Transcript Blood Borne Pathogens - leelanau township emergency services

Blood Borne Pathogens
Mike Berendsohn FF/Paramedic
Leelanau Township Emergency
Services
Introduction
Blood borne pathogens is something that effects all
levels of responders . Healthcare workers also have
the potential for a blood borne exposure. Healthcare
workers are the most likely to be exposed to blood
borne illnesses, but workers form many industries
may become exposed to blood borne pathogens. Any
occupation or tasks that involves the handling,
disposal or transport of blood, feces, medic waste, or
any other potentially infectious material has the
potential to become exposed. This course is
designed to review the Occupational Safety and
Health Administrations standards on blood borne
pathogens and blood borne diseases.
This Course meets the standards for:
• NFPA 1581
• MIOSHA Part 554
• OSHA 29 CRF 1910.1030
The Standard
The OSHA standard applies to all employees that have the potential for an exposure to
blood borne pathogens. Some of the potential occupation that this standard would
apply to includes, Firefighters, Law Enforcement, Medical First Responders, EMT-Baisc’s,
EMT-Specialist’s, and Paramedics . It is the responsibility of the Employer to evaluate
the work conditions and environment for potential exposure hazards. Some of the OSHA
requirements Include:
• Developing an Exposure control plan
• Having universal precautions available to all employees
• Vaccinations and records
• Training
• Post exposure follow up
• Disposal and decontamination
What are blood borne pathogens?
Blood borne Pathogens are:
Communicable Diseases are:
Pathogenic microorganisms that are
present in human blood that can cause
disease in the body. Some examples of
blood borne pathogens include:
A disease that can be transmitted from one
human to another.
• Hepatitis B and C
• Human Immunodeficiency Virus (HIV)
• Tuberculosis
Who is at risk?
Leelanau Township Emergency Services classifies job tasks and lists there potential for
exposure. The job tasks are classified as follows:
• Class 1 = Blood/Body fluid exposure possible
• Class 2 = No exposure potential
The following is a list of job task that are common among Fire/EMS duties.
Assessment (medical)
Class 1
Assessment (trauma)
Class 1
Opening the airway
Class 1
Clearing the airway
Class 1
Suctioning the airway
Class 1
Inserting oral or nasal airway
Class 1
Inserting King airways or Combitube
Class 1
Intubation (ET)
Class 1
Who is at risk?
Assisted breathing techniques
Class 1
Mouth to mouth/nose/stoma
Class 1
Mouth to mask
Class 1
Bag valve mask (and through tube)
Class 1
CPR/Rescue breathing/Chest compressions
Class 1
Oxygen administration
Class 1
Nasal cannula
Class 1
Simple mask
Class 1
Non-rebreather mask
Class 1
Venturi mask
Class 1
Humidifier
Class 1
Nebulizers
Class 1
Who is at risk?
Direct pressure
Class 1
Tourniquet
Class 1
Closed wound bandaging
Class 1
Open wound bandaging
Class 1
Special wound bandaging
Class 1
MAST Pants Application/Inflation/Removal
Class 1
Managing delivery of obstetric
Class 1
Delivery of infants
Class 1
Abnormal deliveries
Class 1
Care of newborns
Class 1
Manual spinal immobilization
Class 1
Patient handling
Class 1
Cervical motion restriction devices
Class 1
Who is at risk?
Spinal motion restriction devices
Class 1
General splinting
Class 1
Rigid splinting
Class 1
Traction splitting
Class 1
All use and assisting with ALS crews
Class 1
Oral medication administration
Class 1
Intravenous medication administration
Class 1
Intramuscular medication administration
Class 1
Use of stethoscope
Class 1
Pulse oximeter/CO oximeter
Class 1
Radio use Portable/mobile
Class 1
Use of sphygmomanometer
Class 1
Lifepak 500/1000/12
Class 1
Who is at risk?
Internal temperature probe
Class 1
Glucometer and lancet use
Class 1
Vehicle inspection (exterior)
Class 3
Vehicle inspection (interior)
Class 1
Vehicle cleaning (interior/external)
Class 1
Dispatching
Class 3
Documentation
Class 3
Obtaining patient refusal
Class 1
Cleaning of equipment
Class 1
Use of stretcher/stair chair
Class 1
Lucas 2 application/use/removal
Class 1
Extrication
Class 1
Starting an IV/IO
Class 1
Who is at risk?
