Transcript IDEC-for-dist-7-and-8-2011

Infectious Disease Exposure Control (IDEC)
Including Required
Bloodborne Pathogens Training
Feb. 2004, L&I
Revised, April 2011, NET 1
Transmission of Diseases
Organisms can enter the body via:
Inhalation –
contaminated
air
2
3
Transmission of Diseases
Organisms can enter the body via:
Ingestion – contaminated
food and water
• Spinach – 3 dead, 200+
sickened (2006)
• Cantaloupes – 300 people in
39 states (2007)
• Tomatoes – 1400 Americans
sickened (2008)
• Peanut–containing products –
9 dead, 690 sickened (2009)
• Hepatitis
4
Transmission of Diseases
Organisms can enter the body via:
Touching contaminated items:
• Bloodborne
• MRSA
5
Bloodborne Pathogens Training
Washington
Industrial
Safety & Health
Rules
Chapter 296-823
WAC
www.lni.wa.gov
6
Bloodborne Pathogens Training
Firefighter
Safety & Health
Rules
Chapter 296305 WAC
www.lni.wa.gov
7
Transmission of BBPs
Occupational Exposure
• means reasonably
anticipated skin, eye,
mucous membrane, or
parenteral (piercing of the
skin) contact with blood or
OPIM that may result from
the performance of an
employee's duties
8
Transmission of BBPs
Exposure Incident
• is a specific
contact with blood
or OPIM that is
capable of
transmitting a
bloodborne
disease
9
Bloodborne Pathogens (BBPs)
OPIM
• semen
• vaginal secretions
• body fluids such as pleural,
cerebrospinal, pericardial,
peritoneal, synovial, and
amniotic
• saliva in dental procedures
(if blood is present)
• any body fluids visibly
contaminated with blood
• body fluid where it is difficult
to differentiate
• any unfixed tissue or
organ (other than intact
skin) from a human
(living or dead)
• HIV- or HBV-containing
cultures (cell, tissue, or
organ), culture medium,
or other solutions
• blood, organs, &
tissues from animals
infected with HIV, HBV,
or BBPs
10
Transmission of BBPs
Bloodborne Pathogens can
enter your body through
• a break in the skin (cut,
burn, lesion, etc.)
• mucus membranes (eyes,
nose, mouth)
• sexual contact
• injection/needlestick/sharps
• other modes
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Transmission of BBPs
Risk of infection
depends on
several factors
Courtesy of Owen Mumford, Inc.
12
Viral Hepatitis - General Overview
The liver is a
large, dark red
gland located in
the upper right
abdomen behind
the lower ribs. It
functions in
removing toxins
(poisons) from
the blood, in the
digestion of fats,
and in other body
processes.
• Virus attacks liver 
inflammation,
enlargement, and
tenderness
• Acute and chronic
infections
• Possible liver damage
ranging from mild to fatal
Courtesy of Schering Corporation
13
HBV - Hepatitis B
General Facts
• Hearty - can live for 7+ days in
dried blood
• 100 times more contagious
than HIV
• Approximately 46,000 new
infections per year (CDC, 2006)
• 1.4 million carriers (CDC, 2006)
• 5,000 deaths/year
• No cure, but there is a
preventive vaccine
We have HBV cases in Thurston County
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HBV - Hepatitis B
Clinical Features
Incubation period
Average 60-90 days
Range 45-180 days
No sign or symptoms
Acute illness (jaundice)
30%
30%-50% (5 years old)
Chronic infection (carrier)
2%-10% (of infected adults)
- Premature death from
chronic liver disease
Immunity
15-25% (of chronically
infected)
Protected from future infection
15
HBV - Hepatitis B
Symptoms
•
•
•
•
•
•
•
flu-like symptoms
fatigue
abdominal pain
loss of appetite
nausea, vomiting
joint pain
jaundice
Normal eyes
Jaundiced eyes
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General Facts
• The most common chronic bloodborne
infection in the U.S. - about 1.5% of
the US population infected (2010)
• 17,000 new infections per year (2011)
• Leading cause of liver transplantation
in U.S.
