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Occupational Safety & Health Administration (OSHA) 29 CFR Part 1910 Effective December 6, 1991 Patricia A. Bunch, EMT-P Kirkwood Community College Click.

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Presentation on theme: "Occupational Safety & Health Administration (OSHA) 29 CFR Part 1910 Effective December 6, 1991 Patricia A. Bunch, EMT-P Kirkwood Community College Click."— Presentation transcript:

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2 Occupational Safety & Health Administration (OSHA) 29 CFR Part 1910 Effective December 6, 1991 Patricia A. Bunch, EMT-P Kirkwood Community College Click right arrow to go forward

3 Bloodborne Pathogens; Needlesticks & Other Sharps Injuries(Effective: April 18, 2001) Reviewed by: Jolene Ott, RN, MS Infection Control Coordinator Mercy Medical Center Cedar Rapids, IA Click right arrow to go forward

4 3 click left arrow to go back Needlestick Safety & Prevention Act n signed into law Nov. 6, 2000 n required OSHA to revise standards of 1991

5 4 Who/What is OSHA? n a government agency from the Department of Labor designed to write and enforce safety practice standards in the workplace

6 5 PURPOSE: n designed to meet the Occupational Exposure Bloodborne Pathogens; Needlesticks & Other Sharps Injuries standards established by OSHA for healthcare professionals at risk of exposure to bloodborne pathogens

7 6 PURPOSE: n as a healthcare worker, you are responsible for practicing your field of medicine according to the administrative rules addressing bloodborne pathogens identified by OSHA. (It’s the law!) OSHA Regulators

8 7 OSHA REGULATORY TEXT n provides standards for Occupational Exposure to Bloodborne Pathogens; Needlesticks & Other Sharps Injuries n mandates compliance to bloodborne pathogen standards as of December 6, 1991 & the revised standards of April 18, 2001 as well as future revisions

9 8 OSHA REGULATORY TEXT n mandates that an employer having employees that are at risk for occupational exposure have an “Exposure Control Plan” designed to eliminate or minimize employee exposure Exposure Control Plan Kirkwood Comm. College

10 9 REGULATORY TEXT n Occupational Exposure refers to any contact with bloodborne pathogens via needle stick, sharps stick, or splash of contaminated body fluids to the eyes, nose, mouth, or non-intact skin while on duty

11 10 REGULATORY TEXT n provides standards designed to minimize risk of disease transmission in the workplace by safe work practices and barriers n provides standards designed to reduce risk of needle sticks & other sharps injuries with new & safer devices key point

12 11 REGULATORY TEXT n the standards require annual training in bloodborne pathogens to stay abreast of current information n the standards require annual review of Exposure Control Plan & must identify new technology considered & implemented in the past year that will eliminate or reduce sharps injuries key point

13 12 REGULATORY TEXT n the standards require non-managerial staff with direct patient care contact be involved in the identification, evaluation & selection of new devices to eliminate sharps injuries key point

14 13 REGULATORY TEXT n the standards mandate that a log of all sharps injuries be maintained to identify high risk areas and evaluate devices being used n the log must protect confidentiality and contain: n the type & brand of device involved in incident n the location of incident n how injury occurred key point

15 14 REGULATORY TEXT n failure to comply with OSHA regulations for safety and training, may result in large fines key point

16 15 Bloodborne Pathogens in OSHA Standards n Hepatitis B Virus (HBV) n Hepatitis C Virus (HCV) n Human Immunodeficiency Virus (HIV)Immunodeficiency n Note: Other forms of viral hepatitis have been identified since the original ruling

17 16 Definition: Bloodborne Pathogens n any virus or microorganism present in human blood and other body fluids that can cause disease

18 17 What about Hepatitis? n there are at least 6 forms of viral hepatitis, A-B-C-D-E & G n hepatitis causes inflammation & swelling of the liver and loss of normal liver function

19 18 What about Hepatitis? n Hepatitis B (HBV) does not respond to antibiotics n HBV has no socioeconomic boundaries

20 19 HBV Specific Characteristics n HBV can lead to acute/chronic cirrhosis of liver & possible liver cancer sick healthy

21 20 HBV Specific Characteristics n HBV is major cause of viral hepatitis n HBV can be prevented n 1- ml of HBV blood contains 100 million infected doses of the hepatitis B virus n HBV is a hardy virus that may live outside of the body for several weeks on surfaces outside the body