Job tasks that could reasonably anticipate a potential exposure:
• Airway suctioning
• Airway management
• Testing blood glucose
• Starting an IV/IO
• Administering medications
• Wound care
• Splinting
• Patient Handling
• Patient Extrication
• Delivery of newborns
• Body Removal
• Decontamination and disinfecting equipment.
How exposures occur
For a blood borne pathogen to be transmitted, the pathogen must enter the individuals
bloodstream. Some of the ways that transmissions can occur includes:
Breaks in the skin - Anytime there is a break in the skin there is a potential for a
transmission. Breaks in the skin can include, scratches, cuts, open wounds, insect bites.
• Needle sticks – Needle sticks are one of the most common forms of transmission of
blood borne pathogens. For an exposure to happen the needle being used must first be
contaminated by the pathogen being transmitted. Sharing of used needles is a very
common form of blood borne transmission
• Other contaminated object – This may include any other type of object that has come
into contact with a transmittable pathogen. Some examples of contaminated object
include: Broken glass, used lancets, medication vials, sharp metal, blood soaked
clothing, amniotic fluids.
• Mucosa membranes – There are many open gateways in the body for the transmission
of BBP. Some examples of these membranes include your mouth, eyes, and nose.
• Pathogens can be transmitted through sexual activity.
How exposures occur
For a transmission to occur:
1. The pathogen must be present in high a
enough concentration.
2. The infected individual must be
susceptible to the pathogen. (Nonvaccinated)
3. The pathogen must have a viable path
of entry into the human body.
All three of the following criteria must be
met for there to have been a potential
Exposure
BBP’s cannot be transmitted by the
following routes:
• Casual contact
•Hand shakes
Once pathogen are introduced into the body there is potential for that pathogens to
transmitted to potential offspring.
Needle stick Exposures
Needle sticks account for approximately
80% of all blood borne exposures. It is not
just the person that is doing the IV start
that is at risk for any exposure. Often it is
the people cleaning up after the incidents
that have accidental exposures due to
unsecured sharps.
Best Protection
Engineering Controls: Employers should make every reasonable effort to reduce
the chances of a potential exposure.
Sharps with Engineered Sharps Injury Protection- a non-needle sharp or a needle device
which is used for withdrawing body fluids, accessing a vein or artery, or administering
medications or other fluids, and which has a build-in safety feature or mechanism that
effectively reduces the risk of an exposure incident.
(Needle cover)
(needle covered)
(Retractable Needle)
Best Practices
Needless System- a device that does not use needles for any of the following:
•The collection of bodily fluids or withdrawal of body fluids after initial venous or arterial
access is established.
•The administration of medication or fluids.
•Any other procedure involving the potential for occupational exposure to blood borne
pathogens due to percutaneous injuries from contaminated sharps.
(blunt tip catheter)
(Luer-lock injection cap)
Best Practices
• It is the responsibility of the employer to provide vaccinations to
employees that have a reasonable risk of exposure to patients.
• Examples of vaccines provided include: Hepatitis B
• These vaccines are too be provided at no cost to the employees.
• These vaccines are to be provided to the employees at a reasonable date
and time for administration.
• The Hepatitis vaccination schedule most often used for adults and children
has been three intramuscular injections, the second and third
administered 1 and 6 months after the first.
• As with all vaccines, there can be minor reactions, including pain and
redness at the injection site, headache, fatigue or a vague feeling of
discomfort. The hepatitis B vaccine is considered very safe.
• the Hepatitis B vaccine is very effective at preventing Hepatitis B virus
infection. After receiving all three doses, the Hepatitis B vaccine provides
greater than 90% protection to infants, children, and adults immunized
before being exposed to the virus.
Best Practices
• Standard (universal) precautions should be followed.
• Standard Precautions are the minimum infection prevention practices that
apply to all patient care, regardless of suspected or confirmed infection
status of the patient, in any setting where healthcare is delivered. These
practices are designed to both protect healthcare providers and prevent
healthcare providers from spreading infections among patients.
