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BLOODBORNE PATHOGENS
PREVENTING DISEASE TRANSMISSION
& INFECTION CONTROL
By Ahmad Thanin
Introduction
• Approximately 5.6 million workers in healthcare
and other facilities are at risk of exposure to
bloodborne pathogens HIV, the Hepatitis B virus
(HBV), and the Hepatitis C virus (HCV)
• protect workers against the health hazards from
exposure to blood and other potentially infectious
materials, and to reduce their risk from this
exposure
Objectives:
At the end of
this session,
the student will
be able to:
List and describe the diseases that
cause the greatest concerns for
providers
Describe how to prevent disease
transmission
Describe the necessary steps the
provider must complete when an
exposure occurs
Main Topics
• Laws and Safety Regulations
• How Exposures Occur
• Diseases that Cause Concern
• Preventing Disease Transmission
• If an Exposure Occurs
• Exposure Control Plans
1- Laws and Safety Regulations
• Infection Control Policies
• Infection Control Manual
• The regulation applies to employers whose employees, as a
result of job requirements, have the potential for exposure
to bloodborne pathogens.
How Exposures Occur
Most common: Needlesticks
Cuts from other contaminated Sharps (scalpels,
broken glass, etc.)
Contact of mucous membranes (for example, the
eye, nose, mouth) or broken skin (cut or abraded)
with contaminated blood
2-How
Exposures
Occur
Disease transmission is a two-way
street:
• Patient to Healthcare provider
• Healthcare provider toPatient
A pathogen is an organism that cause a
disease if enters the body ( basically a
germ)
The immune system relies heavily on the
skin to keep the amount of pathogens
that enter the body to a minimum.
How
Infections
Occur
Chain of infection
The Infectious Agent – or the
microorganism which can cause
disease.
The Reservoir or source of infection
where the microorganism can live and
thrive. This may be a person, an
animal, any object in the general
environment, food or water.
The Portal of Exit from the reservoir.
This describes the way the
microorganism leaves the reservoir. For
example, in the case of a person with
flu, this would include coughing and
sneezing. In the case of someone with
gastro-enteritis microorganisms would
be transmitted in the faeces or vomit.
The Mode of Transmission. This
describes how microorganisms are
transmitted from one person or place
to another. This could be via someone’s
hands, on an object, through the air or
bodily fluid contac
The Portal of Entry. This is how the
infection enters another individual.
This could be landing on a mucous
membrane, being breathed in, entering
via a wound, or a tube such as a
catheter.
The Susceptible Host. This describes
the person who is vulnerable to
infection.
• Infection can be prevented by breaking the Chain
of Infection.
• The chain of infection diagram illustrates and gives
examples of actions that can be taken to break it.
Routes of
Transmission:
• Touching the body fluids from an infected person
Direct Contact
• Touching objects that have been in contact with the
body fluid of an infected person
Indirect Contact
• Breathing in droplets that became airborne when an
infected person coughs or sneezes
Airborne transmission
• Through a bite from an infected animal or insect
Vector-borne transmission
Most infectious diseases are caused by one of five types of
pathogens. The most common are viruses and bacteria.
Viruses: Hepatitis, Chicken Pox, HIV, etc.
Bacteria: Meningitis, Tuberculosis, food poisoning
Fungi: Athlete’s foot, ringworm
Protozoa: Malaria, dysentery
Parasites: Abdominal pain, anemia, etc.
What are Bloodborne Pathogens?
Bloodborne Pathogens are causative agents of disease that are carried in
blood, blood products and other potentially infectious materials. They can
result in severe and deadly disease in healthcare or research personnel.
How
Infections
Occur
Just because pathogens have a means of
getting into the body does not mean that
disease will be transmitted.
For diseases to be transmitted, all four of
the following conditions must be met:
• A pathogen is present.
• There is sufficient quantity of the pathogen to
cause disease.
• A person is susceptible to the specific pathogen.
• The pathogen enters the body through the correct
entry site.
3- Diseases
that Cause
Concern
What Is
infectious?
