Transcript Bloodborne Pathogen Standard

West Liberty Health
Sciences
OSHA’s Bloodborne Pathogens Standard
Prevention of Healthcare Associated Infections and
Multidrug Resistant Organism Transmission
Bloodborne Pathogen Standard:
Exposure Control Plan
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The Exposure Control Plan contains
policies/procedures for OSHA’s Bloodborne Pathogen
Standard
Found in each institution’s Library
Bloodborne Pathogen Standard
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You are covered if it is reasonably anticipated that you could
be exposed to blood or other potentially infectious body
fluids as a result of performing your job duties
Exposure Control Plan (cont.)
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Details what measures will be taken to minimize
your risk of exposure
Explains what procedures to follow if there is an
exposure incident
Includes a method of identifying and evaluating
safety devices such as protective sharps.
Bloodborne Pathogens
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Human immunodeficiency virus (HIV)
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Hepatitis B virus (HBV)
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Attacks the immune system
Infects the liver
Hepatitis C virus (HCV)
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Infects the liver
HIV
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A number of people infected remain healthy for
years
An infected person becomes seriously ill when
the immune system loses its ability to fight
infections
Some infected persons go on to develop
Aquired ImmunoDeficiency Syndrome (AIDS)
HBV
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Most people infected by HBV recover and clear
the infection
About 6% of those infected become chronically
infected for life
Each year, people die from chronic liver disease
and liver cancer linked to HBV.
Hepatitis B Vaccine
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HBV can be prevented by receiving the hepatitis
B vaccine.
The vaccine is
Highly recommended
 Given in a series of 3 shots in the arm
 Safe
 Very effective
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HCV
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Approximately 75% of persons infected will
have no symptoms
Up to 85% will be chronically infected
Leading indicator for liver transplants
No preventative vaccine
How Bloodborne Diseases Spread
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Bloodborne viruses are spread through contact
with blood or other potentially infectious body
fluids which includes
Semen and vaginal secretions
 Body fluid containing visible blood
 Cerebrospinal fluid (fluid around brain/spinal cord)
 Synovial fluid (fluid in joints)
 Pleural fluid (fluid around the lung)
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How Bloodborne Diseases Spread
Peritoneal fluid (fluid in the abdomen)
 Pericardial fluid (fluid around the heart)
 Amniotic fluid (fluid in the uterus of a pregnant
woman
 Non-intact skin or organs
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Transmission
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To acquire a bloodborne pathogen blood or other
potentially infectious body fluids must come in contact
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With mucous membranes including of the
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By contaminated sharp object puncture
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Eyes
Nose
Mouth
Such as a needlestick
With non-intact skin
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Skin abrasion
Acne
Reducing Your Risk
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Standard Precautions
Engineering Controls
Work Practice Controls
Housekeeping
Administration of the hepatitis B vaccine
Standard Precautions
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Based on the principle that the following are potentially
infectious and must be treated that way
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Blood and body fluids
Secretions and excretions
Non-intact skin
Mucous membranes
Remember: All body fluids pose a potential risk for
infection
Standard Precautions involves:
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Hand hygiene
Personal Protective Equipment
Respiratory Hygiene/Cough Etiquette
Safe Injection Practices
Hand Hygiene
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Single most important practice to reduce the
transmission of infectious agents
Includes handwashing and use of alcohol based
product
Handwashing
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HANDWASHING MUST BE DONE
If hands are visibly soiled
 Before eating
 After using the restroom
 After caring for a patient with diarrhea or on contact
precautions for stool
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Stool may contain Clostridium difficile which forms
spores that can only be eliminated by physical removal
Hand Hygiene Guidelines
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Must be done with soap & water or alcohol handrub
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Before and after patient contact regardless of glove use
After contact with the patient’s environment
Immediately before inserting an invasive device
When moving from a contaminated body site to a cleaner
body site
After removing gloves
OTHER SITUATIONS FOR
HAND HYGIENE
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When they look or feel
dirty
Before preparing food or
medication
After eating
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After coughing or
sneezing into your hand
After blowing or wiping
your nose
How To Perform Handwashing
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Turn faucet on and adjust
temperature to warm, not hot
Apply soap to hands to allow
for sufficient coverage of
entire surface
Scrub hands for 15 seconds
Cover entire hand including
fingernails and wrist
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Rinse hands completely in
running water keeping
hands lower than elbows
Dry hands with paper
towel
Use a clean, dry paper
towel to turn off faucet
Alcohol Based Handrub
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Apply enough product to
hands to cover all surfaces of
hands and to remain wet for
15 seconds
Rub hands, fingernails and
wrist area until dry
Fingernails
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Artificial nails and gel products used on nails are
not permitted
If you provide hands-on patient care
 Perform diagnostic studies that required direct
patient contact
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Natural nails should be kept short.
