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BLOODBORNE PATHOGENS TRAINING SELF STUDY COURSE ` BLOODBORNE PATHOGENS AND HEPATITIS B OSHA’S 1991 bloodborne pathogens standard includes provisions for medical follow up for workers who have an exposure incident. The most obvious exposure incident is a needlestick. But any specific eye, mouth, other mucous membrane, non-intact skin, or parenteral contact with blood, body fluids, or other potentially infectious materials is considered an exposure incident and should be reported to the employer. INFECTIOUS DISEASES CAUSED BY BLOODBORNE PATHOGENS Incubation Period: HIV antibiotics may be identified in the body anywhere from 6 weeks to 3 months from the time of the infection, although symptoms may not manifest themselves for 10 – 12 years. At this time we have only a few years’ experience with AIDS, since the disease was first discovered in 1981. Period of Communicability: Probably from the time of infection throughout the remainder of the person’s life. B. Exposure incidents can lead to infection from Hepatitis B virus (HBV) or human immunodeficiency virus (HIV) which causes AIDS. Although few cases of AIDS are directly traceable to workplace exposure, every year about 8,700 health care workers contract Hepatitis B from occupational exposures. Approximately 200 will die from this bloodborne infection. Some will become carriers, passing the infection on to others. A. HIV/AIDS Human Immunodeficiency Virus (HIV) attacks the body’s immune system causing the disease known as AIDS, or Acquired Immune Deficiency Syndrome. Currently, there is no vaccine to prevent infection. Signs and symptoms include: 1. Period of severe fatigue: persists for more than several weeks. 2. Sudden weight loss: 10 lbs. Or more in less than 60 days. 3. Night sweats and/or fever: drenching night sweats and chills with fevers. 4. Diarrhea: diarrhea persisting for more than 1 week is common with AIDS. 5. Bruising and/or bleeding easily. 6. Coughing. 7. Skin rashes and spots. Kaposis Sarcoma also common. Lesions. 8. Swollen glands: Enlarged, hard, painful lymph nodes in at least 2 parts of the body (excluding the groin). 9. Oral Thrush: Creamy white, curd-like patch that coats tongue and surrounds throat and esophagus. It is the esophageal thrush that is case-defining for AIDS. Spread: The AIDS virus has been found in blood, semen, saliva, urine, tears and other body fluids, but transmission has NOT been shown to occur from contact with fluids other than blood and semen. In adults, the virus is most often spread through sexual contact or by sharing needles. Most children who are infected acquire the virus from their infected mothers during pregnancy or at the time of birth. Some children have been infected through transfusions of blood products that contained the AIDS virus. It is possible that spread may occur by getting blood from an infected person into open cuts, abrasions, mouth or eyes of another person. AIDS is NOT spread by coughing, sneezing, hugging or by contact with eating utensils, faucets or toilet seats. The chance of becoming infected by a needle stick is less than 0.5%. HEPATITIS B Hepatitis means “inflammation of the liver”. Hepatitis B is the major infectious blood-borne hazard you face on the job. The chance of becoming infected from a needlestick slip are much greater than Hepatitis A; 30%. If you become infected with Hepatitis B: You may suffer from a loss of appetite, tiredness, abdominal pain, nausea and vomiting; rash or joint pain, jaundice. Your symptoms can vary greatly from none at all to severe illness. The virus is present in the blood and other body fluids. It can be spread from person to person by getting blood or body fluids from an infected person into open skin cuts, abrasions, mucous membranes such as the eyes, nose, and mouth of another person, or by sexual contact. Incubation Period: Ranges from 2-6 months; the average is 3 months. Period of Communicability: May be infectious for many weeks before onset of symptoms and remain infectious for 48 months. Some people (about 10%) are chronic carriers of the virus and may be infectious for life. C. HEPATITIS A Hepatitis A is an infection of the liver. Symptoms are usually sudden, with loss of appetite, nausea, tiredness, fever, and stomachache. Dark-colored urine, light-colored stools and jaundice. Hepatitis A virus is spread when the virus leaves the body through the stool of an infected person and enters another person when contaminated food or objects are placed in the mouth. The chance of becoming infected from a needlestick slip is much lower than Hepatitis B, only 0.5%. Incubation Period: The incubation period is 2-6 weeks after a person is exposed to the virus; most commonly one month. Period of Communicability: The contagious time period is 2 weeks before to 1 week after onset of symptoms. METHODS OF TRANSMISSION Transmission of bloodborne pathogens can occur in the following ways: 1. Directly through person to person contact or indirectly by a person coming in contact with a contaminated surface or object. This is the most common means of disease transmission. 2. 