Capable of causing infection
Caused by a pathogen
Illness resulting from an invasion of
a host by a disease producing
organism
Diseases that
Cause
Concern
• You should be familiar with diseases that can
have serious consequences if transmitted, These
include -
• Herpes - These viruses cause infections to the
skin and mucus membranes.
• Meningitis - A severe infection of the
coverings of the brain and spinal cord.
• Tuberculosis—A disease that predominantly
affects the respiratory system.
• Hepatitis - A viral infection of the liver.
Different forms of hepatitis are transmitted in
different ways.
Diseases that
Cause
Concern
• HIV: A disease that attacks white blood cells
and destroys the body’s ability to fight
infections.
• Childhood Diseases: Diseases such as
measles, mumps and chicken pox pose a
serious risk for persons who did not contract
the diseases as children or were not
immunized against them.
Bloodborne Pathogens of Special Concern To Health
Care Providers
HBV: Hepatitis B virus
HCV: Hepatitis C virus
HIV: Human Immunodeficiency virus
Hepatitis B (HBV)
Infection of liver caused by HBV
Virus is in blood and other body fluids
Spread by exposure to blood and body fluids
Some people are at higher risk of HBV
Hepatitis B (HBV) Symptoms:
Lethargy
Loss of appetite
Fever
Vomiting
Yellow skin & eyes (jaundice)
Dark-colored urine.
Light colored stool
HBV Treatment
• NO CURE
• Fluids
• Rest
• Right diet
• Avoid alcohol & some medicines
Hepatitis B Prevention
Avoid exposure
A VACCINE IS AVAILABLE!
•(Get complete vaccination series)
Hepatitis C (HCV)
Infection of the liver
Virus is in blood and other body fluid
HCV mainly spread by exposure to blood and blood products
Certain people are at higher risk of getting HCV
Hepatitis C (HCV) Symptoms:
Lethargy
Loss of appetite
Abdominal pain
Nausea
Vomiting
Yellow skin & eyes (jaundice)
Urine that is dark in color
Hepatitis C
(HCV)
Treatment
NO CURE
Treatment limited
Rest & fluids
Avoid alcohol & some
medicines
Hepatitis C
(HCV)
Prevention
NO effective VACCINE!
Taking the same precautions that
protect you from Hepatitis B and
HIV will help prevent transmission
of HCV in the workplace.
Human
Immunodeficiency
Virus (HIV)
AIDS is caused by the HIV virus
Some people at higher risk than others
HIV is in blood and other body fluids
HIV is spread by exposure to HIV infected
blood and HIV infected body fluids
Human
Immunodeficiency
Virus (HIV)
Symptoms:
Fever
Weight loss
Swollen lymph nodes
White patches in mouth (thrush)
Certain cancers
eg. Kaposi’s sarcoma, certain lymphomas
Infections
eg. pneumocystis pneumonia, TB, etc.
A blood test may tell if you have HIV
infection or AIDS
HIV treatment
No CURE
A treatment protocol (Zidovudine (AZT) plus lamivudine (3TC) for 28 days)
has been developed by the U.S. Public Health Service and is to be
administered following a high-risk exposure to a known HIV-infected source.
Combination therapy with a variety of medications help people with HIV by
slowing the disease process
HIV and AIDS are
Preventable
A diagnosis of TB
should be
suspected in any
patient with the
following:
Productive cough (>2 to 3 wks duration)
Fever - Chills
Night sweats
Easily fatigable
Loss of appetite (anorexia) -
weight loss
Hemoptysis (bloody sputum)
Managing patients
who may have TB
in ambulatory care
setting and
emergency
departments:
Attempt to identify any potentially TB infected
patient e.g. history, signs & symptoms, any
previous positive TB treatment, or any current
anti-tuberculosis medications.
Utilize engineering controls where possible and
use of approved PPE when treating and
transporting a patient suspected of having TB
TB patients, if medically stable, should remain in
the transport unit (with a provider) until receiving
facility is notified and ready to accept the patient
Developing, implementing,
maintaining, and evaluating a
respiratory protection program:
• Personal Protective Equipment (PPE):
Respiratory Protection (NIOSH approved mask
e.g., N-99 or HEPA and other PPE as per local
protocol)
• Meets adequate filtration standards.
