1. BLOODBORNE PATHOGEN TRAINING
2010

2. Bloodborne Pathogens Training
29 CFR is the OSHA regulation for occupational exposure to blood or other possibly infectious materials.
All employees who can be reasonably expected to be occupationally exposed must be provided with training.
Exposures to blood and other body fluids occur across a wide variety of occupations. Health care workers, emergency response and public safety personnel, and other workers can be exposed to blood through needle stick and other sharps injuries, mucous membrane and skin exposures.
The pathogens of primary concern are the human immunodeficiency virus (HIV), hepatitis B virus (HBV) and hepatitis C virus (HCV).

3. Bloodborne Pathogens
Bloodborne pathogens are viruses, bacteria and other microorganisms that are borne (carried) in a person’s bloodstream and that cause disease.
If a person comes in contact with blood infected with a bloodborne pathogen, he/she may become infected as well.
Found in blood products, semen, vaginal secretions, amniotic fluid, fluid surrounding the brain, spine, heart and joints, and fluids in the chest and abdomen.
Bloodborne Pathogens include other diseases such as syphilis, gonorrhea, hepatitis E, etc. Hepatitis A is not a bloodborne pathogen but it can be transmitted through occupational exposure.

4. Hepatitis and HIV
Of the many different Bloodborne Pathogens we will discuss three of the more talked about types.
Hepatitis B
Hepatitis C
HIV

5. Hepatitis B (HBV) Facts
The major infectious bloodborne hazard you face on the job.
Hepatitis can survive on surfaces at room temperature for several days and in dried blood for up to a 7 days.
There is a vaccine for HBV but there is no cure.
Risk from needlestick or cut exposure is 6-30% if not vaccinated.
CDC estimates up to 1.4 million have chronic Hepatitis B infection.
GA’s rates of reported cases has dropped by 27%.
"Hepatitis" means "inflammation of the liver," and, as its name implies, Hepatitis B is a virus that infects the liver. While there are several different types of Hepatitis, Hepatitis B is transmitted primarily through "blood to blood" contact. Hepatitis B initially causes inflammation of the liver, but it can lead to more serious conditions such as cirrhosis and liver cancer.
There is no "cure" or specific treatment for HBV, but many people who contract the disease will develop antibodies which help them get over the infection and protect them from getting it again. It is important to note, however, that there are different kinds of hepatitis, so infection with HBV will not stop someone from getting another type.
Hepatitis B carriers are people who are have chronic (long-term) infection with HBV and never recover fully from the infection; they carry the virus and can infect others for the rest of their lives. In the United States, about one million people carry HBV.
There are medications available to treat long-lasting (chronic) HBV-infection. These work for some people, but there is no cure for hepatitis B when you first get it. That is why prevention is so important. Hepatitis B vaccine is the best protection against HBV. Three doses are commonly needed for complete protection.

6. Symptoms of Hepatitis B
HBV Attacks the liver. Can be in a chronic carrier state and have no symptoms, or if active state, can develop flu-like illness and:
Your eyes or skin may turn yellow.
You may lose your appetite.
You may have nausea. vomiting, fever, stomach or joint pain.
You may feel extremely tired and not be able to work for weeks or months.
May lead to cirrhosis, liver cancer or death.
The symptoms of HBV are very much like a mild "flu". Initially there is a sense of fatigue, possible stomach pain, loss of appetite, and even nausea. As the disease continues to develop, jaundice (a distinct yellowing of the skin and eyes), and a darkened urine will often occur.
People who are infected with HBV will often show no symptoms for some time. After exposure it can take 1-9 months before symptoms become noticeable. Loss of appetite and stomach pain, for example, commonly appear within 1-3 months, but can occur as soon as 2 weeks or as long as 6-9 months after infection.