• 8,000-10,000 deaths from chronic
disease/year
• No post-exposure prophylactic (PEP)
• No vaccine available
We have HCV cases in Thurston County
Healthy human liver
Copyright 1998 Trustees of Dartmouth College
HCV - Hepatitis C
Hepatitis C liver
A healthy human liver contrasted
with a liver from an individual who
died from hepatitis C. Note the
extensive damage and scarring
from chronic liver disease.
17
HCV - Hepatitis C
Clinical Features
Incubation period
Average 6-7 weeks
Range 2-26 weeks
No sign or symptoms
Acute illness (jaundice)
80%
20% (Mild)
Chronic infection
Chronic liver disease
75%-85%
10%-70% (most are asymptomatic)
Deaths from chronic liver
disease
1%-5%
Immunity
No protection from future infection
identified
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HCV - Hepatitis C
Symptoms
•
•
•
•
•
•
•
flu-like symptoms
jaundice
fatigue
dark urine
abdominal pain
loss of appetite
nausea
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HCV - Hepatitis C
HCV Transmission
• Injecting drug use
• Hemodialysis (long-term)
• Blood transfusion and/or organ
transplant before 1992
• From infected mother to child
during birth
• Occupational exposure to
blood - mostly needlesticks
• Sexual or household
exposures – rare
• Tattoos
• Clinical Procedures (rare)
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Human Immunodeficiency Virus (HIV)
General Facts
• Fragile – few hours in dry
environment
• Attacks the human immune
system, cause of AIDS
• About 1.1 million infected
persons in U.S. (CDC, 2006)
• About 56,000 new cases HIV
infection annually
• Males account for nearly 75%
• No cure; No vaccine available
yet. Since 1996, highly
effective drug therapies have
been available.
• There is PEP
HIV - seen as small spheres on the
surface of white blood cells
We have HIV cases in Thurston County
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Human Immunodeficiency Virus (HIV)
HIV Infection  AIDS
• Many have no symptoms or
mild flu-like symptoms
• Most infected with HIV
eventually develop AIDS
• Incubation period 10-12 yrs
• Only way to know is to be
tested
• Opportunistic infections &
AIDS-related diseases - TB,
toxoplasmosis, Kaposi’s sarcoma,
oral thrush (candidiasis)
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Other Diseases
• MRSA
– Over 50% is CA-MRSA in
Thurston County
• Pertussis
• Meningitis
• Chickenpox
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Tuberculosis
• Bacteria, primarily affects lungs
• Airborne transmission – respiratory
protection required and the respiratory
protection program applies.
• 2 disease states
– Latent infection
– Active disease
• Symptoms
• TB testing process
• No post-exposure prophylaxis but testing
depending on member infection status recommended
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Exposure Control Plan
To eliminate/minimize your risk of exposure
Where can you find it????
25
Exposure Controls
Reducing your risk
• Universal precautions (or
equivalent system*)
• Equipment and Safer
Medical Devices
• Work practices
• Personal protective
equipment
• Housekeeping
• Laundry handling
• Hazard communication
- labeling
• Regulated Waste
Unprotected position
Protected position
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Reducing Your Risk - Exposure Controls
Equipment and Safer Medical Devices
• Physical guards
Sharps disposal containers
-
Closable
Puncture-resistant
Leak-proof
Labeled or color-coded
Upright, conveniently placed in
area where sharps are used
(by/near the patient)
- DO NOT OVERFILL (replace at
¾ full)
- Close, ensure lid tight, tape shut
27
Exposure Controls
NOT Safe Medical Devices
PMs still use unprotected
sharps for Central Lines
and Chest decompression.
Be VERY careful around
these bloody 4” weapons of
infectious destruction.
28
Exposure Controls
Safe Work Practices
Do the job/task in safer ways to minimize any exposure to
blood or OPIM:
Don’t bend or remove
needles or other sharps.
Don’t recap. EVER. EVER.
EVER, unless there is
absolutely no other choice
– then use the one-handed
scoop method.
Use one-handed scoop
method for Epi Pens
29
Exposure Controls
Safe Work Practices
 Wash hands after glove
removal
 Wash hands immediately or as
soon as feasible after exposure.
