Transcript Handwashing - Advocatehealth.com

Bloodborne
Pathogen Training
2011
Advocate Condell Medical Center
Condell EMS System
Prepared by: Sharon Hopkins, RN, BSN, EMT-P
Objectives
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Upon successful completion of this module the EMS
provider will be able to:
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Define the mission of OSHA
Describe what the OSHA Standard was designed
for
Describe the training program for bloodborne
pathogens
Define bloodborne pathogen
Provide an example of potential bloodborne
pathogens
Define the term standard precautions
Objective cont’d
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Define the term body substance isolation
(BSI)
List examples of engineering control
List examples of a work place control
List PPE products available to use
Describe when PPE’s should be used
Recognize signs or labels that indicate the
presence of a bloodborne pathogen hazard
Describe components of housekeeping and
when they are performed
Objective cont’d
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Describe necessary recordkeeping related to
bloodborne pathogens
Define an exposure incident
Review the CMC EMS System Operating
Guideline (SOG) policy for infection control
and exposure
Describe the “Notification of Significant
Exposure” form and how to complete
List routes of exposure to potential BBP
Objective cont’d
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List transmission routes of bloodborne
pathogens in the workplace
List factors affecting disease transmission
Describe the phases of the infectious process
Discuss definition, incubation period,
transmission route, signs and symptoms, and
PPE to use for a variety of infectious diseases
Successfully complete the post quiz with a
score of 80% or better
What is OSHA?
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A federal agency of the US Department of
Labor
Created by Congress in 1971 under the
Occupational Safety and Health Act
Mission:
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To prevent work-related injuries, illnesses, and
death
What is NIOSH?


National Institute for Occupational Safety
and Health (NIOSH) created by the OSH
Act
Functions as a research agency focusing
on occupational health and safety
What is “The Standard”?

In 1990, OSHA issued a standard
(Bloodborne Pathogen Standard) designed
to prevent healthcare workers and others
from being exposed to bloodborne
pathogens such as hepatitis B and HIV
Who does the Standard cover?
All employees who could "reasonably
anticipate"
contact with blood
 contact with other potentially infectious
materials

while performing their job duties
Compliance with the Standard

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The Bloodborne Pathogen Standard
specifies methods that are to be used to
minimize the transmission of bloodborne
pathogens in the work place.
These methods include:
 Standard Precautions
 Engineering and Work Practice Controls
 Personal Protective Equipment (PPE)
 Appropriate Housekeeping Measures
Training
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Employees must be provided information
 When first assigned a task with
potential exposure
 Repeated annually
 During work hours
 When new tasks or procedures are
added
 New exposure risk created must be
addressed
See Notes section for details
Definition Bloodborne Pathogen

Microorganisms that:
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are present in human blood
can infect and cause disease in people who
are exposed to blood containing the pathogen
can be transmitted through contact with
contaminated blood and body fluids
Examples Bloodborne Pathogens
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Human Immunodeficiency Virus (HIV)
Hepatitis B (HBV)
Hepatitis C (HCV)
Non A, Non B Hepatitis
Syphilis
Malaria
Babesiosis
Brucellosis
Examples cont’d
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Leptospirosis
Arboviral infections
Relapsing fever
Creutzfeld-Jakob disease
Human T-lymphotrophic Virus Type 1
Viral hemorrhagic fever
Standard Precautions

A strategy designed to reduce the risk of
transmission of microorganisms from
known and unknown sources
You can’t tell if material is infectious or not
so treat all materials as if they are
infectious!
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Take precautions with every patient
exposure
Controls in Place
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The objective of engineering controls
and work practice controls is the
same:

