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Hamilton County Health Department Health Education Division ---PAGE BREAK--- The Learner Will Be Able To… • Recall three bloodborne pathogens. • Describe three ways bloodborne pathogens can be transmitted. • List three ways a bloodborne pathogen exposure occurs. • Review the procedure for reporting a bloodborne pathogen exposure. ---PAGE BREAK--- Scope and Application… • Bloodborne Pathogens Standards apply to ALL employees with occupation exposure to blood and other potentially infectious materials and waste. ---PAGE BREAK--- Who Is At Risk… • Health Care Providers • Buildings & Grounds Workers • Teachers • Coroners • Law Enforcement Personnel • EMS & Firefighters • Childcare Workers • Anyone providing first‐response medical care ---PAGE BREAK--- What Are Bloodborne Pathogen? • Bloodborne pathogens are infectious microorganisms in human blood that can cause disease in humans. • Bloodborne Pathogens Include: • Hepatitis B (HBV) • Hepatitis C (HCV) • Human Immunodeficiency Virus (HIV) ---PAGE BREAK--- Universal Precautions… • Treat All human blood and other potentially infectious fluids as if they are infectious. • Must be observed in all situations where differentiation between body fluid types is difficult or impossible ‐ all body fluids shall be considered potentially infectious materials. ---PAGE BREAK--- How Are Diseases Transmitted… • Direct Contact • Body Fluids • Indirect Contact • Objects With Body Fluids • Airborne • From The Air • Vector‐borne • Animals And Insects ---PAGE BREAK--- Occupational Exposure… • Reasonable anticipated contact with blood or OPIM. • May result from performance of an employee’s duties. • Occurs by: • Skin • Eyes • Mucous membranes ---PAGE BREAK--- Contaminated… • Presence or the reasonably anticipated presence of blood or other potentially infectious material on an item or surface. ---PAGE BREAK--- Modes of Transmission Of All Bloodborne Pathogens…… • Sexual contact. • Sharing of needles. • From mothers to their babies at or before birth. • Accidental puncture from contaminated needles, broken glass, or other sharps. • Contact between broken or damaged skin and infected body fluids. • Contact between mucous membranes and infected body fluids. • Anytime there is blood‐to‐blood contact with infected blood or body fluids. ---PAGE BREAK--- Other Potentially Infectious Materials (OPIM)… • Blood products • Semen • Vaginal secretions • Cerebrospinal fluid • Pleural fluid (lung fluid) • Synovial fluid (fluid from your joints) • Amniotic fluid (uterine fluid) • Peritoneal fluid (fluid that fills your body cavity) • Saliva in dental settings • Any body fluid that is visibly contaminated with blood ---PAGE BREAK--- Not All Body Fluids Are Infectious… • These body fluids are infectious ONLY if blood is present in them: • Urine • Feces • Vomit • Tears • Sweat • Nasal Secretions • Sputum ---PAGE BREAK--- Transmission Potential… • Contact with another person’s blood or bodily fluid that may contain blood. • Mucous membranes eyes, mouth, nose • Non‐intact skin • Contaminated sharps/needles ---PAGE BREAK--- Transmission Potential… • Infected blood can enter your body through: • Open Sores • Lacerations (Cuts) • Abrasions • Acne • Any damaged or broken skin, such as sunburn or blisters. ---PAGE BREAK--- HIV… • Can only live outside of the body for a few minutes to a few hours. • Attacks the immune system. • CDC estimates that 50,000 people become infected with HIV every year (CDC 2013). ---PAGE BREAK--- HIV… • Approximately 1 in 5 who are HIV + do not know they are infected with the disease. • HIV will develop into AIDS within approximately 10 years. • 6,171 people are living with AIDS in 2014 (ISDH, 12/31/2014). • No cure or vaccine to prevent HIV‐only prevention. ---PAGE BREAK--- Transmission Of HIV… • Sexual contact • Sharing needles or drug equipment. • • Pregnancy, childbirth and breast feeding. • Contact with other body fluids. • Body piercing and tattooing. ---PAGE BREAK--- HIV Is NOT Spread By… • Casual Contact • Saliva • Sweat • Spit • Tears • Air • Insects ---PAGE BREAK--- Acquired Immunodeficiency (AIDS)… AIDS Have Two Of The 23 Opportunistic Infections & White Blood Cell Below 200 Acquired