Transcript Needlestick Safety and Prevention Act

Occupational Exposures to
Bloodborne Pathogens
29 CFR 1910.1030
Training
Morgan County
Emergency Ambulance
Service
The MCEAS invites you to participate in this Bloodborne
Pathogen Training and wants to thank Northeastern University
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Occupational Exposures to
Bloodborne Pathogens
29 CFR 1910.1030
• Covers all workers
occupationally
exposed to blood or
other potentially
infectious materials
Needlestick Safety and
Prevention Act
It amended the Bloodborne Pathogen Standard in 2001 to
require the employer to do the following:
• Update the Exposure Control Plan (ECP) to reflect the changes in
technology that eliminate or reduce exposure
• Annually document the consideration and use of safer medical
devices that are appropriate, commercially available and effective
• Establish and maintain a sharps injury log for recording percutaneous
injuries from contaminated sharps
• Establish a program for identifying, evaluating and selecting safety
devices and work practices in the ECP.
Blood and Other Potentially Infectious
Materials Covered Under the OSHA Standard
Include
Blood
• Human blood
• Blood products
• Blood components
Other Potentially
Infectious Materials
• Human body fluids
• Unfixed human tissue
or organs
• HIV or HBV
containing cells,
tissue cultures or
experimental animals
Body Fluids not Expected to be
Infectious Unless Visibly
Contaminated with Blood
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Urine
Feces
Vomit
Tears
Sweat
Sputum
Nasal Secretions
Occupational Exposure to
Bloodborne Pathogens
• Traditional Concerns:
– Chemicals
– Radiation
– Infectious waste and sharps
• New Concerns:
– Hepatitis B virus
– Human immunodeficiency virus
Hepatitis B Virus (HBV)
• HEPATITIS: Inflammation of the liver caused by
drugs, toxins, autoimmune disease, or infectious
agents.
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Potentially life threatening bloodborne pathogen
Potential for carriers to pass disease to others
Effects can be both acute and chronic
Carriers face higher risk of liver ailments which can be
fatal, including cirrhosis of the liver and primary liver
cancer
– CDC estimates between 140,000 and 320,000
become infected every year in the US
HBV Outcomes
1. Self Limited Acute Hepatitis B
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Body produces antibodies
Coincides with destruction of liver cells with HBV
Lifetime immunity against reinfection
Some risk of extreme symptoms such as jaundice
which may cause hospitalization
2. Chronic HBV Infection
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Can not clear virus from liver cells
Severe long term consequences such as cirrhosis
Hepatitis B Vaccination
• A 3-shot vaccination series is available
for the hepatitis B virus. It is highly
effective.
• Employees with potential occupational
exposure to bloodborne pathogens are
entitled to the vaccination at no cost.
• If you have previously declined the
vaccination but would like to receive it,
please contact your Designated Control
Officer
Symptoms of HBV
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Yellow Eyes and Skin (Jaundice)
Abominable Pain
Fever and Vomiting
Dark Urine
Fatigue
Human Immunodeficiency Virus
(HIV)
• RETRO VIRUS: must use host cell to reproduce
• HIV gradually depletes the number of cells which are essential
for host immune function. This depletion of immune cells
renders the infected individual increasingly susceptible to
opportunistic infections.
• Auto immunodeficiency Syndrome (AIDS)
• HIV is not easily contacted. Risk increases with contact with
infected blood or blood products. Well known routes of
exposure: unsafe sex, needle sharing, blood transfusions.
Symptoms of AIDS
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Fever
Swollen Glands
Diarrhea
Extreme Weight Loss
Skin Lesions
Mental Disorientation
Who is at Risk
The Centers for Disease Control
Reported the Following:
• 816,149 people in the US
are living with HIV/AIDS
through December 2001
• 42 million people are
estimated to be living with
HIV / AIDS worldwide in
2002
• 5 million new HIV
infections occurred in
2002 worldwide
• AIDS caused the death of
3.1 million people
worldwide in 2002
HIV Treatment Advances
• Antiviral drugs called
protease inhibitors have
been developed to slow
the replication of the virus
but are not a cure
• Protocols have been
developed to deal with
high risk exposures to
reduce likelihood of
becoming HIV infected
Occupations at Risk
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Physicians
Paramedics / EMT’s
Athletic Trainers
Morticians
Nurses
Laundry Workers
Clinical Workers
Fire Fighters
Correctional Officers
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Phlebotomists
Dentists
Housekeeping
Coaches
Medical Examiners
Laboratory Workers
Police
Rescue
Maintenance Workers
What to do to Protect Workers
• Universal precautions
• Written Exposure Control Plan
• Identify job classifications at
risk
• Train employees
• Hepatitis B vaccination
• Engineering controls
• Work practice controls
• Personal protective equipment
• Housekeeping
• Labeling
• Exposure incident response
• Record keeping
Routes of Exposure
Path
Worker
Source
Needle sticks & sharps
Most common for health care
workers
Mucous membranes, skin,
eyes, mouth
Spills, splashes, sprays,
infectious materials
Non-intact skin
Cuts provide direct transfer
Transmission of Bloodborne
Pathogens
• Contact with broken skin
can include:
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Rashes
Hang nails
Cuts
Punctures
Abrasions
Acne
– Cold sores
• Contact with mucous
membranes include:
– Eyes, nose, & mouth
• Other modes of
transmission include:
– Sexual contact
– Amniotic fluid, blood during
birthing and occasionally
breast milk (mother/child)
Universal Precautions
Means you treat all blood and other potentially infectious material (OPIM)
as though they are infectious. Work practices or equipment to help you
with universal precautions include:
• Personal Protective
Equipment
• Hand Washing
• Sharps Containers
• Infectious Waste
• Disinfectants
• Reporting Incidents
Wash Your Hands
Percentage of people observed washing their
hands in public restrooms:
• Hand washing after using
toilet:
– Women 74%
– Men 61%
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New York City- 60%
Chicago- 78%
New Orleans- 69%
Atlanta Braves Game
– Women 89%
– Men 46%
Pass the
popcorn!!
