloves have become so common place in so many settings where infectious materials are found that one has to remember that they are considered PPE. Gloves must be worn when it is anticipated that the healthcare worker may have hand contact with blood and body fluids. Gloves must be changed immediately when compromised and changed between patients. Utility gloves can be cleaned and reused if not cracked, torn or showing signs of wear.
Decontamination Hair cover Mask with Eye pro- tection Impervious Apron/gown Arms are Covered Gloves
Exposure Control Plan Employers who have employees exposed to bloodborne pathogens must develop a written exposure control plan to eliminate or reduce the potential exposure to the employee. Fact Sheet No. OSHA 92-46
Exposure Control Plan Exposures must be determined and listed: by all job classifications with potential for exposure. by all tasks (i.e. drawing blood, or surgical scrubbing, CS Decontamination) where exposure occurs.
Exposure Control Plan Methods of Compliance Standard Precautions Engineering and work practice controls, including scheduled maintenance of engineering controls where appropriate. HIV and HBV post–exposure treatment and counseling with follow-up. Hepatitis B vaccination and post exposure evaluation follow-up
Exposure Control Plan PPE required for each task listed. New hire and annual communication of hazards to employees. Documentation of implementation of the plan. Procedure and documentation to evaluate circumstances involving exposure incidents. Employee access to “Exposure Control Plan.”
Training What PPE is necessary How to put on, adjust, wear and remove the PPE Limitations of the PPE Proper care, maintenance, useful life and disposal of PPE
Training (continued) Given the nature of the work, the employee must demonstrate an understanding of the training before being allowed to perform the work requiring the use of PPE. Training must be updated as the tasks require or reviewed when inadequacies in the training are determined by employee behavior.
Occupational Exposure To Bloodborne Pathogens & OSHA
Bloodborne Pathogens BLOODBORNE PATHOGENS FINAL STANDARD: SUMMARY OF KEY PROVISIONS PURPOSE: Limits occupational exposure to blood and other potentially infectious materials since any exposure could result in transmission of bloodborne pathogens which could lead to disease or death. SCOPE: Covers 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. Fact Sheet No. OSHA 92-46
Bloodborne Pathogens EXPOSURE CONTROL PLAN METHODS OF COMPLIANCE HEPATITIS B VACCINATION POST-EXPOSURE EVALUATION AND FOLLOW-UP HAZARD COMMUNICATION INFORMATION AND TRAINING RECORDKEEPING
EXPOSURE CONTROL PLAN Requires employers to identify, in writing, tasks and procedures as well as job classifications where occupational exposure to blood occurs--without regard to personal protective clothing and equipment. METHODS OF COMPLIANCE Mandates universal precautions, (treating body fluids/materials as if infectious) emphasizing engineering and work practice controls. Bloodborne Pathogens
HEPATITIS B VACCINATION Requires vaccinations to be made available to all employees who have occupational exposure to blood within 10 working days of assignment, at no cost, at a reasonable time and place, under the supervision of licensed physician/licensed healthcare professional and according to the latest recommendations of the U.S. Public Health Service (USPHS). Employees must sign a declination form if they choose not to be vaccinated, but may later opt to receive the vaccine at no cost to the employee. Should booster doses later be recommended by the USPHS, employees must be offered them.
Bloodborne Pathogens POST-EXPOSURE EVALUATION AND FOLLOW-UP: Specifies procedures to be made available to all employees who have had an exposure incident plus any laboratory tests must be conducted by an accredited laboratory at no cost to the employee. Follow-up must include a confidential medical evaluation documenting the circumstances of exposure, identifying and testing the source individual if feasible, testing the exposed employee's blood if he/she consents, post-exposure prophylaxis, counseling and evaluation of reported illnesses. Healthcare professionals must be provided specified information to facilitate the evaluation and their written opinion on the need for hepatitis B vaccination following the exposure. Information such as the employee's ability to receive the hepatitis B vaccine must be supplied to the employer. All diagnoses must remain confidential.
Bloodborne Pathogens HAZARD COMMUNICATION Requires warning labels including the orange or orange-red biohazard symbol affixed to containers of regulated waste, refrigerators and freezers and other containers which are used to store or transport blood or other potentially infectious materials. Red bags or containers may be used instead of labeling.
Bloodborne Pathogens INFORMATION AND TRAINING: Mandates training within 90 days of effective date, initially upon assignment and annually--employees who have received appropriate training within the past year need only receive additional training in items not previously covered. There must be opportunity for questions and answers, and the trainer must be knowledgeable in the subject matter.
Bloodborne Pathogens RECORDKEEPING: Medical records to be kept for each employee with occupational exposure for the duration of employment plus 30 years, must be confidential and must include name and social security number; hepatitis B vaccination status (including dates); results of any examinations, medical testing and follow-up procedures.