to reduce or minimize employee
exposure to bloodborne pathogens
Engineering & Work Practice
Controls
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Differences
 One control isolates or removes the
hazard from the workplace
 Engineering control
 One reduces the risk of exposure by
altering how tasks are performed
 Work
practice control
Engineering Controls
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Examples:
 labeled sharps disposal containers
 self-sheathing needles
 safer medical devices
 sharps with engineered sharps injury
protections and needleless systems
 handwashing facilities
 antiseptic hand cleanser
 cleaning supplies and equipment
Work Practice Control
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Examples:
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Prohibiting recapping of needles by a
two-handed technique
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Handwashing
Disinfecting equipment and vehicle
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Handwashing
No eating, drinking, smoking in the ambulance
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Handwashing
Handwashing
Removing a soiled uniform
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Handwashing
Handwashing
Simple
Effective practice
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Prevents transfer of contamination from
your hands to other areas of your body, to
other persons, or to other surfaces you
may contact later
Handwashing
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As soon as possible following an occupational
exposure to blood or other potentially infectious
materials
After removal of gloves
Before and after every patient contact
After toileting
Before and after preparing food
Before and after eating or smoking
After coughing or sneezing into hands or
blowing nose
Handwashing How-to
Take off rings
Turn on faucet
Wet hands
Apply soap
Scrub your hands - minimum 15
seconds
Rinse
Dry hands
Turn off faucet – use
paper towel
Antiseptic Hand Cleaner
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Antiseptic hand cleaners may be used as
an appropriate hand washing practice IF:
Your gloves remained intact
 You have had no occupational exposure to
blood or other potentially infectious materials
 Material can be left to air dry on your skin
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Choose product with at least 60% alcohol
Did You Know?
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Washing with soap and running water
every time you remove your gloves is the
recommended practice over hand
sanitizers
Liquid soap is preferred
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Bar soap can transfer microorganisms
Antimicrobial or plain soap?
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Plain soap good enough for ordinary washing
Antimicrobial is preferred during patient care
Personal Protective Equipment PPE
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The type of protective equipment
appropriate for your job or research varies
with the task and the degree of exposure
you anticipate
PPE – Eye Protection
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Bloodborne pathogens can be transmitted
through the mucous membranes of the
eyes.
Use eye protection whenever there is a
risk of splashing or vaporization of
contaminated fluid
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Airway control (ie: intubation, suctioning)
Cleaning up spills
Cleaning equipment
Mask and Face Shields
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Masks and face shields provide additional
protection for potential eye, nose, or mouth
contamination
Used during tasks that may generate blood or
other potentially infectious materials via:
 Splashes
 Spray
 Spatter
 Droplets
Protective Clothing
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Appropriate protective clothing such as,
but not limited to, gowns, aprons, lab
coats, clinic jackets, or similar outer
garments shall be worn in occupational
exposure situations
Type and characteristics will depend upon
the task and degree of exposure
anticipated.
Employer Responsibilities
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Issue PPE or make it readily accessible in the
work area
Maintain, replace or dispose of any PPE at no
cost to employees
Employer can provide the engineering controls
The employee needs to exercise the work
practice controls for the process to be effective
Signs, Labels & Color Coding
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Signs and labels in the workplace
communicate bloodborne pathogen
hazards to employees.
Warning label must include the universal
biohazard symbol and the term
"biohazard" in a color that contrasts with
the fluorescent orange,
orange-red background
Using Warning Labels
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Warning labels must be affixed to
containers of regulated waste,
refrigerators and freezers containing blood
or other potentially infectious material,
and other containers used to store,
transport, or ship blood or other
potentially infectious materials.
Red bags or red containers can be
substituted for labels.
Warning Labels
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Contaminated equipment which is to be
serviced or shipped must also have a
warning label and a statement regarding
which portions of the equipment remain
contaminated.
Cleaning and Decontamination
Duties
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Review product labeling for any special
directions/precautions
Wear appropriate PPE for task being performed
Remove all blood and debris from surface to be
cleaned
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Products can’t clean the surface if they can’t be in
contact with the surface
Allow disinfectant to air dry
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Leave surface wet 30 seconds for HIV disinfection
Leave surface wet 10 minutes for HBV disinfection
Clean Up Involving Blood or Body
Fluids
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Wear appropriate Personal Protective Equipment
(PPE).
Carefully cover the spill with absorbent material,
such as paper towels, to prevent splashing.
Decontaminate the area of the spill using an
appropriate disinfectant, such as a solution of
one part bleach to ten parts water. When
pouring disinfectant over the area always pour
gently and work from the edge of the spill
towards the center to prevent the contamination
from spreading out.
Clean Up of Spills cont’d
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Wait 10 minutes to ensure adequate
decontamination, and then carefully wipe up the
spilled material.
Be very alert for broken glass or sharps in or
around the spill.
Disinfect all mops and cleaning tools after the
job is done.
Dispose of all contaminated materials
appropriately.
Wash your hands thoroughly with soap and
water immediately after the clean up is
complete.
Housekeeping and Waste Disposal
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Keeping the worksite clean and sanitary is
a necessary part of controlling worker
exposure to bloodborne pathogens.
Cleaning schedules and decontamination
methods depend on:
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type of surface to be cleaned
type of soil that is present
particular tasks or procedures that are being
performed
Recordkeeping