 Remove PPE before leaving
work area.
THINK about where your hands /
gloved hands have been and
what you touch next. 50% of
MRSA is community acquired.
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Exposure Controls
Safe Work Practices
 Do not eat, drink, smoke, apply
cosmetics or lip balm, or
handle contact lenses in any
work areas where there is the
possibility of exposure to blood
or OPIM. This includes the
patient care areas of transport
capable vehicles.
 Do not place food or drink in
refrigerators, freezers, shelves,
cabinets, or on countertops or
bench tops in any work areas.
31
Exposure Controls
Personal Protective Equipment (PPE)
When equipment, safer devices and safe work practices do not
eliminate the exposure, you must wear appropriate PPE.
Appropriate means:
• Meets the standards
• Fits the user
• Functions effectively in the
manner for which it was designed
• Does not permit blood / OPIM to
pass through or reach your
clothes, skin eyes, nose, mouth
or other mucous membrane for
the duration of the time for which
it will be used.
The District provides
appropriate PPE
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Exposure Controls
Personal Protective Equipment (PPE)
• Gloves – latex, nitrile, vinyl, utility
Nitrile and vinyl gloves
Boxes of latex gloves in
glove dispensing rack
- You must wear gloves for
patient contact, handling
contaminated items or
surfaces and for decon.
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Exposure Controls
Personal Protective Equipment (PPE)
Remove gloves safely and properly
 Grasp near cuff of glove and
turn it inside out. Hold in the
gloved hand.
 Place fingers of bare hand
inside cuff of gloved hand and
also turn inside out and over
the first glove.
 Dispose gloves into proper waste
container.
 Clean hands thoroughly with soap and
water (or antiseptic hand rub product if
handwashing facilities not available).
34
Exposure Controls
Personal Protective Equipment (PPE)
• Protective clothing
Gowns and “coveralls” are
provided
- You must use your
judgment - wear them
when appropriate to keep
blood and OPIM from
your skin and clothing.
35
Exposure Controls
Personal Protective Equipment (PPE)
• Eye-Face Protection and Masks
- Safety glasses
- Splash goggles
- Face shield
- Mask
- Respirators
36
Exposure Controls
Personal Protective Equipment (PPE)
• Eye-Face Protection and Masks
Face protection anytime splashes,
sprays, spatters or
droplets of blood or
OPIM pose a hazard
to the eyes, nose,
mouth or can be
reasonably
anticipated
37
Exposure Controls
Personal Protective Equipment (PPE)
• Eye-Face Protection and Masks
Face protection – use when performing the following
tasks:
- Airway management – suctioning, intubation, placement of OP
or NP airways, BVM
- Caring for TB or suspected SARS patients
- Illness with fever and respiratory symptoms
- Any illness with flu-like symptoms
38
Exposure Controls
Personal Protective Equipment (PPE)
• Resuscitation Devices
• Providing mouth-to-mouth is
not prohibited, but should be
avoided whenever possible
• If necessary, attempt to use a
protective device such as a
barrier or BVM
• Document instances of
mouth-to-mouth on District
exposure form
39
Exposure Controls
Housekeeping
Maintain a clean and sanitary workplace
• Wear gloves, and wear eye
protection as necessary for
decon
– All chemicals used for decon are
toxic, or corrosive or both
– Emergency eyewash is readily
available
• All members clean up area after
they perform decon
DISINFECTANT
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Exposure Controls
Laundry
 Contaminated clothing or turnouts into
extractor. Other items to hospital with
patient for disposal
 Handle as little as possible – wear gloves
- Bag/containerize at scene
- Place in leak-proof, labeled or colorcoded containers or bags
 Wear PPE when handling and/or sorting –
gloves, eye protection, maybe gowns
 DO NOT EVER take contaminated clothing
home to wash/decon
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Exposure Controls
Communication of Hazards
• Biohazard Label securely
attached
• Red bags/containers
may substitute for
labels
• Leak proof, closeable
• Replaced routinely – don’t
overfill
Predominantly
Lettering and symbol
fluorescent orange or in contrasting color to
orange/red background
background
42
Exposure Controls
Regulated Waste – what is it?