Standard Precautions “UNIVERSAL PRECAUTIONS ” FOR PREVENTION OF TRANSMISSION OF HIV AND OTHER BLOODBORNE INFECTIONS in 1996. Standard Precautions are a set of precautions designed to prevent transmission of human immunodeficiency virus (HIV), hepatitis B virus (HBV), and other bloodborne pathogens when providing first aid or healthcare.
Standard Precautions Combined the major features of Body Substance Isolation (BSI) and Universal Precautions to prevent transmission of a variety of organisms. They were developed for use in hospitals and may not necessarily apply in other settings where U.P. are used.
Selecting PPE for Chemical & Bioterrorism Preparedness
ANTHRAX scare with US Mail? Irradiation at some mail distribution sites. Steam or EO gas sterilizing of delivered mail in some office buildings and homes.
Chemical & Bioterrorism Preparedness Congress appropriated $135 million dollars to hospitals. Hospitals must select the most appropriate PPE for the protection of patients & staff. Level A protection Level B protection Level C protection
Chemical & Bioterrorism Preparedness Level A protection which provides the highest degree of respiratory and skin protection by providing the user with a fully encapsulated and chemically impervious environment, is not typically recommended for frontline healthcare workers in emergency response and so will not be addressed here.
Chemical & Bioterrorism Preparedness Level B Respiratory Protection OSHA requires a Level B outfit as the minimum level of protection for first responders, including frontline healthcare workers. Splash protective suit. (Saranex) Positive-pressure supplied-air respirator such as an airline respirator or self-contained breathing apparatus (SCBA). Can present a risk to users if not fit tested, trained, and medically evaluated.
Chemical & Bioterrorism Preparedness Level C Respirator Protection Full or half-face air purifying respirator (once contaminant and it’s concentration have been identified). Air-Purifying Respirators (APR) remove contaminants by filtering the breathing zone instead of supply air from a remote source. APRs can filter particulate, chemical vapors & mists or a combination of both. The N95 Particulate Respirator is common in HC settings for use with TB patients (airborne). APRs with high-efficiency particulate air (HEPA) cartridges or canisters can protect against particles such as biological spores, dusts, and fumes.
Level C Respirator Protection Powered Air-Purifying Respirators (PAPRs) filters the ambient air, these units use a battery powered motor and blower to supply air to the user through a hose to a half- or full-face face piece or loose fitting hood/helmet. Chemical & Bioterrorism Preparedness
Protective Clothing Level B suits are spun-bonded and coated with polyethylene, polyvinyl chloride, or Saran and provide good chemical resistance but pose considerable health risk due to heat stress. Level C suits are good for particulate and fiber exposure and are breathable and reduce the likelihood of heat stress, but do not provide protection against fluids.
Staffing Requirements Develop a team of appropriately trained and equipped healthcare workers. – Triage – Decontamination – Treatment – How to avoid contaminating your facility Several staff members from each shift should be provided with and trained in the use of equipment for Level B protection.
Staffing Requirements Healthcare facilities should train sufficient numbers of additional staff in PPE use to allow for rotation in and out of the area during emergency operations. The practice of one-to-one communication between responders in a Level A operation is also encouraged as prudent practice for Level B responses as well.
Summary of ECRI Recommendations Account for human factors in selection of PPE. Do fit testing. Train healthcare workers how to mitigate potentially harmful effects of PPE use. Design and conduct disaster drills. Establish medical surveillance program for personnel responsible for PPE use, etc…
Purchasing AAMI Standards If your organization is not a member of AAMI, you may purchase the Standards directly from SPSmedical at our member discount. The member discount saves you 40-50% depending on the document. For example: ORDER CODE: AAMI ST:79 List Price: $220 Member Price: $110
References & Resources Association for the Advancement of Medical Instrumentation 1110 North Glebe Road, Suite 220, Arlington, VA 22201-4795 703-525-4890 Fax: 703-276-0793 www.aami.org Association of periOperative Registered Nurses 2170 South Parker Road, Suite 300 Denver, CO 80231-5711 800-755-2676 www.aorn.org Canadian Standards Association 5060 Spectrum Way Mississauga, Ontario L4W 5N6 CANADA 800-463-6727 Fax: (416) 747-2510 www.csa.ca Certification Board for Sterile Processing & Distribution 2 Industrial Park, Suite 3 Alpha, NJ 08865 908-454-9555 www.sterileprocessing.org International Assoc. of Healthcare Central Service Materiel Management 213 W. Institute Place, Suite 307 Chicago, IL 60610 312-440-0078 Fax: 312-440-9474 www.iahcsmm.org