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Medical records must be kept for each employee
with occupational exposure for the duration of
employment plus 30 years, must be confidential
and must include name and social security
number; hepatitis B vaccination status (including
dates); results of any examinations, medical
testing and follow-up procedures; a copy of the
healthcare professional's written opinion; and a
copy of information provided to the healthcare
professional.
Recordkeeping cont’d
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Medical records must be made available to
the subject employee, and anyone with
written consent of the employee, but they
are not to be available to the employer.
Recordkeeping cont’d
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Training records must be maintained for
three years and must include dates,
contents of the training program or a
summary, trainer's name and
qualifications, names and job titles of all
persons attending the sessions.
Exposure Incidents
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An exposure incident is an event resulting from
the performance of an employee's duties in
which there has been:
A percutaneous injury involving a potentially
contaminated needle or other sharp
A splash of blood or other potentially infectious
materials to the eyes, mouth, or mucous
membranes
Blood or other potentially infectious materials
contacting broken skin
Potential Exposure
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An occupational exposure should always be
considered an urgent medical concern to ensure
timely postexposure management and
administration of hepatitis B immune globulin
(HBIG), hepatitis B vaccine, and/or HIV postexposure prophylaxis (PEP).
If you are injured or exposed, tell your
supervisor immediately. Your supervisor is
responsible for reporting your injury
correctly.
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Advocate CMC EMS System
Policy
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Notification of significant exposure is to be
reported immediately to the receiving
hospital
Complete “Notification of Significant
Exposure” form
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Leave in sealed envelope for EMS coordinator
The ED MD on duty will advise the
appropriate medical follow-up or need for
consultation with private physician
EMS System Policy cont’d
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Follow-up fees responsibility of the
provider
If ED care is rendered to the provider, they
must sign-in as a patient in the ED
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Guarantees proper documentation the
incident and of care rendered
Notification of Significant Exposure
Form
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Fill in information in the 1st four columns
as completely as possible
Check all means of exposure that apply
Provide information on the type and brand
of device, if involved
Receiving hospitals in Illinois are required
to notify ambulance providers if a patient
has been diagnosed as actively contagious
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Notification made within 72 hours of diagnosis
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Early treatment can significantly
reduce the chance of disease
transmission!
Postexposure Prophylaxis
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The U.S. Public Health Service (PHS) has
published Guidelines for the Management
of Occupational Exposures to HBV, HCV,
and HIV and Recommendations for
Postexposure Prophylaxis", which can be
accessed at:
http://www.cdc.gov/mmwr/preview/mmwr
html/rr5011a1.htm.
Microorganisms
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Disease causing organisms
Microscopic in nature
Can be part of the normal flora or
pathogenic (able to cause disease)
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Bacteria
Viruses
Fungi
Protozoa
Parasites
Routes of Exposure
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Bloodborne
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Airborne
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Influenza, H1N1 flu, meningitis, measles, mumps,
rubella, chickenpox (varicella)
Fecal-oral
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TB, influenza, common cold, RSV, chickenpox
Droplet
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HIV, HBV, HCV, syphilis
HAV, food poisoning
Note: Multiple diseases could be airborne and/or droplet
Disease Transmission
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Direct contact
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Person to person
Physical transfer of microorganisms
 Coughing, sneezing, kissing, sexual
contact, contact with blood or body fluid
Disease Transmission
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Indirect contact
 Susceptible person infected from contact with
contaminated surface
 Person most likely brings contaminated hands
to their face
 Telephones, door knobs, steering wheels,
B/P cuffs, EKG cable, handrails, pens
 Via food products, water, soil
Bloodborne Exposure
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Direct or indirect contact with blood or
infected body fluids
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Needle stick
Splash on broken skin
Splash on mucous membranes
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Eyes, nose, mouth
Airborne Exposure
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Particles remain suspended in air a long
time and float a distance
At risk when less than 6 feet from patient
Transmitted via sneezing, coughing, talking,
shedding of skin
Healthcare worker should wear a N95 mask
Patient should wear a tight fitting surgical
mask
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TB, polio, pneumonia, influenza, chicken pox
Droplet Exposure
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Droplet of moisture expelled from the upper
respiratory tract and then inhaled into the
respiratory system or contacts the mucous
membranes
Droplets too heavy to remain airborne for long
Transmitted during sneezing, coughing, talking
Most at risk when within 3 feet of patient
Wear surgical masks when threat of droplet
exposure
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Common cold, influenza, H1N1, meningitis, rubeola
(measles), whooping cough
Fecal-oral Route
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Ingestion of contaminated food or water
Contaminated hands (usually from
improper handwashing or lack of
handwashing) transfers microorganisms to
all surfaces and objects touched
Recipient touches surface and then brings
contaminated hands to their face or
ingests contaminated product
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HAV, food poisoning
Definitions
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Communicable disease
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Contamination
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Capable of being transmitted to another host
Infectious agent on surface of host but not
penetrating it
Infection
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Penetration of agent has occurred to host
Having the infection does not automatically
imply having the disease
Factors Affecting Disease
Transmission
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Mode of entry
