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Bloodborne Refresher 2014
- 1. 1 Bloodborne Pathogens Annual Refresher Training PRIDE 2014
- 2. 2 What Are We Going To Do ... Talk about any changes in BBP info during the last 12 months Look at local infectious disease numbers A quick review on basic disease information Review information specific to Loudoun County
- 3. 3 National Disease Numbers 2010 AIDS – 36,870 Hepatitis B – 3,405 Hepatitis C – 782 Syphilis – 44,828 TB – 11,182 WNV- 524 Lyme – 22,561
- 4. Measles cases – 74 Mumps – 1,991 Pertussis (whooping cough) – 16,858 Other Key Diseases August 19, 2010
- 5. 5 Virginia Numbers 2011 AIDS 1108 HIV 577 TB 221 Syphilis 717 Hepatitis B 667 West Nile Virus 9 Lyme Disease 1023 2012 (as of 9/1/12) AIDS 415 HIV 769 TB 112 Syphilis 489 Hepatitis B 351 West Nile Virus 9 Lyme Disease 454
- 6. 6 Loudoun Numbers 2011 AIDS 13 HIV 23 TB 12 Syphilis 4 Hepatitis B 64 West Nile Virus 0 Lyme Disease 261 2012 (as of 9/1/12) AIDS 9 HIV 18 TB 7 Syphilis 9 Hepatitis B 46 West Nile Virus 0 Lyme Disease 125
- 7. 7 Infection Control Concepts All diseases are infectious, but not all diseases are communicable. So what are we concerned with?
- 9. 9
- 10. 10 What is the incubation phase?
- 11. 11 What constitutes an exposure?
- 12. 12 Body Fluids That Pose A Risk Primary Risk Blood Semen Vaginal Secretions Secondary Risk Synovial Fluid Pericardial Fluid Pleural Fluid Amniotic Fluid Cerebrospinal Fluid Any other body fluid containing visible blood “O.P.I.M.”
- 13. 13 Tears, sweat, urine, stool, vomitus, nasal secretions, and sputum do not pose a risk unless they contain visible blood!
- 14. Human Bites & Exposure If a patient bites you and draws blood… You have not had an exposure. The patient has had the exposure, to your blood! 14
- 15. 15 What constitutes an exposure? NOT AN EXPOSURE Blood on intact skin Vomit on your face Urine on your skin Patient coughs in the ambulance. AN EXPOSURE Blood on broken skin Vomit (with visible blood in it) in your eyes Blood coughed in eyes and/or mouth while suctioning
- 17. 17 Tuberculosis (TB) Airborne bacteria transmitted by droplet contact Not highly communicable...requires prolonged “close quarters” contact “Incubation” = 4-12 weeks Findings = persistent cough > 3 weeks AND swollen glands, significant weight loss Annual testing recommended
- 18. 2009 lowest case number since 1953 11,540 cases Largest 1 year decrease since 1993 Five states carry over 52% of the total number of cases: Florida, Texas, New York, California, Illinois Tuberculosis 18
- 19. 19 TB Testing The Tuberculin Skin Test (used to be called the PPD) is no longer used by LCFR for annual testing of career staff.
- 20. 20 TB Blood Test Guidelines QuantiFERON (QFT-Gold) Blood test for latent TB infection Used for screening healthcare workers/military personnel/correctional staff No need to return for readings Can be used with personnel who had previous positive TST tests
- 21. 21 Tuberculosis If you are transporting a patient who is actively coughing and is high risk for TB: Place a mask on the patient – an NRB is adequate. Would it be effective to place an N-95 on the patient?
- 22. 22 MRSA
- 23. 23 MRSA Methicillin-resistant staphaureus (MRSA) Most associated with healthcare settings. CDC report from 2010 shows that there has been a significant decline in MRSA since 2005. Most frequent among people with weakened immune systems, the elderly, children.
