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Slide 1 Compass Academy BLOODBORNE PATHOGENS Employee Training Please read all of the information on the slides and the text below each slide. Take the test at the end of the training module. To get credit for completing the quiz put your name at the top of the page and send it as an attachment to the school nurse via e-mail to [email protected] Slide 2 CONTENTS OF THE EXPOSURE CONTROL PLAN Compliance Prevention Protection Work Practices Engineering controls Occupational Health To comply with federal laws, Compass Academy has an Exposure Control Plan; there are 6 components as listed above. The purpose of the Plan is to reduce, minimize, or eliminate occupational exposure to potentially infectious materials which could cause disease or death. Compass Academy is required by federal laws (namely OSHA laws) to assist you in understanding how to protect yourself from getting diseases through direct contact with human blood. Compass Academy is also required by federal law to record annual training of every employee. Slide 3 PERSONAL PROTECTIVE EQUIPMENT (PPE) Protects you from contact with human blood and body fluids Personal protective equipment is provided to reduce the potential for exposure. Gloves will be the most commonly used personal protective equipment in a school district. Gloves should be worn for any contact with blood or blood products. Before putting on gloves, you should first wash your hands. After you have put the gloves on, check for proper fit and punctures. Pull them snug to insure a good fit. To remove the gloves, they should be rolled or pulled from the wrist to the fingers so that the glove is inside out. One glove should be folded into the other and then discarded. This minimizes contamination. Slide 4 BLOODBORNE PATHOGENS • Definition: • Examples: • Pathogenic microorganism • HIV (AIDS) • Present in human blood • Hepatitis B • Can infect and cause disease in humans • Hepatitis C Bloodborne pathogens are disease-causing microorganisms that are present in human blood; they can infect and cause disease in humans. These pathogens include the Human Immunodeficiency Virus (HIV) (the virus that causes AIDS), and the Hepatitis B Virus (HBV). Other bloodborne pathogens are: Syphilis, Hepatitis C, and Hepatitis D. Bloodborne pathogens are spread through blood or other potentially infectious materials. The body fluid with the highest risk is blood. Saliva has the lowest risk. The usual manner to invade the body is blood to blood contact. However, bloodborne pathogens could also enter the body through mucous membranes in the eyes, nose, and mouth. Slide 5 CHARACTERISTICS OF HEPATITIS B VIRUS (HBV) AND HEPATITIS C VIRUS (HCV) Attacks liver Modes of transmission Sexual contact Needle sharing Mother to baby Blood & body fluid contact HBV is vaccine-preventable (not HCV) The liver is an important organ in the human body since it performs several functions including filtering the blood. When the liver is inflamed due to illness or injury, it does not work well. We call the inflammation of the liver hepatitis. There are many forms of hepatitis. We now have hepatitis A, B, C, D, and E. Other types keep being identified. It can be caused by viruses, other diseases, or toxic substances such as alcohol. The most common cause of hepatitis is viral. Hepatitis B virus (HBV) and hepatitis C virus (HCV) can be transmitted from one person to another through sexual contact and through contact with blood. Those who share needles are at high risk of getting hepatitis. Infected mothers can also give hepatitis to their babies. We currently have a good way of preventing the transmission of hepatitis B through vaccination. Unfortunately, we do not have a vaccine to prevent hepatitis C. Slide 6 HEPATITIS B Damages liver 9 of 10 infected develop acute hepatitis 1 of 10 of infected adults become “carriers” The younger you get infected, the more likely you are of being chronically ill 5000 die/year with related diseases Nine out of every ten adults will get rid of the virus from their bodies after a few months. This is ACUTE HEPATITIS. One out of every ten adults will never get rid of the virus from their bodies. This is CHRONIC HEPATITIS. These people remain infectious and we call them “carriers”. These people can transmit HBV to their sexual partners and others who come into contact with their blood. Most adults who contract HBV go through the course of illness and develop HBV antibodies. These individuals are not infectious and now have a natural immunity to the disease. It is dangerous when very young children get Hepatitis B. Nine of ten babies born to infected mothers will end up being carriers. This is why the state of Texas has mandated that children in school be immunized against Hepatitis B. With the help of vaccination, the rate of HBV infection declined by almost 90% in children younger than 19 years by the year 2002. Slide 7 HEPATITIS C Most patients remain infected 75-85% develop long term liver disease The leading indication for liver transplants May involve damage to other organs May lead to Liver Cancer This is a serious form of liver disease. In the past, we only knew of Hepatitis A (which