1. Bloodborne Pathogens Training
Columbus County
Schools
(August 2017)

2. INTRODUCTION Mandatory training for all CCS employees
Complies with OSHA
regulations
Purpose: to eliminate or minimize on-the-job exposure to blood & other potentially infectious materials which could cause disease

3. OBJECTIVES Bloodborne pathogens & diseases
Spread of bloodborne diseases
Tasks that may involve bloodborne pathogen exposure
Ways to reduce the chance of exposure
Hepatitis B Vaccine
Procedure to follow if exposure is suspected

4. What are Bloodborne Pathogens?
Microorganisms that are present in human blood and can cause disease.
Including, but not limited to:
Hepatitis B Virus (HBV)
Hepatitis C Virus (HCV)
Human Immunodeficiency Virus (HIV)
Ebola

5. What is Hepatitis B?
A serious disease that affects the liver caused by the Hepatitis B virus (HBV)
Can cause acute (short-term) illness
Loss of appetite
Tiredness
Pain in muscles, joints and stomach
Diarrhea and vomiting
Jaundice (yellow skin or eyes)
(Acute illness is more common among adults)

6. Hepatitis B (continued)
HBV can cause chronic (long-term) infection which can be very serious, and often leads to:
Liver damage (cirrhosis)
Liver cancer
Death
About 30% of persons have no signs or symptoms

7. How is Hepatitis B spread?
Hepatitis B virus is spread through contact with the blood or other body fluids of an infected person. A person can become infected by:
Contact with a mother’s blood and body fluids at the time of birth
Contact with blood through breaks in the skin such as bites, cuts, or sores

8. Spread of Hepatitis B (continued)
Contact with objects that could have blood on them such as toothbrushes or razors
Having unprotected sex with an infected person
Sharing needles when injecting drugs
Contact with contaminated tattoo and body piercing needles
Being stuck with a used needle on the job
HBV is durable and can survive in dried form on surfaces for at least 7 days (cdc.gov)

9. Hepatitis B Prevention
Get vaccinated against Hepatitis B
Wear gloves when touching blood
Cover any broken skin and rashes with bandages
Do not share razors or toothbrushes
Consider risk involved with tattoo or body piercing
Practice safe sex
Clean up blood spills with proper disinfectant
Good handwashing

10. What is Hepatitis C?
It is a virus that causes inflammation of the liver
It can cause liver cell damage that can lead to cirrhosis and cancer
It is a slow-progressing disease that may take years to cause serious liver damage in some people

11. How is Hepatitis C spread?
It is spread when infected blood from an infected person enters the body of a person who is not infected by:
Sharing needles
Needle sticks or sharps exposure on the job
Infected mother to newborn
Contact with contaminated toothbrushes, razors, tattoo and body piercing tools
Rarely spread through sexual contact

12. Hepatitis C Symptoms 80% of persons have no symptoms
If symptoms are present, they may be very mild and flu-like:
Nausea, fatigue, loss of appetite, fever, headaches, abdominal pain
Jaundice (yellowing of skin or whites of eyes)
Dark urine

13. Prevention of Hepatitis C
There is NO vaccine to prevent HCV
Wear gloves when touching blood
Use an approved disinfectant for blood spill clean-up (NABC or Eco-Lyzer)
Never share needles or syringes
Do not share personal care items such as razors, toothbrushes
Good handwashing

14. What is HIV? HIV is the virus that causes AIDS
AIDS stands for Acquired Immunodeficiency Syndrome
AIDS weakens the body’s immune system so that it cannot fight other deadly diseases.
AIDS is a fatal disease. There is no cure and no vaccine for AIDS.

15. How is HIV spread?
Can occur when blood, semen, vaginal fluid or breast milk enters the body of an uninfected person by:
Having unprotected sex with infected person
Sharing needles or injection equipment with infected person
From infected mother to unborn child, breastfeeding
Needle stick or sharps injury on the job
Infected blood comes in contact with a persons broken skin or by splash to mucous membranes of eyes, mouth, nose
HIV is NOT spread by casual contact.

16. Symptoms of HIV
The only way to know if you are infected with HIV is to be tested for HIV
Many people who are infected with HIV do not have any symptoms at all for many years.

