Bloodborne Pathogens and Prevention of Infection July 2008

2 Objectives 1. Identify common bloodborne pathogens. 2. Describe the risk of bloodborne pathogens to health care workers. 3. List potentially infectious substances and their modes of transmission. 4. Describe how personal protective equipment and work practice controls can be implemented. 5. Describe the health care worker’s role in evaluation of workplace practices and devices. 6. Describe post-exposure care.

3 Bloodborne Pathogens HIVHBVHCVOthers

4 Risks to Health Care Workers HIV – small HCV – 900 annually HBV – 9,000 annually

5 Infectious Fluids Blood Blood Body fluids that contain blood Body fluids that contain blood Semen Semen Vaginal secretions Vaginal secretions Fluid from around an unborn baby Fluid from around an unborn baby Spinal fluid Spinal fluid Fluid around the heart Fluid around the heart

6 Infectious Fluids (continued) Fluid around the lungs Fluid around the lungs Fluid around joints Fluid around joints Tissue removed from the body Tissue removed from the body

7 Other Body Fluids Potentially Infectious Tears Tears Saliva Saliva Sputum/nasal secretions Sputum/nasal secretions Emesis Emesis Urine Urine Feces Feces Not Infectious Sweat Sweat

8 Transmission Sexual contact Sexual contact Sharing needles Sharing needles Transfusions Transfusions Mom  baby Mom  baby

9 Transmission in the Workplace Puncture wounds Puncture wounds Contact with non-intact skin Contact with non-intact skin Mucous membranes Mucous membranes

10 Prevention of Infection Universal Precautions – OSHA Standard Precautions - CDC

11 Hand Decontamination After touching blood, body fluids, secretions, excretions, contaminated items After touching blood, body fluids, secretions, excretions, contaminated items After gloves removed After gloves removed Between patient contacts Between patient contacts Waterless antiseptic agents Waterless antiseptic agents

12 Considered an Exposures When: When: –Blood, blood products, cerebral spinal fluid, semen, vaginal secretions or synovial fluid has had contact with NON-INTACT skin or mucous membranes.

13 Considered an Exposure When When –You have been stuck by a contaminated needle or sharp object

14 Not an Exposure The following is NOT an exposure (unless visible blood noted in the following) The following is NOT an exposure (unless visible blood noted in the following) –Feces, saliva, vomitus, sputum, sweat, urine, nasal secretions, tears, blood on INTACT skin

15 Personal Protective Equipment (PPE) Provided by employer Provided by employer Application, removal, disposal Application, removal, disposal

16 Gloves Handling blood/body fluids Handling blood/body fluids Performing invasive procedure Performing invasive procedure Touching non-intact skin Touching non-intact skin

17 Gloves Correct size Correct size Change if contaminated Change if contaminated Remove inside out Remove inside out Utility gloves Utility gloves

18 Masks, Shields, Eyewear Used when splashing expected Used when splashing expected Replace when wet Replace when wet Wash hands before removing Wash hands before removing Handle by side pieces Handle by side pieces Protective resuscitation equipment Protective resuscitation equipment

19 Protective Clothing Used when splashing expected Used when splashing expected Remove if soiled Remove if soiled Remove from inside and roll Remove from inside and roll Nondisposable laundered by employer Nondisposable laundered by employer

20 Work Practice Controls Sharps Sharps Lab materials Lab materials Decontamination Decontamination Laundry Laundry Waste Waste

21 Safer Medical Devices Sharps with engineered sharps injury protections Sharps with engineered sharps injury protections Needleless systems Needleless systems

22 If Needle Must Be Used… Do not bend or break Do not bend or break Immediately discard in sharps containers Immediately discard in sharps containers Do not recap Do not recap

23 Documentation of Needlestick Injuries The type and brand of device involved The type and brand of device involved The department or area where the exposure occurred The department or area where the exposure occurred An explanation of how the exposure occurred An explanation of how the exposure occurred

24 Other Work Practice Controls Transport specimens in leakproof containers labeled biological hazard Transport specimens in leakproof containers labeled biological hazard Place warning labels on containers with hazardous materials Place warning labels on containers with hazardous materials Do not eat, drink, smoke, apply cosmetics, or handle contact lenses where exposure likely Do not eat, drink, smoke, apply cosmetics, or handle contact lenses where exposure likely Never use pipettes with mouth suction Never use pipettes with mouth suction

25 Spills Put on gloves Put on gloves Wipe up with towel Wipe up with towel Dispose of contaminated towel Dispose of contaminated towel Apply bleach solution Apply bleach solution

26 Linens Wear gloves Wear gloves Place in impervious container if linen is to be transported Place in impervious container if linen is to be transported Label appropriately Label appropriately

27 Waste Label as biohazard Label as biohazard

28 Post-Exposure Wash area Wash area Notify supervisor Notify supervisor Consult physician ASAP Consult physician ASAP Report incident Report incident Obtain medical counseling Obtain medical counseling Keep records confidential Keep records confidential

29 Summary Bloodborne pathogen risks Bloodborne pathogen risks Modes of transmission Modes of transmission Personal protective equipment Personal protective equipment Work practice controls Work practice controls Evaluation of practices/devices Evaluation of practices/devices Post-exposure care Post-exposure care