1. “Bloodborne Pathogens”
Danita Mullings

2. TOSHA believes the information in this presentation to be accurate and delivers this presentation as a community service. As such, it is an academic presentation which cannot apply to every specific fact or situation; nor is it a substitute for any provisions of 29 CFR Part 1910 and/or Part 1926 of the Occupational Safety and Health Standards as adopted by the Tennessee Department of Labor and Workforce Development or of the Occupational Safety and Health Rules of the Tennessee Department of Labor and Workforce Development.

3. Hepatitis and HIV

4. Hepatitis Hepatitis A Hepatitis B Hepatitis C Hepatitis D Hepatitis E
Viruses which attacks the liver
Liver performs many functions vital to life
Blood reservoir, blood filter, carbohydrate, fat, protein metabolism, storage of vitamins, iron, etc.

5. Hepatitis A Caused by infection with Hepatitis A virus NOT BLOODBORNE
Virus is found in the stool of infected persons
HAV is usually spread from person to person by putting something in the mouth (even though it may look clean) that has been contaminated with the stool of a person with hepatitis A
Occurs in epidemics both nationwide and in communities

7. Hepatitis A--Symptoms
Jaundice
Fatigue
Abdominal pain
Loss of appetite
Nausea
Diarrhea
Fever

8. Hepatitis A Prevention
Good personal hygiene and proper sanitation can help prevent hepatitis A
Always wash your hands with soap and water after using the bathroom, changing a diaper, and before preparing and eating food
Vaccine is available

9. Hepatitis B Caused by infection with Hepatitis B virus IS BLOODBORNE
Occurs when blood or body fluids from an infected person enters the body of a person who is not immune 
HBV is spread through
having sex with an infected person without using a condom (the efficacy of latex condoms in preventing infection with HBV is unknown, but their proper use may reduce transmission)
by sharing drugs, needles, or "works" when "shooting" drugs
from an infected mother to her baby during birth
through needlesticks, sharps exposures, blood splashes on the job,
Can cause lifelong infection, cirrhosis (scarring) of the liver, liver cancer, liver failure, and death

10. Hepatitis B Symptoms Jaundice Fatigue Abdominal pain Loss of appetite
Nausea, vomiting 
Joint pain

11. Hepatitis B--Prevention
A safe and effective vaccine is available
Use latex condoms correctly and every time you have sex. (The efficacy of latex condoms in preventing infection with HBV is unknown, but their proper use may reduce transmission.)
If you are pregnant, get a blood test for hepatitis B; Infants born to HBV-infected mothers should be given HBIG (hepatitis B immune globulin) and vaccine within 12 hours after birth.
Never share drugs, needles, syringes, or "works“
Do not share personal care items that might have blood on them (razors, toothbrushes)
At work, do not come into contact with another person’s blood or body fluids

12. Hepatitis C
Hepatitis C is a disease of the liver caused by the Hepatitis C virus (HCV)
IS BLOODBORNE
Occurs when blood or body fluids from an infected person enters the body of a person who is not infected 
HCV is spread through
having sex with an infected person without using a condom (the efficacy of latex condoms in preventing infection with HBV is unknown, but their proper use may reduce transmission)
by sharing drugs, needles, or "works" when "shooting" drugs, through needlesticks, sharps exposures, blood splashes on the job, or
from an infected mother to her baby during birth
through needlesticks, sharps exposures, blood splashes on the job,
Chronic infection: 55%-85% of infected persons
Chronic liver disease: 70% of chronically infected persons
Leading indication for liver transplant

13. Hepatitis C--Symptoms
Jaundice
Fatigue
Dark urine
Abdominal pain 
Loss of appetite
Nausea
80% of infected persons have no signs or symptoms

14. Hepatitis C--Prevention
There is no vaccine to prevent hepatitis C
Do not shoot drugs and never share needles, syringes, or "works"
Do not share personal care items that might have blood on them (razors, toothbrushes)
At work, do not come into contact with another person’s blood or body fluids

15. Hepatitis D
Hepatitis D is a liver disease caused by the hepatitis D virus (HDV)
It is a defective virus that needs the hepatitis B virus to exist