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Virulence
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Organism strength (ability to infect)
 HBV infectious for weeks
 HIV die when exposed to air and light
Dose
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Intact skin an excellent barrier
Mucous membranes often the point of entry
 Eyes, nose, mouth
Number of organisms
Host resistance – general health
Phases of Infectious Process
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Latent period
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Communicable period
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Host infected, does not transmit to others
May have signs and can transmit disease
Incubation period
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Time between exposure and appearance of
symptoms
Phases cont’d
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Seroconversion
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Window phase
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Antibodies created after exposure; lab tests
are positive
Time between exposure and seroconversion
May test “negative” even though person is
infected
Disease period
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Time from onset of signs and symptoms until
resolution or death
Preventing Infection
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Break the cycle:
Infectious
agent
Means of
transmission
Host
Routes of
exposure
Selected Infectious Diseases
Definition
Incubation Period
Transmission Mode
Signs & Symptoms
Recommended PPE’s
Special Considerations
HIV
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A fragile virus that attacks the immune
system
Eventually leads to AIDS – a collection of
signs and symptoms
Incubation is variable and can be in years
Transmission
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Sexual contact
Contact with contaminated blood
Mother to newborn
HIV cont’d
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Signs & symptoms
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Fatigue, fever, sore throat, lymphadenopathy,
splenomegaly, rash, diarrhea, secondary
infections, weight loss, dementia, psychosis
No vaccine
PPE – gloves, goggles, mask, gown as
needed to avoid blood contamination
HIV rarely presents life threatening
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Is more often a psychosocial challenge
Hepatitis B (HBV)
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Viral infection; can develop into chronic
state; affects the liver
Incubation 4 - 25 weeks
Transmitted by direct contact with blood
or body fluids
Complaints start as flu-like symptoms
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Dark urine, light colored stools, fatigue, fever,
jaundice
PPE’s – gloves, goggles, mask, avoidance
of needlesticks
Hepatitis B Virility
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The CDC states that Hepatitis B Virus can
survive for at least one week in dried
blood on environmental surfaces or on
contaminated instruments.
Hepatitis B Vaccine
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Highly effective means of protection from the
virus
Must be offered within 10 days of assignment to
task with exposure risk involved
If employee declines, must sign declination form
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Kept on file
Employee may, at any time, request the
hepatitis B vaccine after initial declination
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3 injection series
Given IM in deltoid
Once started, 2nd dose is in 1 month; 3rd dose 6
months from 1st dose
Hepatitis C (HCV)
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Viral infection causing inflammation of
liver
Can lead to cirrhosis and cancer
Leading reason for liver transplants in the
USA
Incubation 2-25 weeks
Transmission – contact with contaminated
blood
Contagious throughout course of infection
HCV cont’d
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Symptom onset slow (up to 20 years for
chronic infection)
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Loss of appetite
Vague abdominal discomfort
Nausea and/or vomiting
Jaundice less common than with HBV
No vaccine is available
PPE’s – gloves, mask, goggles, avoidance
of needle sticks
Tuberculosis (TB)
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Bacterial infection most commonly
affecting the lungs
TB infection
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TB disease
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Person has the bacteria but is not ill; cannot
spread disease
Person ill, can spread TB
Incubation 4 -12 weeks
Transmission via airborne droplet
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Prolonged exposure increases risk
TB cont’d
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Signs and symptoms
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Fever
Chills
Weakness. fatigue
Night sweats
Weight loss
Dyspnea
Productive cough
Chronic cough
TB cont’d
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PPE’s
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Obtain periodic skin testing
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Respiratory isolation
Tight fitting surgical mask on patient
N95 mask for providers
If positive, need chest x-ray
Provide adequate ventilation while caring
for and transporting the patient with
suspected or positive diagnosis
Chickenpox (Varicella)
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Viral infection
Transmitted via direct and indirect contact
and airborne droplets
Incubation 10 - 21 days
Signs and symptoms
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Sudden onset low-grade fever
Mild feeling of not being well (malaise)
Rash
Chickenpox cont’d
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Contagious about 2 days prior to rash and
until all vesicles have scabbed over
Skin eruptions continue over 3 – 4 days
PPE’s – gloves; surgical mask on patient,
mask on healthcare provider
Vaccination added to childhood
immunization schedule
Bacterial Meningitis
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Bacterial infection causing inflammation of
the covering the brain and spinal cord
Transmitted via contact with respiratory
droplets
Incubation – 2 – 10 days
Sudden onset high fever, headache, stiff
neck, nausea with vomiting, irritability
 Infants – poor feeding, irritability
Bacterial Meningitis cont’d
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PPE’s – gloves, mask (patient and
provider)
Vaccination provided in childhood
immunization schedule
Postexposure antibiotic prophylaxis
provided after exposure
Influenza – The Flu
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Upper respiratory viral disease
Transmitted via respiratory droplet or
airborne in crowded, enclosed spaces
Incubation usually 1 – 5 days
Adults contagious 3 – 5 days after
symptom onset
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Up to 7 days in children
Rapid onset high fever, headache, muscle
aches, sore throat, dry cough
Flu cont’d
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PPE – Mask the patient and provider
Frequent handwashing
Daily cleaning of environment
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Phones, door handles, steering wheels,
counter tops, computers
Best protection – annual flu vaccine
H1N1 Influenza – Swine Flu

