Blood Borne Pathogens

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Blood Borne Pathogens

  1. 1. WELCOMEWELCOME
  2. 2. OSHAOSHA UPDATEUPDATE 20122012 BLOODBORNE PATHOGENSBLOODBORNE PATHOGENS
  3. 3. Rock Hill SchoolsRock Hill Schools
  4. 4. OBJECTIVESOBJECTIVES  To have a basic understanding ofTo have a basic understanding of bloodborne pathogens and the role ofbloodborne pathogens and the role of OSHA.OSHA.  To understand how to report anTo understand how to report an exposure.exposure.  To understand the role of the employeeTo understand the role of the employee in an exposure.in an exposure.  To properly dispose of medical waste.To properly dispose of medical waste.
  5. 5. WHY TRAIN?WHY TRAIN? 1.1. Through education and understanding, theThrough education and understanding, the employee will be protected and the risk ofemployee will be protected and the risk of an exposure can be reduced.an exposure can be reduced. 2.2. IT IS AN OSHA FEDERAL and STATEIT IS AN OSHA FEDERAL and STATE REQUIREMENTREQUIREMENT
  6. 6. WHAT IS OSHA?WHAT IS OSHA? OCCUPATIONALOCCUPATIONAL SAFETY ANDSAFETY AND HEALTHHEALTH ADMINISTRATIONADMINISTRATION
  7. 7. OSHA STANDARDOSHA STANDARD ADDRESSESADDRESSES:: RULES FOR PROTECTINGRULES FOR PROTECTING WORKERS FROM OCCUPATIONALWORKERS FROM OCCUPATIONAL EXPOSURE TO BLOOD ANDEXPOSURE TO BLOOD AND CERTAIN OTHER BODY FLUIDSCERTAIN OTHER BODY FLUIDS POTENTIALLY CONTAININGPOTENTIALLY CONTAINING BLOODBORNE PATHOGENS.BLOODBORNE PATHOGENS.
  8. 8. SCHOOL DISTRICT’S EXPOSURESCHOOL DISTRICT’S EXPOSURE CONTROL PLAN (ECP) MUST BECONTROL PLAN (ECP) MUST BE BASED ON :BASED ON : 29 CFR 1910.103029 CFR 1910.1030 BloodborneBloodborne Pathogens StandardPathogens Standard Federal Register - December 6, 1991Federal Register - December 6, 1991
  9. 9. EXPOSURE CONTROLEXPOSURE CONTROL PLAN is written to:PLAN is written to:  MINIMINZE exposure to blood andMINIMINZE exposure to blood and other potentially infectious materialsother potentially infectious materials (OPIM)(OPIM)  MANAGE exposures properly andMANAGE exposures properly and medicallymedically  DESCRIBE engineering and workDESCRIBE engineering and work practice controls which reduce risk.practice controls which reduce risk.
  10. 10. SCHOOL EXPOSURESCHOOL EXPOSURE CONTROL PLANCONTROL PLAN  Must be reviewed and updated at leastMust be reviewed and updated at least annually and whenever necessary toannually and whenever necessary to reflect new or modified tasks andreflect new or modified tasks and procedures which affect occupationalprocedures which affect occupational exposure and to reflect new or revisedexposure and to reflect new or revised employee positions with occupationalemployee positions with occupational exposure.exposure.
  11. 11. At the time of initial assignment toAt the time of initial assignment to tasks where occupational exposuretasks where occupational exposure may take place (e.g. upon hire)may take place (e.g. upon hire) ANNUALLY for employees inANNUALLY for employees in positions with occupational exposurepositions with occupational exposure BBP TRAINING ISBBP TRAINING IS MANDATORY!!MANDATORY!!
