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BLOODBORNE PATHOGENS For School Staff Composed by Rita Keating RN New Richmond Schools Adapted by Kathy Dahl RN School District of Durand What are Blood Borne Pathogens? Infectious organisms carried in blood that can cause certain communicable diseases such as Hepatitis B, Hepatitis C, HIV/AIDS, and others. HEPATITIS B VIRUS • Poses the greatest risk at school of all Blood Borne Pathogens. • Causes serious liver disease. • Symptoms include jaundice, fatigue, abdominal pain, loss of appetite, etc. • Most infected people recover but some remain carriers and can spread disease. • 5,000 people die from complications linked to HBV every year. • More easily transmitted than Hepatitis C or HIV. • Vaccinations can prevent disease for most people. Hepatitis C virus: • Similar to HBV in that it can cause serious liver disease. Major differences: • chance of being chronically infected. • 75 % of those infected may have no symptoms for 20 years. • Biggest cause of liver transplants • NO VACCINATIONS TO PREVENT HEPATITIS C iNFECTION HIV • • • • Human Immunodeficiency Virus Attacks immune system. Disease varies greatly from person to person. Infected people may develop AIDS. The # of HIV infected people who develop serious illness and who die from AIDS has decreased due to recent treatments. • CDC estimates that at least half of all new HIV cases are among <25 year olds. • NO VACCINE TO PREVENT HIV INFECTION. Occupational Exposure • Occupational Exposure is the risk you have of an exposure while doing your job.Most people infected at work - had contaminated blood splashed on broken skin, eyes, nose or mouth or may be stuck by a contaminated needle, or other sharp object. • School employees have low risk because exposure to blood is infrequent. • When the need arises you need to be prepared. Transmission of BBP: • Most easily spread through direct contact with infected blood. • Also spread through contact with other potentially infectious materials including semen, vaginal secretions, and any other body fluid or tissue containing visible blood. • Not included (unless there is visible blood) are feces, urine, vomit, nasal secretions, sputum, sweat, tears and saliva. The risk of BBP transmission from these fluids is extremely low. Transmission of BBP (continued): • Most commonly transmitted through sharing needles to inject drugs or through unprotected sexual intercourse with an infected person. • Also transmitted from mother to unborn child before or during birth. • Prior to 1992 spread through blood transfusions. • At work is spread when contaminated skin contacts broken skin or mucous membranes of eyes, nose, or mouth. • Also work transmission if contaminated sharp object punctures your skin. You cannot become infected by: • Casual contact such as coughing, sneezing , a kiss on the cheek , a hug or drinking from water fountains or sharing food. These things will NOT transmit Blood Borne Pathogens. How to protect yourself from exposure: 1. Exposure Control Plan • The School District of Durand has an exposure control plan in each school nurse office. • Gloves are available to all staff who may be exposed to Blood. • First Aid supplies and kits to clean up blood spills are available for all school sponsored events. Location of Emergency Clean up Supplies/ First Aid Supplies Caddie Woodlawn • Custodian clean up supplies: main floor janitor closet and furnace room on lower level • First aid supplies, including gloves • Main office healthroom, classrooms for early childhood and severely disabled, playground/phy ed. fanny packs, field trip first aid kits,buses,and teachers lounge and available by request. Location of Emergency Clean up Supplies/ First Aid Supplies Caddie Woodlawn (continued) • Additional Personal Protective equipment: rarely needed, but gown,shoe covers, face shield located in health room and main office • Pocket Mask for CPR: Health Room • Sharps container: Health Room and with individual student supplies as needed. Location of Emergency Clean up Supplies/ First Aid Supplies Arkansaw Middle School: • Custodian Cleanup Kits:located in janitor closet by gym and cafetorium • First Aid Supplies and clean up kits( includes gloves):located in healthroom in main office, Teachers lounge,Lab, kitchen and shop areas, phyed and recess fanny packs,athletic dept., buses, field trip first aid kits, and given to staff as requested. Location of Emergency Clean up Supplies/ First Aid Supplies Arkansaw Middle School:continued • .Personal Protective Equipment:rarely needed but gown, shoe covers, face shield,and cap available in Health room and Janitor closet by gym • Pocket Mask for CPR:Health Room • Sharps Container:Health Room and with student supplies when needed Location of Emergency Clean up Supplies/ First Aid Supplies Durand High School • Custodial Clean up kits: located in janitor closet in each wing or level-contact custodian on duty • First Aid supplies and clean up kits(includes gloves):located in Healthroom, Main office bathroom,Whirlpool room,Teacher”s lounge, Pupil Service conference room, Athletic dept.,and in all necessary depts as needed.( Shop,Labs, Kitchen areas, Band, etc.) First Aid kits are on buses and available for student field trips. Gloves available to staff by Location of Emergency Clean up Supplies/ First Aid Supplies • Durand High School(continued) • Additional Personal Protective equipment: rarely needed but gown, gloves,face shield in Health room and in custodian area. • Pocket Mask for CPR: Health Room and Whirlpool room. Extra face shields available to coaches upon request. • Sharps containers- Health room, maintenance shop, Lab areas, How to Protect yourself: 2. Universal Precautions What are Universal Precautions? • Treating all blood as though it is infected with BloodBorne Pathogens. • Using certain outlined precautions in dealing with all potentially infectious body fluids that may contain blood. • Universal Precautions are your First Line of Defense. What are these precautions? 