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  • 2. (THIS USED TO BE TWO SEPARATETRAININGS)• This inservice will cover the basics of how to protectyourself from body substance “encounters” in the schoolsetting.• Most body substances can cause sickness.• The OSHA Bloodborne Standard addresses only diseasesspread by contact with blood.• This inservice will also address other body substances (suchas respiratory secretions, vomit, feces, etc.).
  • 3. We’ll cover:• Student and Staff Illnesses (The Top 8)• Blood Borne Pathogens– Hepatitis B, HIV/AIDS• Prevention and Screening– Tuberculosis, Vaccinations• What to do if exposed or injured• Confidentiality
  • 4. The Top 8 Hit Parade ofBad Bugs• Upper RespiratoryInfections (Colds)• Pink Eye• Head Lice• Influenza (flu)• Ringworm• Strep Throat• Chickenpox• Mononucleosis
  • 5. Tuberculosis• No annual screeningfor ASD employees• Airborne disease• No vaccine• Person can beinfected without anysigns or symptoms• TB germ “hibernates”in lungs for manyyears• A PPD skin test cantell if infection ispresent
  • 6. • In a public setting, there is no way toknow who is infectious with whatdisease or condition.• Some infections have no signs orsymptoms.• With some diseases a person isinfectious before she shows anysymptoms.• Treat every body substance as if itwere infectious.
  • 7. INFECTIOUS DISEASE PRECAUTIONSAPPLY TO:• Blood• All body substances with visible blood• All body fluids, secretions and excretions -except sweat - regardless of whether ornot they contain visible blood• Non-intact skin (chapped, cut, etc.)• Mucous membranes(mouth, eyes, nose, genitals)
  • 8. Infectious DiseasePrecautions• Treat ALL body substances (except sweat) as if they wereinfectious• Avoid cuts and other “sharps” injuries. Cover cuts that aren’thealed with a bandaid.• Put a barrier between yourself and others’ body substancesby using Personal Protective Equipment or “PPE”• Keep environmental surfaces clean– Bleach water is the best disinfectant (CDC) Use 1:100and make fresh daily.– Other commercial disinfectants available too
  • 9. Getting AroundHow do those nasty things do it?• Saliva, nasal and throat dischargesColds, flu, mono, chickenpox, cold sores, Hep B, TB• Blood– Hepatitis B and C, HIV, Cytomegalovirus• Vomit– Gastrointestinal germs• Feces– Hepatitis A, Salmonella, Shigella, Cytomegalovirus
  • 10. Getting Around, con’t•Semen & Vaginal Secretions–Sexually Transmitted Diseases; HIV,–Hepatitis B•Urine–Cytomeglavirus•Mother to unborn child–HIV; Hepatitis B; Herpes
  • 11. The Chain of Infection• For an infection tooccur, all must be present:• A germ (pathogen)• A source (a place for thegerm to live before itinfects)• Transmission ( a way forthe germ to get from thesource to the person)• Entry (where the germenters the body)• A susceptible host
  • 12. Breaking the Chain• Pink Eye– Wash your hands– Separate towels, washcloths– Throw out old makeup– See doctor for antibiotics• Respiratory Secretions– Cover your mouth– Cough into arm– Wash your hands– Throw out used tissues
  • 13. Breaking the Chain, con’t.• Headlice– Don’t sharecombs, hats– Pick out all nits• Ringworm– Keep lesion covered– Don’t sharetowels, clothes• Chickenpox &Herpes– Secretions arecontagious• Blood and BodyFluids– Put a barrierbetween you andthem– Use PPE
  • 14. 1910.1030(g)(2)(vii)(C)How are BBPs Spread?• DIRECTLY THROUGH SKIN - thru a cut or a break in theskin• THROUGH THE EYES OR MOUTH - by a directsplash/splatter to these surfaces• CONTAMINATED SURFACES - Hepatitis B virus can live upto a week on surfaces• SEXUAL CONTACT• INFECTED MOTHERS -passed to newborn during delivery orbreastfeeding• NOT inhaled, like cold germs
  • 15. Just what is the BloodbornePathogen Standard?• Enacted in 1990 by OSHA in response to AIDS concerns• Covers ALL employees (not just health care workers) whocould be exposed to blood on the job• Requires every employer to have an “exposure control plan”to protect its employees. Each plan must be tailored to itsindividual setting.• Copies of the OSHA Standard and the District’s ExposureControl Plan are in the nurse’s office.
  • 16. Prevention• Stay healthy!Healthy people havestronger immunesystems.– Recreate to reducestress– Don’t smoke– Stay current withvaccines– Eat well– Move! Do something!
