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Bloodborne Pathogens Protecting yourself from disease What are bloodborne pathogens? Disease causing microorganisms, such as viruses, bacteria or parasites that are carried in human blood. The Law Certain jobs may involve contact with blood or other body fluids The U.S. Department of Labor’s Occupational Safety and Health Administration ( OSHA) issued regulations to protect employees from bloodborne pathogens. 29 CFR 1910.1030 is the regulation number • It was issued in 1991 The Law Cont. These regulations require employers to use a combination of engineering, work practice controls, personal protective equipment, medical surveillance and additional safety precautions in the work place. Any employees that are at risk from contact with human blood are required to receive training in bloodborne pathogens. Reporting • An occupational exposure incident occurs if you are in a work situation and come in contact with blood or body fluids. • For OSHA 2000 record keeping purposes, an occupational bloodborne pathogens exposure incident such as , needle stick, laceration or splash is classified as an injury because it is usually the result of instantaneous event or exposure. Reporting • After an exposure employees names are placed on the OSHA 2000 log. • The goal of reporting an exposure is to ensure that an employee receives prompt access to medical services and to identify and adopt other methods or devices to prevent exposures incidents from recurring. Reporting • The following should be included in the report Date and time of incident Job classification Worksite location Work practices being followed Engineering practices in place including name or brand of device such as sharps/ needles PPE Procedure being performed and training received OSHA Expectations The objective of the standard is to limit or prevent exposure to blood or body fluids however, exposure to a bloodborne may occur. If there is a risk of exposure or injury, it is important for you to know the following: There is a way to prevent infection as a result of exposure to the pathogen, such as immunizations OSHA Expectations Continued • The symptoms caused by infection with the pathogen, as well as the natural course of the infection • Counseling specific to the exposure incident is available • The postexposure treatments and follow-up that may be provided to you • THE BOTTOM LINE EDUCATE YOURSELF!!! The Ryan White act • This public law – 101-381, Creates a notification system for emergency response employees listed as police, fire and EMS who are exposed to diseases such as tuberculosis, hepatitis B and C and HIV. • The CDC is currently working a final list of diseases that will be included in this law. Mode of Transmission • Bloodborne pathogens are transmitted when blood or body fluids come in contact with mucous membranes or nonintact skin ( cuts, abrasions, burns, rashes, acne, papercuts, and hangnails). • Transmission may occur from splashes or sprays of blood,handling or touching contaminated items or surfaces and injection under the skin by puncture wounds or cuts from contaminated sharps. Modes of transmission • Types – Direct contact – organism is moved from one person to another through touching. – Indirect contact – infection is spread through inanimate object ( needle stick) – Airborne – spread through droplet or dust – Food borne- spread through infected food or water. – Vector borne ( insects or parasitic worms) CDC Recommendations • ALL persons are potentially infected or can spread an organism that could be transmitted in the health care setting. • Standard precautions must be used on all patient encounters. CDC Recommendations • Hand Washing ( best way to prevent the spread of disease) After touching blood or body fluids Immediately after removing gloves Between patient contacts CDC Recommendations • Personal Protective Equipment (PPE) Gloves – for touching blood or body fluids for touching mucous membranes and nonintact skin Gowns- CDC Recommendations • Patient Care Environment Soiled patient care equipment handle in a manor that prevents transfer of microorganisms to others and to the environment Wear gloves if visibly contaminated Use proper hand hygiene Environmental controls Have procedures for the routine cleaning and disinfection of environmental surfaces CDC Recommendations Environmental controls continued Pay special attention to the frequently touched surfaces with in the ambulance ( handrails, seats, cabinets, doors) Textiles and laundry Handle in a manor that will prevent the transfer of microorganisms to others and to the environment CDC Recommendations Needles and other sharp objects Do not recap, bend, break, or hand-manipulate used needles. Use safety features when available ( needleless IV systems) Place sharps in puncture-resistant containers CDC Recommendations • Special Circumstances Patient resuscitation Use mouthpiece, resuscitation bag, or other ventilation devices to prevent contact with mouth and oral secretions. Respiratory Hygiene/cough etiquette Instruct symptomatic patients to cover their mouth/nose when sneezing or coughing Use tissues and dispose in no-touch receptacles CDC Recommendations Respiratory Hygiene/cough etiquette continued Perform hand hygiene after touching tissues Place surgical mask on patient/provider If mask cannot be used, maintain special separation (> 3’) if possible Specific Bloodborne Pathogens • Hepatitis Viruses – Inflammation of the liver • Hepatitis A (HAV) – Good hygiene and proper sanitation can help prevent hepatitis A. This transmitted via fecal-oral route from contaminated food and water. • The time between infection and the appearance of the symptoms is between two and six weeks • There is a vaccination for HAV Hepatitis A (HAV) • Hepatitis A does not have a chronic stage, is not progressive, and does not cause permanent liver damage. Following infection, the immune system makes antibodies against HAV that confer immunity against future infection. The disease can be prevented by vaccination, and hepatitis A vaccine