16. Hepatitis E
Hepatitis E is a liver disease caused by the hepatitis E virus (HEV)
NOT BLOODBORNE
It is transmitted in much the same way as hepatitis A virus
Hepatitis E does not occur often in the United States

17. Viral Hepatitis - Overview
Type of Hepatitis A B C D E
Source of
feces
blood/
blood/
blood/
feces
virus
blood-derived
blood-derived
blood-derived
body fluids
body fluids
body fluids
Route of
fecal-oral
percutaneous
percutaneous
percutaneous
fecal-oral
transmission
permucosal
permucosal
permucosal
Chronic no
yes
yes
yes no
infection
Prevention
pre/post-
pre/post-
blood donor
pre/post-
ensure safe
exposure
exposure
screening;
exposure
drinking
immunization
immunization
risk behavior
immunization;
water
modification
risk behavior
modification 3

18. HIV Human immunodeficiency virus
HIV can be passed from person to person if someone with HIV infection has sex with or shares drug injection needles with another person
It also can be passed from a mother to her baby when she is pregnant, when she delivers the baby, or if she breast-feeds her baby
Leads to disease AIDS
Destroys the immune system

19. HIV Symptoms
The symptoms are similar to the symptoms of many other illnesses
You might have HIV and still feel perfectly healthy
The only way to know for sure if you are infected or not is to be tested

20. HIV Prevention
Don’t share needles and syringes used to inject drugs, steroids, vitamins, or for tattooing or body piercing
Don’t share equipment ("works") used to prepare drugs to be injected
Use a latex condom to reduce the risk of STD transmission.
Don’t share razors or toothbrushes because of the possibility of contact with blood
If you are pregnant or think you might be soon, talk to a doctor or your local health department about being tested for HIV. Drug treatments are available to help you and reduce the chance of passing HIV to your baby if you have it
At work, do not come into contact with another person’s blood or body fluids

21. You Do Not Get Hepatitis B, C, or HIV
By working with or being around someone who has the disease
From sweat, spit, tears, clothes, drinking fountains, phones, toilet seats, or through everyday things like sharing a meal
From insect bites or stings
From donating blood
From a closed-mouth kiss (but there is a very small chance of getting it from open-mouthed or "French" kissing with an infected person because of possible blood contact)

22. Bloodborne Pathogens (BBPs)
Pathogenic micro- organisms present in human blood that can lead to diseases
Human immuno- deficiency virus (HIV)
Hepatitis B (HBV)
Hepatitis C (HCV)
I. Background for the Trainer:
Pathogens are disease-producing bacteria or microorganisms.
II. Speaker’s Notes:
OSHA defines bloodborne pathogens as pathogenic microorganisms present in human blood that can lead to diseases.
There are many disease-causing pathogenic microorganisms that are covered by this Standard; however, the most common and those of primary concern are:
Human immunodeficiency virus (HIV)
Hepatitis B (HBV)
Hepatitis C (HCV)

23. Other Bloodborne Pathogens
Syphilis
Malaria
Brucellosis
Babeosis
Leptospirosis
Arborviral Infections
Relapsing Fever
Creutzfeld-Jacobs Disease--Mad-cow
Viral Hemorrahgic Fever--Ebola

24. Universal Precautions
Must be observed
All blood and body fluids are treated as if known to be infected with HIV, HBV, HCV, etc.
Do not come into contact with another person's blood or body fluids

25. Potentially Infectious Materials--
Any visibly contaminated body fluid
Any body fluid where differentiation is difficult
Any unfixed tissue or organ
Aqueous and vitreous humors in the eyes
Blood
Semen
Vaginal secretions
Cerebrospinal fluid
Pleural fluid
Pericardial fluid
Peritoneal fluid
Amniotic fluid
Saliva in dental proc.

