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Transcript
OSHA / WISHA BLOODBORNE PATHOGENS TRAINING by: Lanette Dyer 1 Overview • Review of BBP • Exposure Control Plan • Hepatitis B Vaccination • Control Measures • Personal Protective Equipment • Waste Management • Post Exposure Management 2 BLS Sick Called for a 48 year old alcoholic fallen off a stool C/C: rib pain from fall Pt coughing Denies LOC, neck/back/abd pain, dizziness, nausea Recently had “flu” “Get Lost, I didn’t call you” 3 BLS Sick On exam, Slurring words, coughing “Beat It, I didn’t call you” VS: HR 98, BP 142/P, RR 24 Lungs: scattered rhonci Tender to R ant chest 4 BLS Sick What’s wrong with this “Barney?” 5 TB Numbers • 2 billion infected worldwide • 250 new cases in WA last year – 5 in Thurston Co – 18 in Pierce • Risk factors – – – – HIV/IVDA Homeless Prisoners (including nursing homes, dorm slugs) Immigrant (S. & Central America, Africa, SE Asia) 6 TB Testing – TB Testing shall be: Made available free of charge to members Offered at a reasonable time and place Performed under the supervision of someone smart Administered according to the standard recommendations for medical practice current at the time of testing – a) The department shall not make TB testing mandatory. – b) The department shall ensure that members who decline to accept TB testing sign a denial form. 7 TB protection • – Patient gets a particulate mask (unless needing real O2!) If possible move the patient outside to fresh air. Respirators shall be donned by all members of the Emergency Medical Team. Windows opened and exhausted fans shall be operating. Nebulizers should be pointed downward and away from personnel. Coach the patient to cover mouth/nose with his/her hand or tissue during coughing episodes. 8 TB Masks – Wear it 9 Malaria or West Nile? USA Malaria: About 1,000 cases are reported annually Worldwide prevalence of Malaria:Each year, 300 to 500 million people develop malaria and 1.5 to 3 million–mostly children–die, according to the World Health Organization (WHO). 10 Malaria or West Nile? 2004 West Nile Virus Activity in the United States (reported to CDC as of October 12, 2004)* 11 OCCUPATIONAL EXPOSURE • Reasonably anticipated skin, eye, mucous membrane, or puncture wound (parenteral) contact with blood or OPIM (Other Potentially Infectious Materials) that may result from the performance of employee duties. 12 BLOODBORNE PATHOGENS • Pathogenic microorganisms that are present in human blood or OPIM and can cause disease in humans. – Examples include HBV, HCV, HIV 13 Other Potentially Infectious Materials (OPIM) • Human body fluids – Semen, vaginal secretions (not at work!) – CSF, amniotic – any body fluid visibly contaminated with blood 14 NOT Infectious – Feces, snot, saliva, sputum, sweat, tears, vomitus, and urine • Unless blood-stained 15 HBV, HCV and HIV • • • • Bloodborne viruses Can produce chronic infection Transmissible in health-care settings Data from multiple sources (e.g., surveillance, observational studies, serosurveys) used to assess risk of occupational transmission 16 BBP TRANSMISSION Overview • Sexual contact • Sharing needles or syringes • From infected mother to baby • Blood transfusion • Organ transplant • Not transmitted through casual contact 17 Average Risk of Transmission after Percutaneous Injury Source HIV Hepatitis C Hepatitis B Risk (%) 0.3 1.8 30.0 18 Viral Hepatitis About 50,000 reported cases per year 60% hepatitis A 25% hepatitis B 15% hepatitis C <1% unspecified…not enough to count CDC estimates 500-750,000 actual new cases 15,000 deaths per year 4,000,000 carriers 19 Viral Hepatitis—Overview TYPES OF HEPATITIS A Source of virus Route of transmission Chronic infection Prevention B C D E feces blood/ blood/ blood/ blood-derived blood-derived blood-derived body fluids body fluids body fluids feces fecal-oral Fast food Percutaneous, Percutaneous, Percutaneous, mucosal mucosal mucosal fecal-oral no yes pre/postexposure immunization pre/postexposure immunization yes yes blood donor pre/postscreening; exposure risk behavior immunization; modification risk behavior modification no ensure safe drinking water 20 HBV TRANSMISSION • Occurs when blood or body fluids from an infected person enters the body of a person who is not immune. • HBV is spread through – sexual contact with an infected person, – sharing needles/syringes, – needle sticks or sharps exposures on the job, or – from an infected mother to her baby during birth. 