3. Airborne transmission occurs by “droplet infection” via breathing, talking, coughing, or through contaminated dust. These can be the most difficult to control. Bloodborne transmission occurs through contact with blood, semen, vaginal secretions or body fluids. (These substances are also known as infectious materials). Generally, these diseases are transmitted through skin, eyes, damaged skin or mucous membranes (mouth, vaginal or rectal tissue). This mode of transmission includes but is not limited to Hepatitis B virus (HBV) and Human immunodeficiency virus (HIV). WHAT DOES THE VACCINATION INVOLVE? care professional evaluating an employee after an exposure incident will receive the following information: 1. 2. 3. 4. 5. 6. A copy of the OSHA regulations. A description of the exposed employee’s duties as they relate to the exposure incident. Documentation of the route(s) of exposure and circumstances under which exposure occurred. Results of the source individual’s blood testing, if available. All medical records relevant to the appropriate treatment of the employee including vaccination status. Consents needed for HIV screening and HBV treatment. The medical evaluation and follow-up will include the following: The exposed employee’s blood shall be collected as soon as possible and tested after consent is obtained for HIV and HBV status. Post exposure prophylaxis, when medically indicated, as recommended by the U.S. Public Health Service. Counseling. Evaluation of reported illnesses. The Hepatitis B vaccination is a non-infectious, yeast-based vaccine given in three injections in the arm. It is prepared from recombinant yeast cultures, rather than human blood or plasma. Thus, there is no risk of contamination from other bloodborne pathogens nor is there any chance of developing HBV from the vaccine. 1. STANDARD PRECAUTIONS A copy of the health care professional’s written opinion shall be provided by the employer to the employee within 15 days of the completion of the evaluation. The health care professional’s written opinion for Hepatitis B vaccination shall be limited to whether Hepatitis B vaccination is indicated for an employee, and if the employee has received such vaccination. The health care professional’s written opinion for post-exposure evaluation and follow-up shall be limited to the following information: 1. That the employee has been informed of the results of the evaluation. 2. That the employee has been told about any medical conditions resulting from exposure to blood, body fluids, or other potentially infectious materials which require further evaluation or treatment. 3. All other findings or diagnoses shall remain confidential and shall not be included in the written report. Standard precautions have been established to reduce the occurrence of bloodborne transmission. AIDS and Hepatitis B are two communicable diseases which require the use of Standard Precautions. Standard Precautions require that all human blood and all body fluids are treated as if they are known to be infected with HIV, HBV, and other bloodborne pathogens. Standard Precautions require: Handwashing Use of gloves when in contact with blood or body fluids Use of personal protective equipment Bagging contaminated laundry Cleaning and disinfecting procedures for contaminated surfaces Disposal of sharps MEDICAL EVALUATION AND FOLLOW-UP An Exposure Incident is defined as a specific eye, mouth, other mucous membrane, non-intact skin or parenteral (skin piercing) contact with blood, body fluids, or other potentially infectious materials that results from the performance of an employee’s duties. If an Exposure occurs, employees should follow this procedure: 1. 2. 3. 4. 5. Immediately wash hands and contact area with soap and water. If mucous membranes or eyes are the contact area, flush with water. Notify organization’s administration that an Exposure has occurred. Complete an “Exposure Incident” form. Call your physician and schedule a medical evaluation immediately. Complete the top section of the “Post Exposure Medical Evaluation” form and take this form with you to the medical evaluation. A medical evaluation will occur within 24 hours after exposure and will be at no cost to the employee. The health 2. 3. 4. The health care professional’s written opinion shall be kept in the employee’s medical record. In addition to counseling the employee, the health care provider will provide a written report to the employer. This report simply identifies whether Hepatitis B vaccination was recommended for the exposed employee and whether or not the employee received vaccination. The health care provider also must note that the employee has been informed of the results of the evaluation and told of any medical conditions resulting from exposure to blood or body fluids which require further evaluation or treatment. Any added findings must be kept confidential. CONFIDENTIALITY Medial records must remain confidential. They are not available to the employer. The employee must give specific written consent for anyone to see the records. Records must be maintained for the duration of employment plus 30 years in accordance with OSHA’s standard on access to employee exposure and medical records.