Hand Hygiene for Patients and
Visitors
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Proper hand hygiene by patients and visitors will
minimize environmental contamination
Instruct patient and visitors on hand hygiene
including use of alcohol handrub
Provide patient with towelettes for use while in
bed
Personal Protective Equipment
(PPE)
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Wear gown and gloves whenever you expect to
touch blood and body fluids or contaminated
surfaces
Wear mask and eye protection or face shield to
protect from splashes of body fluid
Different tasks require different levels of PPE
WEARING PPE
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PUT THE GOWN ON FIRST, THEN MASK,
THEN GLOVES
REMOVE IN REVERSE ORDER. AVOID
TOUCHING THE OUTER SURFACES OF THE
PROTECTIVE GEAR
REMOVE GLOVES BY PINCHING FIRST
GLOVE AND PEEL BACK. SLIDE UNGLOVED
FINGER UNDER CUFF OF SECOND GLOVE
AND PEEL BACK
WEARING PPE
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Remove mask by touching the strings
Do not leave mask dangling around the neck!
Remove gown by loosening ties, pull down from below
the neckline off the arms and roll inside out
Dispose of protective wear
immediately
Perform hand hygiene
Gloves
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Perform hand hygiene before donning gloves
Change gloves between tasks on the same patient
Change gloves after contact with material that may
contain a high concentration of organisms
Change gloves between patients and before touching
non-contaminated items and surfaces
Gloves (cont.)
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Discard single use gloves after one use
If a glove tears, punctures, leaks or becomes
contaminated, remove it as soon as possible
Wash hands to avoid transfer of microorganisms
to other patients or environments.
Respiratory Hygiene
Cough Etiquette
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Cover coughs and sneezes
Perform hand hygiene
If unable to perform hand hygiene immediately,
cough into arm or jacket
Have patients who are not able to comply wear
a surgical mask when out of their room
Safe Injection Practices
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Use aseptic technique to avoid contamination of
sterile injection equipment
Do not administer medications from a syringe to
multiple patients, even if the needle or cannula is
changed
Use IV bags and other fluid infusion sets for
one patient only
Safe Injection Practices (cont.)
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Do not administer medications from single dose
vials to multiple patients or combine leftovers
for later use
Use single dose vials whenever possible
Do not store multiple dose vials in immediate
patient treatment area
Do not use IV solutions as a common source
for multiple patients
Engineering Controls
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Isolate or remove hazards from the workplace
and includes:
Sharps disposal containers
 Sharps with engineered sharps injury protections
 Needleless systems
 Leakproof trash bags
 Resuscitation equipment
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Resuscitative Equipment
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Use resuscitative mask or other ventilation
devices to avoid mouth to mouth resuscitation
Resuscitative masks should be in all patient
rooms and care areas
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Replace as needed from storeroom stock
Ventilation equipment is located on crash carts
USING SHARPS SAFELY
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Never recap needles
Never bend or break needles
Use safety engineered
needles, syringes and scalpel
blades
Deposit sharps immediately
after use in a designated
sharps container
Sharps containers should not
be more than 3/4ths full to
avoid accidental needlesticks
Work Practice Controls
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Procedures you follow to reduce exposure to blood and
body fluids such as…
Do not eat, drink, smoke, apply cosmetics or lip balms
or handle contact lenses where blood or body fluids are
present
Do not store food or drink in places where blood or
body fluids are present
Never mouth pipette or mouth suction blood or body
fluids
Minimize splashing or spraying of blood or body fluids
Other Safe Work Practices
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Transport lab specimens in closed, leak-proof
containers.
Do not let contaminated equipment touch your skin,
mucous membranes, clothing, other patients, visitors or
items in the environment
Make sure reusable equipment is not used on another
patient until it has been properly cleaned
Single-use items should be discarded appropriately
Housekeeping
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Keep linen away from your body to avoid
contamination of clothes and arms
Clean frequently used surfaces often
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Bedside stand
Clean blood and body spills immediately
Do not reach into trash containers or push trash
down with your hands or feet.
Instead gently shake down
Housekeeping (cont.)
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Carry waste bags by the top, away from your
body
Fluorescent orange-red labels, red bags, red
containers and warning signs are designed to
warn you that the contents contain blood or
body fluids.
