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TFMPP Bloodborne Pathogens Training


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Medical students with the potential for workplace exposure to bloodborne pathogens (BBP), human blood, or bodily fluids should review this training prior to their preceptorship.

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TFMPP Bloodborne Pathogens Training

  1. 1. AWARENESS TRAINING BLOODBORNE PATHOGEN PRESENTED BY Texas Family Medicine Preceptorship Program UT Medical School at Houston - Environmental Health & Safety
  2. 2. HOW INFORMED ARE YOU? Name three bloodborne pathogens (BBP) that are transmitted through bodily fluids. Name three ways you can be exposed to BBP. How many people does tuberculosis affect worldwide? True or False - it is okay to recap a needle? What is a negative pressure room? What is it used for? What cleaning agent should be used when cleaning up a blood spill? What are standard precautions? Can alcohol sanitizers be used to remove blood off hands? 1 2 3 4 5 6 7 8
  3. 3. What is a bloodborne pathogen? TRAINING OUTLINE What do UTHSC-H statistics say? Preventive measures Needlestick injury & exposure information TB presentation & isolation Your rights Blood or other potentially infectious material (OPIM) spill clean up
  4. 4. The standard was originallyissued in 1991, and was later revised for the prevention of contaminatedsharps injuries, needlesticks OSHA Bloodborne Pathogen Standard 29 CFR 1910.1030 OSHABloodborne Pathogen Standard • Educationand selection of sharps injuryreductiondevices (e.g., self- sheathingneedles) In 2001 the revised standard, Needlestick Safety and PreventionAct included: • Maintenanceof a contaminated Sharps InjuryLog
  5. 5. POWERPOINT PRESENTATION Texas Department of State Health Service • Reflect advanced technologythat eliminateor reduce exposures Exposure ControlPlan: • Document annuallyconsideration for safer medical devices BLOODBORNEPATHOGENCONTROL • Solicitinputfrom employees at higher risk of occupational exposure.
  6. 6. Bloodborne PATHOGENS (BBP) Pathogenic microorganisms present in human blood or other potentially infectious material (OPIM), and can infect and cause disease in humans. These pathogens include, but are not limited to, hepatitis B virus (HBV), hepatitis C virus, and human immunodeficiency virus (HIV).
  7. 7. Bloodborne PATHOGENS (BBP) - HIV - HBV - HCV - T. pallidum - Herpes Virus - M. tuberculosis - typically an aerosol hazard - Human T-Lymphotropic Virus Type l (HTLV-l)
  8. 8. Bloodborne PATHOGENS (BBP) Body fluids that can harbor BBP: - Blood - Semen and vaginal secretions - Saliva involved in dental procedures - Synovial fluid - Cerebrospinal fluid - Human tissue and cell cultures - All body fluids containing blood e.g. fluids: pleural, pericardial, amniotic
  9. 9. OCCUPATIONAL EXPOSURE* FIRST SECOND THIRD Mucous membrane contact - Splash in eyes, nose, or mouth Percutaneous inoculation - Misuse of sharps (broken glass, needles, scalpels) Exposure to broken/damaged skin - Risk increases if contact involves a large area of broken/damaged skin or if contact is prolonged 2 3 *Riskincreaseswithhightiterlevelsinthesource 1
  10. 10. How do you get exposed? What should I do if I get exposed? • Needlesticks or cuts from used needles or sharps • Contact of eyes, nose, mouth or broken skin with blood • Assaults – bites, cuts, knife wounds • Punctures • Splashes REPORT ASAP, then: • Needlestick and cuts – wash with soap and water • Splashes – flush nose, mouse, or skin with water • Splashes in the eyes – irrigate with water, saline, or sterile wash
  11. 11. Engineering controls Personal Protective Equipment (PPE) Administrative controls Work place practices PREVENTIVE MEASURES
  12. 12. Leak-proof containers • Use for storage & transportation of ALL bloodborne pathogen material Sharps containers • Fill no greater than ¾ full Needleless devices • Use retractable syringes, self-sheathing needles Engineering controls Biosafety cabinet (BSC) Directional air flow High efficiency particulate air (HEPA) filtration Access control
  13. 13. Face protection • Goggles or safety glasses with side shields Clothing • Lab coats, scrubs, disposable gowns (long pants only and no open toed shoes) • Replaced immediately when contaminated • Lab clothing restricted to work area Gloves • Replaced immediately if torn • Not worn outside the lab area! Personal Protective Equipment
  14. 14. How to properly remove gloves Personal Protective Equipment (cont.) Source: Globus
  15. 15. Medical surveillance • TB skin test (PPD) Immunizations • Hepatitis B series Training Management of staff (SOP compliance) Background checks, security clearance Administrative Controls
  16. 16. Universal / Standard precautions • Treat all human blood and body fluids as if known to be infectious for HIV, HBV, or other potentially infectious material (OPIM) GOOD WORKPLACE PRACTICES
  17. 17. NEVER recap needles! Follow SOPs Survey work area • Note locations of all necessary equipment, waste containers, disinfectants, and soaps Establish & maintain clean & dirty zones DO NOT eat, drink, or apply cosmetics in the work area GOOD WORKPLACE PRACTICES
  18. 18. Decontaminate work surfaces • At start and end of procedures • Immediately after spill • Before removal of equipment Dispose of waste properly Label containers – hazard communication • Chemical & biological working stocks Wash hands frequently, always between patients & always before leaving work area! GOOD WORKPLACE PRACTICES (cont.)