• Qualitatively or quantitatively fit tested
• Respirators available in units
• Ability to be checked for face piece fit (OSHA)
• Must comply with CFR 1910.134 (OSHA
Respiratory Standard)
Use precautions while
performing cough-inducing and
other high hazard procedures:
• Characterized by potential to generate
airborne / droplet secretions
• Aerosolized medication treatment
• Endotracheal Intubation
• Suctioning
• Transporting a patient with active
TB disease in a closed vehicle
What Is Tuberculosis?
Mycobacterial disease
Caused by the infectious agent:
Mycobacterium tuberculosis
Transmitted by infected airborne
particles called droplet nuclei
Tuberculosis
• TB Infection can result from exposure to infectious
droplet nuclei
• Positive PPD but, no clinically apparent signs or
symptoms of TB
• Negative CXR & negative smears and cultures which
means usually not infectious
• May develop into TB disease.
• TB disease develops in a person with tuberculosis
infection
• Usually is infectious if not treated
• Signs and symptoms apparent with positive lab test
Develop and
implement a
program for
routine periodic
counseling and
screening of
HCWs for active
and latent TB
infection:
PPD skin testing is used to detect TB infection
Skin test conversion from negative to positive
indicates a new infection with TB
A person with a positive PPD should be clinically
evaluated for active tuberculosis
A person with a positive PPD should be evaluated for
preventive therapy if no active disease is present
If TB disease is detected, begin treatment per local
policy
Interpretation
of TB Skin Test
Indurations of:
5 mm or larger considered positive
after close personal contact, abnormal
CXR or in known HIV infected persons
10 mm or larger considered positive in
persons with other known risk factors
(HCW)
15 mm or larger considered positive in
all other populations
Promptly
evaluate
possible
episodes of
tuberculosis
transmission in
your healthcare
setting
An exposure to TB is defined as:
Potential exposure to the exhaled air
of an individual with suspected or
confirmed TB disease
Exposure to high hazard procedure
performed on persons with suspected
or confirmed TB disease
Risk Factors for
TB Disease
Development
Only about 1 in 10 people infected ever
suffer active disease
Reactivation of TB is likely if the host has
impaired immunity, including diabetes,
chronic renal failure, malnourished, high-
dose corticosteroid therapy, some
hematologic disorders, or HIV infection
Treatment of
Tuberculosis
Drug susceptibility testing should be
performed on all initial isolates from
patients with TB
Until results are known, two
basic principles of therapy apply:
• Start with the four primary drugs
used in the treatment of TB until
sensitively and resistance are known
• Continue treatment regimen with at least
two drugs known to be effective on the
isolate
Drug Resistant
Tuberculosis
Where therapy is not continuous or
incomplete, multi-drug resistant
tuberculosis can develop (MDR-TB).
MDR-TB can be treated but, treatment
is with second line drugs that are less
effective.
MDR-TB requires longer treatment
regimens: 18 to 24 months (due to
lower efficacy)
TB
Surveillance &
Reporting
• Skin test conversions among personnel
• PPD done at time of employment and (annually)
periodic re-testing thereafter
• Evaluation of exposure incidents
• Evaluations & management of positive PPD skin
tests or symptoms of TB
• Follow-up of personnel with positive PPD skin
test
Follow-up After TB
Exposure
• Clinically evaluate for active TB
• Negative PPD in preceding 3 months
- repeat 12 weeks after exposure
• Negative PPD longer than 3 months ago,
repeat baseline and if this one is
negative, repeat in 12 weeks
• A positive PPD requires clinical evaluation
and management
Tuberculosis
Prevention &
Control
• Unit ventilation: keep adequate ventilation in the
treatment area of the transport vehicle e.g., windows,
exhaust fans, air out vehicle after run
• Work practices to prevent the spread of airborne droplets
• When treating and transporting HIV infected patients,
IVDAs, foreign born, and other high risk groups for TB, PPE
should routinely include airborne protection
• Face & eye protection during exposure
prone activities, e.g. endotracheal intubation, suctioning,
positive pressure demand valve ventilation
• Decontamination with E.P.A. approved
hospital grade detergent disinfectant
• Tuberculosis screening program
• Preventive therapy or treatment
• Documentation
Identify tasks and other activities that
may involve exposure to blood or
other potentially infectious body
materials
4- Preventing Disease
Transmission
• Patient assessment
• Airway management
• Assisting respirations
• Bleeding control
• Contact with body fluids
• Clean-up of scene & equipment
• Establishing an IV
• Emergency childbirth
• Other patient care activities where contact
with blood or body fluids occur
To reduce the risk
of infection:
• Wear gloves
• Minimize contact with body
fluids
• Wash hands or any exposed area
immediately and thoroughly
after you provide care or clean a
spill
Remember
Precautions taken to prevent
exposure to blood or other
body fluids containing visible
blood are known as Universal
Precautions.