Low Level Disinfection
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Performed on items that come in contact with
intact skin
BP cuffs
 Mattresses
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Item must be
Dry
 Visibly clean
 Free of defects
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Defective Items
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Defective items
Mattress with tear or puncture
 Rough surfaces on wooden chairs arms
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Clean and disinfect item as needed
Place defective sticker on item
Remove from service
Report to manager
Low Level Disinfection Procedure
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Use friction to clean item of all visible soil if present
Disinfect the surface by applying disinfectant from a
clean germicidal wipe or spray bottle (i.e, Cavicide)
and a clean towel
Wipe disinfectant over all surfaces using friction
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Friction removes 98% of microorganisms
and bacterial spores (Clostridium
difficile) that the disinfectant cannot kill
Low Level Disinfection Procedure
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Make sure surfaces are wet enough to assure
proper exposure time required by the
manufacturer’s label
Rewet if necessary to obtain
the required exposure time
Cavicide/Caviwipes 3 minutes
 Red top Sani-Cloth 5 minutes
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Neither product kills C.diff spores
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Hand soap is not to be used on inanimate objects.
Control Measures to Avoid
Contamination of the Disinfectant
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Empty and rinse spray bottles before refilling
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Do not “top off” bottle
Do not leave residual water in the bottle
Avoid contamination of bottle straw
Always read the manufacturer’s label for exposure time
and appropriate storage
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Store in closed container
Avoid storing in sunlight
What To Do If Exposed to Blood or
Other Potentially Infectious Body Fluids
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Act quickly, because for some infections,
treatment should start right away
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Post-exposure prophylaxis for HIV should begin
within hours (i.e., 4 hrs ) of the exposure
Remember that an exposure does not always
lead to infection
What To Do If Exposed
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Wash the exposed area with soap and water
If contaminated material gets in your eyes or
mucous membranes, flush them with large
amounts of water
Report the exposure to your supervisor
Report to EMSTAR
Healthcare-Associated Infections
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Infections patients acquire during the course of
receiving treatment for other conditions
Account for an estimated 2 million infections
and 90,000 deaths
$26-$33 billion in added healthcare cost
70% can be prevented by implementing what we
know for prevention
Multidrug-Resistant Organism
(MDRO)
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MDROs are bacteria resistant to one or more of
the best drugs we have to treat them which
makes infections difficult treat.
Two-thirds of the bacteria that cause HAIs are
MDROs
MDROs of concern
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Methicillin resistant Staph aureus (MRSA)
Vancomycin resistant Enterococcus (VRE)
Extended spectrum beta-lactamase (ESBL)
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Occurs with gram negative bacteria
E.coli
 Klebsiella pneumonia
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Klebsiella producing carbapenemase (KPC)
Acinetobacter baumanii
Identification of MDROs
on culture reports
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ESBL
ESBL is listed beneath antibiotics on culture
 Positives are indicated with a (+) sign
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KPC
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Comment will be added beneath Klebsiella on the
culture report indicating the organism is positive for
KPC
Most Common HAIs
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Clostridium difficile associated diarrhea
Catheter associated urinary tract infections
Central line-associated bloodstream infections
Surgical site infections
Ventilator associated pneumonia
Clostridium difficile Infection
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Most common cause of infectious diarrhea
diagnosed in the hospital
A virulent strain exists that is causing epidemics
with significant mortality
Forms spores that can persist in the
environment for months
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Can only be physically removed by
Handwashing (do not use alcohol handrub)
 Friction with environmental cleaning
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Prevention of Catheter-associated
Urinary Tract Infections
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Perform hand hygiene immediately before and
after any manipulation of the catheter
Strict adherence to aseptic technique during
insertion and when obtaining urine sample
Use urinary catheters only when necessary
Catheters left in place only as long as necessary
Keep catheter bag below level of the bladder
Central line-Associated Bloodstream
Infections (CLABSI)
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Maximal barrier precautions during insertion
includes:
Cap
 Mask
 Sterile gown
 Sterile gloves
 Full body drape
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CLABSI Prevention
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Hand hygiene before and after manipulation of
the central line
Thorough cleaning of access ports prior to entry
Approx. 15 seconds or 8 rotations
 One or two swipes is not sufficient
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Surgical Site Infections (SSI)
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Patient should have a thorough CHG bath (i.e.,
Hibiclens) at least the night before and the
morning of surgery
Report any untreated infections to the surgeon
UTI
 URI
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Ventilator Associated Pneumonia
(VAP)
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Hand hygiene and glove use
before and after contact:
With patients and respiratory equipment
 After handling respiratory secretions and
contaminated equipment
 Between contact with contaminated body site and
respiratory devices of the same patient
 Head of bed elevated 30 degree angle
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Transmission Based Precautions
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Used in addition to Standard Precautions for
patients with infection or colonization that
spread easily
3 Types of Transmission Based Precautions
Contact
 Droplet
 Airborne
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Contact Precautions
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Used for infection or MDRO colonization that
is easily transmitted by direct patient contact or
indirect contact with contaminated items
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Colonization – organism lives on a body site but is
not causing an infection
Surfaces can remain contaminated with MDROs
for days to months
Common Contact
Precaution Indications
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MDROs
MRSA
 VRE
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Clostridium difficile associated diarrhea
 Scabies
 Wound drainage not contained
within the dressing
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Basics of Contact Precautions
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Private room
Don gown and gloves before entry into patient
room
Remove gown and gloves before leaving the
room
Perform hand hygiene immediately
Basics of Contact Precautions (cont.)