17. HIV symptoms (continued)
Rapid weight loss
Dry cough
Recurring fever or profuse night sweats
Profound and unexplained fatigue
Swollen lymph glands
Diarrhea that lasts for more than a week
White spots or unusual blemishes on the tongue, in the mouth, or in the throat
Pneumonia
Red, brown, purplish blotches on skin or inside mouth, nose
Memory loss
Depression
Neurological disorders

18. Prevention of HIV Wear gloves when touching blood
Cover breaks in skin with bandages
Clean up blood spills with approved disinfectant
Needles and other sharp instruments should be handled very carefully
Dispose of needles in puncture-proof Sharps Container
Practice safe sex
Good handwashing

19. Workplace Transmission
Bloodborne Pathogens are spread through:
Infected human blood
Other potentially infectious materials (OPIM):
Body fluids containing visible blood
Semen
Vaginal secretions
Cerebrospinal fluid
Synovial fluid
Pleural fluid
Peritoneal fluid
Pericardial fluid
Amniotic fluid

20. Basics of Infections
All of these factors must be present for a potential exposure to occur:
Infected source must be present
Entry site must be present
Route of transmission must be present – such as a contaminated sharp object
Unprotected, susceptible person

21. Exposure Control Plan Designed to prevent BBP exposure
and to protect employees
Provides appropriate treatment and counseling if an exposure occurs
Copy of plan available:
School office
CCS website
Copy may be obtained by contacting:
Pupil Personnel Director
School Nurse

22. Exposure Control Plan Addresses: Employee responsibilities
Exposure determination
Safe work practices & engineering controls
Personal protective equipment
Housekeeping
Communication of hazards to employees
The Hepatitis B vaccination
Post exposure follow-up
Record keeping and surveillance

23. Employee Responsibilities
To comply with the guidelines of plan
To review the plan at least annually
Any employee who fails to follow the provisions of the plan:
May be retrained
May receive personnel counseling
May be subject to disciplinary action

24. How am I exposed at work?
Potential for transmission exist anytime there is “blood-to-blood” contact with infected blood or other potentially infectious materials
Direct transmission – through open cut, abrasion, sore, acne, broken skin, mucous membranes of the eyes, mouth, nose
Indirect transmission – touch contaminant and transfer to mouth, nose or open skin
Accidental injury – injure yourself with a contaminated sharp object such as broken glass, sharp metal, needle, or knife

25. Exposure Determination
Work environment is evaluated for actual and potential hazards for exposure
An identifying list of job classifications that have actual and collateral risk for occupational exposure has been made
Tasks have been identified with recommendations made to reduce the potential of exposure to blood through use of workplace controls and personal protective equipment

26. At-Risk positions (Category I)
“At-risk employees” means employees identified as being at risk for occupational exposure to blood and other potentially infectious materials (OPIM)
Because of their usual duties, they might be exposed to blood as an integral part of performing occupational tasks
It is reasonable to anticipate that exposure could occur

27. Category I Positions Principals/Assistant Principals Athletic Trainers
Coaches
Custodians
Diabetic Care Managers
First-Responders
School Nurses
EC Teachers and EC Teacher Assistants
Plumbers

28. Category II positions (possible risk of occupational exposure)
Biology/Chemistry lab teachers
Maintenance workers
Teachers, substitute teachers and teacher assistants
Cafeteria Staff
Pre-K teachers and teacher assistants
Bus Drivers
Secretaries (if responsible for first aid)
Shop/Trade/Industry teachers
Speech Therapists

29. Examples of tasks causing risks:
Emergency first aid
Handling contaminated laundry
Blood spill clean up
Waste disposal
Assisting with blood sugar monitoring
Administering CPR
Repair/handling contaminated
equipment

30. Examples of Protective barriers/engineering controls
Universal precautions
Use of personal protective equipment (gloves, masks, etc.)
Correct use of approved disinfectants
Use of appropriate disposal containers
Handwashing

31. Universal Precautions
Shall be observed to prevent contact with blood or other potentially infectious materials
If differentiation between blood and body fluid types is difficult or impossible, all body fluids shall be considered potentially infectious materials.