- 24. 24MRSA pimples in a person with a suppressed immune system
- 25. 25
- 26. 26 MRSA
- 27. 27 MRSA Clusters among athletes, military recruits, children, prisoners May live on surfaces contaminated with body fluids containing MRSA
- 28. 28 Primary Means of Transmission Skin-to-skin contact Crowded conditions Poor hygiene Sharing of personal items
- 29. Treatment Incision & Drainage for soft tissue infections No antibiotics 29
- 30. 30 Hepatitis B
- 31. 31 Hepatitis B (HBV) Virus that attacks the liver Very virulent Direct or indirect contact “Window” = 45 days “Incubation” = up to 6 months Early Findings = flu-like illness (communicable) Late Findings = yellow skin/eyes, dark urine, liver enlargement (non-communicable) No cure...vaccine (Recombivax) is available
- 32. 32 Hepatitis B Vaccine Reminder Offers protection via “immunologic memory” There is NO formal requirement or recommendation for a booster Titer 1-2 months after completion of vaccine series is required- OSHA enforcing CDC, 1992,1997, June 29, 2001
- 33. 33 Hepatitis C
- 34. 34 Hepatitis C Cases The acute incidence continues to decline Additional data shows an increased risk with tattoos and body piercing. Rate in US – 1.3% 3.2 million people in U.S. have chronic HCV infection
- 35. 35 Hepatitis C- Transmission Blood IV drug use Mother to infant Intranasal cocaine use Sexual Contact Multiple partners High-risk sexual practices
- 36. 36 Hepatitis C - HCW Infection There is no recommendation for the routine screening of healthcare workers Hepatitis C is not efficiently transmitted occupationally • AJIC, 1999, Vol.. 27 (1):54-55 • CDC, 1998, CDC, 6/29/01
- 37. 37 HIV/AIDS
- 38. 38 Human Immunodeficiency Virus (HIV) Virus that attacks the immune system Low virulence “Window” = 1-12 weeks...”Incubation” = up to 10 years Early Findings = none to mild flu-like symptoms Late Findings = varied, depending on infections produced by ineffective immune system No cure...No vaccine
- 39. 1978 – December, 2006 57* documented cases 0 in fire/EMS personnel 49 were sharps related exposures No new reported cases since 2000 Occupational Infection-HIV CDC, 2008(CDC), NIOSH 39
- 40. Rapid HIV Tests Rapid HIV Testing currently available OraQuick Reveal Uni-Gold Multispot Clearview 40
- 41. If source patient is negative with rapid testing = no further testing of health-care worker Use of rapid testing will prevent staff from being placed on toxic drugs for even a short period of time Testing Issues - Post Exposure •CDC, May , 1998, CDC June 29, 2001, September 2005 41
- 42. 42 Flu
- 43. 43 Influenza (Flu) Airborne virus transmitted by droplet contact Respiratory tract infection caused by the influenza virus. Fever, cough, sore throat, runny nose, muscle aches, extreme fatigue are common. (Clear in 1 to 2 weeks) 20,000 deaths nationwide and more than 100,000 hospitalizations, annually. The elderly and people with chronic health problems are much more likely to be seriously affected
- 44. Flu Vaccine - Annual “Direct patient care” All healthcare workers 44
- 45. CDC Flu Vaccine Program Employers must offer Employers must pay Employees who decline - sign a declination form CDC, February 24, 2006/2008/2009, NFPA 1581 45
- 46. FluMist – Nasal Spray For healthy persons 2- 49 years old Does not need to be stored frozen Do not take if pregnant – live virus vaccine No thimerosal Is egg based Cost reduced No work restriction 46
- 47. „Swine‟ flu is not expected to be a big component of this year‟s flu season. If you had the H1N1 vaccine, it is still protective. No booster is necessary. H1N1 Flu Virus 47
- 48. Fever Sore throat Cough Nausea Vomiting Diarrhea Flu Signs/Symptoms 48
- 49. Adult Shortness of breath Chest pain/pressure Dizziness Confusion Persistent vomiting Pediatric Respiratory distress Bluish skin color Irritability Fever with rash Low fluid intake Not waking or interacting Severe Signs/Symptoms 49
- 50. Place a surgical mask on patient If that isn‟t possible, place a surgical mask on yourself Good handwashing Use good airflow in vehicle If a patient is suspected of having the flu 50
- 51. Flu virus survives on hard surfaces for about 2 hours Routine cleaning is important Equipment Surfaces in vehicle Survival on Surfaces 51
- 53. Anaerobic spore-forming bacillus Clostridium difficile associated disease (CDAD) Hospital-acquired Related to antibiotic treatment C- diff 53
- 54. Surpassing MRSA as the major hospital acquired illness 215,000 infections annually 12,000 deaths Cost $1.6 billion Incidence Rate – Hospital 54
- 55. 263,000 cases each year 16,500 deaths annually Cost $2.2 billion Incidence Rate – Long Term Care 55
- 56. Alcohol handwash is not 100% effective Soap & water is more effective and should be used when available Handwashing & C-diff 56
