Transcript Bloodborne Pathogens

Departmental Safety Representative
(DSR) Session:
Bloodborne Pathogens
Kellie Mayer
Bloodborne Pathogens Coordinator
Bloodborne Pathogens
• Any pathogenic microorganisms or OPIM
(other potentially infectious materials) present
in human blood that can cause disease in
humans.
• Goal: eliminate or minimize occupational
exposure to Hepatitis B virus (HBV), Human
Immunodeficiency virus (HIV), Hepatitis C
virus (HCV), and other bloodborne pathogens
We know blood and blood products
are included in this BBP scope, but
what are Other Potentially Infectious
Materials (OPIM)?
OPIM includes the following:
• Synovial, pleural,
pericardial, and
peritoneal fluid
• Cerebrospinal fluid
• Semen
• Vaginal secretions
• Amniotic fluid
• Saliva (in dental
procedures)
• Any unfixed tissue or organ
from a human
• Any body fluid visibly
contaminated with blood
• All body fluid where it is
difficult to distinguish
between body fluids
• Cell or tissue cultures that
were HIV or HBV infected
Job Duties with Possible
Bloodborne Exposure
• Drawing/processing blood/body fluids
• Working in an area where HIV or HBV is produced or
research is being performed
• Cleaning glassware or disposing of waste contaminated
with blood or OPIM
• Transporting blood or OPIM
• Working in a laboratory area where equipment or work
benches can become contaminated either by a spill or
accident
• Handling laundry, spills or containers of infectious wastes
• First aid, removing bandages
Job classifications in which employees
may have occupational exposure are:
• MD’s, Residents, Interns,
PA’s
• Veterinarians and vet staff
• Nursing Staff: RN's,
LPN's, NA's
• Scientific Department
Personnel
• Laundry staff
• Housing and Resident
Life
• Athletic personnel
• Instructors/Professors/
Faculty
• Childcare Workers
• Security Personnel
• Laboratory Staff
• Housekeeping
• Facilities services staff
Bloodborne Pathogens Standard
• 29 CFR 1910.1030, Occupational Exposure to
Bloodborne Pathogens
• Needlestick Safety and Prevention Act,
P.L. 106-430 2001 July 2001
• Exposure Control Plan updated once a year with
input from staff
• Hepatitis B vaccine
• Follow-up protocol after a bloodborne exposure
• Safety devices and PPE
Bloodborne Pathogens Standard
• The BBP Standard applies to all employers with
employees with reasonably anticipated
occupational exposure to blood or OPIM.
• The Needlestick Safety and Prevention Act
modified the Bloodborne Pathogens standard
expand the requirement that employers identify,
evaluate, and make use of effective safer medical
devices
Modes of transmission of BBP
• Percutaneous - the direct inoculation of infectious
material by piercing through the skin barrier (needlestick
or other accidental injury with a sharp, contaminated
object)
• Direct inoculation - exposure of blood or OPIM to preexisting lesions, cuts, abrasions, or rashes (dermatitis)
provides a route of entry into the body.
• Mucous membrane contact - splashing blood or serum
into an individual's unprotected eyes, nose, or mouth
Penetration by contaminated
sharps is the most common mode
of transmission of bloodborne
pathogens in the workplace.
Hepatitis B Virus (HBV)
• Hepatitis B is caused by a virus that
attacks the liver and can cause lifelong
infection, cirrhosis, liver cancer, liver
failure, or death.
• In 2003, an estimated 73,000 people were
infected with HBV. People of all ages
get hepatitis B and about 5,000 die per
year of sickness caused by HBV.
Hepatitis B Virus
• About 30% of infected persons have no sign or
symptoms of HBV.
• If symptoms occur, they usually begin to appear on
the average of 12 weeks (range 9-21 weeks) after
exposure to hepatitis B virus.
• If you have symptoms, they might include:
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•
•
•
jaundice
dark urine
joint pain
loss of appetite
•
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abdominal discomfort
clay-colored bowel movements
fatigue
nausea
HBV IS PREVENTABLE!
A safe & effective vaccine is available.
• If the vaccine is administered before infection, it
prevents the development of the disease and the
carrier state in almost all individuals.
• Hepatitis B vaccine consists of a series of three
injections – initial, one a month later, and one six
months from the first.
• Available FREE of charge from employer for
high-risk employees
HIV
• HIV (human immunodeficiency virus) is
the virus that causes AIDS (Acquired
Immune Deficiency Syndrome). Once a
person has been infected with HIV, it may
be many years before AIDS actually
develops.
