Transcript What is exposure control? - Greater Baltimore Medical Center

Preventing Exposures to
Blood Borne Pathogens
Updated 10/06
All Staff
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What is exposure control?
Exposure control is an approach to
eliminate employee contact to a
potential health hazard.
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Elements of an exposure
control plan
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Exposure determination
Methods of compliance:
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universal precautions
work practices
engineering controls
use of personal protective equipment
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Elements of an exposure
control plan
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Hepatitis B vaccination program
Procedure for evaluation of exposure
incidents
Post-exposure evaluation and follow-up
Inclusion of evaluation of safer engineering
devices
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Where is your exposure
control plan located?
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A copy of your exposure control plan
should be maintained by your
employer.
It should be reviewed and updated
annually.
You should have access to the plan
for review.
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Why is an exposure control
plan important ?
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Identifies employees at risk for exposure to
bloodborne pathogens
Provides for the education of employees regarding
the bloodborne pathogen risk and how to avoid
this risk
Provides a mechanism to educate employees about
the uses and limitations of engineering controls,
work practices and personal protective equipment
Provides a plan for post-exposure follow-up
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What is an occupational
exposure?
An “occupational exposure is a
reasonably anticipated skin, eye,
mucous membrane, non-intact skin
or parenteral contact with blood
and other potentially infectious
materials that may result from the
performance of an employee’s
duties.”
OSHA
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How can exposures be
prevented?
1) Your employer should identify job
categories at risk for exposure.
2) Consistent use of universal
precautions for all clients.
3) Use of personal protective equipment.
4) Use of engineering controls .
5) Use of safe work practices.
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Prevention is the key!
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How are bloodborne pathogens
transmitted?
Hepatitis B and C and HIV are transmitted in a
healthcare setting:
by needle stick injuries
 contact with blood or body fluids through
cuts, scrapes and breaks in the skin
 splashes to the eye, nose and mouth area
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What are the symptoms of
Hepatitis B and C?
Hepatitis attacks the liver and may cause
serious liver disease.
 Sometimes jaundice occurs with these
infections.
 Hepatitis can feel like a flu-like illness for
months.
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Do people with hepatitis
always have symptoms?
Some people never have symptoms.
 Others are considered in a chronic carrier
state - no symptoms but can pass the disease
to others
 HBV can lead to cirrhosis, liver cancer and
death.
 Hepatitis C may lead to cirrhosis of the
liver.
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How many cases of
Hepatitis B occur each year?
Approximately 140,000 - 320,000 cases
occur each year.
 20,000 people go on to be chronic carriers
 850 people will develop chronic liver
problems
 140-320 people will die from active
Hepatitis B each year
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How many cases of
Hepatitis C occur each year?
35, 000 - 180,000 Americans become
infected with HCV per year
 HCV is associated with 8,000 - 10,000
deaths each year (chronic liver disease
 > 85% of people who become infected with
HCV will go on to develop chronic
infection
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HIV
The number of people with HIV and AIDS
continues to increase.
 Total number of people living with
HIV/AIDS is 40 million as of 2003
 Approximately 5 million people were newly
infected with HIV in 2003
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What are the symptoms of
HIV?
HIV attacks the body’s immune system
 Many people are infected but do not know
they have been infected.
 Early symptoms of AIDS may include
fever, loss of appetite, weight loss, chronic
fatigue and skin rashes.
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Prevention Approaches
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Contact task categories
Category I - Routine contact with blood
and body fluids
 Category II - Occasional contact with blood
and body fluids
 Category III - No contact with blood and
body fluids
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Written Policies which:
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prohibit recapping, breaking or shearing needles
specify safe practices when handling reusable
sharps
require use of mechanical means to clean up
broken glassware
disposal of contaminated sharps
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Standard Precautions
All blood and body fluids are treated as if
known to be infectious for HIV, HBV
and HCV
 Consistently used with all clients
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Engineering Controls
controls that either remove the hazard or
isolate the worker from the hazard
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Examples of controls are sharps disposal
containers, self-sheathing needles, or biosafety
cabinets.
Employees must be instructed in the use of
engineering controls.
There must be regular inspection and replacement
of engineering controls.
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Safe Work Practices
These practices prevent exposures.
HANDWASHING facilities should be close
to the work area.
 Handling of contaminated equipment and
processing of specimens.
 Identification of high risk areas by use of
biohazard labeling.
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Safe Work Practices
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no eating, drinking, smoking, applying lip balm or
cosmetics, or handling of contact lenses in the
work areas where there is a risk of exposure.
handwashing alternatives when running water is
not available
universal precautions when handling all specimens
all contaminated equipment must be
decontaminated prior to servicing
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Personal Protective Barriers
Must be provided at no cost to the employee
nor can cost be past on to clients.
 Include barriers such as fluid-resistant
gloves, gowns, face shields, and masks.
 Employees must be trained in the proper use
and selection of PPE.
 Must be easily accessible
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Hepatitis B immunization
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Educate employee on risk of BBP
Free to employee
Voluntary
If employee declines, a declination form
must be signed.
Offer within 10 days of beginning
employment
Three injections over 6 months
Verify sero-conversion 30 days post
immunization
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Hepatitis B immunization
Non-converters
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Re-immunize with the complete series
Retest 30 days post completion of the second
series. If employee does not demonstrate
immunity, consider as “non responder” and not
immune to Hepatitis B.
If exposed to active HBV, administer Hepatitis
B Immune globulin
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Contaminated Materials
procedures must be followed to
decontaminate the environment,equipment,
laundry and work surfaces
 procedure for collecting, transporting and
disposal of waste
 schedule for cleaning and decontamination
of worksite based on location, type of
surface, soil and tasks involved
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Handling Contaminated
Material
universal precautions
 label with biohazard labeling or use red
bags for disposal
 requirements for disposal include:
close-able, labeled containers, constructed
to prevent leakage during handling, storage,
or transporting.
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Compliance Monitoring
Employers are required to ensure that
employees are following the practices.
 Employee health/infection control programs
 Management monitoring
 Investigation of exposure circumstances
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Post exposure follow-up
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Post exposure follow-up
Determination as to who will be the
provider
 Compliance with Maryland state laws and
OSHA regulations
 Written informed consent of employee and
source prior to HIV testing
 Evaluation of incident to prevent
re-occurrence
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Post Exposure Follow-up
After signed informed consent of
employee and source:
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employee baseline testing to include:
Hepatitis B surface antibody
Hepatitis C antibody
HIV
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source testing to include:
Hepatitis B antigen
Hepatitis C antibody
HIV
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What should be sent
with the employee?
Copy of the OSHA BBP regulations
 Description of duties and responsibilities as
related to the exposure
 Documentation of routes of exposure and
circumstances under which the incident
occurred
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What should be sent
with the employee?
source and employee’s blood work (should
be confidential and sent directly to the
outside provider)
 relevant employee records regarding
immunization
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Elements of healthcare
professionals evaluation
Healthcare professional’s opinion stating
the employee was counseled and advised
will be sent to the employer
 Employee should anticipate a written
opinion of the visit within 15 days. Opinion
should contained detailed information.
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Related issues
Communicable disease
reporting and notification
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COMAR regulations require reporting of
clients with communicable diseases
 A call to your local health department will
meet the requirements and provide an
opportunity for additional information
sharing e.g., staff followup;
 EMS notification in circumstances were
identification of a communicable disease is
communicated to the office
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