7. Hepatitis B Modes of Transmission
HBV is transmitted through activities that involve percutaneous (i.e., puncture through the skin) or mucosal contact with infectious blood or body fluids (e.g., semen, saliva), including
Sex with an infected partner
Injection drug use that involves sharing needles, syringes, or drug-preparation equipment
Birth to an infected mother
Contact with blood or open sores of an infected person
Needle sticks or sharp instrument exposures
Sharing items such as razors or toothbrushes with an infected person

8. Hepatitis C (HCV)
Hepatitis C is a liver disease caused by the hepatitis C virus (HCV), which is found in the blood of persons who have this disease.
Symptoms are milder than HBV or may not even be present (carrier state).
But can lead to cirrhosis, liver cancer or death.
No vaccine available.
Risk from needle-stick or cut exposure is 1.8%.
CDC estimates that 3.2 million people in US have chronic Hepatitis C infection.
GA just started reporting cases in 2004, so statistics are minimal and not sufficient to show true picture.
Hepatitis C is serious for some persons, but not for others. Most persons who get hepatitis C carry the virus for the rest of their lives. Most of these persons have some liver damage but many do not feel sick from the disease. Some persons with liver damage due to hepatitis C may develop cirrhosis (scarring) of the liver and liver failure which may take many years to develop.
Of every 100 persons infected with HCV about:
75 to 85 persons may develop long-term infection
70 persons may develop chronic liver disease
15 persons may develop cirrhosis over a period of 20 to 30 years
Less than 3% of persons may die from the consequences of long term infection (liver cancer or cirrhosis)

9. Hepatitis C Modes of Transmission
HCV is transmitted primarily through large or repeated percutaneous (i.e., passage through the skin) exposures to infectious blood, such as
Injection drug use (currently the most common means of HCV transmission in the United States)
Receipt of donated blood, blood products, and organs (once a common means of transmission but now rare in the United States since blood screening became available in 1992)
Needle-stick injuries in healthcare settings
Birth to an HCV-infected mother

10. Hepatitis C Modes of Transmission
HCV can also be spread infrequently through
Sex with an HCV-infected person (an inefficient means of transmission)
Sharing personal items contaminated with infectious blood, such as razors or toothbrushes (also inefficient vectors of transmission)
Other healthcare procedures that involve invasive procedures, such as injections (usually recognized in the context of outbreaks)

11. Human Immunodeficiency Virus
HIV is the virus that causes AIDS (Acquired Immune Deficiency Syndrome).
Attacks the body’s immune system, making body less able to fight off infection.
May carry virus for years without symptoms.
Will eventually develops AIDS.
May suffer from flu-like symptoms, fever, diarrhea, and fatigue.
May develop AIDS-related illness, including neurological problems, cancer, and other opportunistic disease.
AIDS, or acquired immune deficiency syndrome, is caused by a virus called the human immunodeficiency virus, or HIV. Once a person has been infected with HIV, it may be many years before AIDS actually develops. HIV attacks the body's immune system, weakening it so that it cannot fight other deadly diseases. AIDS is a fatal disease, and while treatment for it is improving, there is no known cure.
Estimates on the number of people infected with HIV vary, but some estimates suggest that an average of 35,000 people are infected every year in the US (in 2000, 45,000 new infections were reported). It is believed that as of 2000, 920,000 persons were living with HIV/AIDS in the United States. These numbers could be higher, as many people who are infected with HIV may be completely unaware of it.

12. Human Immunodeficiency Virus
Unlike HBV, HIV typically lasts less than 2 hours outside the human body.
Not transmitted through casual contact (touching, feeding, or working around patients who carry the disease.
While treatment techniques are improving, there is no cure or preventative vaccine for HIV.
Risk from needlestick or cut exposure is 0.3%.
The HIV virus is very fragile and will not survive very long outside of the human body. It is primarily of concern to employees providing first aid or medical care in situations involving fresh blood or other potentially infectious materials. It is estimated that the chances of contracting HIV in a workplace environment are only 0.4%. However, because it is such a devastating disease, all precautions must be taken to avoid exposure.

13. Human Immunodeficiency Virus
There are approximately 1.2 million Americans living with HIV/AIDS.
CDC estimates that 21% of HIV-positive people don’t know they are infected.
Estimated 56,300 Americans newly infected with HIV each year. More than half of new cases (57%) are aged
GA had cumulative total of 33,847 people reportedly with AIDS (from beginning of epidemic to Dec (8th highest among the 50 states).

