1. BLOODBORNE PATHOGENS

2. “Bloodborne Pathogens” Defined... Pathogenic microorganisms that are present in human blood and can cause disease in humans.

3. BLOODBORNE PATHOGENS DEFINED Disease-causing microorganisms that may be present in human blood or OPIM (other potentially infectious material) –Viruses –Bacteria –Parasites

4. MODES OF TRANSMISSION Puncture wounds or cuts Contact (touch, splash, or spray) with blood or OPIM on: –mucous membrane –non-intact skin cuts, abrasions, burns acne, rashes papercuts, hangnails –contaminated sharps

5. Persons who may be exposed... Firefighter / EMTsFirefighter / EMTs Firefighter / ParamedicsFirefighter / Paramedics Fire LieutenantsFire Lieutenants Fire ChiefsFire Chiefs Day Care WorkersDay Care Workers Medical DepartmentMedical Department

6. Tasks involving potential exposure... Rescue / ExtricationRescue / Extrication Fire SuppressionFire Suppression BLS / ALS procedures (EMS)BLS / ALS procedures (EMS) Handling of deceased personsHandling of deceased persons Disinfecting / Decontaminating proceduresDisinfecting / Decontaminating procedures

8. FERMILAB Exposure Control Plan Engineering & work practicesEngineering & work practices Hepatitis B VaccinationHepatitis B Vaccination Post-exposure evaluation & follow-upPost-exposure evaluation & follow-up Bio-hazard labelingBio-hazard labeling Record keepingRecord keeping Information & trainingInformation & training

9. AIDS Acquired Immunodeficiency Syndrome Caused by HIV Human Immunodeficiency Virus

10. HIV Outcome of infection with the virus varies: Some have no symptoms.Some have no symptoms. Some have less severe symptoms than those with AIDS.Some have less severe symptoms than those with AIDS. AIDS results from destruction of the immune system which allows diseases to threaten life or health.AIDS results from destruction of the immune system which allows diseases to threaten life or health.

11. How Widespread Is HIV ? CDC estimates that 33.6 million people worldwide are living with HIV / AIDS. (32.4 million adults) 2008CDC estimates that 33.6 million people worldwide are living with HIV / AIDS. (32.4 million adults) 2008 Approx. 5.6 million new HIV infections were reported in 2006. More than 15,000 infections each day.Approx. 5.6 million new HIV infections were reported in 2006. More than 15,000 infections each day. One in every 100 adults aged 15 to 49 is HIV- infected.One in every 100 adults aged 15 to 49 is HIV- infected. Worldwide

12. How Widespread Is HIV ? CDC estimates that 650,000 to 900,000 US residents are currently living with HIV infection, of whom more than 200,000 are unaware of their infection.CDC estimates that 650,000 to 900,000 US residents are currently living with HIV infection, of whom more than 200,000 are unaware of their infection. Approx. 43,000 new HIV infections were reported in 2006Approx. 43,000 new HIV infections were reported in 2006 711,344 cases of AIDS have been officially reported to the CDC as of June 30, 2005711,344 cases of AIDS have been officially reported to the CDC as of June 30, 2005 United States

13. You Cannot “Catch” HIV: Through the airThrough the air Through casual, everyday contactThrough casual, everyday contact –(sharing bathrooms, kitchens, etc.) Through nonsexual social situationsThrough nonsexual social situations Through insects or mosquitoesThrough insects or mosquitoes Through urine, feces, nasal secretions, sputum, vomitus, saliva, sweat or tears from an infected personThrough urine, feces, nasal secretions, sputum, vomitus, saliva, sweat or tears from an infected person

14. What Personal Behaviors/Practices Put You at Risk ? Sexual contact with an infected personSexual contact with an infected person Sharing infected needlesSharing infected needles Infected woman to her child at birthInfected woman to her child at birth Blood transfusion *Blood transfusion * *The blood supply is thoroughly screened so that the risk of infection from transfusion is extremely small.