Precautions taken to prevent
exposure to any other type of
body fluids or substances are
known as Body Substance
Isolation (BSI).
Preventing disease
transmission involves
following basic
precautions:
• Personal hygiene: Personal
habits or practices such as hand
washing and proper grooming
• Protective equipment: Protects a
person from direct contact with
infected material (i.e., gloves,
masks, etc.)
Engineering and work practice controls. Help
eliminate or reduce the risk of exposure in
the workplace.
Engineering controls isolate or remove the
hazard (i.e., containers for sharp items such
as needles)
Work practice controls reduce the
likelihood of exposure by changing the way
a task is carried out (i.e., washing hands
before and after giving first aid)
Equipment cleaning and disinfecting
Careful handling of all soiled equipment, supplies,
or other materials until properly taken care of (i.e.,
placing soiled clothing in properly marked plastic
bags for disposal or washing)
The following
steps shall be
followed when
cleaning-up a
contaminated
area/scene:
Isolation of Containments
• Isolate the area where the material is
located to prevent accidental
contamination.
Personal Protective Equipment
• Before attempting to clean the
contaminated area, apply appropriate
Personal Protective Equipment (may
include Gloves, protective eye wear,
footwear, and clothing).
The following
steps shall be
followed when
cleaning-up a
contaminated
area/scene:
Clean-Up Contaminated Area
• If the area has been contaminated with blood
or other bodily fluids, clean the area
immediately.
• Retrieve Bio-Hazard Clean-Up Kit.
• Wipe up any excess fluids with disposable
towels, you may also use the absorbent
powder to solidify any excess fluids and then
scoop-up the material and place it into the Red
Bio-Hazard Bag.
• Place contaminated towels in a Red Bio-Hazard
Bag.
The following
steps shall be
followed when
cleaning-up a
contaminated
area/scene:
Clean-Up Contaminated Area
• A 1:10 dilution of 5.25%–6.15% sodium
hypochlorite (i.e., household bleach) or an EPA-
registered tuberculocidal disinfectant has been
recommended for decontaminating blood spills.
• Let the mixture stand for at least 15 minutes.
• Wipe area with disposable towels and let area air
dry.
• Place all exposed/contaminated materials in the
Red Bio-Hazard Bag.
• Contact your vendor for proper disposal of your
Red Bio-Hazard Bag, it is considered Medical
Waste and it must be disposed of properly.
The following
steps shall be
followed when
cleaning-up a
contaminated
area/scene:
Disinfect / Wash Hands
• As soon as possible, wash hands
to reduce the risk of infection /
contamination. If you are not able
to disinfect / wash hands within a
reasonable amount of time, you
may use a commercial waterless
hand cleanser.
Exposure
Control
Plans
Preventing disease transmission begins
with preparation and planning.
The Exposure Control Pan creates a
system to protect people from
infection.
The Plan requires the employer to
identify who will receive training,
protective equipment and vaccination.
An Exposure Control Plan should contain the
following elements:
Exposure determination
Schedule and method of implementing other parts of the OSHA Standard
Procedures for evaluating details of an exposure incident.
An exposure may include contact with potentially infectious blood or other body fluids through a needle stick, broken
skin,or membranes of the eyes, nose, or mouth.
If it is believed that an exposure has occurred, clean the area of contact thoroughly, write down what happened, and
notify your supervisor immediately.
Necessary follow-up care should be secured.
Follow your worksite’s post-exposure policies and procedures.