22 21 HBV Vaccine Protocol Series of 3 Injections: n (Given in Upper Extremity) n #1 - initial injection n # days after initial injection n # days after initial injection n recommend HBV titre 1-2 months after completion of series

23 22 HBV Vaccine Protocol n Titre for HBV should have an antibody level greater than 10 to determine immunity Titre n routine boosters are not recommended, only given if titre is less than 10, not to exceed 3 boosters n HBV Vaccine is free to employees that are at risk of exposure to HBV on the job

24 23 HBV Modes of Transmission n percutaneous exposure to infected fluids via: open wounds, chapped skin, hangnails, needle sticks, tattoos, body piercing etc. percutaneous n permucosal exposure to infected fluids via: mucosal linings of eyes, mouth & nose permucosal

25 24 HBV Modes of Transmission n human bite that breaks through skin by an HBV infected person n unprotected sex with an HBV infected person

26 25 Risky Tasks with HBV Patient n invasive procedures: n intravenous lines, injections, nasogastric tubes, catheterizations, tracheostomy care, suctioning, surgery, wound care, etc.

27 26 Risky Tasks with HBV Patient n contaminated needle sticks or sharps sticks to include dental burs, dental wires, surgical instruments, glass vials, microscope slides, capillary tubes etc.

28 27 “NEEDLELESS SYSTEMS” n should be used whenever possible n defined as a device that does not use needles for collection of body fluids, administration of meds or fluids

29 28 Risky Tasks with HBV Patient n procedure that induces coughing, vomiting or bleeding such as: oral suction, throat swabs, bronchoscopy, trach care, NG insertion, intubation, etc., trauma and childbirth

30 29 Signs & Symptoms of HBV n fatigue (early sign) n anorexia (early sign) n abdominal pain, nausea & vomiting n disruption of normal liver function n fever/headache (early sign) n jaundice (late sign) n swollen liver

31 30 HCV Specific Characteristics n Hepatitis C (HCV) identified in 1989 (formerly known as Non-A, Non-B) n 85% risk of becoming chronic disease as very difficult for immune system to fight n leading indicator for liver transplants

32 31 HCV Specific Characteristics n cycle of infection, exposure to significant liver disease, up to 20 years or longer exposure serious liver disease infection

33 32 HCV Characteristics n blood transfusions account for 10% of all HCV cases

34 33 HCV Modes of Transmission n Same as HBV

35 34 HCV Modes of Transmission n transfusions prior to July 1992 (whole blood, blood components, hemodialysis, or clotting factors prior to 1987hemodialysis n solid organ transplants prior to July 1992

36 35 Signs & Symptoms of HCV n typically mild initially, significant when liver damage is done n fatigue n abdominal pain n anorexia/nausea/vomiting n may become jaundice in late stages (less frequent than in HBV)

37 36 HDV Specific Characteristics n Hepatitis D (HDV) always associated with coexistence of HBV n HDV tends to be severe n HDV has greater incidence of chronic disease leading to liver cirrhosis

38 37 Modes of Transmitting HDV n believed to be similar to HBV through percutaneous or permucosal exposure

39 38 Signs & Symptoms of HDV n Resemble HBV & HCV n fatigue n anorexia/nausea/vomiting n abdominal pain n fever n swollen liver with disrupted function

40 39 Human Immunodeficiency Virus (HIV) n virus attacks T-4 cells, macrophages, lymphocytes & certain brain cells n virus alters T-4 cell growth, reproduction & eventually destroys the cells

41 40 HIV Characteristics n HIV does NOT respond to antibiotics n no vaccine yet n vaccine in clinical trials Phase III now

42 41 HIV Characteristics n highest concentration of HIV is found in blood, semen and vaginal secretions n HIV eventually results in Acquired Immune Deficiency Syndrome (AIDS) n for every HIV diagnosed patient, there are 40 unknown others n Early stages patient may be asymptomatic key point

43 42 Specific AIDS Infections & Malignancies n leads to infections caused by fungi, viruses, and parasites which a healthy immune system could fight successfully n Also susceptible to certain malignancies Example: oral candidiasis (oral thrush)

44 43 HIV/AIDS Modes of Transmission n blood to blood contact via an infected needle stick or sharps cut (greatest risk for healthcare workers) n 384,325 hospital workers affected annually key point

45 44 HIV/AIDS Modes of Transmission n very similar to HBV, although human bites do not pass the HIV virus as it does HBV n splash to non-intact skin, eyes, nose, or mouth with infected body fluids

46 45 HIV/AIDS Modes of Transmission n infected mother to child n unprotected sexual contact with HIV infected person

47 46 Did You Know? n AIDS is the #1 public health concern in the country n is the second leading cause of death in America between the ages of 24 & 44 wow!

