Prevention is Better than Cure

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.

8. How
Infections
Occur

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

61. Thank you
Ahmad Thanin