Transcript Bloodborne Pathogens in Nursing Homes

Occupational Health Issues
Associated With Long Term Care
Facilities
Bloodborne pathogens
 Tuberculosis
 Latex allergies
 Hazard communication
 Indoor air quality
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Bloodborne Pathogens in Nursing
Homes
Exposure Control Plan
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Exposure Determination
- List of job classifications (all employees exposed, some exposed)
- List of tasks and procedures where exposure may occur (without
regard to use of ppe)
Methods of Compliance
- Universal Precautions
- Engineering Controls
- Work Practice Controls
- Personal Protective Equipment
Universal Precautions
Treat all blood samples and potentially infected materials as if infected..
Use proper personal protective equipment
 Immediate washing of hands and other skin
surfaces if contact with materials
 Wash hands immediately after glove
removal
 Management of sharps
 Exposure incident reporting and follow-up
 Spill response
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Engineering and Work Practice
Controls
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Handwashing facilities and procedures
Contaminated needles handling (no bending, recapping)
Placement of used sharps in special containers (puncture resistant,
labeled, leakproof, color coded)
No eating, drinking, smoking, hangling contacts, use of cosmetics in
exposure areas
No storage of food where blood is present
Minimize splashing, spraying, spattering
No mouth pipetting
Placement of blood in leakproof containers ( labeled, color coded)
De-contamination of equipment
Personal Protective Equipment
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Must be provided, cleaned, laundered, disposed of,
replaced, and used properly.
Gloves, gowns, face shields, masks, resusitation bags, eye
protection, aprons, and caps
Consider possibility of soiling (aprons when changing
dressing), and spattering (eyewear during mouth
examinations)
Cleaning and disposal
Removal before leaving workplace
Stored in containers after use
Housekeeping
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Keep written schedules and methods of cleaning and
decontaminating surfaces and equipment
Maintain clean and sanitary worksite
De-contaminate work surfaces
Use protective coverings
Cleaning of receptacles, pails, bins
No hand contact with broken contaminated glassware
Handling of re-usable sharps
Discarding of contaminated
sharps
Container must be closable, puncture
resistant, leakproof, labeled and color coded
 Keep closed
 Secondary containment if leak occurs
 Disposal according to Federal, State, local
requirements
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Handling of contaminated
laundry
Bag and containerize where used (no
rinsing or sorting)
 Bags labeled and color coded and leakproof
 Protective gloves used when handling
laundry
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Employee training
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Available hepatitis B vaccine, post exposure evaluation, and follow-up
to employees who had incident
Training at initial assignment and annually
OSHA standard
Explanation of HIV and hepatitis B diseases
Modes of transmission
Exposure identification
Tasks which involve exposure
Methods used to prevent exposure
Personal protective equipment use
Decontamination procedures
Emergency procedures
Exposure incident procedures
Labels and signs
“BIOHAZARD”
 Use of red bags and containers in stead of
labels
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Recordkeeping
Vaccination and other medical records
 Training records
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Medical Waste Handling
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State and local laws (44 states require disposal and tracking) and RCRA
Subtitle J Medical Waste Tracking Act Demonstration Program
Council of State Govenors - Model State Plans for Medical Waste
Identify waste
Packaging and lable
Segregation
Destruction of waste
Disposal - most require treatment before disposal
Recordkeeping and tracking
Training employees
Incineration, steam autoclave, microwave, grinding and chemical
treatment
Transporter and disposal site permitting and insurance concerns
Tuberculosis
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Drug resistant strains
Homeless population
HIV
14% increase since 1985 (recent decline due to
greater awareness)
Outbreaks in hospitals, homeless shelters, nursing
homes, and AIDS residential care centers
TB is an inhalable airborne infectious disease
OSHA Enforcement Policy
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In response to employee complaints, or
Part of regular IH inspection for CDC identified workplaces
- Health care facilities, homeless shelters, LTC facilities,
correctional institutions, and drug treatment centers
Inspect if confirmed or suspected TB in passed 6 months
Based on 1994 CDC revised guidelines
Use of general duty clause 5(a)(1) - “...workplace free of recognized
hazards ...”
Infection control plan
Proposed standard in 1997?
Infection Control Plan
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Early detection through skin tests
Training and information
- signs and symptoms
- medical surveillance and therapy
- Site procedures
- Use of controls
Medical screening and re-test every 6 months ( 3 months for high risk and 12
months for low risk)
Management and restriction of infected individuals
Isolation rooms under negative pressure and warning signs
PPE - HEPA respirators
Latex Allergies
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Rise in latex glove use as result of OSHA bloodborne pathogen standard
and CDC recommendations for universal precautions
Affects about 8% to 10% of health care workers
Direct skin contact with latex or airborne powders from inside
Severity and hypersensitivity grows with exposure
Symptoms include contact dermatitis, anaphylactic shock, respiratory
failure
Can be confirmed through patch skin testing
Cornstarch powder can carry latex protein and become airborne - air
sampling can be done to assess exposure
Control through education, substitution, low powder/low allergy gloves,
manufacturing rinse processes, complete avoidance, and medical history
and screening
New non-powdered gloves, low allergen gloves, non-latex gloves,
establishment of safe zones for sensitized
Hazard Communication Plan
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OSHA 29CFR1910.1200
Written plan
Labeling of hazardous materials
MSDSs obtained and available
Employee training
- Health effects
- Signs and symptoms of exposure
- Controls
- OSHA requirements
Indoor Air Quality/Sick Building
Syndrome
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Sensitive elderly population
Investigation techniques
- Questionnaire
- Air sampling (specific contaminants or indicator gasses)
- Ventilation evaluation
- Heat/humidity evaluation
Sources (chemical, biological, inside, outside, chemicals, off-gassing
of furnishings)
Controls (low emmission furnishings, HVAC maintenance, chemical
control, local ventilation of sources, moisture control, fresh air volume
and mixing)
Standards (chemical levels, CO, ventilation)