- 58. Routine Immunizations HBV Vaccine MMR Tdap Chickenpox Vaccine Flu Vaccine CDC, 1997, OSHA,1999,2005
- 59. CDC Statement Health-care personnel place themselves and their patients at risk if they are not protected against measles. In accordance with current recommendations, health-care personnel should have documented evidence of measles immunity¶¶ readily available at their work location (3). If this documentation is not available when measles is introduced, major costs and disruptions to health-care operations can result from the need to exclude potentially infected staff members and rapidly ensure immunity for others (6). CDC, May 1, 2008
- 60. 60 Mumps In order to be considered immune: History of physician diagnosis OR Receipt of at least 1 dose of mumps vaccine OR Positive mumps IgG
- 61. 61 Mumps Vaccine - Update 2 doses needed for coverage 1 dose = 80% protection Vaccine cannot be used post-exposure CDC, 2006
- 62. 62 Mumps Exposure Within 3 feet of infected person No surgical mask used
- 63. Measles – Virginia 2008 8 EMS personnel exposed No documentation of immunity available Personnel needed an average of 36 hours off duty for testing Cost- $14,400.00
- 64. Vaccination prevents influenza regardless of antiviral resistance – get vaccinated CDC, Dr. Fiore 64
- 65. 65 Reduce the Risks of Disease Transmission through…. PREVENTION
- 66. 66 The Prevention Program Includes… Education on Infection Control Encouraging good hygiene practices Eat a healthy diet Proper cleaning & disinfection of athletic equipment Proper handling of blood and OPIM
- 67. 67 By altering one component of the triangle, one or more of the other components may be changed Environment – Surfaces, Equipment, Personnel who come to work with infections Causal Agent - Herpes, HOST: Recruits, Staph Infections EMTs, MRSA Firefighters, Officers
- 68. 68 Host (Personnel) Healthy Habits Diet rich in green, yellow, and orange vegetables can bolster natural immunity. Drinking 8 to 10 glasses of water a day can help flush disease causing organisms from the body. Regular exercise.
- 69. 69 Alter the Environment Hygiene Practices Keep cuts & scrapes clean and covered Do not share personal items Towels, soap, razors, tweezers, sports equipment, ball caps, linen etc. Shower after PT or strenuous activities Hand Hygiene Wash your hands Soap and water is best Waterless hand sanitizer if soap & water is not available Antibacterial soap is not recommended
- 70. 70 Cleaning of equipment All Chemical Germicides and Bleach Solutions (1 part bleach to 100 parts water) MIX Appropriately USE Appropriately READ and FOLLOW LABELS
- 71. 71 Infection Control BSI – aka Standard Precautions Good handwashing NRB or Surgical mask on the patient Protective eyewear N-95 respirator for care provider
- 72. 72 Prevention for HCW’s Handwashing - After touching blood/body fluids/contaminated objects After glove removal Provide 15 sec. of friction DO NOT squeeze the site to express blood
- 73. 73 Hand Hygiene Guidelines No antibacterial soap Alcohol based foam or gel No artificial nails or extensions • CDC, October,2002
- 74. 74 Glove Use - Reminder Practical and feasible- Gloves must be used when there is reasonable anticipation of contact with contaminated surfaces or when performing vascular access procedures, direct contact with patient mucous membranes or non- intact skin
- 75. 75 Prevention for HCW’s Mask Use - Eye Protection For procedures that may generate splash/splatter of blood/body fluids
- 76. 76 Mask Clarification Surgical mask Filters what goes out Respirator Filters what comes in Never put a respirator on a patient
- 77. Needle safe Devices 77 Genie™ safety Lancets Filter Straws Baxter Multi-dose vial adapters Micro Pin Blunt cannula
- 78. 78 Loudoun County Infection Control Officers Designated Infection Control Officer – Deputy Chief Jose Salazar Back up Infection Control Officers – Battalion Chief Tim Menzenwerth Captain James Cooper Captain Micah Kiger Captain Mike Mahoney Captain Daniel Neal
- 80. 80 When an exposure happens! Don‟t Panic…did you really get exposed? Clean the site with soap and water as soon as possible. Immediately call LCFR – ECC and have the Infection Control Officer notified Notify the receiving health care facility of the exposure. Do not provide your personal insurance information
- 81. 81 When an exposure happens! The ICO will discuss your report with you and provide you with additional instructions. Follow-up procedures may be required. All information pertaining to your exposure incident will be keep confidential.
- 82. 82 When an Exposure Occurs If the source patient is identified and tested, there is no need to draw bloods on employee. If source patient tests are positive, then follow up will be done.
