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Senior Housing Management Title: Bloodbourne Pathogens: Lesson 1 Safety Seminar Effective Date: July 15, 2009 Prepared by: MJJ Outdated SOP#: P840 Reviewed Date: June 28, 2017 Approved by: DKJ Occupational Exposure to Bloodbourne Pathogens The Occupational Exposure to Bloodborne Pathogens Standard (OSHA 29 CFR 1910.1030) was published December 6, 1991. The purpose of the standard is to reduce worker risk by eliminating or minimizing employee exposure incidents to bloodborne pathogens, such as Hepatitis B Virus (HBV) and Human Immunodeficiency Virus (HIV). Bloodbourne Pathogens mean “pathogenic microorganisms that are present in human blood and can cause disease in humans. These pathogens include, Immunodeficiency Virus (HIV)”. Because it is the exposure to the blood or other body fluids that carries the risk of infection, those individuals whose occupational duties place them at risk of exposure to blood and other potentially infectious materials are also at risk of becoming infected with these bloodborne pathogens, developing disease, and in some cases, dying. Over 5.5 million health care workers are at risk under this standard and, therefore, compliance is mandatory. The standard encompasses workers in physician office settings, nursing homes, hospitals, laboratories, dentist offices, emergency personnel, housekeeping, linen services, and others who may come in contact with blood and other potentially infectious materials in the performance of their duties. This training session will inform and explain the standard, Senior Housing Management Exposure Control Plan to reduce the risk of exposure, and the compliance of the standard due by March 6, 1992. This training program will be offered at no cost to the employee during normal working hours. Training must be offered within ten days of initial assignment to a task that has a potential for exposure to blood and other potentially infectious materials. These training records must be maintained by Senior Housing Management for three (3) years. Training will be conducted within each calendar year and with each assignment of a new or modified task that may result in the potential for exposure. Training records will include: 1. 2. 3. 4. The dates of the training sessions; The contents or a summary of the training session; The names and qualifications of the persons conducting the training sessions; The names and titles of all persons attending the training session. These files may be kept in each employee’s file. Senior Housing Management is required to provide a safe working environment with the necessary barriers and equipment that are appropriate and accessible, at no charge, to ensure the safety of the employee. The employees are required to follow the procedures developed by Senior Housing Management, but also have the right to demand protection necessary to ensure safety. The Bloodborne Pathogen Standard administers the full legal force behind OSHA standards and Universal Precautions. A copy of the standard and Senior Housing Management Exposure Control Plan are available upon request from the community executive director, and are in the community’s Standard Operating Procedures. Universal Precautions is “an approach to infection control. According to the concept of Universal Precautions, all human blood and certain body fluids are treated as if known to be infectious for HIV, HBV, and other bloodborne pathogens”. Senior Housing Management ® 6/28/2017 Version 2.0 | Page 1 of 6 Senior Housing Management Title: Bloodbourne Pathogens: Lesson 1 Safety Seminar Effective Date: July 15, 2009 Prepared by: MJJ Outdated SOP#: P840 Reviewed Date: June 28, 2017 Approved by: DKJ A Health and Safety Manager or other facility representative will be assigned the task of implementing and assuring compliance with the Exposure Control Plan. The community executive director, is the overall coordinator of the program, acting as a representative of Senior Housing Management, and has overall responsibility. The training of the Bloodborne Pathogen Standard and Senior Housing Management Exposure Control Plan (ECP) will consist of the following elements: 1. A copy of the OSHA Standard 29 CFR 1910.1030 and an explanation of its contents are located in the facility’s administrative office. 2. A general explanation of the epidemiology and symptoms of bloodborne diseases; 3. An explanation of the modes of transmission of bloodborne pathogens; 4. An explanation of Senior Housing Management Exposure Control Program and its availability and location in community located in the community’s administrative office; 5. An explanation of the appropriate methods for recognizing tasks and other activities that may involve exposure to blood and other potentially infectious materials; 6. An explanation of the use and limitations of methods that will prevent or reduce exposure, including appropriate engineering controls, work practices, and personal protective equipment; 7. Information on the tapes, proper use, location, removal, handling, decontamination and disposal of personal protective equipment; 8. An explanation of the basis for selection of personal protective equipment; 9. Information on the Hepatitis B vaccine, including information on its efficacy, safety, methods of administration, and the benefits of being vaccinated, and that the vaccine and vaccination be offered free of charge; 10. Information on the appropriate actions to take and persons to contact in an emergency involving blood and other potentially infectious materials; 11. An