32. Handwashing When: Proper technique (Germ Buster sign)
must be performed as soon as possible to flush contaminated material from the skin adequately
after handling soiled items and equipment, immediately after gloves are removed
Proper technique (Germ Buster sign)
Antiseptic hand cleanser shall be provided when hand washing facilities is not feasible
(available from Pupil Personnel Services Director)

33. Contaminated Sharps Shall be handled with caution
Contaminated needles shall not be bent,
recapped or removed
Shearing or breaking of contaminated needles is prohibited
Immediately after use, contaminated sharps shall be placed in appropriate container for disposal (Sharps container)
Sharps container shall be easily accessible & located closely
to immediate area where sharps are being used
Container shall be puncture resistant, leak proof and labeled with biohazard warning symbol
Container shall be maintained upright throughout use and not be allowed to overfill

34. In areas of likely exposure:
Never eat, drink, apply cosmetics/lip balm, handle contact lenses, or put food or drink in refrigerators, freezers, shelves, cabinets or counter tops where blood or potentially infectious materials are present
Minimize blood splashing and splattering in emergency situations

35. Personal Protective Equipment (PPE)
Always protect yourself first before becoming exposed to blood or body fluids and have a barrier between you and the potentially infectious material
Always have PPE readily available and wear in exposure situations
Remove PPE that is torn, punctured or of poor quality
Put contaminated PPE in plastic lined container per waste disposal procedure

36. Gloves
Shall be worn when it can be reasonably anticipated that hand contact may occur with blood or other potentially infectious materials
Cover open cuts or sores on your hands before gloving
Single use gloves must be replaced ASAP when contaminated, torn or otherwise not fully protective.
Utility gloves may be decontaminated for reuse if in good condition.
Powderless, non-allergenic gloves shall be made available if needed
Keep gloves in top right hand desk drawer to ensure accessibility for substitute teachers

37. Glove removal technique
Remove contaminated gloves carefully – never touch the outside with bare skin
Dispose of them so that no one else will come into contact with them

38. Resuscitation devices
Mouthpieces, pocket masks or bag-valve mask devices must be used for CPR.

39. How do I get PPE items Gloves are available from each school office
CPR face shields are available at each school for designated first responders
Employee must take responsibility for replacing PPEs as needed (through school office)
Notify a school administrator, school nurse or Pupil Personnel Services Director if you need PPE items

40. Housekeeping Immediately call a custodian to clean
up and decontaminate surfaces that
come into contact with blood or other potentially infectious materials
An EPA-registered disinfectant solution must be used for blood clean up (NABC or Eco-Lyzer)
Treated surfaces must remain wet for 10 minutes
Gloves should always be worn for cleanup
Small spills –absorb blood with lots of paper towels or granular absorbent and then clean with approved disinfectant

41. Housekeeping (continued)
Large spills – flood area with disinfectant before cleaning, then clean with fresh disinfectant.
Mops, pails, sponges, utility gloves must be decontaminated with approved disinfectant
Broken glassware shall not be picked up directly with hands. Mechanical means must be used (broom and dust pan, tongs, etc.) and items must be placed in a rigid, puncture resistant container (e.g. sharps container, cardboard box).

42. Disposal of waste contaminated with blood and OPIM
The following procedures shall be followed for handling and disposal of such items that include, but are not limited to bloody bandages, gauze, dressings, sponges, paper towels, sanitary pads, swabs and used gloves or other PPE:

43. Waste disposal (continued)
Wear gloves
Place items in a leak proof plastic bag
Remove gloves using proper technique and place in the plastic bag with the contaminated items
Securely fasten the bag and place in a second plastic leak proof bag, also securely fastened, as an extra precaution
Dispose of as regular trash

44. When to use red biohazard bags:
For disposal of regulated waste including:
Items that would release blood or other OPIM in a liquid or semi-liquid state if compressed
Items that are caked with dried blood or OPIM and are capable of releasing these materials during handling

45. Use of red biohazard bags (continued)
Wear gloves
Place items in a red biohazard bag.
Remove gloves using proper technique and place in the biohazard bag with the contaminated items. Double bag items and secure closure of both bags.
Secure and close the bag to contain all contents and prevent leakage of fluids during handling, storage and transport.
If outside contamination of the bag occurs, it must be placed in a second bag or container.
The red biohazard bag shall be placed in an outside trash container to be picked up by the county sanitation department.