Engineering Controls
Serve to reduce employee exposure in the
workplace by either isolating the worker
from the exposure or removing the hazard
• Hand washing and eyewash
facilities
• Autoclaves for
decontaminating waste
• Sharps disposal containers
• Biological safety cabinets
• Centrifuges with aerosol
covers
• Secondary containers
• Safer medical devices (needle
safe / needles-less)
Needle Safe Devices
Work Practice Controls
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Wash your hands frequently
Do not bend or recap needles if possible
Place sharps in appropriate containers ASAP
Do not eat, drink, or apply cosmetics in work
areas
• Do not mouth pipette
• Minimize splashing, spraying, splattering, and
generation of droplets during procedures
Personal Protective
Equipment
Wear Eye Protection:
• When manipulating quantities
of blood large enough to
generate a splash
• Cleaning up a spill of blood
• Administering first aid where
the victim is actively bleeding
When Using Gloves:
• Inspect to insure they are not
defective
• Replace when contaminated or
as soon as feasible
• Do not reuse disposables
• Remove gloves when you
leave the work area
• Wash your hands after you
remove your gloves
Regulated Waste Disposal
Contaminated Items that:
Would release blood or other potentially
infectious materials
• IF they are:
– Pourable
– Drippable
– Compressible
Tags, Labels & Bags
• Tags and Labels shall be
fluorescent orange or redorange with lettering and
the Biohazard symbol in a
contrasting color.
• Bags must have this label
on them or they must be
red in color and leak
proof.
What to do if an Exposure
Incident Occurs
• Flush the affected area with water
immediately
• Report incident to your supervisor
• Go to Appalachian Regional
Hospital
– Fill out an Exposure Incident Report
& Accident Form
Exposure Follow-up
• You will undergo a medical evaluation
• There will be an accident / incident
investigation
• Additional medical follow-up as necessary
CONFIDENTIALITY IS IMPORTANT
Record keeping
The employer shall maintain records
for:
• The duration of the employment
• PLUS 30 years
• Records must be kept CONFIDENTIAL!
Spill Clean-up
Your department or research group should
be geared up to handle small spills.
• Use PPE – at minimum gloves and eye protection must be
worn
• Use appropriate disinfectants
• Use mechanical means (tongs, dustpans, etc.) to pick up
sharp objects
• Dispose of waste properly
Participation of Student
Athletes with HBV or HIV
HBV Infection
• Decisions based on clinical
signs
• Competitive training not a
problem for asymptomatic
carriers
• Combative sports not
recommended because of
higher transmission risk
HIV Infection
• Decision based on health
status
• Exercise and training not
harmful to infected
individuals
• Concerns of transmission
from wounds or mucous
membranes
NCAA SPORTS MEDICINE
HANDBOOK
Wound with oozing or bleeding
• Stop practice or game ASAP
• Player should leave the field of play and
receive treatment
• Athlete should not return until approved by
medical personnel
• Saturated uniforms must be replaced
NCAA Guideline 2H
Universal Precautions
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Wear gloves and protective eye wear
Wash contaminated hands immediately
Clean contaminated surfaces
Use proper needle handling procedures
Use resuscitation mouthpieces and bags
Avoid patient contact when you have dermatitis
Bag and wash soiled linen
Follow universal guidelines in the athletic
environment
Good Web Resources Related
to Bloodborne Pathogens
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NCAA - www.ncaa.org
EH&S - www.ehs.neu.edu
OSHA - www.osha.gov
CDC - www.cdc.gov
NIH - www.nih.gov
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