General Post Exposure Evaluation & Follow-
Up Guidelines:
DOCUMENT ROUTE OF EXPOSURE &
CIRCUMSTANCES UNDER WHICH THE
EXPOSURE OCCURRED
IDENTIFICATION & DOCUMENTATION
OF SOURCE INDIVIDUAL INFORMATION
Thank you
Ahmad Thanin

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Bloodborne pathogens

  • 1. BLOODBORNE PATHOGENS PREVENTING DISEASE TRANSMISSION & INFECTION CONTROL By Ahmad Thanin
  • 2. Introduction • Approximately 5.6 million workers in healthcare and other facilities are at risk of exposure to bloodborne pathogens HIV, the Hepatitis B virus (HBV), and the Hepatitis C virus (HCV) • protect workers against the health hazards from exposure to blood and other potentially infectious materials, and to reduce their risk from this exposure
  • 3. Objectives: At the end of this session, the student will be able to: List and describe the diseases that cause the greatest concerns for providers Describe how to prevent disease transmission Describe the necessary steps the provider must complete when an exposure occurs
  • 4. Main Topics • Laws and Safety Regulations • How Exposures Occur • Diseases that Cause Concern • Preventing Disease Transmission • If an Exposure Occurs • Exposure Control Plans
  • 5. 1- Laws and Safety Regulations • Infection Control Policies • Infection Control Manual • The regulation applies to employers whose employees, as a result of job requirements, have the potential for exposure to bloodborne pathogens.
  • 6. How Exposures Occur Most common: Needlesticks Cuts from other contaminated Sharps (scalpels, broken glass, etc.) Contact of mucous membranes (for example, the eye, nose, mouth) or broken skin (cut or abraded) with contaminated blood
  • 7. 2-How Exposures Occur Disease transmission is a two-way street: • Patient to Healthcare provider • Healthcare provider toPatient A pathogen is an organism that cause a disease if enters the body ( basically a germ) The immune system relies heavily on the skin to keep the amount of pathogens that enter the body to a minimum.
  • 9. Chain of infection The Infectious Agent – or the microorganism which can cause disease. The Reservoir or source of infection where the microorganism can live and thrive. This may be a person, an animal, any object in the general environment, food or water. The Portal of Exit from the reservoir. This describes the way the microorganism leaves the reservoir. For example, in the case of a person with flu, this would include coughing and sneezing. In the case of someone with gastro-enteritis microorganisms would be transmitted in the faeces or vomit. The Mode of Transmission. This describes how microorganisms are transmitted from one person or place to another. This could be via someone’s hands, on an object, through the air or bodily fluid contac The Portal of Entry. This is how the infection enters another individual. This could be landing on a mucous membrane, being breathed in, entering via a wound, or a tube such as a catheter. The Susceptible Host. This describes the person who is vulnerable to infection. • Infection can be prevented by breaking the Chain of Infection. • The chain of infection diagram illustrates and gives examples of actions that can be taken to break it.
  • 10. Routes of Transmission: • Touching the body fluids from an infected person Direct Contact • Touching objects that have been in contact with the body fluid of an infected person Indirect Contact • Breathing in droplets that became airborne when an infected person coughs or sneezes Airborne transmission • Through a bite from an infected animal or insect Vector-borne transmission
  • 11. Most infectious diseases are caused by one of five types of pathogens. The most common are viruses and bacteria. Viruses: Hepatitis, Chicken Pox, HIV, etc. Bacteria: Meningitis, Tuberculosis, food poisoning Fungi: Athlete’s foot, ringworm Protozoa: Malaria, dysentery Parasites: Abdominal pain, anemia, etc.
  • 12. What are Bloodborne Pathogens? Bloodborne Pathogens are causative agents of disease that are carried in blood, blood products and other potentially infectious materials. They can result in severe and deadly disease in healthcare or research personnel.
  • 13. How Infections Occur Just because pathogens have a means of getting into the body does not mean that disease will be transmitted. For diseases to be transmitted, all four of the following conditions must be met: • A pathogen is present. • There is sufficient quantity of the pathogen to cause disease. • A person is susceptible to the specific pathogen. • The pathogen enters the body through the correct entry site.