• Standard Precautions include: 1) hand hygiene, 2) use of personal
protective equipment (e.g., gloves, gowns, masks), 3) safe injection
practices, 4) safe handling of potentially contaminated equipment or
surfaces in the patient environment, and 5) respiratory hygiene/cough
etiquette.
• Treat all potential infectious material as contaminated.
Best Practices
• Sharps containers will be stored in a manner to prevent spillage of its
contents during use or transit.
• There will be no eating, drinking, smoking, make-up, or contact lenses
application allowed in the interior of the ambulance(s) when exposure is
possible.
• No food or drink is allowed to be stored in refrigerators, on shelves,
cabinets, counter tops or bench seats where infectious material maybe
present.
• Hand washing facilities will be readily available to all personnel. Antiseptic
(waterless) hand cleaner is available on all department response vehicles.
• Crews are recommended to run the exhaust and ventilation fans in the
patient compartment while transporting patients.
Records keeping
• Needle Stick and Prevention Act Mandated that a Sharps Injury Log be
kept.
• In the event of an Exposure:
Name and Social Security Number
Shot Record and TB Test
Employer’s Copy of Exam, Testing, and Follow-up Procedures
Health Care Professionals Written Opinion
Copy of Info given to the Health Care Professional
Employee’s Records Kept Confidential Unless Written Consent is Given by
Employee.
• Training:
Dates of Training
Contents of Training
Name and Qualifications of Trainer
Names and Job Title of Trainee
Kept for a minimum of 3 yrs.
What is out there?
Hepatitis:
There are many strains of hepatitis. The main strains of hepatitis that we
will be focus on will be strains B and C. These strains pose the greatest health risk.
Hepatitis A: Hepatitis A is a liver disease that results from infection with the Hepatitis A
virus. It can range in severity from a mild illness lasting a few weeks to a severe illness
lasting several months. Hepatitis A is usually spread when a person ingests fecal matter
— even in microscopic amounts — from contact with objects, food, or drinks
contaminated by the feces or stool of an infected person.
The best way to prevent Hepatitis A is by getting vaccinated
What is out there?
Hepatitis B: Hepatitis is a disease cause by the hepatitis B virus. The hepatitis B virus
attacks the liver. The liver in impacted by cirrhosis (hardening of the liver) liver cancer,
liver failure, and death. Hepatitis B symptoms manifest themselves within 12 weeks.
Some of the symptoms include:
• Jaundice of the eyes and skin
•Loss of appetite
• Nausea
• Abdominal pains
• Stiff joints
• Tiredness and weakness
Hepatitis is a preventable disease. Hepatitis B has a vaccine that can prevent a potential
infection
What is out there?
Hepatitis C: Hepatitis C is a liver disease that results from infection with the Hepatitis
C virus. It can range in severity from a mild illness lasting a few weeks to a serious,
lifelong illness. Today, most people become infected with the Hepatitis C virus by
sharing needles or other equipment to inject drugs. Before 1992, when widespread
screening of the blood supply began in the United States, Hepatitis C was also
commonly spread through blood transfusions and organ transplants. There is no
vaccine for Hepatitis C. The best way to prevent Hepatitis C is by avoiding behaviors
that can spread the disease, especially injection drug use.
What is out there?
Hepatitis D: Hepatitis D is a serious liver disease caused by the Hepatitis D virus (HDV). It
is uncommon in the United States, and only occurs among people who are infected with
the Hepatitis B virus. The transmission of HDV is similar to how HBV is spread and
requires contact with infectious blood. There is no vaccine for Hepatitis D.
Hepatitis E: Hepatitis E is a serious liver disease caused by the Hepatitis E virus (HEV).
While rare in the United States, Hepatitis E is common in many parts of the world. HEV is
similar to Hepatitis A, in that it is spread in similar ways and usually results in an acute
infection. It is transmitted from ingestion of fecal matter, even in microscopic amounts,
and is usually associated with contaminated water supply in countries with poor
sanitation. There is currently no FDA-approved vaccine for Hepatitis E
What is out there?
Human Immunodeficiency Virus (HIV): HIV stands for human immunodeficiency virus.