48 47 Body Fluids that Pose Risks! n Blood n amniotic fluid n semen n saliva in dental procedures n cerebral spinal fluid n any body fluid contaminated with blood n synovial fluid n any unfixed body tissue living or dead n peritoneal

49 48 ENGINEERING CONTROLS n defined as the means of isolating or removing bloodborne pathogens from the workplace n Examples: – self-sheathing needles – properly labeled waste containers – properly labeled disposable sharps containers – clean-up kits for bloodborne pathogen spills

50 49 ENGINEERING CONTROLS n Self-sheathing needles & IV catheters Auto Guard Shielded IV Catheter Safety Glide Syringe & Shielding IM Needle

51 50 ENGINEERING CONTROLS n Properly lined & functional waste containers n routine inspection of infectious waste containers for evaluation of effectiveness & proper working order required

52 51 ENGINEERING CONTROLS n Proper disposable waste containers n must be labeled and designed to host infections wastes n must be leak proof, puncture resistant and labeled properly n must be decontaminated

53 52 ENGINEERING CONTROLS n Sharps containers must be: n able to close tightly n puncture resistant n leak proof (sides & bottom) n labeled properly n maintained at safe levels, not to exceed full Healthcare workers or custodial staff must replace full Sharp’s containers with a new one to avoid potential sharps sticks

54 53 ENGINEERING CONTROLS n Clean-up kits n structural or mechanical devices must be present that allow prompt, safe handling of body fluids

55 54 ENGINEERING CONTROLS n bloodborne pathogen spills n must be cleaned-up as soon as identified

56 55 ENGINEERING CONTROLS n utility gloves n must be worn for custodial procedures that involve cleaning contaminated surfaces or spills n may be re-used

57 56 ENGINEERING CONTROLS n dust pans, brooms, forceps or heavy weighted paper n must be available to pick-up contaminated sharps n utility gloves MUST be worn during the pick-up procedure

58 57 WORKPLACE PRACTICE CONTROLS n relates to behaviors necessary to use engineering controls effectively: n correct use of Sharps containers essential to minimize risk of exposure

59 58 WORKPLACE PRACITCE CONTROLS n relates to behaviors necessary to use engineering controls effectively: n no re-capping, bending or removal of needles must use self-sheathing devices

60 59 WORKPLACE PRACTICE CONTROLS n wash hands per Center for Disease Control (CDC) standards: n 3-5 ml. soap n friction rubbing not to exceed seconds n rinse wrist to fingertips n dry fingertips to wrist Most important action to reduce spread of infections is “HANDWASHING”

61 60 WORKPLACE PRACTICE CONTROLS n alternative handwashing: n anticeptic hand cleaners/alcohol rinses (considered best germ kill if visibly clean hands) n anticeptic towelettes n NOT a substitute for soap & water which must be used as soon as available or when obvious soil is visible

62 61 WORKPLACE PRACTICE CONTROLS n compliance with OSHA rules n no eating, drinking, smoking, or application of make- up including lip balms or touching of contact lenses in biohazard areas Disease causing micro- organisms may be present

63 62 WORKPLACE PRACTICE CONTROLS n OSHA regulators impose big fines! n failure to comply with biohazard standards considered willful violations n willful violations could cost $7,000 to $70,000 per person per incident OSHA Regulator Get this

64 63 STANDARD PRECAUTIONS n all blood and certain body fluids are to be treated as if contaminated with HIV, HBV or other bloodborne pathogens n the barriers provided cannot protect you if they are not worn. YOU must apply when appropriate key point

65 64 STANDARD PRECAUTIONS n PPE after splashed, TOO LATE! n exposure will affect your entire circle of love n work smart and enjoy your circle of love for a long time YOU spouse son daughter mom dad sister brother lover

