Transcript Bloodborne Pathogen Power-Point

West Virginia Northern Community College
Patient Care Technician
Bloodborne Pathogen Discussion
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A central venous catheter, also called a central line, is a long,
thin, flexible tube used to give medication, fluids, blood
products or monitor central venous pressure. These catheters
are designed for short-term use of a week to two weeks
(Haller,2002).
The catheter is often inserted in the arm, chest or groin
through the skin into a large vein.
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Bloodstream infections can occur as a side effect from
treatment received in an ICU, IMU, or wherever a patient
may be with a CVAD.
A bloodstream infection begins when a pathogen enters the
line from bacteria.
According to the Center for Disease Prevention 1 in every
20 patients obtain an infection while during their hospital
stay(Adams,2009).
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In 2010 18,000 catheter related infections occurred in ICU’s
in the hospitalized patient.
Catheter related bloodstream infections in patients with
central lines can be deadly, killing as many as 1 in 4 who
gets them.
Infections are one of the leading causes of hospitalization
and death(Adams,2009).
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Evidenced based practice through randomized, controlled trials
has proven and provides a solid foundation to identify that nursing
care activities help prevent catheter related blood stream infections
(McKinney, 2006).
Care “bundles” are groupings of best practices that pertain to a
specific disease process. Implementing the bundles in practice has
shown results in better outcomes for decreasing infection
(O’Grady,2011).
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One proposed central-line care bundle is based on a protocol used at
Rady Children’s Hospital in San Diego (McKinney, 2006). Proven
effective in preventing catheter related central line infections, it includes
the following components:
Hand hygiene. For healthcare workers caring for a patient with an
intravascular line, rigorous hand hygiene is critically important to remove
transient hand flora that may have been picked up from other patients or
environmental surfaces (Ridley, 2011).
Maximal barrier precautions during insertion. During line placement, the
patient should be covered with a sterile drape from head to toe, with a
small opening at the insertion site. The operator must wear a cap, mask,
sterile gown, and sterile gloves.
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Chlorhexidine skin antisepsis. Evidence shows chlorhexidine is
more effective than povidone-iodine or alcohol in reducing skin
flora around the insertion site and has a residual effect not seen
with povidone-iodine or alcohol (Ridley, 2011).
Optimal catheter-site selection with femoral-vein avoidance in
adults due to bowel/urine contamination. Although many
intensivists and anesthesiologists prefer the internal jugular site for
easier insertion, evidence suggests that lines placed using the
subclavian vein have the lowest infection risk.
Daily review of line necessity, with prompt removal of
unnecessary lines. Every day a catheter stays in place, a risk exists
that infectious organisms may gain entry through the insertion site
or by line manipulation (Ridley, 2011).
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The benefits to decreasing the number of line related infections
would be shorter length of stay for the patient, and lower cost to
both the hospital and the patient (Haller, 2002).
Hospital infections add more than $30 billion annually to the
nation's health tab in hospital costs alone.
Hospital-acquired infections add considerable morbidity and
mortality to patient care. By taking the steps to decrease central line
infections we can increase quality of care provided to the patients
and decrease length of stay, which in turn will decrease the chance
of a hospital acquired infection (Skilton, 2008).
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AIDS, Hepatitis B, and Hepatitis C are bloodborne
infections caused by bloodborne pathogens
(disease causing agents found in the blood).
HIV, HBV, and HCV are not only found in the
blood, but in other body fluids that may contain
blood, such as: urine, vaginal secretions, semen,
fluids from around an unborn baby, the spine,
heart, lungs, or joints, and tissue removed from the
body.
All body fluids, if unable to differentiate between
body fluids, should be considered infectious.
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HIV, the precursor to AIDS can live in ones body from
several weeks to several months before developing
symptoms. Though symptoms may only last a few
days, once exposed, you are a permanent carrier of the
AIDS virus, and able to infect others.
HIV, though it may take up to 10 years, can develop
into the AIDS virus.
Acquiring AIDS leaves you helpless against fighting
off infections, along with other symptoms such as
diarrhea, weight loss, fevers, confusion, memory loss,
depression, motor dysfunction.
AIDS is terminal, and acquiring infections like TB,
pneumonias, and cancers will lead to death.