explanation of the procedure to follow if an exposure incident occurs, including the method of reporting the incident and the medical follow-up that will be made available; 12. Information on the medical counseling that Senior Housing Management will provide for exposed individuals; Senior Housing Management ® 6/28/2017 Version 2.0 | Page 2 of 6 Senior Housing Management Title: Bloodbourne Pathogens: Lesson 1 Safety Seminar Effective Date: July 15, 2009 Prepared by: MJJ Outdated SOP#: P840 Reviewed Date: June 28, 2017 Approved by: DKJ 13. An explanation of the signs, labels, and/or color coding used to denote biohazards; and, 14. An opportunity for interactive questions and answers with the person conducting the training session. Epidemiology, Symptoms and Modes of Transmission of Bloodborne Pathogens In discussing bloodborne pathogens, the training will focus on Hepatitis B Virus and the Human Immunodeficiency Virus. By incorporating the information presented on these disease states regarding the modes of transmission and prevention, the same principles will protect the worker against exposure to other bloodborne diseases, such as Hepatitis C, Delta Hepatitis, Syphilis, Malaria, and others. Hepatitis means “inflammation of the liver” and can be caused by a number of agents or conditions, including drugs, toxins, autoimmune disease, and infectious agents, including viruses. The most common causes of Hepatitis are viruses. There are four types of viral Hepatitis important in the U.S. 1. Hepatitis A, formally called “infectious hepatitis” is spread by fecal contamination and is not generally considered a significant risk to health care workers. 2. Hepatitis B, formally called “serum hepatitis” is transmitted by blood contact and is a major risk to health care workers. 3. Delta Hepatitis may co-infect with Hepatitis B or may infect persons already infected with HBV and can increase the severity of acute and chronic liver disease. Nosocomial infection has been reported. 4. Non-A, non-B Hepatitis is caused by viral agents other than Hepatitis A and Hepatitis B. Two that have been identified are Hepatitis E transmitted by oralfecal route, and Hepatitis C spread by blood contact. Of the types of Hepatitis listed, Hepatitis B virus is the major infectious bloodborne occupational hazard to health care workers. The Centers for Disease Control (CDC) estimates there are approximately 8,700 infections in health care workers with occupational exposure to blood and other potentially infectious materials in the U.S. each year. Approximately 200 deaths each year are reported due to these occupational exposures. Infected health care workers can spread the infection to family members, or rarely, to their patients. The use of Hepatitis B vaccine, engineering and work practice controls, and personal protective equipment, will work in conjunction to prevent almost all of these occupational exposures. Hepatitis B is caused by the Hepatitis B virus (HBV) that attacks and replicates in liver cells. There is a laboratory test to determine its presence in blood, and indicate an individual who is currently infected, and therefore, is potentially infectious to others. All viral hepatitis look basically the same. Unfortunately, the destruction of liver cells is clinically apparent with the Hepatitis B virus. Senior Housing Management ® 6/28/2017 Version 2.0 | Page 3 of 6 Senior Housing Management Title: Bloodbourne Pathogens: Lesson 1 Safety Seminar Effective Date: July 15, 2009 Prepared by: MJJ Outdated SOP#: P840 Reviewed Date: June 28, 2017 Approved by: DKJ Approximately one-third (1/3) of those infected will have a severe clinical course with jaundice (yellowing of the eyes and skin), dark urine, extreme fatigue, anorexia, nausea, abdominal pain, and sometimes joint pain, rash, and fever. About twenty percent (20%) of jaundice cases will require hospitalization, and will cost several weeks to months of work loss. However, not all infected individuals will demonstrate these clinical signs. Approximately one-third (1/3) will show no symptoms when infected with the virus, and one-third (1/3) will have a relatively mild clinical course with flu-like symptoms, which is not diagnosed as Hepatitis. These individuals, however, are still considered infectious. Development of chronic HBV infection has more severe long-term consequences. About six to ten percent (6-10%) of newly infected adults cannot clear the virus from their liver cells, and become chronic HBV carriers. These carriers are at high risk of developing Chronic Persistent Hepatitis, Chronic Active Hepatitis Cirrhosis of the Liver, and primary Liver Cancer. Chronic Active Hepatitis is a progressive, debilitating disease that often leads to Cirrhosis of the Liver after five to ten (5-10) years. Chronic HBV infection has been estimated to cause ten percent (10%) of the 25-30,000 deaths that occur due to Cirrhosis each year. Groups as diverse as the AMA stated, “the loss of health care workers to Hepatitis B virus infection overshadows the risk of AIDS and is almost entirely preventable”. Modes of Transmission Hepatitis B Virus is spread via several routes: 1. Parenteral-by direct inoculation through the skin; 2. Mucous membranes-blood contamination of the eye or mouth; 3. Sexual; or, 4. Perinatal-infected mother to a newborn infant. The most efficient mode of transmission is direct inoculation of infectious blood, such as occurs during blood transfusion, needle sharing by IV drug users, or needlestick or other sharp instrument injury in health care workers. One milliliter of