  12. 12. BBP TRAINING INCLUDES:BBP TRAINING INCLUDES:  NEW HIRE EDUCATION ANDNEW HIRE EDUCATION AND TRAININGTRAINING  ANNUAL EDUCATION AND TRAININGANNUAL EDUCATION AND TRAINING  AVAILABILITY OF PPEAVAILABILITY OF PPE  OFFERING OF HEPATITIS B TO ATOFFERING OF HEPATITIS B TO AT RISK EMPLOYEESRISK EMPLOYEES  PROPER REPORTING OFPROPER REPORTING OF NEEDLESTICK AND BLOOD/BODYNEEDLESTICK AND BLOOD/BODY FLUID EXPOSURESFLUID EXPOSURES
  13. 13. OFFERING HEPATITIS BOFFERING HEPATITIS B IMMUNIZATIONIMMUNIZATION  High risk employees determined by LocalHigh risk employees determined by Local Education Agency (LEA) policyEducation Agency (LEA) policy  BBP Training – offer Hep B series within 10BBP Training – offer Hep B series within 10 days of BBP training (OSHA)days of BBP training (OSHA)  Hep B Series: 0 – 1 month – 5 monthsHep B Series: 0 – 1 month – 5 months  Hep B Titer: 4 to 6 weeks post 3Hep B Titer: 4 to 6 weeks post 3rdrd vaccinevaccine  FormsForms – ConsentConsent – Refusal /DeclinationRefusal /Declination ((OSHA 1910.1030 Appendix A) – Vaccine Information Statement (CDCVaccine Information Statement (CDC))
  14. 14. NO DIFFERENCE INNO DIFFERENCE IN STATUSSTATUS ALL AT RISK EMPLOYEESALL AT RISK EMPLOYEES DEPENDING ON JOBDEPENDING ON JOB DESCRIPTIONDESCRIPTION  PART TIMEPART TIME  FULL TIMEFULL TIME  TEMPORARYTEMPORARY  ““Per Diem” or “Leased” Healthcare WorkersPer Diem” or “Leased” Healthcare Workers
  15. 15. REVIEW SOME TERMS THATREVIEW SOME TERMS THAT ARE LOCATED IN THE ECPARE LOCATED IN THE ECP  STANDARD PRECAUTIONSSTANDARD PRECAUTIONS  AT-RISK EMPLOYEESAT-RISK EMPLOYEES  PPEPPE  WORK PRACTICE CONTROLSWORK PRACTICE CONTROLS  ENGINEERING CONTROLSENGINEERING CONTROLS  OPIMOPIM  PEPPEP
  16. 16. STANDARD PRECAUTIONSSTANDARD PRECAUTIONS  TREAT ALL BLOOD ANDTREAT ALL BLOOD AND BODY FLUIDS AS IF THEYBODY FLUIDS AS IF THEY ARE KNOWN TO BEARE KNOWN TO BE INFECTIOUSINFECTIOUS
  17. 17. AT-RISK EMPLOYEESAT-RISK EMPLOYEES  Those employees who byThose employees who by nature of task have the potentialnature of task have the potential to be exposed to blood, bodyto be exposed to blood, body fluids or other potentiallyfluids or other potentially infectious materials.infectious materials.