It is the virus that can lead to acquired immunodeficiency syndrome, or AIDS. Unlike
some other viruses, the human body cannot get rid of HIV. That means that once you
have HIV, you have it for life.
In the United States, HIV is spread mainly by having sex with or sharing drug injection
equipment with someone who is infected with HIV. HIV cannot be spread by casual
contact such as hugging or shaking hands.
Post-exposure prophylaxis (PEP) is medicine that is used to prevent HIV after a possible
exposure.
Symptoms of HIV infection include:
•Fever
•Diarrhea
•Fatigue
•Weight loss
•Night sweats
What is out there?
Methicillin-resistant Staphylococcus aureus (MRSA): is a bacteria that is resistant to
many antibiotics. In the community, most MRSA infections are skin infections. In
medical facilities, MRSA causes life-threatening bloodstream infections, pneumonia and
surgical site infections.
What is out there?
Tuberculosis (TB): is caused by a bacterium called Mycobacterium tuberculosis. The
bacteria usually attack the lungs, but TB bacteria can attack any part of the body such
as the kidney, spine, and brain. If not treated properly, TB disease can be fatal.
TB is spread through the air from one person to another. The TB bacteria are put into
the air when a person with TB disease of the lungs or throat coughs, sneezes, speaks,
or sings. People nearby may breathe in these bacteria and become infected.
Symptoms of TB disease include:
• A bad cough that lasts 3 weeks or longer
• Pain in the chest
• Coughing up blood or sputum
• Weakness or fatigue
• Weight loss
• No appetite
• Chills
• Fever
• Sweating at night
What is out there?
Bacterial meningitis: Bacterial meningitis is usually severe. While most people with
meningitis recover, it can cause serious complications, such as brain damage, hearing
loss, or learning disabilities. In the united states, about 4,100 cases of bacterial
meningitis, including 500 deaths, occurred each year between 2003–2007.
The germs that cause bacterial meningitis can be contagious. Some bacteria can spread
through the exchange of respiratory and throat secretions (e.G., Saliva or mucus).
Meningitis infection may show up in a person by a sudden onset of fever, headache, and
stiff neck. It will often have other symptoms, such as
• Nausea
• Vomiting
• Increased sensitivity to light
• Altered mental status (confusion).
The most effective way to protect you against certain types of bacterial meningitis is to
complete the recommended vaccine schedule. Antibiotics may be recommended for
close contacts of people with meningococcal meningitis.
What is out there?
Herpes Zoster (shingles): Shingles is caused by the varicella zoster virus (VZV), the same virus
that causes chickenpox. After a person recovers from chickenpox, the virus stays dormant
(inactive) in the body. For reasons that are not fully known, the virus can reactivate years
later, causing shingles. Shingles is not caused by the same virus that causes genital herpes, a
sexually transmitted disease.
Symptoms of shingles can include:
• Rash
• Fever
• Headache
• Chills
• Upset stomach
The only way to reduce the risk of developing shingles and the long-term pain from postherpetic neuralgia (phn) is to get vaccinated. CDC recommends that people aged 60 years
and older get the shingles vaccine.
What is out there?
Clostridium difficile (C-Diff): is a bacterium that causes inflammation of the colon,
known as colitis. The bacteria are found in the feces. People can become infected if
they touch items or surfaces that are contaminated with feces and then touch their
mouth or mucous membranes. Healthcare workers can spread the bacteria to patients
or contaminate surfaces through hand contact.
Symptoms include:
• Watery diarrhea (at least three bowel movements per day for two or more days)
• Fever
• Loss of appetite
• Nausea
• Abdominal pain/tenderness
In about one in four patients, Clostridium difficile infection will resolve within 2-3 days
of discontinuing the antibiotic to which the patient was previously
exposed. Clostridium difficile is generally treated for 10 days with antibiotics
prescribed by your healthcare provider.
What is out there?
Ebola hemorrhagic fever (Ebola HF): is one of numerous Viral Hemorrhagic Fevers. It is
a severe, often fatal disease in humans and nonhuman primates. Ebola HF is caused by
infection with a virus of the family Filoviridae.