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A new strain of influenza virus
Transmitted person to person primarily via
droplets
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Coughing
Sneezing
Contact with contaminated objects
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Contaminated hands touch the nose and mouth
and introduce the virus
Incubation could range 1 – 7 days
Considered contagious up to 7 days from
symptom onset
H1N1 cont’d
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Symptoms similar to regular flu
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Fever
Cough
Sore throat
Body aches
Chills
Fatigue
Critical situation
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Respiratory difficulty
Cyanosis
Pain, pressure in chest or abdomen
H1N1 cont’d
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PPE
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Gloves
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HANDWASHING
Disinfecting surfaces after each call
Frequently disinfect surfaces likely to have
hand contact
General Advice
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Get vaccinated
Cover mouth and nose when coughing or
sneezing
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Use elbow not hand
Throw tissue away after one use
Wash hands often
Avoid touching eyes, nose, mouth with hands
Practice good personal health

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Get plenty of rest
Eat healthfully
Manage stress
Stay physically active
3 C’s To Stay Healthy
 CLEAN
– COVER – CONTAIN
Wash your hands
 Cover your cough and sneeze
 Contain your germs
 Stay home if sick

Pertussis – Whooping Cough
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Highly contagious bacterial disease
Incubation 7 – 10 days
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Range total 4 – 21 days
Transmitted most commonly respiratory
droplet and airborne
Most at risk
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Infants prior to vaccination
Aging population with lost immunity
Those never vaccinated
Whooping Cough cont’d
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Signs and symptoms in phases
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1st phase – sneezing, watery eyes, loss of
appetite, listless, noticeable night cough
2nd phase – in 10 -14 days paroxysms of
coughing, thick mucous coughed up
3rd phase – in 4 weeks coughing decreases in
frequency; can last for months
Vaccination – DTaP
 Immunity not life long; need repeat
vaccination
Whooping Cough cont’d
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PPE – gloves, surgical mask patient and
provider, goggles, possible gown
Complications often from the spasmodic
forceful coughing
Pneumothorax
 Rib fractures
 Hypoxia during coughing spells

Staph Infections
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Staphylococcus aureus, often referred to simply
as "staph," are bacteria commonly carried on
the skin or in the nose of healthy people
Approximately 25% to 30% of the population is
colonized (bacteria are present, but not causing
an infection) in the nose with staph bacteria
One of the most common causes of skin
infections in the United States
Most of these skin infections are minor (such as
pimples and boils) and can be treated without
antibiotics
Staph bacteria can also cause serious infections
MRSA – Methicillin-Resistant
Staphylococcus Aureus
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
Type of bacteria that is resistant to
common antibiotics such as methicillin,
oxacillin, penicillin and amoxicillin.
Consequently, MRSA infections can be far
more difficult to treat quickly than
traditional staph infections.
Occurs most frequently among persons in
hospitals and healthcare facilities who
have weakened immune systems.
Community Associated MRSA