  • 14. 3- Diseases that Cause Concern What Is infectious? Capable of causing infection Caused by a pathogen Illness resulting from an invasion of a host by a disease producing organism
  • 15. Diseases that Cause Concern • You should be familiar with diseases that can have serious consequences if transmitted, These include - • Herpes - These viruses cause infections to the skin and mucus membranes. • Meningitis - A severe infection of the coverings of the brain and spinal cord. • Tuberculosis—A disease that predominantly affects the respiratory system. • Hepatitis - A viral infection of the liver. Different forms of hepatitis are transmitted in different ways.
  • 16. Diseases that Cause Concern • HIV: A disease that attacks white blood cells and destroys the body’s ability to fight infections. • Childhood Diseases: Diseases such as measles, mumps and chicken pox pose a serious risk for persons who did not contract the diseases as children or were not immunized against them.
  • 17. Bloodborne Pathogens of Special Concern To Health Care Providers HBV: Hepatitis B virus HCV: Hepatitis C virus HIV: Human Immunodeficiency virus
  • 18. Hepatitis B (HBV) Infection of liver caused by HBV Virus is in blood and other body fluids Spread by exposure to blood and body fluids Some people are at higher risk of HBV
  • 19. Hepatitis B (HBV) Symptoms: Lethargy Loss of appetite Fever Vomiting Yellow skin & eyes (jaundice) Dark-colored urine. Light colored stool
  • 20. HBV Treatment • NO CURE • Fluids • Rest • Right diet • Avoid alcohol & some medicines
  • 21. Hepatitis B Prevention Avoid exposure A VACCINE IS AVAILABLE! •(Get complete vaccination series)
  • 22. Hepatitis C (HCV) Infection of the liver Virus is in blood and other body fluid HCV mainly spread by exposure to blood and blood products Certain people are at higher risk of getting HCV
  • 23. Hepatitis C (HCV) Symptoms: Lethargy Loss of appetite Abdominal pain Nausea Vomiting Yellow skin & eyes (jaundice) Urine that is dark in color
  • 24. Hepatitis C (HCV) Treatment NO CURE Treatment limited Rest & fluids Avoid alcohol & some medicines
  • 25. Hepatitis C (HCV) Prevention NO effective VACCINE! Taking the same precautions that protect you from Hepatitis B and HIV will help prevent transmission of HCV in the workplace.
  • 26. Human Immunodeficiency Virus (HIV) AIDS is caused by the HIV virus Some people at higher risk than others HIV is in blood and other body fluids HIV is spread by exposure to HIV infected blood and HIV infected body fluids
  • 27. Human Immunodeficiency Virus (HIV) Symptoms: Fever Weight loss Swollen lymph nodes White patches in mouth (thrush) Certain cancers eg. Kaposi’s sarcoma, certain lymphomas Infections eg. pneumocystis pneumonia, TB, etc.
  • 28. A blood test may tell if you have HIV infection or AIDS
  • 29. HIV treatment No CURE A treatment protocol (Zidovudine (AZT) plus lamivudine (3TC) for 28 days) has been developed by the U.S. Public Health Service and is to be administered following a high-risk exposure to a known HIV-infected source. Combination therapy with a variety of medications help people with HIV by slowing the disease process
  • 30. HIV and AIDS are Preventable
  • 31. A diagnosis of TB should be suspected in any patient with the following: Productive cough (>2 to 3 wks duration) Fever - Chills Night sweats Easily fatigable Loss of appetite (anorexia) - weight loss Hemoptysis (bloody sputum)
  • 32. Managing patients who may have TB in ambulatory care setting and emergency departments: Attempt to identify any potentially TB infected patient e.g. history, signs & symptoms, any previous positive TB treatment, or any current anti-tuberculosis medications. Utilize engineering controls where possible and use of approved PPE when treating and transporting a patient suspected of having TB TB patients, if medically stable, should remain in the transport unit (with a provider) until receiving facility is notified and ready to accept the patient
  • 33. Developing, implementing, maintaining, and evaluating a respiratory protection program: • Personal Protective Equipment (PPE): Respiratory Protection (NIOSH approved mask e.g., N-99 or HEPA and other PPE as per local protocol) • Meets adequate filtration standards. • Qualitatively or quantitatively fit tested • Respirators available in units • Ability to be checked for face piece fit (OSHA) • Must comply with CFR 1910.134 (OSHA Respiratory Standard)
  • 34. Use precautions while performing cough-inducing and other high hazard procedures: • Characterized by potential to generate airborne / droplet secretions • Aerosolized medication treatment • Endotracheal Intubation • Suctioning • Transporting a patient with active TB disease in a closed vehicle
  • 35. What Is Tuberculosis? Mycobacterial disease Caused by the infectious agent: Mycobacterium tuberculosis Transmitted by infected airborne particles called droplet nuclei