  19. 19. • Get the hepatitis B vaccine • Review the employer’s Exposure Control Plan • Dispose of sharps PROMPTLY into an appropriate container • Use sharps devices with safety features • Clean work surfaces • Use personal protective equipment (such as gloves and face shields) GOOD WORKPLACE PRACTICES (cont.) How can you protect yourself overall?
  20. 20. BLEACH ALCOHOL CIDEX Cleaning agents/disinfectants you will encounter Start from perimeter and work your way in ROUTINE DECONTAMINATION
  21. 21. On average only 40% of healthcare workers regularly wash their hands Hand Hygiene Hospital acquired infections result in transmission of: • MRSA – Methicillin resistant S. aureus • 1.2 million infections; 48,000 patient deaths yearly • VRE – Vancomycin resistant Enterococci • $4.5 billion yearly cost for treatment Methods of contamination: • Moving patients • Taking blood pressure • Touching bedrails Source: HandHygieneResourceCenter
  22. 22. The Inanimate Environment Can Facilitate Transmission Contaminated surfaces increase cross-contamination X Represents VREculturepositivesites Source - Abstract: The Risk of Hand and Glove Contamination after Contact with a VRE (+) Patient Environment. Hayden M, ICAAC, 2001, Chicago, IL.
  23. 23. Proper hand washing is VITAL to infection prevention! You may not realize you have germs on your hands! Hand Hygiene (cont.) Wash your hands, even if gloves have been worn… • Before patient contact, including between different patients • AFTER contact with anything contaminated • During patient care • Before and after invasive procedure • Before and after contact with wound • Between procedures on different body parts of the same patient • Between glove changes • Immediately if skin is contaminated or if an injury occurs
  24. 24. Proper Hand Washing Wet hands with warm (not hot) water Apply soap on hands • Liquid soap is better (germs can live on wet soap bars) Rub hands together for at least 15 seconds • Wash longer if there is visible dirt on hands • Cover all surfaces of hands and fingers – including between fingernails, backs of hands, thumbs, and under fingernails Rinse hands thoroughly with warm water Dry hands thoroughly • If using blow dryer, push button with elbow • If available, use towel to turn off water
  26. 26. Source: Hand Hygiene Resource Center “Happy Birthday” Song -or- “ABC” Song
  27. 27. WHERE WE MISS
  28. 28. Hand Hygiene (cont.) Alcohol sanitizers • 62% ethyl alcohol • Accepted as effective under certain conditions • Should not be used when there is visible dirt or grime
  29. 29. Hand Hygiene (cont.) WASH BEFORE WASH AFTER Eating Caring for someone who is sick Using Toilet Blowing nose, coughing, or sneezing Caring for someone who is sick
  30. 30. Most Cited Sources of Needlestick IMPROPER LIGHTING IMPROPER HANDLING NOT FAMILIAR WITH DEVICE IMPROPER SHARPS DISPOSAL UNCOOPERATIVE PATIENTS Overfilled sharps containers Passingto other personnel Improper suture technique
  31. 31. EXPOSURE NEEDLESTICK POSSIBLE APPLYROUTINEFIRSTAID IMMEDIATELY Cleansite of injurywith soap & flush with water for at least 15 minutes Flushmucous membraneswith water or salinefor at least 15 minutes NOTIFYSUPERVISOR/ PRECEPTOR CompleteFirstReport of Injury • Usedto processinsuranceclaims& helpsidentifytrends SEEKMEDICALATTENTION Student HealthServices Clinic –lookin your student handbook