is not Bloodborne) and Hepatitis B, but we now know that there are several other types of Hepatitis. For purposes of this training, we will concentrate on … o Hepatitis B Virus (HBV) o Hepatitis C Virus (HCV) and o Human Immunodeficiency Virus (HIV). Slide 8 INFECTIOUS BODY FLUIDS – HBV AND HCV Blood Serous fluid Semen Vaginal secretions Saliva (in dental procedures) Infectious body fluids include blood, serous fluid (clear or yellowish fluid with blood), semen, vaginal fluids and saliva mixed with blood. When a human bite breaks the skin, it is considered a potential HBV exposure, but not a high risk for either HBV or HIV exposure. If human saliva falls into your eyes or nose, it is considered an exposure but this is a very low risk. Slide 9 MODE OF TRANSMISSION – HBV AND HCV Sexual contact (Less for HCV) Exposure to blood * Sharing of contaminated needles, razors, toothbrushes, skin piercing, tatoos, manicure tools, etc. * Blood contact with non-intact skin * Transfusions Infected mother to child HBV and HCV are passed from person to person through sexual contact and through direct contact of blood; the risk for HCV is lower than HBV. There is also a possibility of contamination by direct contact with surfaces. To prevent this, surfaces contaminated with blood should be cleaned thoroughly. HBV can survive dried and at room temperature for at least one week. Our custodians use solutions approved for the use of cleaning up blood. HIV is spread in similar ways. However, for HIV to be passed from one person to another, it usually takes more contact with a larger amount of blood as compared to the Hepatitis virus. Always discourage the sharing of personal items such as razors among our students. Bloody items need to be handled with gloves and bagged separately; bloody surfaces and items need to be cleaned and disinfected immediately; any sharp instrument with blood needs to be thrown in a red biohazard sharps/needle box. Slide 10 EXAMPLES OF PERSONS AT RISK FOR HEP C AND WHO SHOULD GET TESTED Anyone who ever injected illegal drugs, even if they injected only once years ago Persons who received a blood transfusion before July 1992 Someone born to a woman who was HCV positive at the time of the birth Because the symptoms may not be obvious, those who have injected drugs may not know they were infected with the virus several years ago. Anyone who received transfusions before 1992 may not have received the benefits of this improved testing. Slide 11 SYMPTOMS OF HBV AND HCV Jaundice Fatigue Possible stomach pain Loss of appetite Nausea Darkened urine ============================= *** 30% with HBV and 80% with HCV have NO SYMPTOMS Symptoms might not be immediately noticed or diagnosed. There are blood tests to help in the diagnosis. Of great concern is that MANY PEOPLE HAVE NO SYMPTOMS but are carrying the disease around and may be infecting others. Slide 12 HEPATITIS B VIRUS IS NOT SPREAD BY. .. Coughing Sneezing Air Food (unlike Hepatitis A) Water Urine Feces (unlike Hepatitis A) ============== (Also not likely to spread Hep C) Body fluids generally not considered infectious include urine and feces, unless they are contaminated with visible blood. HBV is not spread by air, food, water, sneezing or coughing. Slide 13 HEPATITIS B VACCINE Employees at risk of exposure are offered Hepatitis B vaccine Employee may decline the vaccine Employees who initially decline can later receive it The hepatitis B vaccine will be offered to employees who are determined to have occupational exposure to bloodborne pathogens. The vaccination will be provided at no cost. First, we must determine that you are at risk for exposure to blood. Slide 14 HEPATITIS B GUIDELINES At my workplace I… (almost never) (a few times) (6-12/year) 1. Am bitten by a student 2. Am scratched with potential for blood contacting broken skin 3. Clean up students’ blood 4. Clean and dress oozing/bloody wounds ____________________________________________________________ If all the listed exposures to blood occur “almost never” your occupation is not likely placing you at risk. However, you should consult with your school nurse after any exposure incident. If all exposure incidents listed occur a few times a year or less, you are not at increased risk for Hepatitis B. Vaccine should be considered most seriously by those who circled more than 3 “A few times” a year. If you checked one or more on the “6-12/year” column, you should strongly consider receiving the Hepatitis B vaccine series. If you are determined to be at risk, you will be asked if you do, or do not, want the vaccine at the beginning of each school year. Slide 15 HEPATITIS B VACCINATION Three injections in deltoid muscle Mild to no side effects Produces only one antibody Series of 3 injections * Immediately * 6 – 8 weeks * Six months If you receive the vaccine prior to exposure to hepatitis B, your body will develop antibodies against the disease. While no vaccine is 100% effective, the efficacy of the vaccine is very high --- 80-95% effective. However, efficacy is influenced by such factors as age, gender and body mass, i.e. an overweight smoker over the age of 40 may not respond as well as a 20 year old non-smoker who is not