Develops after contact with HIV Immunodeficiency A weakening of the immune system A group of signs and/or caused by a disease Usually Within Ten Years ---PAGE BREAK--- The Liver… • The liver is one of the most important organs in the human body. • The liver is intimately involved in almost every part of the body’s processes. • The function of the liver are: • Fuel Management • Nitrogen Excretion • Water Balance • Detoxification ---PAGE BREAK--- Hepatitis B… • A virus that infects the liver. • HBV can live outside the body for 7 days. • 90% of adults contracting the disease will recover and develop immunity. • Up to 10% of adults who contract the disease will not recover, but will have chronic Hepatitis B. ---PAGE BREAK--- of Hepatitis B… • Fever • Fatigue • Loss of appetite • Nausea/Vomiting • Abdominal Pain • Dark Urine • Clay‐Colored Stools • Joint Pain • Jaundice ---PAGE BREAK--- Hepatitis B Transmission… • Infants born to infected mothers. • Sex partners of infected persons. • Men who have sex with men. • Sharing toothbrushes, razors and finger nail clippers. 1 Out Of 20 People Will Develop HBV If They Have Risk Factors (Indiana State Department Of Health) ---PAGE BREAK--- Hepatitis B Transmission… • Injected or inhaled drugs. • Tattoos and body piercings. • Have ever traveled to countries where HBV is common. • Ever been in jail or prison. • Ever had hemodialysis. ---PAGE BREAK--- Hepatitis B Vaccine… • No risk of developing Hepatitis B from the vaccine. • The vaccine is 90%+ effective. • The vaccine is given in three doses: • Dose # 1 ‐ Initial dose • Dose # 2 ‐ 30 Days after dose 1 • Dose # 3 ‐ 4 months after dose 2 ---PAGE BREAK--- Hepatitis C… • The most chronic bloodborne disease in the United States! • Approximately 3.2 million people are chronically infected. • 80% of people have no signs or • May remain undetected in the body for years. ---PAGE BREAK--- Risk Groups For Hepatitis C… • Most commonly occurs in people who have: • Received a blood transfusion before 1992. • Shared needles/drug equipment. • Tattoos/body piercing. • Been born to a mother who has Hep. C. • Shared nail clippers or toothbrush with a person who has Hep. C. • As many as 90% of drug abusers are infected with Hep C within 5 years of first injecting.(ISDH) • Risk of sexual transmission appears to be low. ---PAGE BREAK--- Signs and of Hepatitis C… • Fever • Fatigue • Dark Urine • Clay‐Colored Stools • Abdominal Pain • Nausea/Vomiting • Joint Pain • Jaundice • In those people who do develop the average time period from exposure to onset is 14‐180 days (Average is 45 days). ---PAGE BREAK--- Co‐Infection… • Some people are infected with both HIV and Hepatitis C. • CDC estimates that 3,000,000 people are co‐infected in the United States. • 50%‐90% of injection drug abusers are infected with both HIV and Hepatitis C (CDC). • A person who has a co‐infection will usually develop liver damage faster. ---PAGE BREAK--- Your Exposure Potential… • Post‐Accident Cleanup. • Administering First‐Aid. • Janitorial or Maintenance Work. • Handling of any Waste Products. ---PAGE BREAK--- What Is Included In An Exposure Plan? • Introduction/Purpose of the Plan • Why do we have or need a plan. • Program Management • Who is responsible for the plan. • Who reviews the plan each year. • Exposure Determination • Job classifications that are at risk. ---PAGE BREAK--- What Is Included In An Exposure Plan? • Compliance: • Who is responsible to make sure staff are safe. • PPE • Work practice controls. • Personal hygiene (handwashing). • Housekeeping: • How to clean up a spill. • Medical Waste: • How to deal with medical waste. • Red bags • Sharps ---PAGE BREAK--- What Is Included In An Exposure Plan? • Hazardous Communication: • Labels and signs. • Training and Record Keeping: • Within 10 days of hire. • Every year thereafter. • Sharps Log: • How a person was stuck. • Appendix: • OSHA definitions • Exposure forms ---PAGE BREAK--- What Is Included In An Exposure Plan? • Hepatitis B Vaccine Program: • What job classifications are at high risk for HBV. • Post Exposure Evaluation and follow up: • What to do after an exposure occurs. • Record Keeping: • What information will be kept. • What information is needed. ---PAGE