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OSHA Bloodborne Pathogen Standard Infectious Diseases Bill Edstrom, Epidemiologist Spokane Regional Health District Who is Covered? • All employees who may reasonably expect to be exposed to blood and OPIM that may contain pathogens • Designed to eliminate or minimize employees’ exposure to human blood and other potentially infectious materials (OPIM) in the workplace What are pathogens? Germs transmitted from one person to another through contact with blood or OPIM • Anyone whose job involves handling or possibly being exposed to blood or blood products, or OPIM 1 Caution! You do NOT need to directly contact someone carrying a bloodborne pathogen to be at risk for exposure! Risks also come from: • Clinical specimens • Biohazardous trash • Blood- or body fluidsoaked laundry • Needles or sharps Exposure Control Plan • OSHA requirement • Must describe: – – – – Exposure prevention Engineering and work practice controls Universal precautions Personal protective equipment Annual Training Required: • How diseases are transmitted and their symptoms • Protective measures to prevent exposure • Procedures to be followed if exposed Infectious Disease Transmission • Stages of Disease Transmission: 1. Someone has an infection 2. The infectious pathogen leaves the Infected person’s body 2 Serious Bloodborne Pathogens Infectious Disease Transmission: 3. The infectious pathogen reaches another person and enters his or her body. Transmission: - Bloodborne - Airborne - Vector - Direct or indirect contact 4. The second person develops the infection. Hepatitis A Hepatitis B Hepatitis C Transmission Person-to-Person through fecal-oral Exposure to fecally contaminated food/water Blood/Semen OPIM All Body Fluids Contaminated needles Unclean tattoo/piercing tools Sharing contaminated items Signs & Symptoms Fever Fatigue N/V ABD pain Dark Urine Clay-colored stool Joint pain Loss of appetite Jaundice Flu-like symptoms Loss of Appetite Nausea Fatigue Muscle/joint aches Mild fever Stomach pain Jaundice MOST INFECTED PEOPLE DO NOT HAVE SYMPTOMS Severity Symptoms last < 2 months, can last up to 6 months Major liver damage Cirrhosis Liver CA Infection for decades No Cure – Prevention is critical Prevention Vaccine Vaccine No Vaccine •Fatigue •Loss of appetite •Nausea •Anxiety •Weight Loss •Alcohol Intolerance •Abdominal pain •Loss of concentration •Jaundice • Hepatitis B virus (HBV) • Hepatitis C virus (HCV) • Human immunodeficiency virus (HIV) Measures • Measures you take to prevent HBV, HCV, and HIV also help prevent diseases caused by other bloodborne pathogens 3 HIV and AIDS Do Exposures Always Cause Infection? • NO • Whether pathogens are present in the source blood or body fluid • The risk of infection • after an exposure depends • on: • Acquired immunodeficiency syndrome (AIDS) is caused by the human immunodeficiency virus (HIV) • The number of pathogens present • There are almost one million HIV-positive people in the U.S. • The type of injury or exposure • Your current health and immunization status HIV and AIDS HIV and AIDS • AIDS damages cells essential for immune function Transmission Through an infected person’s body fluids Signs & Symptoms One quarter of the HIV-infected persons in the U.S. do not know that they are infected. Loss of appetite Fever Swollen lymph nodes Night sweats Inability to fight off infection • People with AIDS are more susceptible to opportunistic infections • The disease is eventually fatal Severity Life-long Prevention No Vaccine Weight Loss Skin rashes Diarrhea Tiredness 4 OSHA Standard • Requires employers to use strategies to reduce occupational exposures: Prevention • Engineering controls • Work practice controls • Personal protective equipment • Universal precautions Engineering Controls Work Practice Controls • Needleless systems • Use of personal protective equipment (PPE) • Eye wash stations • Handwashing • Handwashing facilities • Decontamination and sterilization of equipment and areas • Biohazard labels 5 Personal Protective Equipment • Gloves OSHA Standard Requires that your employer: • Jumpsuits, aprons – Provide PPE at no cost • Eye shields, goggles – Train you how to use equipment • Face masks, face shields – Must clean, repair, or replace it as needed • Caps • Booties For Unexpected Exposure Employer Responsibilities • If blood or OPIM splashes in your eyes or other mucous membranes, flush area with running water for 20 minutes • Identify and document source of blood or OPIM • Wash any exposed area well with soap, using an antibacterial soap • Obtain consent and arrange to test the source blood – Gently treat any scabs and sores • Inform you of the test results • Report the exposure to your supervisor • Arrange for you to have your blood tested • Save any potentially contaminated object for testing purposes • Arrange counseling and medical care for you as needed • Seek medical care 6 Three Types of Airborne Pathogens • Viral Airborne Pathogens • Bacterial • Fungal Airborne Pathogens • Precautions for tuberculosis also lower the risk for other airborne pathogens – Meningitis – Influenza – Pneumonia – Tuberculosis Airborne Pathogens • Spread by inhaling the germ • Coughing or sneezing tiny droplets of moisture into the air containing pathogens • Pathogens can remain airborne for several hours 7 Airborne Transmission • Depends On: – How contagious the infectious person is Tuberculosis Transmission Signs & Symptoms Many people with TB infection have no symptoms! Weight loss Fever Night sweats Feeling weak – Where the exposure occurs – How long the exposure lasts Inhaling the TB pathogen after an infected person coughs or sneezes Severity Skin test cannot distinguish between TB infection and TB disease Chest x-ray and phlegm sample needed to determine diagnosis – How healthy you are at the time of the exposure Prevention Engineering Controls H1N1 and EMS H1N1 (“Swine Flu”) • EMS personnel should stay more than 6 feet away from patients and bystanders with symptoms and exercise appropriate routine respiratory droplet precautions while assessing all patients for suspected cases of swineorigin influenza. • Assess all patients for symptoms of acute febrile respiratory illness (fever plus one or more of the following: nasal congestion/ rhinorrhea, sore throat, or cough). 8 H1N1 and EMS H1N1 and EMS • If no acute febrile respiratory illness, proceed with normal EMS care. • If symptoms of acute febrile respiratory illness, then assess all patients for travel to a geographic area with confirmed cases of swineorigin influenza within the last 7 days or close contact with someone with travel to these areas. Questions • If travel exposure, don appropriate PPE for suspected case of swine-origin influenza. • If no travel exposure, place a standard surgical mask on the patient (if tolerated) and use appropriate PPE for cases of acute febrile respiratory illness without suspicion of swine-origin influenza (as described in PPE section). Contact: Renee Anderson 509-232-8155 1-866-630-4033 [email protected] Fax: 509-232-8168 9