overweight. At this time there is no vaccine available for Hepatitis C Virus. We can only offer you the Hepatitis B vaccine. You should take all 3 injections to get the most protection against Hepatitis B. If you have received all three injections of the Hepatitis B vaccine in the past, there is no need to repeat this. Slide 16 THE GOOD NEWS ABOUT HEPATITIS Since 1995, HAV decreased by 88% Since 1990, HBV decreased by 79% Since 1992, HCV decreased by 92% In March 2007, the CDC reported that the rates of newly diagnosed cases of Hepatitis A, B, and C had all declined due to better rates of vaccination, especially of children and due to decreased infections because of greater awareness, counseling, case finding, education and prevention. Blood donations are also better screened. Problems remain among unvaccinated adults and those adults with risk factors such as intravenous drug users or those with multiple sex partners. Problems also remain among older adults who got infected years ago and are now developing chronic hepatitis. Slide 17 CHARACTERISTICS OF HUMAN IMMUNODEFICIENCY VIRUS (HIV) Attacks immune system Modes of transmission →Sexual contact →Sharing needles →Mother to baby →Other blood & body fluid contact Not vaccine preventable Virus is killed easily outside the body HIV is the virus that causes AIDS (autoimmune deficiency syndrome). HIV destroys the immune system in humans by attacking the T-helper cells (or CD4 cells) in the body. These T cells help your body fight off infections. The antibody response (the body’s response to the virus) commonly shows within 3 – 6 months. Some people will develop detectable antibodies within 2 to 8 weeks. 90% develop antibodies by 3 months. In rare cases, it takes up to 6 months. If you think you have been exposed to HIV, you should be tested immediately for a baseline reading, at 6 weeks, 3 months, and 6 months. About 25 - 30% of HIV-infected persons in the United States are also infected with Hepatitis C virus (HCV). The percentage could be as high as 90% if the HIV infection was obtained by sharing dirty needles. Slide 18 SYMPTOMS OF HIV Weakness Fever Sore throat Nausea Headaches Diarrhea Loss of weight Not able to fight infections Sometimes no immediate symptoms Symptoms are not always immediate; some infected individuals may have no symptoms for many years. When they do appear, they may not be immediately diagnosed as having HIV. The CDC estimates that about one million people in the United States are living with HIV or AIDS. About one fourth of these people do not even know that they are infected. The CDC also estimates that 1700 teenagers ages 15 to 19 were diagnosed with HIV during 2007. Slide 19 MODES OF HIV TRANSMISSION Sexual contact Exposure to blood * Contaminated needle sharing * Blood contact with non-intact skin * Transfusions * Infected mother to child Exposure to blood would include blood contact with broken skin or mucous membranes. Exposure to blood is the only work-related or occupational means of transmission. This virus is very fragile. Unlike the Hepatitis virus, it will not live very long outside of the human body. The greatest risk is in a person’s personal life, and is not work related. The more sexual partners you have, the greater the risk you have of getting HIV. If you are an intravenous drug user and you share needles with others, you are at high risk of getting HIV. There are very few to no cases of household members contracting HIV from nonsexual contact. Casual contact is not a mode of transmission. Slide 20 BODY FLUIDS CONTAINING HIV Blood Serous fluid Vaginal fluids Semen Saliva (in dental procedures) Blood has the highest concentration. Serous fluid is the clear or yellowish fluid typically present with blood. Saliva has a low risk. Slide 21 AIDS IS NOT SPREAD BY: Donating blood Hand shakes Telephone Swimming pool Coughing Food/Water Restaurants Sneezing Faucets Door Knobs Hot Tubs Beverages Schools Hugging Clothing Toilet Seats Touching Day Care Centers Combs Mosquitoes Public Transportation There is no reason to be afraid of having casual contact with someone who has HIV or AIDS. Slide 22 THE GOOD NEWS ABOUT HIV Those infected are now living longer. There are good medications to help. New medications are being developed every year and people are living much longer than before. However, treatment is costly. The immune system remains fragile, and HIV infected persons are immunocompromised – they are at risk for catching several illnesses because they may not be able to fight infections. Some will respond differently and have been able to lead productive lives even though they are afflicted. If you want more information for someone who is HIV positive you can go to this website… http://www.cdc.gov/hiv/pubs/brochure/livingwithhiv.htm Slide 23 WHAT IS AN EXPOSURE? Blood contact with broken skin Piercing mucous membranes or skin: Needle sticks Bites Cuts Abrasions Here is an example of an exposure: You are assisting a student who fell and cut his head; the blood is profuse and seeps through the cloth you are using to put pressure on the wound. You are not wearing gloves, and blood comes into contact with your hand which is severely chapped. An exposure simply means