- 83. 83 Loudoun County, Virginia www.loudoun.gov Management and Financial Services, Human Resources / Benefits 1 Harrison St., SE, 4th Floor, MS #41A Leesburg, VA 20177-7000 Telephone (703) 777-0517 Fax (571) 258-3212 Employee’s Report of Injury (Must Be Handwritten) Instructions-Employee: Please complete this report and return to your supervisor. Supervisor: Review incident with employee and then ente r the required information onto the Employer’s Accident Report. Send both original injury reports to the Workers’ Comp dept. within 48 hours. Name (First, Middle, Last) _______________________________________________________________________ Address__________________________________ City_________________________ State______ Zip_________ Phone No. ____________________ Date of Birth _________________ Social Security No. ___________________ Job Title _____________________ Department _____________________________________________________ Injury Date ___________________ Time of Injury __________ Overtime Yes/No Last Day Worked___________ Date Supervisor Notified___________________ Date Returned to Work __________________________________ What was the injury or illness? State exact part of the body affected and what the injury or illness was. Injury________________________________________________________________________________________ Body Part______________________ Specific Area_______________________ Please Circle: Left Right N/A What were you doing just before the incident occurred? Describe the activity, as well as the tools, equipment or material you were using. Be Specific. Example: “Arresting subject .” ____________________________________________________________________________________________ ____________________________________________________________________________________________ How did the injury/illness occur? Example: “While arresting subject, fell to the ground and landed on arm.” ____________________________________________________________________________________________ ____________________________________________________________________________________________ Where did the incident happen? __________________________________________________ What can be done to prevent future occurrence? ____________________________________________________________________________________________ Where did you go for medical treatment? ______________________________________N/A I certify that the information in this Work-Related Injury Report is true and accurate to the best of my knowledge. I understand that the County will rely upon this form in evaluating my claim. I further understand that this document may be presented or used in support of or against a claim for payment under the County’s policy of workers’ compensation insurance. I understand falsification of any information on or about this injury report form or the alleged injury, and the assertion of a false workers’ compensation claim, are violations of Virginia’s Criminal laws, may result in a fine and imprisonment and/or termination of my employment. Employee Signature___________________________________________________ Date _____________________ Supervisor Signature___________________________________________________Date_____________________ Employee’s report of injury
- 84. 84 Employer’s Accident Report (formerly: Employer’s First Report of Accident) The boxes Reason for filing VWC file number Virginia Workers’ Compensation Commission 1000 DMV Drive Richmond, VA 23220 to the right are for the Insurer code or PEO Ref. No. 90267 Insurer location 760 See instructions on the reverse of this form use of the insurer Insurer claim number Employer 1. Name of employer (trading as or doing business as, if applicable) County of Loudoun, VA 2. Federal Tax Identification Number 54-0948306 3. Employer’s Case No. (if applicable) 4. Mailing address P.O. Box 7000, 1 Harrison Street., SE Leesburg, Virginia 20177 5. Location (if different from mailing address) 6. Parent corporation /Policy Named Insured (if applicable) or PEO name Loudoun County Government 7. Nature of business County Government/Volunteer Fire & Rescue 8. Name and Address of Insurer or self-insurer for this claim Wells Fargo Disability Management 9. Policy number 10. Effective date Time and Place of Accident 11. City or county where accident occurred Loudoun County 12. Date of injury 13. Hour of injury a.m. p.m. 14. Date of incapacity 15. Hour of incapacity 13a. Time began work a.m. p. m. 16. Was employee paid in full of day of injury? Yes No 17. Was employee paid in full for day incapacity began? Yes No 18. Date injury or illness reported 19. Person to whom reported 20. Name of other witness 21. If fatal, give date of death Employee 22. Name of employee (Last, First, Middle) 23. Phone Number 24. Sex Male Female 25. Address 26. Date of Birth 27. Marital Status Single Divorced 28. Social Security Number Married Widowed 29. Occupation at time of injury or illness (SOC code, if applicable) 30. Is worker covered by PEO policy? Yes No 31. Number of dependent children 32. How long in current job? 33. Date of Hire 34. Was employee paid on a piece work or hourly basis? Piece work Hourly 35. Hours worked per day 36. Days worked per week 37. Value of perquisites per week Food/Meals Lodging Tips Other 38. Wages per hour $ 39. Earnings per week (inc. overtime) $ $ $ $ $ Nature and Cause of Accident 40. Machine, tool, or object causing injury or illness 41. Specify part of machine, etc. 42. Describe fully how injury or illness occurred 43. Describe nature of injury or illness, including arts of body affected 43a. Overnight inpatient hospitalization? Yes No 43b. Treated in Emergency Room? Yes No 44. Physician (name and address) 45. Hospital (name and address) 46. Probable length of disability 47. Has employee returned to work? Yes No If Yes 48. At what wage? 49. On what date? 50. EMPLOYER: prepared by (name, signature, title) 51. Date 52. Phone Number 53. INSURER: (name of processor) 54. Date 55. Phone number 56. THIRD PARTY ADMINISTRATOR (if applicable) 57. Address 58. Phone number This report is required by the Virginia Workers’ Compensation Act Employer’s Accident Report VWC Form No. 3 (rev. 03/22/02) Employer’s Accident report to be filled out by supervisor