26. Other Body Fluids
These body fluids do NOT have enough virus in them to transmit disease UNLESS they are contaminated with blood
Urine
Feces
Tears
Sweat
Vomitus
Spit

27. Splash to Mucous Membranes
Modes of Transmission
Non-Intact Skin
Stick or Cut
Splash to Mucous Membranes

28. Exposure Control Plan
Employer's plan describing how compliance with the standard is achieved
Describes what employees are covered
Describes tasks that are covered
Describes post-exposure follow-up procedures
Must be reviewed and updated annually
Must be accessible to employees
Everyone should know the procedure to follow to obtain a copy

29. Handwashing The single most important aspect of infection control
Wash hands when contaminated with blood or body fluids and after removing gloves
Use antiseptic hand cleaner clean paper/cloth towels or antiseptic towelettes when "in the field"
Wash hand with soap and water asap

30. Needles/Sharp Objects
Use sharps with sharps injury prevention or needleless systems
Place in puncture resistant, labeled, leak-proof containers for transport, storage, and/or disposal
Keep the container closed
Do not bend, break, recap, or remove needles
Do not pick up contaminated broken glass directly with the hands
Do not reach by hand into containers where contaminated sharps are placed

33. Eating/Drinking
Do not eat or drink in areas where there is exposure to blood or body fluids
Do not store food in refrigerators, freezers, cabinets, on shelves or countertops where blood or other body fluids are present

34. Personal Protective Equipment (PPE)
Wear PPE to prevent blood or body fluids from getting on your clothes, skin, underclothes, etc.
Must be provided at no cost to the employee
Employer must enforce the use
Must be removed prior to leaving the work area and placed in designated area

35. PPE Parental exposure Mucous membrane Non-intact skin stick or cut
splash
Non-intact skin
spill or splash

36. Decontamination
Clean and decontaminate all equipment and environmental and working surfaces after contact with blood and/or body fluids
Decontaminate with appropriate disinfectant
EPA registered tuberculocidal disinfectant
EPA registered disinfectant with label stating it is effective against HIV and HBV
Household bleach, diluted 1:10-1:100, made fresh daily

37. Contaminated Laundry
Remove contaminated clothing when it becomes contaminated
Place immediately in bag or container that is labeled
Prevent leakage

38. Hepatitis B Vaccination
Your employer must offer you the HBV vaccination after you have received training and within 10 working days of job assignment
At no cost
Provided by PLHCP
According to US Public Health Service most current recommendations
“Immunization of Health Care Workers: Recommendations of ACIP and HICPAC,” MMWR, Vol. 46, No. RR-18

39. HBV Vaccination
Sign a declination statement if do not want to take the shots
Highly recommended
Few contraindications
Three-shot series
No booster currently recommended
Each employee should be given a health care professional’s written opinion as to whether it is safe for YOU to take the shots and whether or not you did
Can decline now, take the shots later

40. Post-Exposure Follow-up
After exposure incident
Stick or cut
Splash
Non-intact skin exposure
At no cost
Begin ASAP after exposure incident
Report exposure incident to your supervisor or designated personnel immediately

41. Post-Exposure Follow-up
Investigation of the incident
ID source individual, obtain consent, and test their blood to determine HBV, HCV, and HIV infectivity ASAP
Results of source individual's test given to exposed person
Obtain and test exposed person's blood for HBV, HCV, and HIV serological status

42. Post-Exposure Follow-up
Post-exposure prophylaxis as indicated by CDC
Counseling
Evaluation of reported illnesses
According to U.S. Public Health Service Guidelines
HIV--“Updated U.S. Public Health Service Guidelines for the Management of Occupational Exposures to HIV and Recommendations for Postexposure Prophylaxis,” September 30, 2005, Vol 54, RR-09
HBV, HCV--“Updated U.S. Public Health Service Guidelines for the Management of Occupational Exposures to HBV, HCV, and HIV and Recommendations for Postexposure Prophylaxis” June 29, 2001, Vol 50, No. RR-11

43. Written Opinion
Employee will be provided a copy of the Health Care Professional's Written Opinion for Post-Exposure Follow-up within 15 days of completion of the evaluation

45. Labels
Containers with contaminated items
Can substitute red

46. Training
Before exposure
Annually
At no cost

47. Records Medical records Name and social security number
HBV vaccination status
Results of exposure incident follow-up
Health care professional's written opinions
Info provided to health care professional
Confidential

48. Records Training Dates Contents Names and qualifications of trainers
Names and titles of persons attending

49. What’s Wrong Here?

58. Resources www.osha.gov www.tennessee.gov/labor-wfd/tosha www.cdc.gov
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Jackson Office
Nashville Office
Knoxville Office
Kingsport Office
Chattanooga
Consultative Services