14. HIV Modes of Transmission
Sexual Contact
Sharing of hypodermic needles
Accidental puncture from contaminated needles, broken glass, or other sharps
Contact between broken or damaged skin and infected body fluids
Contact between mucous membranes and infected body fluids
It is important to know the ways exposure and transmission are most likely to occur in your particular situation, be it providing first aid to a student in the classroom, handling blood samples in the laboratory, or cleaning up blood from a hallway.
Bloodborne pathogens such as HBV and HIV can be transmitted through contact with infected human blood and other potentially infectious body fluids such as:
Semen (the viscid, whitish fluid from the male)
Vaginal secretions (fluid from the female cervix).
Cerebrospinal fluid (colorless liquid that surrounds the brain and spinal cord).
Synovial fluid (fluid that lubricates and cushions the joint).
Pleural fluid (fluid between the pleural membranes of the lung and the inner chest wall).
Peritoneal fluid (fluid in the gastrointestinal organs).
Amniotic fluid (fluid which surrounds the fetus).
Saliva (in dental procedures).
Any body fluid that is visibly contaminated with blood.

15. Occupational Exposures
In health-care settings, bloodborne pathogens can be spread when infected fluids enter the body through:
Needle-stick injuries or other sharps injuries
Cuts, scrapes and other breaks in the skin
Splashes into the mouth, nose, eyes
(mucus membranes)
If someone infected with HBV cut their finger on a piece of glass, and then you cut yourself on the now infected piece of glass, it is possible that you could contract the disease. Anytime there is blood-to-blood contact with infected blood or body fluids, there is a slight potential for transmission.
Unbroken skin forms an impervious barrier against bloodborne pathogens. However, infected blood can enter your system through open sores, cuts, abrasions, acne, or any sort of damaged or broken skin such as sunburn or blisters.
Bloodborne pathogens may also be transmitted through the mucous membranes of the eyes, nose, or mouth. For example, a splash of contaminated blood to your eye, nose, or mouth could result in transmission.

16. Standard Precautions Dispose of contaminated items correctly
Treat ALL blood and potentially infectious body fluids, secretions and excretions (except sweat) as if they are infectious.
Use PPE
Decontaminate and clean-up appropriately
Dispose of contaminated items correctly
"Universal Precautions" is the name used to describe a prevention strategy in which all blood and potentially infectious materials are treated as if they are, in fact, infectious, regardless of the perceived status of the source individual. In other words, whether or not you think the blood/body fluid is infected with bloodborne pathogens, you treat it as if it is. This approach is used in all situations where exposure to blood or potentially infectious materials is possible. This also means that certain engineering and work practice controls shall always be utilized in situations where exposure may occur.

17. Reducing Your Risk
Five major tactics reduce your risk of exposure to bloodborne pathogens on the job:
Engineering controls
Employee Work Practices
Personal Protective Equipment
Housekeeping
Hepatitis B Vaccine

18. Engineering Controls
Physical or mechanical systems that eliminate hazards at their source:
Safety needle devices
Sharps containers
Biohazard labels
Leak-proof bags and containers for transporting specimens; disposing of waste
Alcohol hand gel
Germicides for disinfecting equipment

19. Employee Work Practices
Procedures you follow on the job to
reduce you risk of exposure:
Handle sharps carefully; don’t recap.
Place sharps immediately into sharps container.
Good hand hygiene practices.
Minimize splashing of fluids.
Do not eat, drink, smoke, apply cosmetics or lip balm where you may be exposed.
Don’t keep food/drink in refrigerators, cabinets or shelves where blood or infectious materials may be present.

20. Personal Protective Equipment
Latex gloves
Masks
Aprons, Gowns
Face shields
Resuscitation devices
Personal protective Equipment should prevent blood or other possible infectious material from contaminating work clothes, street clothes, undergarments, skin, eyes, mouth, or other mucous membranes.

21. Personal Protective Equipment
Always wear personal protective equipment in exposure situations.
PPE must be appropriate for the task.
Remove PPE that is torn or punctured, or has lost its ability to function as a barrier to bloodborne pathogens.
Gloves must fit properly.
Remove PPE before leaving the work area.
Probably the first thing to do in any situation where you may be exposed to bloodborne pathogens is to ensure you are wearing the appropriate personal protective equipment (PPE). For example, you may have noticed that emergency medical personnel, doctors, nurses, dentists, dental assistants, and other health care professionals always wear latex or protective gloves. This is a simple precaution they take in order to prevent blood or potentially infectious body fluids from coming in contact with their skin. To protect yourself, it is essential to have a barrier between you and the potentially infectious material.
If you work in an area with routine exposure to blood or potentially infectious materials, the necessary PPE should be readily accessible. Contaminated gloves, clothing, PPE, or other materials should be placed in appropriately labeled bags or containers until it is disposed of, decontaminated, or laundered. It is important to find out where these bags or containers are located in your area before beginning your work.
If you have a first aid kits in your classroom, make sure it contains latex gloves MINIMALLY! Other items you may wish to have are gloves, face shields, aprons, and goggles.
Remember to use universal precautions and treat all blood or potentially infectious body fluids as if they are contaminated. Avoid contact whenever possible, and whenever it's not, wear personal protective equipment. If you find yourself in a situation where you have to come in contact with blood or other body fluids and you don't have any standard personal protective equipment handy, you can improvise. Use a towel, plastic bag, or some other barrier to help avoid direct contact.