46. Contaminated Sharps Disposal
Shall be discarded immediately in
“Sharps Container”
Sharps container must be maintained upright throughout use, replaced when necessary and not be allowed to overfill.
Container shall be closed immediately prior to removal to prevent spillage or protrusion of contents
Contact school nurse for disposal of filled Sharps Containers

47. Biohazard Warning Label
Warning labels shall be affixed
to containers used to dispose of and store regulated waste

48. Contaminated Clothing
Wear gloves to handle contaminated clothing
Use universal precautions and minimal agitation at site where generated
Place clothing in a leak proof plastic bag for transport home or to laundering area
If degree of contamination meets regulated waste definition, a red biohazard bag should be used
Can be washed with regular laundry

49. What to do if exposed Remove PPE
Wash exposed area immediately with soap and running water
Flush exposed eye or mucous membranes with water
Immediately report the exposure to your supervisor, who will inform Pupil Personnel Services Director
The School Safety Officer will complete an Incident Report form
Take the completed form to Whiteville Urgent Care for a post-exposure medical evaluation

50. Hepatitis B Vaccine Provides 90% protection against HBV
Given as a series of 3 shots
Gives long-term protection from HBV infection, possibly lifelong
Very safe vaccine. Mild side effects may include soreness at injection site, elevated temperature
Severe problems extremely rare
Available at no cost to Category I employees at Columbus County Health Department(authorization by Pupil Personnel Services Director required)
Vaccine Titer
Only if complete vaccine series is provided by CCS
Test for Anti-HB within 1-2 months of vaccine completion.
If no response, repeat vaccine series and Anti-HB or employee to
be evaluated for HBsAg-positive status.

51. Who should NOT get the HBV Vaccine?
People who have ever had a life-threatening allergic reaction:
To baker’s yeast (the kind for making bread)
To a previous dose of Hepatitis B Vaccine

52. Questions
Contact your School Nurse or Dr. Heather Wing, Pupil Personnel Services Director
Employees with jobs listed as Category I positions, contact your school nurse or Pupil Personnel Services Director for Hepatitis B vaccine information

53. AED/Epi box (know the location)

54. Management of Anaphylaxis:
Emergency Epinephrine Auto-Injector Administration
Designated trained school personnel are authorized to use emergency epinephrine auto-injector devices to deliver emergency medical aid to any person suffering from an anaphylactic reaction during the school day or at a school-sponsored event of school property.
Designated trained school personnel are authorized to use emergency epinephrine auto-injector devices to deliver emergency medical aid to any person suffering from an anaphylactic reaction during the school day or at a school-sponsored event of school property.
IMMEDIATE ASSESSMENT:
Are the signs or symptoms SEVERE?
For any of:
LUNG: Short of breath, wheeze, repetitive cough
HEART: Pale, blue, faint, weak pulse, dizzy, confused
THROAT: Tight, hoarse, trouble breathing/swallowing
MOUTH: Obstructive swelling (tongue and/or lips)
SKIN: Many hives over body
Or combination of symptoms from different body areas:
SKIN: Hives, itchy rashes, swelling (e.g., eyes, lips)
GUT: Vomiting, cramping pain
Take Immediate Action
)INJECT EPINEPHRINE IMMEDIATELY
. Less than 66 lbs, give EpiPen Jr.
b. 66 lbs and greater, give EpiPen
)CALL 911
)Begin monitoring (see box below)
Monitor as below.
Observe for severe signs or symptoms – if any develop, take immediate action above.
Contact parent/guardian.
MILD SYMTOMS ONLY:
MOUTH: Itchy mouth
SKIN: A few hives around mouth/face, mild itch
Monitoring
Stay with student/person. Closely monitor the individual until EMS arrives. Perform CPR and maintain airway, if necessary. Keep the individual lying flat, raise legs and keep warm. If breathing is difficult or they are vomiting, let them sit up or lie on their side. If EMS has not arrived and symptoms persist, a repeat dose of Epinephrine auto-injector every 5-20 minutes after the first dose may be administered. The individual must be referred to a physician for medical evaluation, even if symptoms resolve completely. Symptoms may recur after the Epinephrine wears off, as much as 24 hours later.
Resources:

55. Diabetes Signs/Symptoms

56. Return to Learn/ Concussion Awareness