  18. 18. PPE = PERSONALPPE = PERSONAL PROTECTIVE EQUIPMENTPROTECTIVE EQUIPMENT  GLOVESGLOVES  MASKSMASKS  EYE PROTECTIONEYE PROTECTION  FACE SHIELDSFACE SHIELDS  RESPIRATORS – WHAT KIND?RESPIRATORS – WHAT KIND?  GOWNS, APRONS, LAB COATGOWNS, APRONS, LAB COAT
  19. 19. WORK PRACTICEWORK PRACTICE CONTROLSCONTROLS  HAND WASHINGHAND WASHING  PROPER USE OF SHARPSPROPER USE OF SHARPS CONTAINERCONTAINER  STORAGE and SHIPPING ofSTORAGE and SHIPPING of CONTAMINATED EQUIPMENTCONTAMINATED EQUIPMENT  NO EATING, DRINKING, SMOKING,NO EATING, DRINKING, SMOKING, HANDLING CONTACT LENSES andHANDLING CONTACT LENSES and APPLYING MAKE-UP at work areas,APPLYING MAKE-UP at work areas, including school health officeincluding school health office
  20. 20.  RESPIRATORRESPIRATOR  MEDICAL SAFETY DEVICESMEDICAL SAFETY DEVICES  SHARPS CONTAINERS –SHARPS CONTAINERS – DISINFECTANTSDISINFECTANTS ENGINEERING CONTROLSENGINEERING CONTROLS
  21. 21. OPIM = OTHER POTENTIALLYOPIM = OTHER POTENTIALLY INFECTIOUS MATERIALINFECTIOUS MATERIAL ANY BODY FLUID THAT ISANY BODY FLUID THAT IS GROSSLY CONTAMINATED WITHGROSSLY CONTAMINATED WITH BLOOD OR ANY INTERNAL BODYBLOOD OR ANY INTERNAL BODY CAVITY FLUIDCAVITY FLUID
  22. 22. PEP = POST EXPOSUREPEP = POST EXPOSURE PROPHYLAXISPROPHYLAXIS  MEDICATION REGIMEN AVAILABLEMEDICATION REGIMEN AVAILABLE TO EXPOSED PERSON IF SOURCETO EXPOSED PERSON IF SOURCE IS POSITIVE FOR:IS POSITIVE FOR: – HEP B – NON-RESPONDER (HEP BHEP B – NON-RESPONDER (HEP B VACCINE = IMMUNITY)VACCINE = IMMUNITY) – HIV – SEVERAL MEDICATIONSHIV – SEVERAL MEDICATIONS AVAILABLEAVAILABLE – HEP C – NO PEP AVAILABLEHEP C – NO PEP AVAILABLE
  23. 23. Infectious Waste BiohazardInfectious Waste Biohazard SymbolSymbol
  24. 24. BBP’s: BLOOD/BODYBBP’s: BLOOD/BODY FLUIDSFLUIDS If saliva, tears, urine, feces,If saliva, tears, urine, feces, vomitus, sweat or sputum isvomitus, sweat or sputum is grossly bloody then . . . it isgrossly bloody then . . . it is considered contaminated.considered contaminated. OtherwiseOtherwise NONO risk (Not a BBPrisk (Not a BBP Exposure).Exposure).
  25. 25. FACTORS INCREASINGFACTORS INCREASING TRANSMISSION PROBABILITY OFTRANSMISSION PROBABILITY OF BBPBBP (CDC1995)(CDC1995)  DEEP INJURYDEEP INJURY  VISIBLE BLOOD ON DEVICEVISIBLE BLOOD ON DEVICE  DEVICE PLACED DEEPLY IN VEIN ORDEVICE PLACED DEEPLY IN VEIN OR ARTERYARTERY  TERMINAL ILLNESS IN SOURCE (DEATHTERMINAL ILLNESS IN SOURCE (DEATH FROM AIDS WITHIN 2 MONTHS OFFROM AIDS WITHIN 2 MONTHS OF EXPSOURE)EXPSOURE)  LARGE VOLUME OF BLOODLARGE VOLUME OF BLOOD AAOHN JOURNAL, JANUARY 2003.AAOHN JOURNAL, JANUARY 2003.