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Make sure clothing and hands do not touch
potentially contaminated environmental surfaces
or items upon exiting the room
Dedicate noncritical patient-care equipment
Stethoscope
 Thermometer
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Clean and disinfect equipment before use with
another patient
Multi-Use Electronic Equipment
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Includes VS machine and mobile computers
Clean and disinfect (i.e., with germicidal wipes)
routinely
At least daily
 Preferably at the beginning of each shift
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Do not take VS machine into contact precaution
rooms
Clean and disinfect touched surfaces of mobile
computer after use on contact precaution patient
Droplet Precautions
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Droplet transmission takes place when large
droplets from an infected person are propelled a
short distance through sneezing or coughing,
thereby reaching another person’s eyes, nose, or
mouth
Patient should wear a surgical mask over nose
and mouth when out of their room
Droplet Precautions
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Healthcare worker should wear surgical mask
upon entering the patient’s room
Teach patient to cover coughs and sneezes into
bent elbow.
Indications
Pertussis
 Seasonal influenza
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H1N1 requires use of respirator
Airborne Precautions
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Involves contact with small droplets or dust
particles that suspend the infectious agent in the
air
Indications
Tuberculosis
 Measles
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Airborne Precautions
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Patient wears surgical mask to leave their room
Healthcare worker wears a fit-tested respirator
Fit-testing performed by Employee Health (8580)
 Call for appointment if need fit-testing
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Patients are placed in negative pressure rooms
Door(s) to room must be kept closed tight
Tuberculosis
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0-2 cases of active TB is diagnosed between
Ohio, Marshall, and Belmont Counties each year
New employees receive a two step PPD skin test
to identify latent TB on employment
Repeat PPD required annually on your birth
month
Preventive therapy available for persons at high
risk for active TB that have latent TB identified
by PPD testing as recommended by a physician
Patient and Family Education
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The Joint Commission requires the following
patient education be documented
C. difficile and MDROs with 48 hours of admission
or diagnosis
 Surgical site prevention prior to the procedure
 Central line associated bloodstream infection
prevention prior to central line insertion
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INFECTION CONTROL IS A
TEAM EFFORT. HELP
KEEP YOURSELF AND
OTHERS SAFE! PLAY YOUR
PART IN REDUCING THE
RISK OF INFECTION.
Quiz
1. Print the next slide: quiz
2. Complete the written quiz
3. Turn it in to your clinical
instructor/supervisor
OSHA/ INFECTION CONTROL
To take the test, go to “File,” “Print,” and change the printing to “Current slide only”
and gray scale, then hit “Print”
Name_______________________ Dept.________________ Date __________________
1.
True or False Infection control benefits everyone including patients, visitors, and all healthcare workers.
2.
True or False Standard precautions include hand hygiene, wearing gloves, and wearing a gown when coming in contact with
body fluids.
3.
True or False Transmission based precautions include contact, droplet, and airborne.
4.
True or False Multidrug resistant organisms are easy to get rid of and respond well to antibiotics.
5.
True or False It is OK to use alcohol based hand rub after caring for a patient with C-diff.
6.
True or False Hand hygiene is the single most important step in preventing the spread of infection.
7.
True or False When using a disinfectant, it is important to make sure a surface is wet enough to assure proper exposure time
to kill an organism.
8.
True or False Always remember to read the manufacturer’s label for exposure time and appropriate storage when cleaning and
disinfecting.
9.
True or False The products Cavicide and Sani-cloths used for disinfecting can kill C-diff.
10.
True or False Artificial nails and gel products for nails are permitted to be worn by healthcare workers.
SCORE: _______________________________