Hepatitis Positive (HbsAg) blood may contain one hundred million infectious doses of virus. Of susceptible health care workers sustaining needlestick puncture injuries from HBV positive patients, seven to thirty percent (730%) will become infected if they do not receive post-exposure prophylactics. Direct inoculation may occur in less apparent ways. Pre-existing lesions on hands (i.e., torn cuticles on hands) may provide a route of entry for the virus. In addition, transfer of contaminated blood via inanimate objects (equipment) or environmental surfaces (counter tops) have been shown to cause infections. In general, fewer than twenty percent (20%) of infected health care workers report needlestick injuries from an infected patient. Therefore, although gloving will not stop direct puncture injuries, it can provide the necessary barrier between blood and an open lesion. Senior Housing Management ® 6/28/2017 Version 2.0 | Page 4 of 6 Senior Housing Management Title: Bloodbourne Pathogens: Lesson 1 Safety Seminar Effective Date: July 15, 2009 Prepared by: MJJ Outdated SOP#: P840 Reviewed Date: June 28, 2017 Approved by: DKJ Studies document that health care workers with Chronic Hepatitis often transmit Hepatitis to their spouses or sexual partners and other family members. Therefore, any exposure may be significant and must be reported to the facility manager, who acts as the Health and Safety Manager. HBV Epidemiology Most infected health care workers are unaware they have been exposed to or infected with HBV. Approximately one percent (1%) or more of hospitalized patients are HBV carriers. They are asymptomatic and unaware they are carriers, and their medical histories do not indicate a problem. Health care workers often take extraordinary precautions when dealing with a known carrier, but are often unaware they may treat five (5) carriers for every one (1) recognized. Therefore, the need to implement Universal Precautions and use the Hepatitis B vaccine in health care workers in mandated by the Bloodborne Pathogen Standard and implemented by the facility manager, the Health and Safety Manger. Transmission via the Environment It has been documented that the HBV virus can survive for at least one week dried at room temperature on environmental surfaces. Medical procedures, as well as disinfectant procedures and sterilization techniques, must be adequate to prevent the spread of this virus. Any sterilization or disinfection procedure, sterilizing agent, or high level disinfectant will kill the virus if used as directed. Diluted solutions (1:10-1:100 of sodium hypochlorite - household bleach) are particularly effective is used properly. Certain low level “germicides,” such as quaternary ammonium compounds, are not considered effective against this virus. Unfortunately, many facilities soak medical and dental instruments in this solution and health care workers may handle the sharp instruments soaked in these solutions with a false sense of security. HBV Vaccine Hepatitis B vaccination is the most important part of any HBV control program, because gloving and other protective devices cannot completely prevent puncture injuries from needles and other sharp instruments. The currently licensed Hepatitis vaccines are given intramuscularly in the deltoid in three doses over a six (6) month period. These vaccines induce protective antibody levels in 85-97% of healthy adults. Protection against both the illness and development of the carrier state last at least nine (9) years. For persons with normal immune status, it is not recommended that a booster dose of Hepatitis B vaccine be given after the initial series, but may do so in the future if it appears that immunity conferred by the vaccine wanes after a period of time. Booster doses should be given when antibody levels fall below 10 m/ml. Percutaneous and mucous membrane exposures to blood will continue to occur in the health care setting and may result in exposure to Hepatitis B. Pre-exposure vaccination is the most effective method for preventing such an infection. As the old adage states, “an ounce of prevention is worth a pound of cure.” Senior Housing Management is required to provide this vaccine at no charge to all employees upon initial assignment to a job task that involved exposure to blood and other potentially infectious materials. If, however, an individual initially declines the Hepatitis B vaccine but later changes his/her mind, the vaccine is still available at Senior Housing Management ® 6/28/2017 Version 2.0 | Page 5 of 6 Senior Housing Management Title: Bloodbourne Pathogens: Lesson 1 Safety Seminar Effective Date: July 15, 2009 Prepared by: MJJ Outdated SOP#: P840 Reviewed Date: June 28, 2017 Approved by: DKJ no charge. Post-Exposure Prophylaxis Effective post-exposure prophylaxis exists for HBV exposures, if appropriate protocols are followed. The February 9, 1990 recommendations of the Immunization Advisory Committee specify that if the source individual is known to be HBV positive, then the exposed individual should be given Hepatitis B immunoglobulin (HBIg) and the Hepatitis B vaccine series should be initiated. Hepatitis B vaccine is recommended for any previously unvaccinated health care worker who has a needlestick or other percutaneous accident with a sharp instrument or permucosal (ocular or mucous membrane) exposure to blood. Report all exposures immediately to the community executive director, or whoever is the Health and Safety Manager so any necessary steps may be taken. Senior Housing Management ® 6/28/2017 Version 2.0 | Page 6 of 6