22. Housekeeping General housekeeping specifics:
Clean all equipment and surfaces contaminated immediately.
Do not pick up broken glass which may be contaminated with gloved or bare hands.
Place contaminated sharps and infectious wastes in designated containers.
Handle contaminated laundry as little as possible and with minimal agitation.

23. Hepatitis B Vaccine
The Hepatitis B Vaccine is available to all clinical staff at no cost.
3 injections over 6 month period.
85 – 97% effective at protecting you from getting the disease or becoming a carrier.

24. Hand Hygiene
Any exposed skin should be washed thoroughly as soon as possible.
Avoid harsh or abrasive soaps.
If washing facilities are not available, use waterless hand sanitizer.
Follow CDC hand hygiene guidelines.
Handwashing is one of the most important (and easiest) practices used to prevent transmission of bloodborne pathogens. Hands or other exposed skin should be thoroughly washed as soon as possible following an exposure incident. Use soft, antibacterial soap, if possible. Avoid harsh, abrasive soaps, as these may open fragile scabs or other sores. Hands should also be washed immediately (or as soon as feasible) after removal of gloves or other personal protective equipment.
Because hand washing is so important, you should familiarize yourself with the location of the hand washing facilities nearest to you. Laboratory sinks, public restrooms, janitor closets, and so forth may be used for hand washing if they are normally supplied with soap. If you are working in an area without access to such facilities, you may use an antiseptic cleanser in conjunction with clean cloth/paper towels or antiseptic towelettes. If these alternative methods are used, hands should be washed with soap and running water as soon as possible.
Hand washing is considered to be the most effective method of preventing transmission of BBPs

25. Emergency Procedures If you are exposed:
Don’t panic.
Wash needlesticks and cuts with soap/water.
Flush splashes to nose, mouth, or skin with water.
Irrigate eyes with clean water or saline.
Report the exposure immediately
Your risk of contracting disease is very low.
Exposure Control Plan in each office
In an emergency situation involving blood or potentially infectious materials, you should always use Universal Precautions and try to minimize your exposure by wearing gloves, splash goggles, pocket mouth-to-mouth resuscitation masks, and other barrier devices.
If you are exposed, however, you should:
Wash the exposed area thoroughly with soap and running water. Use non-abrasive, antibacterial soap if possible.
If blood is splashed in the eye or mucous membrane, flush the affected area with running water for at least 15 minutes.
Report the exposure to your supervisor as soon as possible.
You may also request blood testing or the Hepatitis B vaccination if you have not already received it.
Your risk of contracting disease is very low. If you are stuck with a needle contaminated with HBV contaminated blood, you have a 10% - 30% chance of developing HBV. If you are stuck with a needle contaminated with HCV contaminated blood, you have a 3% - 10% chance of developing HCV. If you are stuck with a needle contaminated with HIV contaminated blood, you have a 0.3% chance of developing HIV.

26. Sharps Prevention
One out of five healthcare workers sustain a needlestick injury every year. (800,000/year in US from needles/sharps).
5% During
device recapping
15% During
or related
to device
disposal
40%
During
device use
40%
After device
use, before disposal

27. Tuberculosis (TB)
Disease of the lungs caused by a bacterium Mycobacterium Tuberculosis.
Spreads when a person with active TB coughs, sneezes, speaks or sings.
Germs can stay in the air for several hours.
Latent TB-have TB germs in your body but they are not active. Cannot spread these germs to others.
Georgia ranked 9th highest rate of TB among 50 states based on case rates/ population in 2007.

28. Tuberculosis General Symptoms include: Weakness Weight loss Fever
Night Sweats
Coughing
Chest pain
Hemoptysis (coughing up blood)