  26. 26. ELEMENTS OF ANELEMENTS OF AN INFECTIONINFECTION THREE ELEMENTS NEEDED FOR ANTHREE ELEMENTS NEEDED FOR AN INFECTION:INFECTION: 1.1. HOSTHOST 2.2. INFECTIOUS DOSEINFECTIOUS DOSE 3.3. ROUTE OF ENTRYROUTE OF ENTRY
  27. 27. TERMINOLOGY:TERMINOLOGY: “EXPOSUREEXPOSURE” = a behavioral event/ incident (e.g. needle stick, mucous membrane splash) “INFECTIONINFECTION” = a biologic/ immunologic event (i.e. growth of organism, antibody response = seroconversion) “DISEASEDISEASE” = a clinical event (i.e., symptoms and/or signs of the infection) R. Ball, MD, MPH
  28. 28. WHAT IS HEPATITIS B?WHAT IS HEPATITIS B?  VIRAL INFECTION OF THE LIVERVIRAL INFECTION OF THE LIVER  SYMPTOMS - NONESYMPTOMS - NONE/MILD//MILD/SEVERESEVERE  CHRONIC CARRIERS (5%) CAN DEVELOPCHRONIC CARRIERS (5%) CAN DEVELOP CHRONIC LIVER DISEASE AND CANCHRONIC LIVER DISEASE AND CAN INFECT OTHERSINFECT OTHERS  95% SPONTANEOUS RESOLUTION95% SPONTANEOUS RESOLUTION  INCUBATION PERIOD – AVERAGE 60-90INCUBATION PERIOD – AVERAGE 60-90 DAYS. RANGE 45-180 DAYS.DAYS. RANGE 45-180 DAYS.  HEPATITIS B VACCINE – PROVIDESHEPATITIS B VACCINE – PROVIDES IMMUNITY IN MAJORITY – MAY HAVEIMMUNITY IN MAJORITY – MAY HAVE NON-RESPONDERSNON-RESPONDERS
  29. 29. WHAT IS HEPATITIS C?WHAT IS HEPATITIS C?  VIRAL INFECTION OF THE LIVERVIRAL INFECTION OF THE LIVER  CAN LEAD TO CIRRHOSIS AND CANCER.CAN LEAD TO CIRRHOSIS AND CANCER.  LEADING INDICATOR FOR LIVERLEADING INDICATOR FOR LIVER TRANSPLANTTRANSPLANT  FLU-LIKE SYMPTOMS OR NO SYMPTOMSFLU-LIKE SYMPTOMS OR NO SYMPTOMS  INCUBATION PERIOD – AVERAGE 6-7INCUBATION PERIOD – AVERAGE 6-7 WEEKS. RANGE 2-26 WEEKS.WEEKS. RANGE 2-26 WEEKS.  NO VACCINE OR PEP AVAILABLE.NO VACCINE OR PEP AVAILABLE.
  30. 30. HEPATITIS C VIRUSHEPATITIS C VIRUS  CLINICALCLINICAL:: – 60-70% - No Symptoms60-70% - No Symptoms – 10-20% - Mild Symptoms10-20% - Mild Symptoms – 20-30% - Symptoms (Jaundice)20-30% - Symptoms (Jaundice)  ~85% become chronic (lifelong)~85% become chronic (lifelong) carriers!carriers!
  31. 31. HEPATITIS C VIRUSHEPATITIS C VIRUS  RISK FACTORSRISK FACTORS  (90% New Acute Hep C) – diagnosed cases(90% New Acute Hep C) – diagnosed cases – Injecting drug use (~60%) > sexualInjecting drug use (~60%) > sexual exposures (15%) > transfusions (1% -exposures (15%) > transfusions (1% - prev. 10% prior to 1992) >prev. 10% prior to 1992) > occupationaloccupational (HCWs – 1-2%)(HCWs – 1-2%) >> unknown (10-20%)unknown (10-20%)  ~3-4 million chronic carriers in USA (CDC)~3-4 million chronic carriers in USA (CDC)  ~36, 000 new infections annually in US~36, 000 new infections annually in US  50,000 - 70,000 cases estimated in South50,000 - 70,000 cases estimated in South CarolinaCarolina
  32. 32. WHAT IS HIV?WHAT IS HIV? HIV=VIRUS THAT CAUSES AIDSHIV=VIRUS THAT CAUSES AIDS – Human Immunodeficiency Virus that Destroys THuman Immunodeficiency Virus that Destroys T Cells (Necessary for Healthy Immune System)Cells (Necessary for Healthy Immune System) INCUBATION PERIOD: Conversion to HIV +INCUBATION PERIOD: Conversion to HIV + Within 25 Days to 3 months. Rarely Longer ThanWithin 25 Days to 3 months. Rarely Longer Than 6 Months.6 Months. – Can Be HIV POSITIVE But Not Have AIDS.Can Be HIV POSITIVE But Not Have AIDS. – PEP is available – initiate as soon as possible!!PEP is available – initiate as soon as possible!! Interval after which there is no benefit for humansInterval after which there is no benefit for humans is undefined.is undefined.