  • 17. Prevention, con’t• Avoid BAD BUGS– Wash your hands. Don’t give germs a free ride into yourbody.– Put a barrier between you and body substances.– Remember, EVERYTHING you touch has been touched bysomeone else.• Get Immunized– Flu shots every year.– Hepatitis B if you could be exposed to blood.– Keep tetanus status current.– Talk to your doctor if traveling to 3rd world countries.(This includes parts of Mexico)
  • 18. Vaccine PreventableDiseases• Influenza• Measles, Mumps and Rubella (MMR)• Polio• Hepatitis A & B• Chickenpox• Tetanus, Diptheria & Pertussis• There are more vaccines for travelers. Check withyour doctor.
  • 19. What are “bloodbornepathogens”?These are viruses, found mostlyin blood, that can cause:HIV & AidsHepatitis BHepatitis C(and other diseases too)
  • 20. Some of you will stay formore detailed training aboutbloodborne pathogens.(The nurse will tell you who getsto stay and who can leave)
  • 21. In Conclusion:• Remember, student health information isconfidential• The single most important thing you can do toprevent the spread of germs is HANDWASHING.• If you have reason to think you have been exposedto a disease at school, tell the nurse.
  • 22. 1910.1030(g)(2)(vii)(D)Just what is the “BloodbornePathogen (BBP) Standard?”• A federal law enacted in 1990 by theOccupational Safety and Health Organization(“OSHA”)in response to AIDS concerns• Covers ALL employees (not just health careworkers) who could be exposed to blood on thejob• Requires every employer to have an “exposurecontrol plan” to protect its employees. Eachplan must be tailored to its individual setting.• Copies of the OSHA Standard and the ASDExposure Control Plan are in the nurse’s office.
  • 23. 1910.1030(g)(2)(vii)(E)Who does this apply toin the ASD?• Job classifications inwhich ALL employeeshave exposure:– Nurses– Noon Duties– Safety/Security– Coaches– DesignatedResponders• Job classifications inwhich SOMEemployees may haveexposure:– Teachers– Teachers’Assistants– Admin Assistants– Custodians
  • 24. 1910.1030(g)(2)(vii)(A)ASD Exposure Control Plan• A copy of the schoolplan, and of the actualOSHA regulation, is inthe nurse’s office.• The nurse can get youa copy, and explain itscontents.
  • 25. What are Bloodborne Pathogens?(or “BBPs”)• Viruses, bacteria, other micro-organisms presentin human bloodthat can causedisease:– HIV/AIDS– Hepatitis B– Hepatitis C– Malaria, syphilis
  • 26. 1910.1030(g)(2)(vii)(C)How are BBPs Spread?• DIRECTLY THROUGH SKIN - thru a cut or abreak in the skin• THROUGH THE EYES OR MOUTH - by a directsplash/splatter to these surfaces• CONTAMINATED SURFACES - Hepatitis B viruscan live up to a week on surfaces• SEXUAL CONTACT• INFECTED MOTHERS -passed to newborn duringdelivery or breastfeeding• They are NOT inhaled (like cold germs).
  • 27. 1913.1030(g)(2)(vii)(F)Universal Precautions• Wash your hands before and after gloving.• Treat ALL body substances (except sweat) as if they wereinfectious• Avoid cuts and other “sharps” injuries. Cover cuts that aren’thealed with a bandaid.• Put a barrier between yourself and others’ body substances byusing Personal Protective Equipment or “PPE”• Keep environmental surfaces clean– Bleach water is the best disinfectant (CDC) Use 1:100 and makefresh daily.– Other commercial disinfectants available too
  • 28. 1910.1030(g)(2)(vii)(B)Hepatitis B• A liver disease, usually without symptoms• Symptoms, when present, include:– Loss of appetite– Fever– Tiredness– Yellowing of skin and eyeballs– Nausea, vomiting and diarrhea– Dark urine– Pain in muscles, joints, swollen stomach
  • 29. 1910.1030(g)(2)(vii)(B)Hepatitis B, con’t• Highest incidence in 20-49 year olds• Incubation period is 45-180 days• Used to have 260,000 new infections annuallyin 1980’s; now down to 78,000• 1.25 million adults are chronic carriers• Chronic carriers have 274 x greater chance ofdeveloping liver cancer• Have a 6-30% risk of infection if exposed tovirus
  • 30. 1910.1030(g)(2)(vii)(I)Hepatitis B Vaccine• Free to allemployeesexposed to bloodon the job• Extremely safevaccine• 3 shots over 6months
  • 31. 1910.1030(g)(2)(vii)(I)Hepatitis B Vaccination Election orDeclination Form• All (potentially exposed) employees mustcomplete one• Either accept or refuse the Hepatitis BVaccine• If you want to start the vaccine, also fill outthe “Authorization for Hepatitis B VaccineSeries” form and fax to Risk Management• Risk Management must authorize• School nurse can advise where to get the shots