15. How Can You Prevent HIV Transmission in Your Personal Life? Refrain from: Vaginal or oral sex with someone who uses IV drugsVaginal or oral sex with someone who uses IV drugs Sex with someone you don’t know wellSex with someone you don’t know well Sex with someone who has multiple sex partnersSex with someone who has multiple sex partners Sex without a condom - with an infected personSex without a condom - with an infected person Sharing IV drug needlesSharing IV drug needles

16. What Is Hepatitis B? Caused by the Hepatitis B Virus (HBV).Caused by the Hepatitis B Virus (HBV). Damages the liver, causing symptoms that range from mild or unapparent to severe or fatal.Damages the liver, causing symptoms that range from mild or unapparent to severe or fatal. 25% of infected individuals develop acute hepatitis.25% of infected individuals develop acute hepatitis. 6% to 10% become HBV carriers. Carriers can develop liver disease and are infectious to others.6% to 10% become HBV carriers. Carriers can develop liver disease and are infectious to others.

17. Hepatitis B... 12,000 health care workers become infected through occupational exposure each year.12,000 health care workers become infected through occupational exposure each year. 500-600 infected health-care workers are hospitalized each year.500-600 infected health-care workers are hospitalized each year. 200-300 infected health-care workers die each year with associated diseases.200-300 infected health-care workers die each year with associated diseases.

18. What Personal Behaviors Put You at Risk for HBV Infection ? Sexual contact with an infected personSexual contact with an infected person Sharing drug needles and syringes with infected personSharing drug needles and syringes with infected person Since blood supply is screened for HBV, the chance of being infected through transfusion is extremely small.Since blood supply is screened for HBV, the chance of being infected through transfusion is extremely small.

19. What Occupational Exposures Put a Worker at Risk for HBV Infection ? Contact with blood or potentially infectious body fluids through: Needle stickNeedle stick Broken or non-intact skinBroken or non-intact skin Mucous membranes of eyes, nose and mouthMucous membranes of eyes, nose and mouth Saliva injected through a human bite can also transmit HBV.

20. Body Substance Isolation (BSI) The same BSI equipment & procedures that will protect against exposure to HIV will protect the worker against HBV.

21. Blood tests are available to detect antibodies for HBV in an infected person.

22. Vaccines provide protection against HBV infection (90% protection for 7 or more years) Vaccines provide protection against HBV infection (90% protection for 7 or more years) Vaccines are 70% to 80% effective when given within 1 week of exposure

23. Personal Protective Equipment Gloves Disposables protect against blood and fluidsDisposables protect against blood and fluids Normally provide no protection against sharpsNormally provide no protection against sharps Must be changed if soiled or tornMust be changed if soiled or torn Must be changed between handling of different peopleMust be changed between handling of different people

24. Personal Protective Equipment Masks, Eyewear & Gowns Not necessary unless blood or other potentially infectious fluids are or could be presentNot necessary unless blood or other potentially infectious fluids are or could be present Masks & eyewear should be worn together if splashes are anticipatedMasks & eyewear should be worn together if splashes are anticipated Gowns or aprons are worn to avoid soaking of clothesGowns or aprons are worn to avoid soaking of clothes

25. Universal Precautions Consider everything contagiousConsider everything contagious Personal Protective Equipment (PPE)Personal Protective Equipment (PPE) –MUST be provided free of charge PPE is carried on all EMS apparatusPPE is carried on all EMS apparatus Fire fighting gear offers little or no protectionFire fighting gear offers little or no protection

26. Contaminated Equipment If possible, use as much disposable equipment as possible.If possible, use as much disposable equipment as possible. Reusable equipment should be decontaminated with a germicidal solution as soon as possible / practical.Reusable equipment should be decontaminated with a germicidal solution as soon as possible / practical. Consider patient’s clothing / belongings as contaminated if soiled.Consider patient’s clothing / belongings as contaminated if soiled.