  32. 32. • Baseline Labs • HIV antibody (with consent) • RPR (Syphilis) • Hepatitis B surface antibody • HCV antibody • If source is known to be Hepatitis C+, also obtain liver function & HCV RNA tests • CBC with differential and platelets, chemistry profile, urine pregnancy test if source is known HIV+ and if exposed personnel chooses to utilize post-exposure prophylaxis Medical Surveillance for injury • Hepatitis B Vaccination • Tuberculosis skin test, Quantiferon test
  33. 33. Percutaneous injury transmission rates with blood or blood products • Hepatitis B 2 – 40% • Hepatitis C 3 – 10% • HIV 0.2 – 0.5% CDC Exposure Risk
  34. 34. Cough Chest Pain Coughing up blood Weakness Fever and/or night sweats Weight loss TB Presentation & Isolation
  37. 37. TB Presentation & Isolation (cont.) Routinely ask all patients: • History of TB disease? • Symptoms suggestive of TB? Patients with history or symptoms of undiagnosed TB: • Refer promptly for medical evaluation of possible active infection • Wear surgical mask • Provide urgent care in TB isolation areas (i.e., negative pressure rooms) TB Reporting In Texas: 512.533.3000
  38. 38. TB Presentation and Isolation (cont.) REMINDER Bloodborne Pathogens can be transmitted via the following routes: • Airborne • Droplet • Contact
  39. 39. How to protect yourself & the patient REMEMBER Place mask on patient Use an N-95 respirator when caring for the patient (get fitted) • Routine duties • Sputum-inducing procedure Enforce cough etiquette
  40. 40. In the event of a possible exposure to bloodborne pathogens, the person is entitled to: • Confidential medical evaluation and follow-up • Documentation of routes of exposure • Identification, documentation, testing, and results of the source individual • Counseling • Evaluation of reported illness • Source patient blood draw YOUR RIGHTS
  41. 41. Blood (or OPIM) Spill Clean Up Clean all blood (or OPIM) spills with a 10% bleach solution or another EPA-approved disinfectant Apply the approved disinfectant to perimeter of spill Allow at least 15 minutes of disinfectant contact time • Slowly proceed inwards Dispose all materials used to clean up spill (e.g. towels, gloves) in a biohazard bag
  42. 42. Biological Waste Disposal Place red biohazard bags inside hard-walled, leak-proof secondary containment • Do not over fill! Place sharps in an appropriate hard-walled, leak-proof sharps container • Do not recap needles! • Do not over fill (no more than ¾ full)! • Let clinic administrator or manager know if it needs to be replaced
  43. 43. What is Biological Waste & What is Trash? Bloody Gloves Used Needles Disposable Gowns (Unsoiled) UA Dipstick Unsoiled Exam Gloves Identify which receptacle these (below) belong in
  44. 44. What is Biological Waste & What is Trash? Unsoiled Exam Gloves Disposable Gowns (Unsoiled) Bloody Gloves Used Needles UA Dipstick
  45. 45. INFORMATION RESOURCES Available resources about bloodborne pathogens • Contact your Occupational or Employee Health Clinic or report to the Institutional Emergency Department IMMEDIATELY • Biological Safety Manual (in every lab & website) • OSHA Bloodborne Pathogen Standard • Center for Disease Control • Texas Department of State Health Services
  46. 46. REMEMBER! You are responsible for knowing and practicing all the BBP training and safety precautions outlined in this presentation while participating in your Family Medicine preceptorship. Make sure you have your preceptors number and tell someone immediately whenyou are exposed to any bloodbornepathogens.
  47. 47. QUESTIONS? Refer to your Student Handbook Please remember: Contact your preceptor immediately following any exposures Go to the nearest Occupational or Employee Health Clinic or go to the Emergency Department for treatment