- 85. 85 Loudoun County, Virginia www.loudoun.gov Management and Financial Services, Human Resources / Benefits 1 Harrison St., SE, 4th Floor, MS #41A Leesburg, VA 20177-7000 Telephone (703) 777-0517 Fax (571) 258-3212 Volunteer’s Report of Injury (Handwritten) Instructions-Volunteers: Please complete this report and return to your supervisor. Supervisor: Review incident with employee and then enter the required information onto the Employer’s Accident Report. Send both original injury reports to OHS@loudoun.gov within 48 hours. Name (First, Middle, Last) _______________________________________________________________________ Address__________________________________ City_________________________ State______ Zip_________ Phone No. ____________________ Date of Birth _________________ Social Security No. ___________________ Job Title _____________________ Department _____________________________________________________ Injury Date ___________________ Time of Injury __________ Date Supervisor Notified___________________ Date Returned to Work __________________________________ What was the injury or illness? State exact part of the body affected and what the injury or illness was. Injury________________________________________________________________________________________ Body Part______________________ Specific Area_______________________ Please Circle: Left Right N/A What were you doing just before the incident occurred? Describe the activity, as well as the tools, equipment or material you were using. Be Specific. Example: “Arresting subject.” ____________________________________________________________________________________________ ____________________________________________________________________________________________ How did the injury/illness occur? Example: “While arresting subject, fell to the ground and landed on arm.” ____________________________________________________________________________________________ ____________________________________________________________________________________________ Where did the incident happen? __________________________________________________ What can be done to prevent future occurrence? ____________________________________________________________________________________________ Where did you go for medical treatment? ______________________________________N/A I certify that the information in this Work-Related Injury Report is true and accurate to the best of my knowledge. I understand that the County will rely upon this form in evaluating my claim. I further understand that this document may be presented or used in support of or against a claim for payment under the County’s policy of workers’ compensation insurance. I understand falsification of any information on or about this injury report form or the alleged injury, and the assertion of a false workers’ compensation claim, are violations of Virginia’s Criminal laws, may result in a fine and imprisonment and/or termination of my employment. Volunteer’s Signature_________________________________________________ Date _____________________ Supervisor Signature__________________________________________________Date_____________________ Volunteer Report of Injury
- 86. 86 Good Samaritan Exposure Complete the “Good Samaritan Handout” at scene. If unable to locate form, provide the Infection Control Officer the following: Good Samaritan’s name Contact information Unit # the patient was transported by Incident # and Patient # Name of facility patient was transported to
- 87. 87 GOOD SAMARITAN EXPOSURE FORM If you have received a person’s blood or body fluid into your eye, mouth, nose, or other mucous membrane, non-intact (an open area of your skin), or an object containing blood or body fluids pierced your skin, then you have receive an exposure.. The Virginia law on deemed consent states that if you have received an exposure (as defined above) to a person’s blood or other potentially infectious materials while rendering emergency assistance, you are entitled to have the person tested for HIV, Hepatitis B, and Hepatitis C and to receive the results of those tests. Call the Loudoun County Emergency Communication Center at (703) 777-0637 immediately, and advise them that you have received an exposure and are requesting the Designated Infection Control Officer to assist you. Please provider your name and the phone number where you can be reached at that time. The Designated Infection Control Officer will need the following information (Obtain from the fire-rescue member on the emergency scene): Date and Time of event: ___________________ Agency and Unit # the patient was transported by: _________ Incident # ______________ Patient # (if more than one) _______ Name of the medical facility the source patient was transported to: _____________________________________ .
- 88. 88 What Questions do you have ?
Editor's Notes
- Masking the patient is the most direct protection as secretions are contained at the source. A surgical mask will offer you protection as well
- Survival time on surfaces is approximately 2 hours. The importance of cleaning between patient transports is important. This is especially important as transmission via stool has not been ruled out.