  33. 33. AIDS = ACQUIREDAIDS = ACQUIRED IMMUNODEFICIENCY SYNDROMEIMMUNODEFICIENCY SYNDROME – ½ People who are HIV + Develop½ People who are HIV + Develop AIDS Within 10 YearsAIDS Within 10 Years – HIV + Opportunistic Diseases/HIV + Opportunistic Diseases/ Destroyed T Cells = AIDSDestroyed T Cells = AIDS
  34. 34. RISK OF INFECTION WITHRISK OF INFECTION WITH HEP C, HEP B, and HIVHEP C, HEP B, and HIV AFTER ONE NEEDLESTICK EXPOSURE-------AFTER ONE NEEDLESTICK EXPOSURE-------  HEP B: 30% (UNLESS VACCINE IMMUNITY)HEP B: 30% (UNLESS VACCINE IMMUNITY)  HEP C: 1 – 3%HEP C: 1 – 3%  HIV : 0.3%HIV : 0.3% AFTER MUCOUS MEMBRANE EXPOSURE,AFTER MUCOUS MEMBRANE EXPOSURE, EXAMPLE - SPLASH---------EXAMPLE - SPLASH---------  HEP B: 10% (UNLESS VACCINE IMMUNITY)HEP B: 10% (UNLESS VACCINE IMMUNITY)  HEP C: 1%HEP C: 1%  HIV: 0.1 %HIV: 0.1 %
  35. 35. HEPATITIS B, HEPATITIS C,HEPATITIS B, HEPATITIS C, & HIV& HIV  Life-threatening BBPLife-threatening BBP  Transmitted through exposure to bloodTransmitted through exposure to blood and other infectious body fluidsand other infectious body fluids  Anyone with occupational exposure isAnyone with occupational exposure is at riskat risk  Workers must use PPE andWorkers must use PPE and engineering controlsengineering controls
  36. 36. OCCUPATIONAL EXPOSURES:OCCUPATIONAL EXPOSURES: HCW (HCP) RESPONSIBILITIESHCW (HCP) RESPONSIBILITIES  KNOW BASIC BBP (HBV, HCV,KNOW BASIC BBP (HBV, HCV, HIV) ISSUESHIV) ISSUES  ATTEND ANNUAL BBP TRAININGATTEND ANNUAL BBP TRAINING  KNOW WHAT IS A BONA FIDEKNOW WHAT IS A BONA FIDE EXPOSUREEXPOSURE  REPORT IT!!!! Per School Policy.REPORT IT!!!! Per School Policy.  If you don’t know, ASK!!!!If you don’t know, ASK!!!!