66 65 PERSONAL PROTECTIVE EQUIPMENT (PPE) n barriers designed to minimize the risk of exposure to blood & other potentially infected materials to include: – gloves (exam, surgical & utility) – gowns – masks – eyewear – booties – caps

67 66 PERSONAL PROTECTIVE EQUIPMENT (PPE) n OSHA standards require that: n PPE must be provided by the employer n “you are responsible” for wearing PPE appropriately

68 67 PERSONAL PROTECTIVE EQUIPMENT (PPE) n PPE must prevent blood or other potentially infectious materials from passing through the barrier to the healthcare worker

69 68 PERSONAL PROTECTIVE EQUIPMENT (PPE) n exam gloves & surgical gloves n must fit properly n may not be re-used n must be worn whenever there is a potential for body fluid contact n must be removed after each patient

70 69 PERSONAL PROTECTIVE EQUIPMENT (PPE) n gowns n must be worn whenever there is a potential risk of body fluid splashes onto clothing (blood, vomit, sputum, urine, feces, etc.)

71 70 PERSONAL PROTECTIVE EQUIPMENT (PPE) n face mask & shield or goggles n must be worn whenever there is potential risk of body fluid splashes to the mucosal membranes of eyes, nose or mouth

72 71 PERSONAL PROTECTIVE EQUIPMENT (PPE) n caps & shoes n caps are worn to protect patient from you n shoes are worn when procedures are done that produce large volumes of blood and other body fluids

73 72 PERSONAL PROTECTIVE EQUIPMENT (PPE) n Removal of Contaminated PPE n must be done before leaving the contaminated area n must be placed in appropriate containers n must wash hands

74 73 KIRKWOOD REGULATED WASTE GUIDELINES n definition regulated waste n any visible blood, potentially infectious body fluids, purulent body drainage or piece of body tissue is considered regulated waste and must be placed in a biohazard leak-proof container by trained personnelpurulent

75 74 KIRKWOOD REGULATED WASTE GUIDELINES n contaminated sharps n are considered regulated waste and must be placed in a puncture proof Sharps container

76 75 KIRKWOOD BLOODBORNE PATHOGENS GUIDELINES n contaminated spills require surfaces to be cleansed with n germicidal cleanser or bleach solution (1:10 bleach to water)made fresh daily n soap and water will not kill many viruses

77 76 KIRKWOOD REGULATED WASTE GUIDELINES n regulated waste disposal n all regulated waste material(s) will be placed in appropriately labeled container by trained staff n biohazard waste containers are in all biohazard areas

78 77 KIRKWOOD REGULATED WASTE GUIDELINES n removal of regulated waste from campus n sealed regulated waste containers go to Environmental Training Center n picked-up by professional service and disposed of in compliance with OSHA standards

79 78 KIRKWOOD REGULATED WASTE GUIDELINES n infection control n students practicing infection control outside of Kirkwood will follow the policies and procedures of the clinical site (this means reading the Exposure Control Plan before you begin procedures)

80 79 KIRKWOOD BLOODBORNE PATHOGENS GUIDELINES n infection control n all students and staff participating in infection control procedures will have documentation of HBV vaccinations or a medical waiver on file at Kirkwood

81 80 KIRKWOOD BLOODBORNE PATHOGENS GUIDELINES n training standards n all students/staff participating in infection control procedures will have documented bloodborne pathogen and tuberculosis exposure training prior to participating in the procedures

82 81 KIRKWOOD BLOODBORNE PATHOGENS GUIDELINES n training standards n training must be current through the entire semester, if not you will be required to renew early n non-compliance may result in large fines, no clinic activity or loss of employment

83 82 KIRKWOOD BLOODBORNE PATHOGENS GUIDELINES n when exposed to bloodborne pathogens n immediately wash the area with soap and water or flush the eyes, nose and mouth with water n report incident to your clinical supervisor knowing time could be critical What do you do?

84 83 KIRKWOOD BLOODBORNE PATHOGENS GUIDELINES n referral to nearest ER for post exposure care will be required n Kirkwood incident report must be filed within 72 hours of the incident with Campus Health Department (preferably as soon as possible following the incident) What should you expect?