• HIV kills or damages cells in the body’s
immune system, gradually destroying the
body’s ability to fight infection and
certain cancers.
computer generated
art quality graphics of
HIV was done by
Russell Kightley of
Canberra, Australia.
HIV
• As of December 2001, occupational exposure to HIV
has resulted in 57 documented cases of HIV
seroconversion among healthcare personnel (HCP) in
the US.
• The average risk for HIV transmission after a
percutaneous exposure to HIV-infected blood has been
estimated to be approximately 0.3%.
• HIV does not survive well outside the body, making
the possibility of environmental transmission remote.
HIV
• Some infected with HIV have no symptoms for up
to ten years.
• Within a month or two after exposure to the virus
some experience flu-like illness such as:
• fever, headache, fatigue, weight loss, diarrhea, night
sweats, enlarged lymph nodes
• These symptoms usually disappear within a week
to a month and are often mistaken for those of
another viral infection. During this period, the
individual is very infectious.
HCV
• Hepatitis C virus (HCV) is a liver disease
• After a needlestick or sharps exposure to HCV
positive blood , about 1.8% healthcare workers
will get infected with HCV.
• Recent studies suggest that HCV may survive
on environmental surfaces at room temperature
at least 16 hours, but no longer than 4 days.
HCV
80% of persons infected have no signs or
symptoms for HCV. When present, symptoms
may include:
• jaundice
• fatigue
• dark urine
• abdominal pain
• loss of appetite
• nausea
Occupational Exposure Prevention
The risk of occupational exposure can be
minimized or eliminated using a combination of
engineering and work practice controls, personal
protective clothing and equipment, training, medical
surveillance, warning signs or labels, and other
provisions described in this next section.
Standard Precautions
• Guidelines to decrease the risk of occupational
exposure to blood or body fluids
• A system of infection control which assumes that
every direct contact with body fluids is infectious
and requires every employee exposed to direct
contact with body fluids to be protected as though
such body fluids were infected with a bloodborne
pathogen
• Provides adequate protection against bloodborne
infections from both humans and animals
• Engineering Controls means controls (e.g.,
sharps disposal containers, self-sheathing needles
or shielded needle devices, needleless devices,
blunt needles, plastic capillary tubes) that isolate
or remove the bloodborne pathogens hazards from
the workplace.
• Work Practice Controls means controls that
reduce the likelihood of exposure by altering the
manner in which a task is performed such as
prohibiting recapping of needles by a two-handed
technique.
Engineering and Work Practice
Controls
• The employer must:
– Evaluate available engineering controls
(safer medical devices)
– Train employees on safe use and
disposal
– Implement appropriate engineering
controls/devices
Personal Protective Equipment
• Gloves (latex or nonlatex)
– When to use them:
• when there is reasonable anticipation
of employee hand contact with blood,
OPIM, mucous membranes, or nonintact skin
• when handling or touching
contaminated surfaces or items.
Latex Allergies
Latex gloves have proven effective in
preventing transmission of many infectious
diseases to health care workers. However,
for some workers, exposures to latex may
result in allergic reactions.
For further reading:
http://www.cdc.gov/niosh/topics/latex/
http://www.osha.gov/SLTC/latexallergy/index.html
Personal Protective Equipment
• Gowns, aprons, fluid-resistant clothing
• Face shields, eye protection (safety
glasses, goggles)
• Surgical mask and/or N-95 respirator
• Surgical caps, shoe covers
Even though the use of PPE is very
important in controlling exposure to
BBPs, it is your last line of defense
against exposure if engineering and
work practice controls fail.
Do not rely only on PPE for
protection.
Housekeeping:
Sharps Disposal
• Keep sharps container upright,
readily available in the work area
• Never place sharps into the regular trash
• Use a leak-proof, puncture-resistant
sharps container labeled with the biohazard symbol
• Do not overfill - dispose of sharps container as
biohazard waste when it is 2/3 full
Training
• OSHA standards require that all employees
with occupational exposure participate in a
training program.
• Training must be provided at the time of initial
assignment to tasks where occupational
exposure may take place and at least annually
thereafter.
Warning Signs and Labels
• Fluorescent orange or orange-red label
with word “Biohazard” and biohazard symbol in
contrasting color must be provided on:
• Containers of regulated waste
• Refrigerators/freezers used to store blood/OPIM
• Containers used to store, transport, or ship
blood/OPIM
• Contaminated equipment
• Red bags may be substituted for biohazard labels
on biohazardous waste bags.
Housekeeping: Decontamination
Work surfaces should be decontaminated with
an appropriate disinfectant such as 10% bleach
solution or an EPA approved disinfectant after
completion of procedures, immediately or as
soon as feasible when surfaces are overtly
contaminated or after any spill, and at the end of
the work shift.