  • 36. Tuberculosis • TB Infection can result from exposure to infectious droplet nuclei • Positive PPD but, no clinically apparent signs or symptoms of TB • Negative CXR & negative smears and cultures which means usually not infectious • May develop into TB disease. • TB disease develops in a person with tuberculosis infection • Usually is infectious if not treated • Signs and symptoms apparent with positive lab test
  • 37. Develop and implement a program for routine periodic counseling and screening of HCWs for active and latent TB infection: PPD skin testing is used to detect TB infection Skin test conversion from negative to positive indicates a new infection with TB A person with a positive PPD should be clinically evaluated for active tuberculosis A person with a positive PPD should be evaluated for preventive therapy if no active disease is present If TB disease is detected, begin treatment per local policy
  • 38. Interpretation of TB Skin Test Indurations of: 5 mm or larger considered positive after close personal contact, abnormal CXR or in known HIV infected persons 10 mm or larger considered positive in persons with other known risk factors (HCW) 15 mm or larger considered positive in all other populations
  • 39. Promptly evaluate possible episodes of tuberculosis transmission in your healthcare setting An exposure to TB is defined as: Potential exposure to the exhaled air of an individual with suspected or confirmed TB disease Exposure to high hazard procedure performed on persons with suspected or confirmed TB disease
  • 40. Risk Factors for TB Disease Development Only about 1 in 10 people infected ever suffer active disease Reactivation of TB is likely if the host has impaired immunity, including diabetes, chronic renal failure, malnourished, high- dose corticosteroid therapy, some hematologic disorders, or HIV infection
  • 41. Treatment of Tuberculosis Drug susceptibility testing should be performed on all initial isolates from patients with TB Until results are known, two basic principles of therapy apply: • Start with the four primary drugs used in the treatment of TB until sensitively and resistance are known • Continue treatment regimen with at least two drugs known to be effective on the isolate
  • 42. Drug Resistant Tuberculosis Where therapy is not continuous or incomplete, multi-drug resistant tuberculosis can develop (MDR-TB). MDR-TB can be treated but, treatment is with second line drugs that are less effective. MDR-TB requires longer treatment regimens: 18 to 24 months (due to lower efficacy)
  • 43. TB Surveillance & Reporting • Skin test conversions among personnel • PPD done at time of employment and (annually) periodic re-testing thereafter • Evaluation of exposure incidents • Evaluations & management of positive PPD skin tests or symptoms of TB • Follow-up of personnel with positive PPD skin test
  • 44. Follow-up After TB Exposure • Clinically evaluate for active TB • Negative PPD in preceding 3 months - repeat 12 weeks after exposure • Negative PPD longer than 3 months ago, repeat baseline and if this one is negative, repeat in 12 weeks • A positive PPD requires clinical evaluation and management
  • 45. Tuberculosis Prevention & Control • Unit ventilation: keep adequate ventilation in the treatment area of the transport vehicle e.g., windows, exhaust fans, air out vehicle after run • Work practices to prevent the spread of airborne droplets • When treating and transporting HIV infected patients, IVDAs, foreign born, and other high risk groups for TB, PPE should routinely include airborne protection • Face & eye protection during exposure prone activities, e.g. endotracheal intubation, suctioning, positive pressure demand valve ventilation • Decontamination with E.P.A. approved hospital grade detergent disinfectant • Tuberculosis screening program • Preventive therapy or treatment • Documentation
  • 46. Identify tasks and other activities that may involve exposure to blood or other potentially infectious body materials
  • 47. 4- Preventing Disease Transmission • Patient assessment • Airway management • Assisting respirations • Bleeding control • Contact with body fluids • Clean-up of scene & equipment • Establishing an IV • Emergency childbirth • Other patient care activities where contact with blood or body fluids occur
  • 48. To reduce the risk of infection: • Wear gloves • Minimize contact with body fluids • Wash hands or any exposed area immediately and thoroughly after you provide care or clean a spill
  • 49. Remember Precautions taken to prevent exposure to blood or other body fluids containing visible blood are known as Universal Precautions. Precautions taken to prevent exposure to any other type of body fluids or substances are known as Body Substance Isolation (BSI).