  37. 37. OCCUPATIONAL EXPOSURES:OCCUPATIONAL EXPOSURES: RESPONSIBILITIESRESPONSIBILITIES  FIRST STEPS: Examine site of exposureFIRST STEPS: Examine site of exposure  FIRST AID (e.g. wash off blood, useFIRST AID (e.g. wash off blood, use standard disinfectant)standard disinfectant)  IDENTIFY SOURCE PATIENT; REPORTIDENTIFY SOURCE PATIENT; REPORT STATSTAT TO SUPERVISOR; CHECKTO SUPERVISOR; CHECK PROTOCOLS/ PROCEDURESPROTOCOLS/ PROCEDURES  GET MEDICAL CONSULTATION;GET MEDICAL CONSULTATION; FOLLOW UP per school post-exposureFOLLOW UP per school post-exposure management planmanagement plan  Test the SOURCE if possible. If source is aTest the SOURCE if possible. If source is a student, careful explanation to the parent ofstudent, careful explanation to the parent of source. (usually negative = reassurance)source. (usually negative = reassurance) Adapted from slide provided by R. BALLAdapted from slide provided by R. BALL
  38. 38. IF YOU THINK YOU HAVEIF YOU THINK YOU HAVE BEEN EXPOSEDBEEN EXPOSED IMMEDIATELYIMMEDIATELY TAKE CARE OFTAKE CARE OF YOURSELF andYOURSELF and IMMEDIATELYIMMEDIATELY NOTIFYNOTIFY School AdministrationSchool Administration School NurseSchool Nurse
  39. 39. PAPERWORK WILL BEPAPERWORK WILL BE DONE BYDONE BY the employee with thethe employee with the help of the school nurse .help of the school nurse .
  40. 40. Human Bite Management & BBPsHuman Bite Management & BBPs Recommendations: 2009Recommendations: 2009 Red BookRed Book American Academy of PediatricsAmerican Academy of Pediatrics CDC. MMWR June 29, 2001CDC. MMWR June 29, 2001 Updated US Public Health Service Guidelines...Updated US Public Health Service Guidelines...  ““Feces, nasal secretions,Feces, nasal secretions, salivasaliva, sputum,, sputum, sweat, tears, urine, and vomitus are notsweat, tears, urine, and vomitus are not considered potentially infectious unless theyconsidered potentially infectious unless they contain (visible) blood.” – CDCcontain (visible) blood.” – CDC
  41. 41. BITE MANAGEMENT ISSUESBITE MANAGEMENT ISSUES  ALWAYS HAVE 2 PERSONS INVOLVED:ALWAYS HAVE 2 PERSONS INVOLVED: ”BITER” & “BITEE””BITER” & “BITEE”  EVALUATE: did biter’sEVALUATE: did biter’s salivasaliva →→ bitee’s wound?bitee’s wound?  EVALUATE: did bitee’sEVALUATE: did bitee’s bloodblood →→ biter’s mouth?biter’s mouth?  HIV & Hep C are NOT transmitted via saliva “unlessHIV & Hep C are NOT transmitted via saliva “unless visibly grossly bloody” (prior to bite); Hep B may be ifvisibly grossly bloody” (prior to bite); Hep B may be if repetitiverepetitive  CONSIDER other (more likely) pathogens (i.e.CONSIDER other (more likely) pathogens (i.e. bacteria)bacteria)  Consult physician re: testing both people for BBPsConsult physician re: testing both people for BBPs R. Ball, MD, MPH
  42. 42. Student ExposuresStudent Exposures Notify the school nurse of anyNotify the school nurse of any possible/definite exposures immediately!possible/definite exposures immediately!  Recommend protocol in placeRecommend protocol in place – Contacting parents of source and exposedContacting parents of source and exposed childchild – Determine protocol if source child needs toDetermine protocol if source child needs to be testedbe tested – Notify Risk ManagementNotify Risk Management  Review with legal if neededReview with legal if needed
  43. 43. Any ExposureAny Exposure If you are in a location that does not have aIf you are in a location that does not have a nurse you can contact any district nurse fornurse you can contact any district nurse for direction. If you are unsure how to reach adirection. If you are unsure how to reach a nurse, contact Student Services (981-1041)nurse, contact Student Services (981-1041) and they will connect you with a nurse.and they will connect you with a nurse.
  44. 44. RESOURCE WEBSITESRESOURCE WEBSITES  www.cdc.govwww.cdc.gov  www.osha.govwww.osha.gov  www.nasn.orgwww.nasn.org National Association of School NursesNational Association of School Nurses – Occupational Exposure to BBPOccupational Exposure to BBP
  45. 45. QUESTIONS????QUESTIONS????

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