you have come in contact with human blood or body fluids and your skin is not intact. One of the most important actions you can take to reduce your risk of infections is to maintain your skin in good condition. Your skin is a good barrier to bloodborne pathogens. Do not allow your skin to get overly cracked because your skin may get small openings with the cracks. Use lotion on dry skin. Cover any open sores or abrasions while you are at school. To avoid cuts, never pick up broken glass with your hands. Use a broom and a dust pan instead. Slide 24 FIRST AID PROCEDURES Use personal protective equipment Call for assistance Instruct injured person on self-care Dispose of material appropriately Wash hands thoroughly Report to Exposure Control Officer If you are called upon to deliver first aid, you should use gloves and/or other types of barriers and avoid direct contact with blood. Advise the injured person to apply pressure himself if possible. Get rid of all bloody materials carefully in a plastic bag. You should double bag the contents for extra protection. Remember to wash your hands. If you give CPR (cardiopulmonary resuscitation) mouth to mouth without a shield, this is considered an exposure. Before you need it, find out what items are available to you at your school such as face/mouth shields when performing CPR. Remember that the risk is low from saliva so do not hesitate to give CPR mouth to mouth if you need to. If you think you were exposed to body fluids or if you performed mouth to mouth CPR, OSHA Bloodborne Pathogen Standards direct you to report to the “Exposure Control Officer” -- this means call the school nurse. Slide 25 INJURED STUDENT/ATHLETE Cover any open sores before playing If injured when playing, clean/cover wound Remove/replace clothing with blood on it Surfaces with blood need to be cleaned Put clothing stained with blood in plastic bag If you help a student who is bleeding, remember to cover open sores before resuming the activities. Use extra care in handling any clothing and the surface area that gets blood on it. Seek advice from the school custodians for proper clean up of the surfaces. Slide 26 NOSEBLEEDS Sit student up Head slightly forward Ask student to pinch nose lightly Ask student to hold tissue under nose If you assist, wear gloves Students can have nosebleeds for a variety of reasons. Follow these steps and/or seek advice from your school nurse. Slide 27 POST-EXPOSURE PROCEDURES For Exposed Individuals: Wash exposed area thoroughly Report incident to supervisor Fill out exposure report form Request blood testing If needed, get Hep B vaccine Get evaluation by MD In the event of an exposure incident, it is important to wash the skin or flush the mucous membrane immediately. If an exposure incident occurs, a confidential medical evaluation and follow-up will take place. All aspects of the post-exposure and follow-up are confidential. You may consult your personal physician if you choose or go to the emergency department. Remember that if you are exposed to blood, you should act quickly. Please call the school nurse ir you have any questions. Slide 28 POST-EXPOSURE PROCEDURES Remember to take these steps: Wash the affected part of your body with plenty of soap and water If your eyes were affected, flush them very well with water Call school nurse; forms to complete are online Report to the E R of Med Center Hosp in Odessa Remember that if your skin is intact, there is very little risk of any exposure even if someone’s blood fell on you. Remember that human saliva is a very low risk for an exposure to you. If someone spits at you, there would have to be some blood in the saliva for you to be exposed and it is unlikely in most situations. You have the right to receive medical treatment at no cost to you when you have a possible exposure to a bloodborne pathogen while at work. Only you can decide if you want to be treated. You should not delay in taking action when you are exposed to blood or human secretions. Slide 29 WORK PRACTICES TO PREVENT EXPOSURE / REDUCE RISKS Universal precautions – MOST IMPORTANT Handwashing facilities /suitable cleanser Procedures to minimize needle sticks, blood splashing, etc. Appropriate storage/disposal Universal Precautions mean……treating all blood and certain body fluids as if they are infectious. Frequent hand washing with plenty of soap is the single most important factor utilized for all types of infection control. Slide 30 BLOODBORNE PATHOGENS SUMMARY 1. Compass Academy has an Exposure Control Plan. 2. This BBPathogen training must be recorded by law. 3. BBPathogens include HBV, HCV and HIV. 4. Hepatitis B vaccine is available if you are at risk. 5. Use barriers/gloves; practice Universal Precautions. 6. Handle glass, needles, all sharps carefully. 7. Avoid contact with blood. 8. If exposed, wash immediately. 9. If exposed, receive a medical evaluation. PLEASE NOTE: Hepatitis B vaccination is offered to Compass Academy employees whose job category places them at risk for blood exposures. If you feel you are at risk as defined by slide #14, contact your school nurse for information on vaccination. This is the end of the training. Please proceed to the test that follows.