has been proven effective in controlling outbreaks worldwide. Hepatitis B (HBV) • Hepatitis B (HBV) – There has been a decline in HBV in recent years. • Transmission of hepatitis B virus results from exposure to infectious blood or body fluids. • The acute illness causes liver inflammation, vomiting, jaundice and—rarely—death. Chronic hepatitis B may eventually cause liver cirrhosis and liver cancer—a fatal disease with very poor response to current chemotherapy • There is a vaccine available. The vaccine comes in series of three shots. Hepatitis B (HBV) • There is a vaccine available. The vaccine comes in series of three shots. • Acute infection with hepatitis B virus is associated with acute viral hepatitis – an illness that begins with general ill-health, loss of appetite, nausea, vomiting, body aches, mild fever, dark urine, and then progresses to development of jaundice. Hepatitis B (HBV) • It has been noted that itchy skin has been an indication as a possible symptom of all hepatitis virus types. The illness lasts for a few weeks and then gradually improves in most affected people. A few patients may have more severe liver disease and may die as a result of it. The infection may be entirely asymptomatic and may go unrecognized. Hepatitis C (HCV) • Hepatitis C is an infectious disease affecting the liver, caused by the hepatitis C virus (HCV). The infection is often asymptomatic, but once established, chronic infection can progress to scarring of the liver (fibrosis), and advanced scarring (cirrhosis) which is generally apparent after many years. In some cases, those with cirrhosis will go on to develop liver failure or other complications of cirrhosis, including liver cancer. Hepatitis C (HCV) • The hepatitis C virus is spread by blood-toblood contact. Most people have few, if any symptoms after the initial infection, yet the virus persists in the liver in about 85% of those infected. Persistent infection can be treated with medication, peginterferon and ribavirin being the standard-of-care therapy. Fifty-one percent are cured overall. Hepatitis C (HCV) 50% not a large percentage. PPE is essential! Human immunodeficiency Virus (HIV) • HIV causes AIDS acquired immunodeficiency syndrome. • a condition in humans in which the immune system begins to fail, leading to lifethreatening opportunistic infections. Infection with HIV occurs by the transfer of blood, semen, vaginal fluid, or breast milk. Within these bodily fluids. Human immunodeficiency Virus (HIV) • The four major routes of transmission are unsafe sex, contaminated needles, breast milk, and transmission from an infected mother to her baby at birth (perinatal transmission). • That newborn may be infected. Treat ALL people even infants as if they are infected. Human immunodeficiency Virus (HIV) • Treatment with anti-retrovirals increases the life expectancy of people infected with HIV. Even after HIV has progressed to diagnosable AIDS. Human immunodeficiency Virus (HIV) • HIV infection has basically four stages: incubation period, acute infection, latency stage and AIDS. The initial incubation period upon infection is asymptomatic and usually lasts between two and four weeks. Human immunodeficiency Virus (HIV) • The second stage, acute infection, lasts an average of 28 days and can include symptoms such as fever, lymphadenopathy (swollen lymph nodes), pharyngitis (sore throat), rash, myalgia (muscle pain), malaise, and mouth and esophageal sores. Human immunodeficiency Virus (HIV) • The latency stage, which occurs third, shows few or no symptoms and can last anywhere from two weeks to twenty years and beyond. AIDS, the fourth and final stage of HIV infection shows as symptoms. Symptoms of Acute AIDS Human immunodeficiency Virus (HIV) • In general, if infected blood comes into contact with any open wound, HIV may be transmitted. Human immunodeficiency Virus (HIV) • Post-exposure follow up and prophylaxis – There is no cure for HIV. All decisions about laboratory testing and prophylaxis are made in consultation with your health care professional. – Testing for the HIV antibody should be done as soon as possible after exposure and thereafter, periodically for least 6 months. Antibodies usually become detectable within 3 months of infection. Human immunodeficiency Virus (HIV) • Post – exposure treatment should be made in conjunction with a infectious disease specialist. • Post – exposure treatment is not recommended for all occupational exposures. 99.7% of the exposures do not lead to HIV infections. • If treatment is recommended it should begin within hours of the exposure. Tuberculosis (TB) • Tuberculosis usually attacks the lungs but can also affect other parts of the body. It is spread through the air, when people who have the disease cough, sneeze, or spit. Most infections in humans result in an asymptomatic, latent infection, and about one in ten latent infections eventually progresses to active disease, which, if left untreated, kills more than 50% of its victims. Tuberculosis (TB) • The classic symptoms are a chronic cough with blood-tinged sputum, fever, night sweats, and weight loss. Infection of other organs causes a wide range of symptoms. Tuberculosis (TB) • Skin test are often used for routine screening of high risk individuals. • Interferon-γ release assays are blood tests used in the diagnosis of some infectious diseases. There are currently two interferon-γ release assays available for the diagnosis of tuberculosis: Tuberculosis (TB) Skin Test Tuberculosis (TB) • Treatment – Treatment for TB uses antibiotics to kill the bacteria. Effective TB treatment is difficult, due to the unusual structure and chemical composition of the mycobacterial cell wall, which makes many antibiotics ineffective and hinders the entry of drugs. Tuberculosis (TB) • The two antibiotics most commonly used are rifampicin and isoniazid. However, instead of the short course of antibiotics typically used to cure other bacterial infections, TB requires much longer periods of treatment (around 6 to 24 months) to entirely eliminate mycobacteria from the body.[