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.

1. AWARENESS TRAINING
BLOODBORNE
PATHOGEN
PRESENTED BY
Texas Family Medicine
Preceptorship Program
UT Medical School at Houston -
Environmental Health & Safety

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. 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. 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. 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. 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. 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. 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. 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. 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. Engineering
controls
Personal
Protective
Equipment
(PPE)
Administrative
controls
Work place
practices
PREVENTIVE MEASURES

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. 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. How to
properly
remove
gloves
Personal Protective Equipment (cont.)
Source: Globus

15. Medical surveillance
• TB skin test (PPD)
Immunizations
• Hepatitis B series
Training
Management of staff (SOP compliance)
Background checks, security clearance
Administrative Controls

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. 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. 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. • 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. BLEACH
ALCOHOL
CIDEX
Cleaning agents/disinfectants you will encounter
Start from perimeter and work your way in
ROUTINE DECONTAMINATION

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
http://www.handhygiene.org/

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. 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. 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

25. WHAT SONG IS ABOUT 15 SECONDS LONG?

26. Source: Hand Hygiene Resource Center
http://www.handhygiene.org/
“Happy Birthday” Song
-or-
“ABC” Song

27. WHERE
WE
MISS

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. 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. 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. 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

34. • 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

35. 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

36. Cough
Chest Pain
Coughing up blood
Weakness
Fever and/or night sweats
Weight loss
TB Presentation & Isolation

37. WHO TUBERCULOSIS DATA

38. TEXAS TUBERCULOSIS DATA

39. 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

40. TB Presentation and Isolation (cont.)
REMINDER
Bloodborne Pathogens can
be transmitted via the
following routes:
• Airborne
• Droplet
• Contact

41. 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

42. 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

43. 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

44. 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

45. 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

46. What is Biological Waste & What is Trash?
Unsoiled Exam Gloves
Disposable Gowns (Unsoiled)
Bloody Gloves
Used Needles
UA Dipstick

47. 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

48. 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.

49. 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

50. THANK YOU FOR LEARNING