When an infection does occur in humans, there are several ways in which the virus can
be transmitted to others. These include:
• Direct contact with the blood or secretions of an infected person
• Exposure to objects (such as needles) that have been contaminated with infected
secretions
Symptoms of Ebola HF typically include:
• Fever
• Headache
• Joint and muscle aches
• Weakness
• Diarrhea
Personal protective equipment
Level A PPE
Level A - To be selected when the greatest level of skin, respiratory, and eye protection is
required.
The following constitute Level A equipment; it may be used as appropriate;
1. Positive pressure, full face-piece self-contained breathing apparatus (SCBA), or positive
pressure supplied air respirator with escape SCBA, approved by the National Institute for
Occupational Safety and Health (NIOSH).
2. Totally-encapsulating chemical-protective suit.
3. Coveralls.
4. Long underwear.
5. Gloves, outer, chemical-resistant.
6. Gloves, inner, chemical-resistant.
7. Boots, chemical-resistant, steel toe and shank.
8. Hard hat
9. Disposable protective suit, gloves and boots (depending on suit construction, may be
worn over totally-encapsulating suit).
Personal protective equipment
Personal protective equipment
Level B PPE
II. Level B - The highest level of respiratory protection is necessary but a lesser level of
skin protection is needed.
The following constitute Level B equipment; it may be used as appropriate.
1. Positive pressure, full-facepiece self-contained breathing apparatus (SCBA), or positive
pressure supplied air respirator with escape SCBA (NIOSH approved).
2. Hooded chemical-resistant clothing (overalls and long-sleeved jacket; coveralls; one or
two-piece chemical-splash suit; disposable chemical-resistant overalls).
3. Coveralls.
4. Gloves, outer, chemical-resistant.
5. Gloves, inner, chemical-resistant.
6. Boots, outer, chemical-resistant steel toe and shank.
7. Boot-covers, outer, chemical-resistant.
8. Hard hat.
9. Face shield.
Personal protective equipment
Personal protective equipment
Level C PPE
III. Level C - The concentration(s) and type(s) of airborne substance(s) is known and the
criteria for using air purifying respirators are met.
The following constitute Level C equipment; it may be used as appropriate.
1. Full-face or half-mask, air purifying respirators (NIOSH approved).
2. Hooded chemical-resistant clothing (overalls; two-piece chemical-splash suit;
disposable chemical-resistant overalls).
3. Coveralls.
4. Gloves, outer, chemical-resistant.
5. Gloves, inner, chemical-resistant.
6. Boots (outer), chemical-resistant steel toe and shank.
7. Boot-covers, outer, chemical-resistant.
8. Hard hat.
9. Escape mask.
10. Face shield.
Personal protective equipment
Personal protective equipment
Level D PPE
IV. Level D - A work uniform affording minimal protection: used for nuisance
contamination only. (Most commonly used PPE level in Rescue and EMS)
The following constitute Level D equipment; it may be used as appropriate:
1. Coveralls.
2. Gloves.
3. Boots/shoes, chemical-resistant steel toe and shank.
4. Boots, outer, chemical-resistant.
5. Safety glasses or chemical splash goggles.
6. Hard hat.
7. Escape mask.
8. Face shield.
Personal protective equipment
N95 Facemasks
The N95 respirator is the most common of the seven types of particulate
filtering face piece respirators. This product filters at least 95% of airborne
particles but is not resistant to oil.
EMS PPE Kits
Light duty PPE kit
(30 second exposure kit)
Heavy duty PPE kit
Fire Department PPE kits
Fire department PPE kit are avail be on every Fire department response vehicle.
Kits include: Gloves, N95 masks, 30 Second exposure kits, Red biohazard bags, A
liquid solidification powder and PAWS antimicrobial wipes.
Cleaning and decontamination
•Decontamination- the use of physical or chemical means to
remove, inactivate, or destroy bloodborne pathogens on a
surface or item to the point where they are no longer capable
of transmitting infectious particles and the surface or item is
rendered safe or handling, use, or disposal.
•Disinfect- to inactivate virtually all recognized pathogenic
microorganisms, but not necessarily all microbial forms, on
inanimate objects.
