Bloodborne Pathogens

What Are Bloodborne Pathogens? Microorganisms such as viruses or bacteria that are carried in blood and can cause disease in people Transmitted through contact with blood or other bodily fluids Mode of transmission: Human blood Semen Vaginal secretions Cerebrospinal fluid Synovial fluid

Bloodborne Pathogen Transmission Bloodborne pathogens are transmitted through contact with infected human blood and other body fluids such as Semen Vaginal secretions Cerebrospinal fluid Synovial fluid Pleural fluid Peritoneal fluid Amniotic fluid Saliva

Skin Provides a Barrier Unbroken skin forms an impervious barrier against bloodborne pathogens. However, infected blood can enter your system through Open sores Cuts Abrasions Acne Any sort of damaged or broken skin such as sunburn or blister

Mucous Membranes Bloodborne pathogens may also be transmitted through the mucous membranes of the Eyes Nose Mouth

Types of Bloodborne Pathogens Most significant— Hepatitis B (HBV) HIV Also— Hepatitis C (HCV) Hepatitis A & D Syphilis

If you are exposed… Wash the exposed area thoroughly with soap and running water Use non-abrasive, antibacterial soap Flush mouth, nose, eyes for 15 minutes if blood is splashed in mucous membranes Remove clothing that is contaminated as soon as possible & place in approved container Report exposure to your supervisor Fill out an exposure report form Request blood testing & Hepatitis B vaccination

Hepatitis B Virus

is a virus that causes infection and inflammation of the liver is transmitted primarily through “blood to blood” contact can lead to serious conditions such as cirrhosis & liver cancer can survive in dried blood for up to seven days

HBV Transmission Infected blood and body fluids In infected persons, HBV can be found in: Blood Body tissue Saliva Semen Vaginal secretions Urine Breast milk

HBV Transmission in the Workplace Puncture wounds from sharps Contaminated body fluids entering: An opening or break in the skin Splashing into mucous membranes—eyes, nose, mouth

HBV Transmission Outside the Workplace Unprotected sex Intravenous drug use (sharing needles) Blood transfusions

HBV Symptoms  Mild flu-like symptoms  Fatigue  Weakness  Nausea  Abdominal pain  Headache  Fever  Possible jaundice  Darkened urine

Hepatitis B Vaccinations There is no cure or specific treatment Many people develop antibodies to fight the disease which may prevent future infection Employees who have routine exposure to bloodborne pathogens (doctors, nurses, first aid responders, etc) shall be offered the Hepatitis B vaccine series at no cost to themselves unless: They have previously received the vaccine series Antibody testing has revealed they are immune The vaccine is contraindicated for medical reasons

Vaccination Process  Series of three shots  Second shot is given one month after the first  Third shot follows five months after the second  This series gradually builds up the body’s immunity to the Hepatitis virus  Given in the deltoid muscle of upper arm

Do not take the vaccine if: You are allergic to yeast You are pregnant or planning to become pregnant within the year You are ill (cold, flu, or on medication) on your appointment date You are in doubt due to other medical issues, concerns, or complications (see your physician)

HIV/AIDS

Human Immunodeficiency Virus HIV is the virus that leads to AIDS HIV depletes the immune system HIV does not survive well outside the body There is still no vaccine available

Transmission of HIV HIV is spread when infected blood, semen, vaginal fluids, or breast milk gets into the bloodstream of another person: Sexual contact Sharing needles Pregnancy, childbirth and breastfeeding Workplace exposure to blood and/or body fluids

Transmission of HIV HIV is NOT spread through: Casual contact Saliva Sweat Spit Tears Air Insects

HIV Symptoms Symptoms of HIV infection can vary, but often include: Weakness Fever Sore throat Nausea Headaches Diarrhea White coating on tongue Weight loss Swollen lymph glands

Acquired Immunodeficiency Syndrome (AIDS) Development of opportunistic infections that do not usually infect people with a healthy immune system The signs and symptoms depend on the type of infection Swollen lymph glands in the neck, underarm, and groin area Recurrent fever Persistent headaches and night sweats Constant fatigue Persistent diarrhea Without treatment, a person could die from a simple infection

Hepatitis C (HCV)

General Facts About Hepatitis C Identified in 1989 One of most common causes of chronic liver disease, cirrhosis, and cancer Most commonly occurs in people who have received blood transfusions before 1992 shared needles had tattoos had body piercing Risk of sexual transmission appears to be small No evidence that it can be transmitted by casual contact, through foods, or by coughing/sneezing Transmission from mother to child appears to be uncommon

Hepatitis C The virus is very robust The virus can remain undetected in the body for years Most Hepatitis C infections become chronic and lead to liver disease and liver failure There is no vaccine for Hepatitis C

Symptoms of HCV Appetite loss Fatigue Nausea Vomiting Vague stomach pain Muscle and joint pain Jaundice yellowing of skin yellowing of the whites of the eyes dark urine

Hepatitis A and D HAV Most common in children Often spread by close personal contact or poor hygiene Unprotected sexual intercourse HDV Occurs from complications from HBV

Bloodborne Pathogens Standards

CDC Centers for Disease Control Organization within federal government Monitors outbreaks of infections Advises affected groups on how to handle situations Control the spread of diseases

OSHA Occupational Health and Safety Administration Federal agency develops regulations for employees whose jobs may put them at risk of bloodborne pathogen exposure Requires each workplace to develop and keep hands on exposure control plan Defines staff duties, documentation of exposure, personal protective equipment, etc