  • 50. Preventing disease transmission involves following basic precautions: • Personal hygiene: Personal habits or practices such as hand washing and proper grooming • Protective equipment: Protects a person from direct contact with infected material (i.e., gloves, masks, etc.)
  • 51. Engineering and work practice controls. Help eliminate or reduce the risk of exposure in the workplace. Engineering controls isolate or remove the hazard (i.e., containers for sharp items such as needles) Work practice controls reduce the likelihood of exposure by changing the way a task is carried out (i.e., washing hands before and after giving first aid)
  • 52. Equipment cleaning and disinfecting Careful handling of all soiled equipment, supplies, or other materials until properly taken care of (i.e., placing soiled clothing in properly marked plastic bags for disposal or washing)
  • 53. The following steps shall be followed when cleaning-up a contaminated area/scene: Isolation of Containments • Isolate the area where the material is located to prevent accidental contamination. Personal Protective Equipment • Before attempting to clean the contaminated area, apply appropriate Personal Protective Equipment (may include Gloves, protective eye wear, footwear, and clothing).
  • 54. The following steps shall be followed when cleaning-up a contaminated area/scene: Clean-Up Contaminated Area • If the area has been contaminated with blood or other bodily fluids, clean the area immediately. • Retrieve Bio-Hazard Clean-Up Kit. • Wipe up any excess fluids with disposable towels, you may also use the absorbent powder to solidify any excess fluids and then scoop-up the material and place it into the Red Bio-Hazard Bag. • Place contaminated towels in a Red Bio-Hazard Bag.
  • 55. The following steps shall be followed when cleaning-up a contaminated area/scene: Clean-Up Contaminated Area • A 1:10 dilution of 5.25%–6.15% sodium hypochlorite (i.e., household bleach) or an EPA- registered tuberculocidal disinfectant has been recommended for decontaminating blood spills. • Let the mixture stand for at least 15 minutes. • Wipe area with disposable towels and let area air dry. • Place all exposed/contaminated materials in the Red Bio-Hazard Bag. • Contact your vendor for proper disposal of your Red Bio-Hazard Bag, it is considered Medical Waste and it must be disposed of properly.
  • 56. The following steps shall be followed when cleaning-up a contaminated area/scene: Disinfect / Wash Hands • As soon as possible, wash hands to reduce the risk of infection / contamination. If you are not able to disinfect / wash hands within a reasonable amount of time, you may use a commercial waterless hand cleanser.
  • 57. Exposure Control Plans Preventing disease transmission begins with preparation and planning. The Exposure Control Pan creates a system to protect people from infection. The Plan requires the employer to identify who will receive training, protective equipment and vaccination.
  • 58. An Exposure Control Plan should contain the following elements: Exposure determination Schedule and method of implementing other parts of the OSHA Standard Procedures for evaluating details of an exposure incident. An exposure may include contact with potentially infectious blood or other body fluids through a needle stick, broken skin,or membranes of the eyes, nose, or mouth. If it is believed that an exposure has occurred, clean the area of contact thoroughly, write down what happened, and notify your supervisor immediately. Necessary follow-up care should be secured. Follow your worksite’s post-exposure policies and procedures.
  • 59. General Post Exposure Evaluation & Follow- Up Guidelines: DOCUMENT ROUTE OF EXPOSURE & CIRCUMSTANCES UNDER WHICH THE EXPOSURE OCCURRED IDENTIFICATION & DOCUMENTATION OF SOURCE INDIVIDUAL INFORMATION
  • 60.