1. Protecting Employees from Bloodborne Pathogens

2. Course Objectives After completion of this course, attendees should be able to: Discuss the components of Occupational Health and Safety Administration (OSHA) Bloodborne Pathogen Standard Describe HIV, hepatitis B and hepatitis C Review occupational risks for exposure to bloodborne diseases Discuss engineering and work practice controls Describe appropriate personal protective equipment Define an occupational exposure, discuss the steps to take if you are exposed

3. By definition, ALFs are non-medical facilities that provide assistance with activities of daily living. By design, ALFs provide unique services to residents who want to live as independently as possible for as long as possible. By day, many of these services carry the risk of acquiring a serious disease. Assisted Living Facilities (ALFs)

4. Your Risks Caring for the needs of your residents may expose you to bloodborne pathogens when: Assisting with bathing and oral care Performing dressing changes Monitoring blood glucose Performing injections Managing nose bleeds and abrasions Handling diapers, linens, and trash Cleaning rooms, common areas, and equipment Cleaning blood/body fluid spills

5. The Facts Anyone, regardless of age, race, or socioeconomic status, can carry a bloodborne disease. Often, without knowing it.

6. Bloodborne Pathogens Standard (BBP) Written by the Occupational Safety and Health Administration (OSHA) – Title 29 of the Code of Federal Regulations (29 CFR 1910.1030) Purpose: To protect you and reduce your risks for occupational exposure to disease Describes policies and practices that employers must establish to protect employees who have contact with blood/body fluids in their job

7. Bloodborne Pathogens Standard (BBP) The Bloodborne Pathogens Standard describes important strategies that can reduce the risk of infection on the job. These include: Exposure Control Plan Engineering Controls Work Practice Controls Standard Precautions/Personal Protective Equipment Housekeeping Hepatitis B Vaccine Occupational Exposure Follow-up

8. Bloodborne Pathogens Bloodborne pathogens are diseases that are carried in the blood and can be transmitted by contact with infected blood. The most common include: Hepatitis B Hepatitis C HIV

9. Hepatitis B Serious liver disease Most cases resolve, 10% of adult cases can be chronic 800,000 - 1.4 million chronically infected 43,000 new cases in 2007 30% of people infected don’t have symptoms Treatment available to keep the virus under control

10. Hepatitis B Symptoms include loss of appetite, fatigue, jaundice, abdominal pain, and nausea Healthcare workers (HCW) are at increased risk Can be prevented by vaccination Treatment available to keep the virus under control

11. Hepatitis C Serious liver disease 17,000 new infections in 2007 (estimated) Many people do not have symptoms for 20 years after first infected 3.2 million chronically infected Chronic infection: 75-85% of cases

12. Hepatitis C Increased risk for liver cancer 60-70% of cases develop chronic liver disease Treatment available to keep the virus under control No vaccine available

13. HIV Disease that causes the immune system to lose its ability to fight infection 1.1 million infected (1 in 5 undiagnosed) Chronic infection Some people progress to Acquired Immunodeficiency Syndrome (AIDS) Clinical symptoms vary; initial infection may cause flu-like illness Antiviral medications available to treat illness No vaccine available

14. Transmission Bloodborne pathogens are spread by contact with blood and other potential infectious materials such as: Semen and vaginal fluids Cerebrospinal fluid (spinal cord) Synovial (joint) and pleural fluid (lung) Peritoneal (abdominal), pericardial (heart), and amniotic fluid (uterus) Saliva (dental procedures)

15. Bloodborne pathogens can enter the body in a variety of ways, including: Needles Broken glass (broken blood tubes) Non-intact skin exposure through cuts, skin abrasions, and mucous membranes of mouth, eyes and nose Touching your mouth, eyes, nose or open skin after touching surfaces or equipment contaminated with blood or contaminated body fluids Transmission

16. Transmission Risk Risk of infection depends on: The pathogen involved The type/route of exposure The amount of virus in the infected blood/body fluid at the time of exposure The amount of infected blood/body fluid involved in the exposure Specific immune response of the individual who was exposed Presence and timeliness of post-exposure treatment

17. Transmission Risk Risk of infection following an occupational needlestick or cut from a known positive source: HBV:6% - 31% HCV: 1.8% HIV: 0.3%

18. Exposure Control Plan The Plan is a document that describes how your employer will address the components of the Bloodborne Pathogens Standard. It includes: Who is covered under the standard Ways to reduce the risk of exposure Procedures to follow if there is an occupational exposure.

19. Engineering Controls Systems or mechanical devices that minimize hazards in the workplace. Examples: Self-sheathing or retractable needles Sharps disposal containers

20. Engineering Controls Sharps safety rules Use needles with safety devices Never recap, break or bend needles Never leave needles unattended Never reuse disposable sharps Dispose of all needles in a regulated, color-coded, labeled sharps container Sharps containers should be changed when ½ - ¾ full.

21. “One-Hand” or “Scoop” Technique Step 1: Place the cap on a flat surface, then remove your hand from the cap Step 2: With one hand, hold the syringe and use the needle to “scoop up” the cap Step 3: When the cap covers the needle completely, use the other hand to secure the cap on the needle hub. Be careful to handle the cap at the bottom only (near the hub).

