OSHA Occupational Safety and Health Administration
3 Most Common Bloodborne Pathogens Hepatitis C Virus (HCV) Hepatitis B Virus (HBV) HIV (Human Immunodeficiency Virus)
Bloodborne Pathogen Pathogenic organisms that are present in human blood and can cause disease in humans. Other bloodborne pathogens: Syphilis, Malaria, West Nile Virus
Universal Precautions Blood and other potentially infectious material from ALL patients must be treated as if known to be infectious for HIV, HBV, HCV, or other bloodborne pathogens regardless of the perceived “low risk” of a patient, or patient population. Treat everyone as if they are a carrier of a bloodborne pathogen
12 body fluids covered by OSHA standard Blood Semen Vaginal secretions Cerebrospinal fluid Pleural fluid Pericardial fluid Amniotic fluid Synovial fluid Other body fluids Unfixed tissues Body organs Any body fluid
Hepatitis viruses (HBV and HCV) Viruses that attack the liver. Result in chronic illness, cirrhosis of the liver, liver cancer, or could result in death due to liver failure. Transmitted by exposure to infected blood and body fluids No cure, but prevention may be obtained for HBV through a series of 3 vaccines. Most effective method of prevention for HBV is the HBV vaccine Most effective method of prevention for HCV is monogamous relationships, universal precautions, avoid IV drug use
Human Immunodeficiency Virus (HIV) A virus that destroys the body’s immune system(lymphocytes, in particular), leaving the body defenseless against different and unusual life threatening illnesses. Transmitted by exposure to infected blood and body fluids No cure; antiviral drugs are very effective treatment, but they are very costly Prevention: monogamous relationships, avoidance of IV drug use, correct use of universal precautions
S&S common with HBV infection ( may take 6 weeks to 6 months for some signs of illness to occur) Fatigue Anorexia/weight loss Low grade fever Aching muscles or joints Stomach pain Nausea Diarrhea Jaundice of the skin/sclera Dark colored urine Light colored stool
S&S of HIV (infected people may not have S&S for years) Unexplained, persistent fatigue Unexplained fever, night sweats, or shaking Chills lasting several weeks or more Diarrhea for a period of several weeks Lymphedema Dry cough that does not go away Leukoplakia Unexplained/sudden weight loss of over 10 pounds Anorexia
Modes of transmission for HBV and HIV(uncommon in health care setting) Vaginal, oral, and anal intercourse Sharing needles (drugs) Contaminated blood products Sharing personal care items (razors, nail clippers, toothbrushes) Tattoos, ear piercing, and acupuncture with infected needle/equipment Neonatal infection during birth Skin, eye, mucous membrane or parenteral contact with blood or other infectious waste Breast milk of infected mother (HIV)
Modes of Transmission(common in health care settings) Stick or Cut Non-Intact Skin Splash to Mucous Membranes
Tasks that may involve exposure Wound care, debridement Personal care of the pt. Pt.transfer, exercises, positioning Suctioning Catheter changes Enemas, impaction removal IM/sub-q injections Surgical procedures Post mortem/morgue care Vascular access procedures Respiratory txs. CPR Douches Insertion of vaginal/rectal suppositories Oral/rectal temperature Whirlpool Emergency first aide procedures Transporting/processing lab specimens Dental procedures
How do we kill bloodborne pathogens? AntisepticsDisinfectants
Antiseptic Chemical agents that eradicate organisms from the skin 3 most common FDA approved: –1. Chlorhexidine Gluconate (CHG) – most common, leaves residual on skin for some time –2. Alcohols – reduce bacteria but dry skin –3. Iodophors – water-soluble complexes of iodine compounds, harsh on skin, stain clothing
Disinfectant Chemical agent used to eradicate organisms from environmental surfaces and instruments. 10% solution of household bleach is an effective and economical solution. Must be prepared fresh daily. 1 part bleach to 9 parts water
How can we break the chain of disease transmission? WASHING. YOUR. HANDS!!!!