27. Needles & Sharps Disposal Needles should not be recapped or manipulated by hand.Needles should not be recapped or manipulated by hand. Disposable blades and other sharps should be placed in a puncture-resistant container.Disposable blades and other sharps should be placed in a puncture-resistant container. Puncture-resistant containers should be readily available at all times.Puncture-resistant containers should be readily available at all times. Scissors, glass, lancets should be considered.Scissors, glass, lancets should be considered.

28. Hand Washing Wash hands upon arrival at hospital or returning to quarters.Wash hands upon arrival at hospital or returning to quarters. Use utility or designated sink -- not the food preparation area.Use utility or designated sink -- not the food preparation area. Wash thoroughly with soap & water or germicidal cleanser.Wash thoroughly with soap & water or germicidal cleanser. Antiseptic hand cleaners should be available for special situations.Antiseptic hand cleaners should be available for special situations.

29. Cleaning & Decontaminating Spills of Blood: Wear gloves and clean with disposable towels. Place soiled linens in a red plastic bag.Wear gloves and clean with disposable towels. Place soiled linens in a red plastic bag. Wear eye & face protection if splashing is a possibility.Wear eye & face protection if splashing is a possibility. Wear shoe covers if amount of blood is great.Wear shoe covers if amount of blood is great.

30. Cleaning & Decontaminating Spills of Blood: Decontaminate with tuberculocidal solution or 10:1 solution of bleach. Wipe area with clean towels and let air dry.Decontaminate with tuberculocidal solution or 10:1 solution of bleach. Wipe area with clean towels and let air dry. Waste/unused cleaning solution should only be poured down sanitary drains. Sinks shall be disinfected after use.Waste/unused cleaning solution should only be poured down sanitary drains. Sinks shall be disinfected after use. Remove contaminated items, shoe coverings, etc. and place in a red plastic bag for proper disposal. Remove gloves last. Wash hands after removing gloves.Remove contaminated items, shoe coverings, etc. and place in a red plastic bag for proper disposal. Remove gloves last. Wash hands after removing gloves.

31. Laundry Handle soiled items as little as possible.Handle soiled items as little as possible. If possible, remove soiled linens at place of use and place in red plastic bags that prevent leakage.If possible, remove soiled linens at place of use and place in red plastic bags that prevent leakage.

32. Labeling

33. Record Keeping Records MUST BE kept for the duration of employment plus 30 years.

34. Guidelines & Procedures 1.Pre-hospital providers should have on record their past medical history Tetanus Hepatitis B Vaccination

35. Guidelines & Procedures 2.Each ambulance should have a hand washing product and surface cleaner available at all times. Most EPA approved germicidals OK 10% bleach may be substituted but some equipment could be bleach sensitive.

36. Guidelines & Procedures 3.Hand Washing should be done before & after contact with patient 4.Gloves should be worn when there is any risk with bodily fluids 5.Masks, gowns and protective eyewear should be worn when there is any risk of splattering or spraying of infectious material

37. Guidelines & Procedures 10.Soiled clothing – linens should be placed into leak proof bag, sealed and transported to ER. Rescuer clothing laundered ASAP. 11.Sharps should be handled with extreme caution. DO NOT RECAP, BEND or CUT USED NEEDLES. Use appropriate puncture resistant containers.

38. Guidelines & Procedures 12.Where possible, disposable equipment should be used on all patients. Where not possible equipment should be cleaned immediately with a commercial disinfectant or bleach solution. 13.CPR should use appropriate protection, avoid mouth-to-mouth, clean & disinfect if not disposable.

39. Guidelines & Procedures 14.Exposure to blood or body substance, should: Fill out “Exposure form” Verbal report Evaluation by ED within one hour Follow-up determined by ED in accordance with Policy Provider reports incident to Employer

40. Guidelines & Procedures 15.Exposure to eyes should necessitate immediate irrigation & evaluation by Fermilab Office or ED if off hours. 16.Exposure to skin should necessitate washing with warm soap & water or commercial agent, & seek evaluation by Fermilab Medical Office or ED if off hours.