•Sterilize- the use of a physical or chemical procedure to
destroy all microbial life, including highly resistant bacterial
endospores.
Cleaning and decontamination
Cleaning and decontamination
Cleaning products are located in both ambulances and in the utilities
room of the Northport station. Follow the manufactures
recommendation for application of cleaning supplies.
Cleaning and decontamination
Additional cleaning products located in both ambulances and in the utilities
room of the Northport station. Follow the manufactures recommendations
for application of cleaning supplies.
How to dispose of waste
“Red Bag” Items- The regulated
waste items must be placed in
bio-hazard bags are saturated
non-sharp materials. They are
taken to the emergency
department , and placed in the
dirty utility room at Munson
Medical Center.
“Sharps” Containers- Full “Sharps”
containers must be sealed, taken to the
emergency department, and placed on the
counter in the dirty utility room.
What to do if exposed
•Contact the Medical Director, (s)he will then contact Munson
Medical Center.
•Fill out an Incident Report and the Exposure Paperwork.
•Contact the Charge Nurse at MMC and tell them you are a HCP.
–Charge will Contact the Nurse Supervisor in the ER
–They will Contact the Infectious Control Officer.
•They will Test the Source Individual.
•You will Register as a Patient and be tested as needed.
•The Information will be returned to the Exposure Liaison and
possibly the Exposed.
What to do if exposed
• Exposure forms are located in the
• If exposed, information cards are in
safety books. Safety books are
located in every department
response vehicle. Safety books are
also located in both the Fire and
EMS offices.
both ambulances for exposure
reporting instructions.
What to do if exposed
Leelanau township emergency services incident/safety report
What to do if exposed
First responders request for testing page 1
What to do if exposed
First responders request for testing page 2
Post exposure follow-up
• The exposed personnel will be evaluated by a healthcare
professional in the emergency room if deemed necessary.
• After evaluation the member/employee must bring postexposure documentation to the Deputy EMS chief before
returning to active duty.
• Any costs for subsequent treatment is the responsibility of the
Township.
• It is the responsibility of the member to obtain but not
ultimately pay for this treatment.
Ryan White Act.
Ryan White and his mom courageously fought AIDS-related discrimination and helped
educate the Nation about his disease. Ryan White was diagnosed with AIDS at age 13.
He and his mother Jeanne White Ginder fought for his right to attend school, gaining
international attention as a voice of reason about HIV/AIDS. At the age of 18, Ryan
White died on April 8, 1990, just months before Congress passed the AIDS bill that
bears his name – the Ryan White CARE (Comprehensive AIDS Resources Emergency)
Act. The legislation has been reauthorized four times since – in 1996, 2000, 2006, and
2009 – and is now called the Ryan White HIV/AIDS Program.
Ryan White Act.
• The Ryan White Act. Is important for EMS and rescue workers because it
allows testing of source individual without their consent for emergency
responders.
• Meaning if you have a reasonable suspicion that a patient you have been in
contact with could have exposed you to a pathogen, The hospital can test the
patient for the suspected disease and begin treatment for the responders.
•Request a exposure form at the receiving hospital.
For additional information
• OSHA Part 1910:
https://www.osha.gov/pls/oshaweb/owadisp.
show_document?p_table=STANDARDS&p_id=
10051
• MIOSHA Part 554
http://www.michigan.gov/documents/CIS_WS
H_part554_35632_7.pdf
• Further inquiry: Mike Berendsohn EMS
Training officer
Works Cited
https://www.osha.gov/pls/oshaweb/owadisp.sh
ow_document?p_table=STANDARDS&p_id=97
67
http://www.cdc.gov/niosh/npptl/topics/respirat
ors/disp_part/n95list1.html
http://hab.hrsa.gov/abouthab/ryanwhite.html
http://www.cdc.gov/vaccines/vpdvac/hepb/default.htm#vacc
Works Cited
http://www.cdc.gov/hepatitis/B/bFAQ.htm#bFA
Q38
https://www.osha.gov/pls/oshaweb/owadisp.sh
ow_document?p_table=STANDARDS&p_id=10
051
http://www.michigan.gov/documents/CIS_WSH
_part554_35632_7.pdf