  • 32. 1910.1030(g)(2)(vii)(B)HIV Infection Signsand Symptoms• Flu-like illness occurring 1-6 weeks afterexposure• Rapid weight loss• Diarrhea lasting over a week• Pneumonia• Dry cough• Fever and/or night sweats• Swollen lymph glands in armpits, groin or neck• White spots on tongue• Blotches on the skin• Memory loss, depression
  • 33. 1910.1030(g)(2)(vii)(B)HIV/AIDS• Spread through blood, breast milk and sexualactivities• No vaccine• 0.3% infection rate• Does NOT survive on environmental surfaces• 816,000 cases of AIDS in US (CDC, 12/01)• HIV= Human Immunodeficiency Virus
  • 34. 1910.1030(g)(2)(vii)(B)Signs & Symptoms ofHepatitis C• 80% have no symptoms at all• 5% infection rate• Yellow skin & eyeballs• Dark urine• Tiredness• Abdominal pain• Loss of appetite• nausea
  • 35. 1910.1030(g)(2)(vii)(B)Hepatitis C (HCV)• No vaccine• 3.9 million Americans infected; 200 millionworldwide• 25,000 new infections a year in US• Number 1 cause of liver disease in US• Can have no symptoms for decades• Vietnam vets have 4xgreater incidence• Blood transfusion before July 1992 is biggest risk• Most infections now due to injection drug use• For every 1 person with HIV, there’s 4 with HCV
  • 36. 1910.1030(g)(2)(vii)(K)Exposure Incident Definition• A contact with blood or bloody fluid, to anymucous membrane (example =eyes, nose, mouth) orto broken, chapped or cut skin• A puncture wound from a used syringe, lancet orother sharp
  • 37. 1910.1030(g)(2)(vii)(J)What to do if an exposure occurs?• Immediately wash area/rinse eyes• Change clothes if necessary• Notify supervisor• Get medical evaluation at once• Document the incident• Supervisor informs Risk Management
  • 38. 1910.1030(g)(2)(vii)(L)Post exposure evaluation• Will be assessed forneed for HIV chemo-therapy• Hepatitis B statuswill be checked out• May have blooddrawn on yourselfand source• Counseling• No cost to employee• Confidential
  • 39. 1910.1030(g)(2)(vii)(G)Personal ProtectiveEquipment• Specialized clothing or equipment wornby employee for protection:– Gloves– CPR shield– Masks– Eye Protection– Face Shields– Gowns or aprons• Provided at no cost to employees
  • 40. 1910.1030(g)(2)(vii)(G)Examples of PPE
  • 41. 1910.1030(g)(2)(vii)(H)When to use PPE• Before any possible contact with a bodysubstance• If splashing or splattering is possible,protect your face with a mask and eyeprotection, or a shield. Protect yourclothes with an impervious gown or apron.• Dispose of PPE after task is completed.Don’t continue to wear soiled PPE.
  • 42. 1910.1030(g)(2)(vii)(E)Procedures that may involve exposure:• Giving injections(nurses)• First Aid & CPR• Personal care ofstudents with multipledisabilities• Clean up of blood spills• Student fights &altercations
  • 43. 1910.1030(g)(2)(vii)(F)Work Practice Controls• Work procedures tofollow to preventcontact with blood orOPIMs:– Handwashing– Training– Spills clean up– Handling ofsharps
  • 44. 1910.1030(g)(2)(vii)(F)ENGINEERING CONTROLS• Equipmentdesigned toprevent orminimize contactwith a bloodbornepathogen at work:– Sharps Container– Biohazard Signs– Handwashingfacilities
  • 45. 1910.1030(g)(2)(vii)(F)Decontamination• If area is heavily soiled, cover with thick papertowels.• Wearing gloves, wipe up the towels.• Clean surface with bleach solution or ASDapproved disinfectant. Allow to air dry.• If towels are dripping body fluids, dispose of inbiohazard container.
  • 46. 1910.1030(g)(2)(vii)(M)Universal Symbolfor Biohazards
  • 47. Regulated Waste(as defined by OSHA) thatMUST go into biohazard containers:• OPIM = “other potentially infectious materials”• Liquid or semi-liquid blood or body fluidscontaminated with blood• Contaminated items that would release bloodor OPIM in a liquid or semi-liquid state ifcompressed• Items that are caked with dried blood orOPIM that would release when handled• Contaminated sharps, syringes
  • 48. Regulated Waste, con’t• Regulated waste must be placed inregulated waste containers• Containers must beclosable, labeled or color-coded, and marked with thebiohazard symbol• Regulated waste will be incinerated• Call Risk Management for pickup
  • 49. Questions?