OSHA Mandates Exposure control plan be on hand Training of staff about bloodborne pathogens Documentation and reporting of all exposures Personal protective equipment be available to staff Hepatitis B vaccine be offered to all at-risk staff Special containers be used for biohazardous materials and sharps Staff follow standard precautions Proper disinfection techniques be used to clean tools and work surfaces

Bloodborne Pathogens Rule Published 1992 Clear provisions for employers regarding infection control practices Intent to eliminate or minimize occupational exposure to blood or other potentially infectious materials

Methods of Compliance

Employee Protection Training of Employees Work Practice Controls Engineering Controls Personal Protective Equipment Administrative Controls Vaccines Where Possible Universal Precautions

Observe Universal Precautions Infection control guidelines designed to protect workers from exposure to diseases spread by blood and certain body fluids. All patients should be assumed to be infectious for bloodborne diseases such as AIDS and hepatitis B.

Universal Precautions Wash hands before and after all patient or specimen contact Treat the blood of all patients as potentially infectious Treat all linen soiled with blood or body secretions as potentially infectious Wear gloves if contact with blood or body fluids is possible Immediately place used syringes in a nearby impermeable container; do not recap or manipulate needles or sharps in any way Wear protective eyewear and mask if splatter with blood or body fluids is possible Wear a mask if there is a risk of infection by TB or other airborne organisms

Personal Protective Equipment

Personal Protective Equipment (PPE) PPE provides protection against exposure to infectious materials and must be routinely used when contact with blood or body fluids is anticipated Selection of PPE is task oriented PPE is appropriate when under normal conditions it prevents blood and body fluids from reaching an employee’s work clothes, street clothes, undergarments skin, mouth, eyes, other mucus membranes

Examples of PPE Gloves Gowns, aprons, sleeves Laboratory coats Face shields or masks Eye protection Mouthpieces Resuscitation bags, pocket masks Foot protection

Gloves Gloves should be made of latex, nitril, rubber, or other water impervious material Inspect gloves before use Double gloving can provide an additional layer of protection If you have cuts or sores on your hands, you should cover these with a bandage or similar protection as an additional precaution before donning your gloves Don’t touch the outside of used gloves

Removing Contaminated Gloves PINCH one glove back by the cuff until it comes off inside out. Discard or cup in the palm of your gloved hand.

Removing Contaminated Gloves HOOK a finger of your bare hand inside the cuff of the remaining glove PULL BACK so this glove also comes off inside- out with the first glove tucked inside it WASH HANDS!

Rules to Follow Treat all blood or potentially infectious body fluids as if they are contaminated Always wear personal protective equipment in exposure situations Replace PPE that is torn or punctured Remove PPE before leaving work area Properly disinfect or dispose of used PPE Wash hands immediately after removing PPE

Hand Washing Technique

Wash Hands When visibly soiled After using the bathroom After removing gloves After blowing your nose After sneezing in your hands Before and after eating, handling food, drinking or smoking

Wash Hands Before and after assisting a child in using the toilet After diaper changes After contact with runny noses, vomit, or saliva Before feeding children After handling pets, animals, or animal waste After handling garbage

Technique for Hand Washing Remove rings and watches before washing If hands-free dispenser is not available, dispense paper towels before washing Hand should be positioned lower than the arms to avoid contamination

Decontamination Procedures

Decontamination & Sterilization All surfaces, tools, equipment and other objects that come in contact with blood or potentially infectious materials must be decontaminated and sterilized as soon as possible. Equipment and tools must be cleaned and decontaminated before servicing or being put back to use

Decontamination Solution of 5.25% sodium hypochlorite (household bleach) Diluted between 1:10 and 1:100 with water Standard recommendation is to use at least a quarter cup of bleach per one gallon of water Use Lysol or some other EPA-registered tuberculoid disinfectant. Check the label of all disinfectants to make sure they meet this requirements

Medical Waste

Signs & Labels Warning labels must be placed on containers of regulated waste, refrigerators and freezers containing blood or other potentially infectious material and other containers used to store, transport, or ship blood or other potentially infectious material

Regulated Medical Waste Liquid or semi-liquid blood or other potentially infectious materials Contaminated items that would release blood or other potentially infectious materials in a liquid or semi-liquid state if compressed Items that are caked with dried blood or other potentially infectious materials

Regulated Medical Waste Red bags and sharps containers are provided for the collection of regulated medical waste A sharps container, red bag, and storage box should be available in the Nurse’s and/or Custodian’s office

Biohazard Containers

Requirements for Handling Laundry Handle contaminated laundry as little as possible, with minimal agitation Place wet contaminated laundry in leak- proof labeled or color-coded containers before transport; use red bags or bags marked with biohazard symbol Wear appropriate PPE when handling and/or sorting contaminated laundry

Employee Determination

Exposure Determination Each principal/custodian/supervisor who has employees with occupational exposure must prepare an exposure determination. Must contain: A list of all job classifications in which all employees in those job classifications have occupational exposure A list of job classifications in which some employees have occupational exposure

All Employees at Risk of Exposure School nurses School Aides who work with the developmentally disabled Lifeguards Security Guards Health Aides Custodial Cleaners

Some Employees at Risk of Exposure Principals Assistant Principals Laboratory Teachers Custodians Designated CPR/First Aid Responders Physical Education Teachers

Occupational Exposure Employees Will receive specialized training annually Will be offered the Hepatitis B vaccination series Will be provided with post-exposure evaluation and follow-up in the case of an exposure incident Will be provided with personal protective equipment