BREAK--- Personal Protective Equipment… • Anything that is used to protect you from contact with a person’s blood or body fluids. • They include: • Latex or Nitrile gloves • Goggles or Face Shield • CPR Mask • Aprons • N95 mask and Respirators ---PAGE BREAK--- PPE Rules… • Always wear PPE in an exposure situation. • Remove and replace PPE that is torn or punctured, or has lost it’s ability to function as a barrier to body fluids. • Remove and properly dispose of PPE before leaving the work area. • Wash your hands when you take off the PPE! ---PAGE BREAK--- How To Take Off Gloves… Source: http://training.prolinkhq.com/BBP_Training/cha03/12cha03.htm ---PAGE BREAK--- Hand Washing… • Wash hands immediately after removing PPE. • Use an antibacterial soap. • A hand antiseptic can be used, but wash with soap and water as soon as possible afterward. ---PAGE BREAK--- ---PAGE BREAK--- ---PAGE BREAK--- Regulated Medical Waste… • Liquid or semi‐liquid blood or other potentially infectious materials and sharps. • Must be placed in closeable leak‐proof container built to contain all content during handling, storage, transport or shipping and be appropriately labeled or color‐coded. ---PAGE BREAK--- Decontamination Procedures… • Use appropriate personal protective equipment. • Absorb grossly bloody materials with absorbent materials and place in a tied, red bag. • Decontaminate mop, broom or dust pan in a bleach solution. ---PAGE BREAK--- Decontamination… • When cleaning up surfaces, use diluted bleach solution or other approved EPA solution. • If you use bleach, you need to use (1:10 Bleach) • Put on your PPE. • Do an initial wipe up of the spill. • Spray the disinfectant and allow it to stand for 10 minutes, then wipe up. ---PAGE BREAK--- Decontamination… • Dispose of all wipes in a biohazard container. • PPE should be taken off and disposed of in a biohazards container. • Wash your hands! ---PAGE BREAK--- Contaminated Laundry… • Contaminated laundry must be handled as little as possible and gloves must be worn: • Bagged or contained at its location of use. • Place and transport in bags or containers that are labeled or color‐ coded. • Place in a container that will prevent soak‐through to the exterior. ---PAGE BREAK--- Signs and Labels… • Labels must include the universal biohazard symbol, and the term “Biohazard” must be attached to: • Containers of regulated biohazard waste • Refrigerators or freezers containing blood or OPIM • Containers used to store, transport, or ship blood or OPIM ---PAGE BREAK--- Exposure Determination… • Employer required to identify job classifications where occupation exposures can occur: • Job classification in which ALL have occupational exposure • Job classification in which SOME have occupational exposure • List of all tasks and procedures in which occupational exposures occur ---PAGE BREAK--- Exposure Incident… Keep Calm Tell a supervisor ASAP If body fluid enters eyes or mouth, wash with water for 20 minutes. If body fluid comes in contact with broken or chapped skin or needle stick, wash with soap and water for 20 minutes! Call Riverview Workmed ASAP at 317‐502‐ 7577 (24 hours a day). If You Do Have A True Exposure, You Have TWO Hrs. To Start Treatment! ---PAGE BREAK--- Exposure Incident… • Post‐Exposure Evaluation: • Confidential medical evaluation. • Document route of exposure. • Identify source individual. • Test source blood (with consent). • If source can not be identified, your blood will be tested. • Results provided to exposed employee by the health care provider. ---PAGE BREAK--- Injury Report… ---PAGE BREAK--- Worker’s Compensation… ---PAGE BREAK--- Known Source… Know Source Know Source ---PAGE BREAK--- UN‐KNOWN Source… Un‐Know Source ---PAGE BREAK--- Sharps Log… If You Are Stuck With A Needle Or A Sharp ---PAGE BREAK--- Ryan White Law… • The Ryan White Law mandates that the source patient test results be provided to the designated infection control officer of the employee involved in an exposure incident ---PAGE BREAK--- IF IT IS WET AND NOT YOURS, DO NOT TOUCH IT WITHOUT GLOVES! ---PAGE BREAK--- Sources… • Centers For Disease Control and Prevention • IOSHA • Indiana State Department Of Health • OSHA • Medical Reserve Corps • University of Arkansas