21 HBV SYMPTOMS • About 30% of persons have no signs or symptoms. • Signs and symptoms are less common in children than adults. jaundice fatigue abdominal pain loss of appetite nausea, vomiting joint pain 22 HCV TRANSMISSION • HCV is spread through – – – – Unsafe sexual practices sharing needles/syringes, needlesticks or sharps exposures on the job, or from an infected mother to her baby during birth. 23 HCV TRENDS/STATISTICS • Number of new infections per year has declined from an average of 240,000 in the 1980s to about 25,000 in 2001. • Most infections are due to illegal injection drug use. • Transfusion-associated cases occurred prior to blood donor screening; now occurs in less than one per million transfused unit of blood. • Estimated 3.9 million (1.8%) Americans have been infected with HCV, of whom 2.7 million are chronically infected. http://www.cdc.gov/ncidod/diseases/hepatitis/c/fact.htm 24 HCV SYMPTOMS • 80% of persons have no signs or symptoms. jaundice fatigue dark urine abdominal pain Long hair Bad acting 25 The Fire Service Controversy 26 The Fire Service Controversy 27 HIV STATISTICS • United States: – Through December 2001, a total of 816,149 cases of AIDS had been reported to the CDC. • 57 proven cases amongst Health Care workers • Another 138 “maybe” • Worldwide: 65 million people since beginning. – At the end of 2002, an estimated 42 million people were living with HIV infection or AIDS. 28 HIV TRANSMISSION • HIV is spread by – sexual contact with an infected person, – sharing needles/syringes, – Needle sticks or sharps exposures on the job. – Less commonly (and now very rarely in countries where blood is screened for HIV antibodies), through transfusions of infected blood or blood clotting factors. – Babies born to HIV-infected women may become infected before or during birth or through breast-feeding after birth. 29 HIV SYMPTOMS • Many people do not have any symptoms when • they first become infected with HIV. Some people, however, have a flu-like illness within a month or two after exposure to the virus. These symptoms usually disappear within a week to a month and are often mistaken for those of another viral infection. During this period, people are very infectious, and HIV is present in large quantities in genital fluids. 30 HIV/AIDS SYMPTOMS • Varying symptoms – No symptoms to flu-like symptoms – Fever, lymph node swelling, rash, fatigue, diarrhea, joint pain • Many people who are infected with HIV do not have any symptoms at all for many years. • Will develop AIDS – Weight loss, night sweats, diarrhea, loss of appetite, rash, lymph node swelling – Lack of resistance to disease 31 MRSA Methicillin-resistant Staphylococcus Aureus • 20-30% Healthcare worker’s nostrils • Lots of nosocomial spread • Normally found in bed-ridden long term care patients • Main transmission via direct contact – So wash hands, wear gloves – If needed, gown/mask 32 Preventing Transmission of Bloodborne Viruses in HealthCare Settings • Promote hepatitis B vaccination • Treat all blood as potentially infectious • Use barriers to prevent blood contact • Prevent percutaneous injuries • Safely dispose of sharps and bloodcontaminated materials 33 EXPOSURE CONTROL PLAN • Written Document • Accessible to all personnel • Update at least annually – Or when alterations in procedures create new occupational hazards 34 EXPOSURE CONTROL PLAN • KEY ELEMENTS – Identification of job classifications/tasks where there is exposure to blood/OPIM. – Schedule of how/when provisions of standard will be implemented. – Methods of communicating hazards to staff. – Need for Hepatitis B vaccination. – Post exposure evaluation and follow-up. 35 EXPOSURE CONTROL PLAN • KEY ELEMENTS – Recordkeeping/compliance methods • Engineering/work practice controls • Personal protective equipment (PPE) • Housekeeping – Procedures for postexposure evaluation and followup 36 TRAINING • Initial training – Provided at time of initial assignment to tasks with occupational exposure or when job tasks change. • Annual refresher training • Employer has record keeping responsibility 37 PROGRAM • Communicate hazards • Identify/control hazards • Preventive measures – Hepatitis B vaccine – Engineering controls – Safe work practices – PPE – Housekeeping 38 HEPATITIS B VACCINATION • Effective in preventing hepatitis B – 95% develop immunity • 3-dose vaccination series • Test for antibodies to HBsAg 1 to 2 months after 3-dose vaccination series completed. • Re-vaccinate those who do not develop adequate antibody response. 