What is the difference between
cleaning and disinfecting?
• Cleaning and disinfecting are not the same thing.
In most cases, cleaning with soap and water is
adequate. It removes dirt and most of the germs.
• You should disinfect areas where there are both
high concentrations of dangerous germs and a
possibility that they will be spread to others.
• Disinfectants, including solutions of household
bleach, have ingredients that destroy bacteria and
other germs.
Exposure Control Plan:
The ECP must be updated annually to include:
• changes in technology that reduce/eliminate
exposure
• annual documentation of consideration and
implementation of safer medical devices
• solicitation of input from non-managerial
employees
Employee Responsibilities
• Completing training/orientation as required
• Following the Exposure Control Plan and the
Standard Precautions Policy
• Using work practices, engineering controls, and
personal protective equipment as outlined in the
Exposure Control Plan
• Obtaining the HBV vaccine or signing the
declination form
Employee Responsibilities
• Reporting exposure incidents to their supervisor
and assisting the supervisor in completing First
Report of Injury/Illness and EPINet Forms
• Pursuing follow-up care after an occupational
exposure
Failure to follow these policies could result
in disciplinary action.
Recordkeeping
• Sharps Injury Log
– Maintained by Office of Environmental Health &
Safety (OEHS) independently from OSHA 300 Log
– Contains necessary documented information for
each needlestick/sharp related incident:
• type and brand of device involved
• department or area of incident
• description of incident
• Training records – 3 years
Recordkeeping
• Confidential medical records – duration
of employment + 30 years
• EPINet (Exposure Prevention Information Network)
forms
– helps to track trends, problem areas, types of
medical devices, etc. related to BBP occupational
exposure incidents and injuries
• First Report of Injury and Illness Form
Where do I go and what
must I do if I am
exposed?
What to Do: Post-Exposure
• Wash exposed area with soap and water for 5 minutes
– if at TNPRC, please use one of the bite kits that are
available in each work area for your 15 minute scrub using
betadine
– if eye or mucous membrane contact, flush with sterile
water or saline for 5 minutes
• Report the incident to your supervisor.
• Complete First Report of Occupational Injury/Illness
Form
• Report for medical evaluation (please review the next
few slides for places to report)
Where to Go Post-Exposure:
General Medical Surveillance
• Any bloodborne pathogens exposure incident is an
event for which immediate attention must be
sought, as the effectiveness of prophylaxis
depends on the immediacy of its delivery.
• Seek medical attention in the same manner that it
would be sought should any occupational injury
occur (e.g., emergency room, physician's office,
urgent care clinic).
Where to Go Post-Exposure:
Injuries Sustained at TNPRC
(Tulane National Primate Research Center)
• Go to Employee Health (B- Bldg) at TNPRC for
medical evaluation during business hours.
• Report to Employee Health at TNPRC for followup visits
• If an exposure incident occurs after hours or on the
weekend, your supervisor will notify the
veterinarian on call and page the nurse at
(985) 966-6515 for further instructions.
Where to Go Post-Exposure:
Injuries Sustained while on Rotation at
Another Facility
• If on rounds at another hospital, report
there for initial visit but you must still
notify the Bloodborne Pathogen
Coordinator at (504) 988-6608.
It is VERY important to bring the patient’s source
blood (if available) with you when you report for initial
evaluation. Your care is dependant on the HIV, HBV,
and HCV status of the source patient to whom you
were exposed.
Similarly, when dealing with nonhuman primates it is
important to note which monkey was the source for the
bite/scratch to allow for proper evaluation of infection
in the source animal.
Failure to do this can result in delayed or
unnecessary treatment for you.
Summary of Post-Exposure
Employee Responsibilities
1.
Wash/flush exposed injury area for 5 minutes (15
minutes if at TNPRC for possible B virus
exposure).
2.
Promptly report the incident to your supervisor.
3.
Complete the First Report of Injury and EPINet
forms.
4.
Report to appropriate clinic/emergency
department (depending on your location) for
medical evaluation.
You can always reach the
Bloodborne Pathogens Coordinator
24 hours a day
by work cell phone (504)419-1391
or call (504)988-5486 and press 1.
Tulane University
Office of Environmental Health & Safety (OEHS)
Please contact the BBP Coordinator for questions, comments,
and/or interactive discussion.
Kellie C. Mayer
(504-419-1391) [email protected]
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http://aurora.tcs.tulane.edu/ehs/enterssn.cfm?testnum=25
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