MRSA infections acquired by persons who have
not been recently hospitalized or had a medical
procedure (such as dialysis, surgery, catheters)
are known as CA-MRSA (Community Associated
MRSA) infections.
CA-MRSA infections can be transmitted in
settings such as workout facilities or locker
rooms
Are usually manifested as skin infections such as
pimples and boils
Results Of Contracting MRSA




Skin infections, pimples, boils
Pneumonia
Bloodstream infections
Potentially death
Transmission of MRSA

Spread of MRSA skin infections is direct
and indirect
Close skin-to-skin contact
 Cuts or abrasions
 Poor hygiene


Methods of Contraction
Crowded living conditions
 Contaminated items or surfaces
 Weakened immune system

MRSA

PPE
 Gloves
 Transport patient with a clean sheet
 Do not use the sheet from the bed
the patient was lying in, if possible
 Avoid placing laundry in contact with
uniform; wear gown if contact made
with uniform

Handwashing
Vancomycin-resistant Enterococcus
- VRE


Bacteria normally found in intestines
Produces disease when bacteria invade
other areas


Healthy individuals rarely at risk


Urinary tract, wounds, blood
Healthy individuals can transmit VRE via
indirect methods
Those at most risk – weakened immune
systems and other health issues
VRE

Spread via contact
Feces
 Contaminated equipment
 Healthcare worker’s hands


PPE




Gloves
Gown if clothing contact anticipated
Handwashing – single most important process
to control spread of VRE
Disinfect equipment after calls
 Prevents indirect spread of VRE
Content Review



Review the following questions
After determining an answer, click the
mouse to check your knowledge
To complete the course and receive 3
hours of CE credit, take the 10 question
quiz via your Medical Officer or
Educational Liaison
Question # 1

Who does the OSHA's Bloodborne
Pathogens standard cover?
1. All employees, regardless of occupation or
workplace
2. All employees in jobs where occupational
exposure to bloodborne pathogens can be
"reasonably anticipated“
3. Only employees who work in health care
settings, such as hospitals or clinics
4. Only employees who use needles on the job
Question # 2

Which label indicates that a
biohazard is present?
Question # 3

Which of the following is not an example
of an other potentially infectious material
(OPIM)?
1. Blood from experimental animals infected
with HIV or HBV
2. Cerebrospinal fluid
3. Urine
4. Unfixed body organs going to the lab for
analysis
Question # 4

Which of the following is a true statement
concerning handwashing after occupational
exposure to blood or other potentially infectious
materials?
1. If your gloves are still intact when you remove them,
there is no need to wash your hands afterwards.
2. Strong abrasive soaps are most effective in removing
contamination from hands.
3. Using an antiseptic towelette is always an acceptable
alternative to washing your hands with soap and water.
4. The best practice is to thoroughly wash your hands
with soap and water after any potential exposure.
Question # 5

How often should work surfaces, such as
counters or cabinet surfaces, be
decontaminated?
1. Whenever procedures involving blood or other
potentially infectious materials are completed
2. At the end of each work shift, if the surface
may have become contaminated since the last
cleaning
3. Immediately or as soon as feasible following a
spill of blood or other potentially infectious
material
4. All of the above
Question #6

Are gloves required/mandatory when
giving an injection?
YES
or
NO
Gloves are not required to be worn when giving an
injection as long as hand contact with blood or other
potentially infectious materials is not reasonably
anticipated. As EMS begins all field calls with gloves
already on, this would be a mute consideration to the
EMS provider in the field.
Source: USDOL FAQ’s
Resources





www.lakecountyil.gov/Health/H1N1.htm
Ready.illinois.gov
www.flu.gov
LCHD Flu Hotline: 847-377-8350
www.osha.gov/pls/oshaweb/owadisp.show_
document?p_table=standards&p_id=10051
Bibliography









Condell Medical Center EMS System Operational
Guidelines & Infield Policy Manual. January 2001
Environmental Health & Safety On-line Training Module.
BBP. 2010.
Region X SOP’s March 2007. Amended May 1, 2008.
www.cdc.gov
www.cdc.gov/ncidod/hip/Blood/Exp to blood.pdf
www.cdc.gov/sharpsafety/
www.Illinoispoisoncenter.org
www.osha.gov/OshDoc/data_BloodborneFacts/
www.osha.gov/SLTC/bloodbornepathogens/index.html