39 HEPATITIS B VACCINATION • Safe, effective, and long-lasting • Booster doses of vaccine and periodic serologic testing to monitor antibody concentrations after completion of the vaccine series are not necessary for vaccine responders. 40 CONTROL MEASURES • Engineering and work practice controls – Needle less systems – Sharps containers/shuttles • PPE required when occupational exposure to BBP remains after instituting these controls. 41 EXPOSURE CONTROL PLAN Summary • Employers must implement safer medical devices – Appropriate, commercially available, and effective • Appropriate – Based on reasonable judgment in individual cases, will not jeopardize patient/employee safety or be medically compromised • Effective – Based on reasonable judgment, will reduce the likelihood of an exposure incident involving a contaminated sharp 42 PPE “You got what!?” • Know where yours is 43 PPE • Gloves • Surgical mask • Long-sleeved protective apparel (e.g., bunker) • Protective eyewear with solid side shields • Chin-length face shield worn with a surgical mask 44 GLOVES • Per SOP’s wear gloves on all pt contacts. • Remove gloves after caring for a patient. • Do not wear the same pair of gloves for the care of more than one patient. • Removal: grasp at wrist and strip off “inside-out”. 45 EYEWEAR/FACE SHIELD • Wear when splash, spray, or spatter is anticipated. • Eyewear must have solid side shields. • Remove by headband or side arms. – Do not touch shield or lens area. • May be decontaminated and reused. • A chin-length face shield may be worn with a mask if additional protection is desired. 46 PROTECTIVE APPAREL • Long sleeves required by OSHA if worn as PPE. • Wear when splash, spray, or spatter is anticipated. • Remove immediately if penetrated by blood/OPIM. – Use tie strings to remove and peel off. – Minimize contact during removal. • If reusable, place in marked laundry container. 47 PPE • Employer responsibility – Will provide, maintain, and replace – Ensure accessibility in appropriate sizes – Provide alternative products (e.g., latex-free gloves, powderless gloves, glove liners) – Will ensure employee use – Launder or discard if appropriate 48 HOUSEKEEPING • Employer must ensure clean/sanitary • • workplace. Work surfaces, equipment, and other reusable items must be decontaminated upon completion of procedure when contaminated with blood/OPIM. Barriers protecting surfaces/equipment must be replaced when contaminated or at end of the work shift. 49 Postexposure Management: Wound Care • Clean wounds with soap and water. • Flush mucous membranes with water. • No evidence of benefit for: – application of antiseptics or disinfectants. – squeezing (“milking”) puncture sites. • Avoid use of bleach and other agents caustic to skin. 50 Postexposure Management Notification • Report Immediately • Exposed individual must be directed to a qualified health-care professional. – Antiretroviral drugs (if indicated) should be administered immediately! 51 Postexposure Management: The Exposure Report • Date and time of exposure • Procedure details…what, where, how, with what device • Exposure details...route, body substance involved, volume/duration of contact • Information about source person • Information about the exposed person • Exposure management details 52 Postexposure Management: Assessment of Infection Risk • Type of exposure – – – – Percutaneous Mucous membrane Non-intact skin Bites resulting in blood exposure • Body substance • Source evaluation – – – – Presence of HBsAg Presence of HCV antibody Presence of HIV antibody If source unknown, assess epidemiologic evidence – Blood – Bloody fluid – Potentially infectious fluid or tissue 53 Postexposure Management: Unknown or Untestable Source • Consider information about exposure – Where and under what circumstances – Prevalence of HBV, HCV, or HIV in the population group • Testing of needles and other sharp instruments not recommended – Unknown reliability and interpretation of findings – Hazard of handling sharp 54 Postexposure Management: Evaluating the Source • If the HBV, HCV, and/or HIV status of the source is unknown, testing should be done. • Testing should be performed as soon as possible. • Consult your laboratory regarding most appropriate test to expedite obtaining results. • Informed consent should be obtained in accordance with state and local laws. 55 How to live long? 56 The Healthy Way 57