• Liquid or semi-liquid blood or OPIM
• Contaminated items that would release blood or OPIM in
a liquid or semi-liquid state if compressed
• Items caked with dried blood or OPIM that are capable
of releasing these materials
during handling
• Contaminated sharps
• Pathological and microbiological
wastes containing blood or OPIM
43
Exposure Controls
Regulated Waste - Containers
• All items in Stericycle containers
must be in red bags that are tied
shut.
• If leaking is possible, double or
triple bag (like suction units)
• Do not overfill. “Liner” bag must
be tied shut before pickup of
waste container.
• Keep containers closed
44
Exposure Controls
Separation of Station Areas
• Clothing that needs to be cleaned or
decontaminated must be kept out of living,
sleeping, kitchen and personal hygiene areas
• Consider new information on movement of
contaminants (like MRSA) from scenes to
vehicles to stations and unexpected areas and
to your home
45
Prevention – Vaccinations and Testing
•
•
•
•
HBV
TB
MMR and Tetanus
Flu
46
Hepatitis B Vaccine
• You can decline vaccination
for any reason.
• If you decline, you must sign
Declination Form.
• You can also change your
mind and get vaccination at
later date at no cost.
• Records maintained in
confidential medical file.
47
TB Testing
• Tuberculin skin test, also called PPD
– If you have had positive test, don’t get another (it will still be
positive)
• Injection site evaluated 48 – 72 hours later
• Positive or negative results
– Positive – presence of TB bacteria.
• Follow up.
• Not sick, can’t give anyone TB
– Negative – no TB bacteria
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Other Vaccinations
• District offers the following at no cost to
members:
– MMR
– Tetanus
• District offers, at no cost, flu shots to
District members and their family
members
Measles, above. Mumps, below
For any vaccination or testing,
contact Assistant Chief LeMay
49
Exposure Incidents
If you have an exposure incident to blood or OPIM,
immediately do the following:
 Thoroughly clean the affected area
• Wash needlesticks, cuts, and
skin with soap and water
• Flush with water splashes to the
nose and mouth
• Irrigate eyes with clean water,
saline, or sterile irrigants
 Report exposure to your supervisor
50
Exposure Incidents
The District will provide for a post-exposure medical
evaluation and follow-up
BBP exposures evaluated at St Petes
• No cost, confidential
• Testing for HBV, HCV, HIV
• Preventive treatment when indicated
• Seek testing of source person
• “Forced” HIV testing allowed by law
• Request for HBV, HCV
• Ryan White Act - provide results to
exposed employee
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Vaccination & AB
response status of
exposed member
Source Pt
HBsAg +
Source Pt
HBsAg -
Source Pt
unknown or not
available for
testing
Unvaccinated
HBIG X 1 and
initiate HBV series
Initiate HBV series
Initiate HBV series
Known responder
No treatment
No treatment
No treatment
Unknown
responder
HBIG X 1 and
initiate or
revaccinate OR
HBIG X 2
No treatment
If known hi risk
source, treat as if
source HBsAg+
AB response
unknown
Test exposed
member.
NO tx for Anti-HBs
AB adequate - no
treatment
AB inadequate HBIG X 1 and
vaccine booster
No treatment
Test exposed
member
AB adequate - no
treatment
AB inadequate vaccine booster
and recheck titer
1-2 mos
HBV Post Exposure
Prophylaxis Matrix,
CDC, 2002
52
Post-exposure evaluation
Hepatitis C
 Request blood draw of source
patient
 Baseline blood draw of responder
 Serial blood draws for responder (8
wks, 3 mos, 6 mos, etc.)