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HBV-Infected individuals breakdown:
1/3 No Symptoms
 1/3 Mild Flu-Like Symptoms That Will Resolve
 1/3 Clinically Diagnosable HBV
 6% - 10% of individuals infected with HBV will
become chronic, life-long carriers of HBV, with or
without an active infection, with few to no
symptoms, but will be able to transmit the disease.
 >2% will die from acute or chronic HBV.
 Vaccination is the number one prevention of
acquiring HBV and treatment may be effective if
initiated immediately.
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Hepatitis C infections are the most common
chronic bloodstream infections in the US.
An estimated 4.1 million people are carriers of
the HCV.
There are NO vaccines or immune globulin
products available to prevent transmission.
HCV will ultimately lead to death, related to
serious liver disease.
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Transmission Outside of the Workplace
Include:
Sexual Contact (vaginal secretions, semen, blood)
 Drug Users (sharing of needles)
 Transfusions of Infected Blood (though screening of
blood has cut down on this mode significantly)
 Mother-to-Child in Utero
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Transmission Inside the Workplace Include:
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Puncture Wounds from contaminated needles, or
sharp instruments.
Contact With Broken Skin (even the smallest of nicks
in your skin or a paper cut are large enough to allow
infection in).
Mucous Membranes (the membranes that line your
eyes, nose, and mouth can be infected by touching
them with contaminated hands or by the splashing
of fluids if proper protective equipment is not
utilized).
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Universal Precautions, originally developed by the
CDC is a key component of OSHA’s Bloodborne
Pathogen Standard.
Standard precautions: Apply to all blood and
body fluids, secretions and excretions, with the
exception of sweat, tears, and intact skin.
Both Universal & Standard Precautions apply to
every person, whether an existing infection is
known or not.
CDC has further developed extended precautions
known as, airborne, droplet, and contact
precautions that must be used along with
Universal and Standard Precautions.
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Immediate Reporting of an exposure can help
control bloodborne infections.
Wash exposed site immediately.
 Inform your supervisor of the incident.
 Consult a doctor without delay.
 A post-exposure follow-up will as well be required.
 OSHA requires that blood be drawn immediately
and tested for baseline results to use for comparison
later.
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If exposed, CDC (2012), states that a prophylaxis may be required to
reduce the risk of infection.
For HIV, AZT in combination with other drugs may be used, depending
on the severity of the exposure.
For HBV, Persons who have written documentation of a complete
hepatitis B vaccine series and who did not receive post vaccination testing
should receive a single vaccine booster dose.
Persons who are in the process of being vaccinated but who have not
completed the vaccine series should receive the appropriate dose of
hepatitis B immune globulin (HBIG) and should complete the vaccine
series.
Unvaccinated persons should receive both HBIG and hepatitis B vaccine
as soon as possible after exposure (preferably within 24 hours). Hepatitis
B vaccine may be administered simultaneously with HBIG in a separate
injection site. The hepatitis B vaccine series should be completed in
accordance with the age-appropriate vaccine dose and schedule (1st dose
after exposure, 2nd dose 1 month after first dose, and 3rd dose is 6 months
after).
For HCV, interferon, though not recommended currently, may increase
the rate of resolved infection if started soon enough.
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If exposed, CDC (2012), states that a prophylaxis may be required to
reduce the risk of infection.
For HIV, AZT in combination with other drugs may be used, depending
on the severity of the exposure.
For HBV, Persons who have written documentation of a complete
hepatitis B vaccine series and who did not receive post vaccination testing
should receive a single vaccine booster dose.
Persons who are in the process of being vaccinated but who have not
completed the vaccine series should receive the appropriate dose of
hepatitis B immune globulin (HBIG) and should complete the vaccine
series.
Unvaccinated persons should receive both HBIG and hepatitis B vaccine
as soon as possible after exposure (preferably within 24 hours). Hepatitis
B vaccine may be administered simultaneously with HBIG in a separate
injection site. The hepatitis B vaccine series should be completed in
accordance with the age-appropriate vaccine dose and schedule (1st dose
after exposure, 2nd dose 1 month after first dose, and 3rd dose is 6 months
after).
For HCV, interferon, though not recommended currently, may increase
the rate of resolved infection if started soon enough.