Procedures that must be followed by handwashing Patient contact Removing gloves and other protective wear Handling blood and other body fluids When visibly contaminated with blood or tissues Before leaving patient care area Periodically during the day when handling body fluids
Handling of sharps(anything that might penetrate the skin) Accidents involving contaminated sharps are the most common route of exposure to bloodborne pathogens Exposure may occur through: needlestick, cuts from sharp instruments or equipment, broken glass, cuts from scalpels or blades.
Work practice controls associated with sharps Avoid using sharps if possible, change the technique to eliminate the sharp involved Contaminated needles should not be bent, recapped, broken or removed Recapping of needles should only be performed if there is no feasible alternative method. Use scoop technique Contaminated broken glassware must not be picked up with the hands. Sweep into a hard sided receptacle. Use tongs Reusable sharps must be stored in a manner so that they are clearly visible. Decontaminate ASAP Disposable sharps should be stored & disposed in puncture-resistant, leakproof, and closable containers that are labeled with biohazard symbol Sharps containers should be located as close to the area of use and disposed of before they are full When transporting sharps containers, they must be closed and locked prior to transport. if risk of leak exists, place into secondary container
This is the universal BIOHAZARD SYMBOL. It must be visible on anything that might contain bloodborne pathogens…even physicians’ office buildings.
Items that must display the biohazard symbol All specimens Laundry bags Contaminated equipment that is sent for service or repair Sharps containers Containers of regulated waste,refrigerators, freezers, phlebotomy trays or other containers used to store, transport, or ship blood or other potentially infectious materials
Labels Containers with contaminated items Can substitute red
How might you protect yourself? Personal Protective Equipment(PPE) –A barrier worn to protect skin, clothing, and mucous membranes. –PPE must be provided for you by your employer at no cost to you.
PPE Parenteral exposure –stick or cut Mucous membrane –Splash, inhale Non-intact skin –spill or splash
Types and purpose of PPE Gloves: protect hands Gowns: protect clothing Face shield: protects eyes, nose, mouth Masks: protects nose, mouth Eyewear, safety goggles: protect eyes Respirators: contain devices that filter contaminants which might enter the respiratory system (special use; must be fitted).
Removal, decontamination, and disposal of PPE The exposed portion of the equipment is turned to the inside. Equipment should be placed in the proper receptacle for decontamination or disposal If equipment is reusable, is should be cleaned properly with 10% bleach solution between uses. Reusable equipment should be cleaned immediately after each exposure.
Selecting PPE Consider the following –Type of fluid or tissue involved –Potential exposure volume of infectious material –Probable route of exposure –Overall working conditions
HBV vaccine most frequently reported adverse reactions Injection-site soreness Erythema (redness) Swelling Contraindicated in persons hypersensitive to yeast, and mercury. Can be given at 0,1 and 6 months Can be given at 0,1, and 2 months Preferably administered IM (intramuscular) Offered to employee at no cost
Documentation of HBV vaccination Date of each vaccination Manufacturer and lot number Site of injection Who administered the vaccine Any adverse reactions No vaccine for HCV or HIV
What do you do when there is a blood spill? A. Personal protection – wear gloves B. Clean-up, disposal and disinfection- flood area with 10% bleach solution and let set for 15 min. Wipe clean with absorbent material and let air dry C. Hazard communication – “wet floor sign”
What do you do with contaminated sharps and laundry? Dispose of in the nearest available container that is appropriate for the type of waste.
Have you been offered the HBV vaccination free of charge? YES
Exposure control plan Health care facilities must anticipate what your exposure might be All health care facilities must have one and must include the following: Identification of employees with occupational exposure Procedure for evaluating exposure incidents Schedule for implementing provisions of the standards
If you have been exposed take immediate action Wash needle sticks, cuts, and exposed skin with soap and water Flush splashes of blood to the nose, mouth, or skin with clean water, saline, or sterile irrigates Report exposure to supervisor Follow exposure control plan
Exposure control (con’t) Must be accessible to employees, available to OSHA, and reviewed and updated at least annually. If exposed to blood/body fluids in this classroom –eport to Mrs. Kuth –Report to clinic