 No post-exposure prophylaxis
available
 Responder must take bloodborne
disease transmission precautions
until know if seroconversion
53
Post-exposure evaluation
HIV
 Require blood draw of source
patient
 NEW HIV quick test, results in
minutes rather than hours or days
 Or Baseline blood draw of
responder (you have right to think
about getting your blood baselines
tested for 90 days)
 Post exposure prophylaxis depends
on exposure, source patient, quick
test.. PEP toxic to liver – can cause
medical problems in responder
 Counseling
54
PEP
• Post-Exposure Prophylaxis
– Anti-HIV medications for someone who has had a
substantial exposure; usually to blood
• Optimally start within 2 hours after exposure,
preferably within 24 hours
• Continue for 28 days
• Doesn’t protect against other Bloodborne
pathogens (HBV, HCV)
From HIV Occupational Exposures Counseling Course, 6-2006, Beth McGinnis
55
Serology
• HIV test checks for antibodies, not virus.
• Primary tests used to identify HIV antibodies:
– ELISA - highly sensitive.
– Western Blot - highly specific.
• PCR testing - actually looks for virus.
– Expensive.
– Not readily available.
From HIV Occupational Exposures Counseling Course, 6-2006, Beth McGinnis
56
Mandatory Source Testing
• Source
– Someone whose bodily fluids have come into contact with a
law enforcement officer, firefighter, health care provider or
health care facility staff, certain other professions
• The individual with the occupational exposure can
request a source HIV test
• Doesn’t eliminate need for baseline testing.
• Provisions for PEP should also not be contingent on a
source’s test results.
From HIV Occupational Exposures Counseling Course, 6-2006, Beth McGinnis
57
Window Period for Antibody Detection
0 weeks
3 weeks
6 weeks
3 months
Most people fall here
Infected
with HIV
Earliest
detection
85%
of
infections
detected
Over 99%
of
infections
detected
Note: In very rare situations, detection of antibodies may take up to 6 months or longer.
From HIV Occupational Exposures Counseling Course, 6-2006, Beth McGinnis
58
Post-exposure evaluation
Post Exposure follow-up
 Medical facility provides employee
with copy of the doctor’s written
opinion within 15 days of completion
of evaluation
 Provides employee with information
about laws on confidentiality for the
source individual
 Provides employer with notification
that member has been seen and
has been given instructions. No
results are provided to the
employer.
59
Counseling the Health Care Worker
• State Law requires certain items be covered in a
testing session (can be provided as written or
verbally)
– Benefits of learning HIV status and the potential
dangers of the disease
– Methods of HIV transmission and ways to prevent
transmission
– Meaning of HIV test results and importance of
obtaining results
From HIV Occupational Exposures Counseling Course, 6-2006, Beth McGinnis
60
Counseling the Health Care Worker
• Know that: infection occurs infrequently
• If necessary, 4-week regimen of PEP based on
USPHS guidelines will be initiated
• Discuss behavioral measures to prevent secondary
transmission
–
–
–
–
Sexual Abstinence or Condom Use
Not sharing personal items (toothbrushes, razors, etc.)
No donation of blood, organs, tissue, or semen
Discontinuing breast feeding should be considered
From HIV Occupational Exposures Counseling Course, 6-2006, Beth McGinnis
61
Post-Test Counseling for the HCW
• Test Results of Source Person are confidential
• Repeat testing at 6 weeks, 12 weeks, and 6
months post-exposure
• Check in on prevention behaviors
• If symptoms present, retest
From HIV Occupational Exposures Counseling Course, 6-2006, Beth McGinnis
62
Post-exposure evaluation
Post Exposure NET requirements
 Member Injury, Illness and
Exposure form by end of shift or no
later than 24 hours
 BVFF form
 Supervisor ensures investigation
 NET wants all instances of blood on
your skin – whether or not it is an
exposure incident – to be
documented. Our PPE and
procedures should prevent this from
happening.
63
Training
• IDEC training is required
– Before initial assignment
– When changes made to tasks or procedures
– Annually, within 1 year of previous training
• Provided by knowledgeable person
• Students must have opportunity to have
interactive questions / answers
• Specific topics must be addressed
– See 296-823 and 296-305
• Records must be maintained for 3 years
64
Recordkeeping
Medical Records
• Confidential, separate from personnel
records
• Hepatitis B vaccination and post-exposure
evaluations
– No results of post exposure evals
• HCP’s written opinions
• Information provided to HCP as required
• Maintain for length of employment + 30
years
65
Any Questions?
66