22. Work Practice Controls Practices in the workplace that protect you from disease and prevent transmission to your residents and coworkers. These include: Hand hygiene Personal hygiene Personal protective equipment

23. Work Practice Controls: Hand Hygiene Hand hygiene includes both hand washing and the use of alcohol-based hand gels. Hand washing involves the use of soap, water, friction, and drying. Alcohol-based hand gels decontaminate hands by removing organisms on the skin.

24. Work Practice Controls Hand Hygiene Hand hygiene is appropriate: – Between residents – Every time you remove your gloves – Before and after entering a resident’s room – Whenever hands are in contact with blood or other body fluids, WASH THEM IMMEDIATELY Artificial nails should not be worn; natural nails should be no longer than ¼ inch

25. Work Practice Controls: Personal Hygiene Self-protective practices that protect you from disease: Do not leave food and drinks in refrigerators, freezers or on counter tops where blood or potentially infectious materials can be present, e.g., nurses station Do not use petroleum-based lubricants with latex gloves Do not eat, drink, apply cosmetics, or handle lip balm in an area where you might be exposed to blood or body fluids

26. Standard Precautions A set of precautions designed to protect staff and residents from exposure to disease Use for ALL residents, ALL body fluids, ALWAYS Includes: – Hand hygiene – Personal protective equipment (PPE), including resuscitation devices – Safe injection practices – Sharps injury prevention – Care of environment – Cleaning of care equipment – Respiratory hygiene/cough etiquette – Handling of linen and regulated medical waste – Special lumbar puncture procedures – Patient/resident placement

27. Personal Protective Equipment Protective wear that serves as a barrier between you and blood/body fluids: Gloves Gowns Masks Goggles/Face shields Resuscitation devices

28. Protective Equipment Varies with task Maintained, replaced, and disposed of by facility Fit properly Supplied at no cost to employee Free of flaws Facility must offer training on use Must be cleaned carefully and as soon as possible to prevent contamination Utility gloves can be reused if not damaged

29. Housekeeping Facility cleaning schedule Procedure for cleaning up blood spills Use standard precautions when handling all linen (including sheets, clothes) Regulated medical waste policy/procedure

30. Hepatitis B Vaccine Single most significant factor in preventing hepatitis B infection in healthcare workers Must be offered to all employees who have exposure to blood or body fluids on the job Safe, effective Series of three shots Long-term immunity

31. Occupational Exposure: Immediate Response If you should get stuck by a needle or if you have direct skin or mucous membrane contact with blood or other body fluids, you will be provided with counseling and follow-up care. Exposures should be reported immediately (within two hours) so that appropriate care can be initiated.

32. Occupational Exposure: Post-Exposure Counseling and Follow-up Don’t panic Wash the area with soap and water Flush eyes or mucous membranes with water Report the incident immediately to your supervisor and record date and time of incident

33. Occupational Exposures You will be offered counseling by trained medical staff to determine your risk of acquiring a bloodborne disease If there is a risk, appropriate testing and follow-up of the patient and employee will be initiated Keep all follow-up appointments

34. Education Training in the BBP Standard is required upon hire and annually thereafter Training must be conducted by a person who is knowledgeable in the subject Training must be offered at a convenient location and on company time Training records must be kept at least 3 years

35. Recordkeeping Medical records must be maintained for the length of employment plus 30 years Sharps injury log must be maintained for 5 years from the date of exposure – Type and brand of device involved – Department or area of incident – Description of incident

36. Summary The Bloodborne Pathogen Standard applies to anyone who has exposure to blood/body fluids while performing job duties. Your employer must provide engineering and workplace controls to help prevent occupational exposure, including personal protective equipment and safe needle devices. The hepatitis B vaccine must be offered to anyone who has exposure to blood and body fluids while performing their regular job duties.

37. Summary Occupational exposures should be reported immediately to your supervisor because follow-up testing should be initiated as soon as possible. You are responsible for following the policies and procedures written by your employer and for using the safety measures available to you to reduce your risk of exposure to bloodborne diseases.

38. Self Test (True or False) 1. The Bloodborne Pathogens Standard covers anyone who has the potential for contact with blood while working. 2. HIV, HBV, and HCV may cause no obvious symptoms. 3. Standard Precautions should be used with ALL residents.

39. 4. Used needles and syringes should always be placed in a regulated sharps container. 5. Every employee is responsible for following the BBP Standard when performing job duties that require contact with blood and body fluids. 6. Training in the BBP Standard is only required upon hire. Self Test (True or False)

40. Resources Centers for Disease Control and Prevention – http://www.cdc.gov/HAI/organisms/organisms.html http://www.cdc.gov/HAI/organisms/organisms.html Occupational Safety and Health Administration – http://www.osha.gov/SLTC/bloodbornepathogens/index.html http://www.osha.gov/SLTC/bloodbornepathogens/index.html Virginia Department of Health – Contact your local health department (http://www.vdh.virginia.gov/lhd/) – Office of Epidemiology, Division of Surveillance and Investigation (804) 864-8141 Department of Environmental Quality – http://www.deq.state.va.us/ http://www.deq.state.va.us/