85 84 KIRKWOOD BLOODBORNE PATHOGENS GUIDELINES n post exposure activities will include: n student/staff being monitored by the Kirkwood Campus Health Department n counseling will be available n blood testing in compliance with OSHA standards will be done

86 85 KIRKWOOD BLOODBORNE PATHOGENS GUIDELINES n remember: blood is not always visible to the naked eye; n therefore, regard all body fluids as potentially infectious key to safety

87 86 TUBERCULOSIS (TB) EDUCATION FOR THE HEALTHCARE PROVIDER Guidelines per U.S. Dept. of Health and Human Services

88 87 OBJECTIVES FOR TB EDUCATION n definition of TB disease vs. infection n specific characteristics of TB n transmission of TB (from alveoli) n who is at risk of TB exposure n workplace practices that put healthcare workers at risk for TB exposure n prevention of TB n signs & symptoms of TB

89 88 TUBERCULOSIS n defined as an airborne bacterial infection caused by Mycobacterium tuberculosis

90 89 Latent TB Infection Characteristics n a positive Mantoux skin test indicates exposure to Mycobacterium tuberculosis n mm or greater of induration determined by risk category (hardened area) determines positive reaction mm or greater induration

91 90 Latent TB Infection Characteristics n a positive Mantoux test indicates the patient has TB infection or the disease n NOTE: once the Mantoux test is determined to be positive, the patient should not be required to have another as they will always be positive

92 91 Latent TB Infection Characteristics n it may take 2 to 3 months before skin sensitivity reacts positively following exposure to Mycobacterium tuberculosis n 10% of infections develop TB disease

93 92 Latent TB Infection Characteristics n a positive Mantoux requires referral to a medical doctor for a chest x-ray & sputum smear testing to rule out TB disease n this patient will have no signs or symptoms of TB n this patient is NOT contagious

94 93 TB Disease Characteristics n a positive Mantoux test n a chest x-ray reveals TB infiltration in the lungs n or positive cultures from other infected organs

95 94 TRANSMISSION OF TB FROM THE LUNG n spread from person to person via airborne nuclei (talking, coughing, sneezing, singing or laughing) n through close contact with contagious TB patient for an extended period of time singing coughing laughing

96 95 WHO IS AT RISK FOR TB? n healthcare workers n underprivileged & institutionalized persons n alcoholics & IV drug users n foreign-born persons n homeless/shelter residents

97 96 WHO IS AT RISK FOR TB? n Immuno-compromised persons with HIV, or on chemotherapy n diabetics n cancer patients n gastrectomy patients gastrectomy

98 97 RISKY PROCEDURES IN THE WORKPLACE FOR TB n procedures with infected TB patients that include: n endotracheal intubation n oral/tracheal suction n any procedure that induces coughing n any procedure that induces bleeding n irrigation of TB infected organ n non-compliance with standards regarding OSHA approved filter masks

99 98 PREVENTION OF TB n wear the filter respirator when patient exhibits signs & symptoms of TB and/or has a diagnosis of TB n don’t wait for a diagnosis to protect yourself n “work smart” OSHA approved respirators may be reused until tested ineffective. Facilities should test regularly

100 99 PREVENTION OF TB n get adequate rest n sleep in a well ventilated area n eat a healthy diet n avoid alcohol and recreational drugs

101 100 SCREENING FOR TB n after initial 2-Step Mantoux testing, have yearly Mantoux test (may be more frequent if working in a high risk setting)

102 101 SIGNS & SYMPTOMS TB DISEASE n fatigue n weakness n fever n weight loss n night sweats n productive cough n hemoptysis (late sign) hemoptysis early signs & symptoms - very similar to flu symptoms, but last much longer

103 102 Bioterrorism n 4 Agents used in bioterrorism disasters:  anthrax  botulism  plague  small pox

104 103 Bioterrorism  when several people have same symptoms  when many people appear with like illnesses after attending same event or traveling to same location  normally well persons are extremely ill and dying under unusual conditions Be suspicious!

105 104 Bioterrorism n Seek help if you have suspicious/unusual conditions with several people Use the following resources:  Infection Control Coordinator in community  Your County Public Health Department  IOWA Department of Public  Centers for Disease Control & Prevention

106 105 Bioterrorism n Protective Measures to be taken by Healthcare worker:  ALL body secretions could be infectious, therefore use standard precaution equipment for every situation  provide tissue to persons coughing & have them cover mouth & nose when coughing  specific recommendations will be given once the specific agent in the attack has been identified


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