1. Barriers - use gloves , cover any hand cuts with bandaids before gloving. Gowns and eye protection may be necessary for someone dealing with a lot of blood or if it may spray. 2. Avoid touching the outside of contaminated gloves, always wash your hands after removing gloves. 3. Discard used gloves appropriately. 4. Wash hands immediately after contact with blood or other body fluids and after removing gloves. 5. Use hand sanitizer if no soap and water available. Precautions (continued): 6. Disinfect any contaminated surfaces with an appropriate germicidal agent. HBV can survive on surfaces for 7 days. (Suggestion for at home use is mixture of 1 part bleach to 9 parts water) 7. Pick up broken glass with broom and dustpan - not your hands. Do not reach into trash cans for anything. 8. Use a mouth barrier if you have to perform CPR. Pocket Masks are located in each Health Room. CPR certified staff members may request a handy disposable face shield from school nurse. Precautions (continued): 9. Dispose of needles, sharp objects in red “sharps” containers in health offices. (Staff or students with daily use of sharps or needles will use sharp containers kept at the location where the procedure is done.) 10. Any item with dripping blood will be placed in a plastic bag with a biohazard label and disposed of in a designated biohazard container. Biohazard labels are with cleanup supplies and spill kits in designated locations. Biohazard waste containers are in all school building at these locations: High School-Custodial supply closet in Fine Arts Hall Middle School-Custodial supply closet by Gym HBV Vaccine: 2nd Line of Defense • Prevents Hepatitis B infection. • The vaccine is very safe and effective. • State of WI requires HBV vaccine for all grades. • Therefore most students have been immunized against HBV. • Vaccine series of 3 doses needs to be completed for effectiveness. How do I get the HBV vaccine? • Offered to those in High-risk categories: CDS staff, Early Childhood staff, Occupational Therapists, Physical therapists, Custodial staff, Maintenance staff, Building Principals, Secretaries and Aides that have health room responsibilities, and Coaches as determined by Athletics Director. (see school nurse if you haven’t been notified or have questions about your job and risk of exposure) • Three dose series of vaccines offered through Pepin County PublicHealth and paid for by the School District of Durand. • If not offered it through school responsibilities, contact your own MD and insurance provider for further information. What if you have not been immunized against HBV? • If you have not been vaccinated against HBV and you have had an actual blood exposure you can still begin the HBV series within 24 hours of the exposure and it is equally effective as if you had been previously immunized!! What does this mean when it comes to first aid? • Don’t avoid administering first aid! • Be calm - reassure the victim. • Minor scrapes and cuts - encourage victim to administer their own 1st aid with some direction from you until you can assist with protection. • If assistance needed put on a pair of gloves or utilize some other barrier, be creative. • Wash your hands when you are done. “Teachable Moments” • Model good behavior for students when it comes to protecting yourself. • Take the time to explain why you are putting on gloves or washing your hands. • Correct children when they try to help others and risk exposure. Make sure they wash their hands and explain why. Use health tips from additiional resources at the end of this presentation for lessons on Handwashing and Communicable diseases. Risky situations in schools: BLOODY NOSES • Students with bloody noses should sit up, keep their heads slightly forward, pinch the nostrils to stop the bleeding, and hold a tissue under the nose to catch any blood. • Direct the student to do this, if you need to assist - put on gloves or use another barrier. Most kindergarten students can do this. • Students should dispose of their own bloody tissues in an appropriate container, then wash the blood off of their hands and skin. Risky situations (continued): ATHLETIC INJURIES • Athletes should bandage existing cuts or scrapes before participation. • An athlete who is injured and bleeding should stop play immediately, care for the injury & replace any blood tainted clothing before resuming play. • Blood on equipment/surfaces needs to be cleaned appropriately. Risky situations (continued): • • • • BITES More common in Elementary school. If bitten by anyone, immediately wash the area with soap and water. Both individuals should seek medical attention. Human bites that cause severe trauma and bleeding can transmit bloodborne and other pathogens. Risky situations (continued): • • • • SYRINGES OR NEEDLES The CDC reports that used needles have been found in public places. Use caution if you come upon a syringe or needle in the environment. Do not break, bend, or recap the needles. Use a broom or dustpan to pick up and discard the object appropriately. If accidentally stuck, wash with soap and water immediately and seek medical attention. Risky situations (continued): BODY FLUIDS • If you have to deal with body fluids you must wear gloves. • Feces, urine, vomit, sputum, nasal secretions, saliva and used tampons can harbor infectious organisms, including BBP when blood is visible. • You will normally call custodian for cleanup during school hours: but assist if necessary. • Pick up or sop up with paper towels and disinfect. Dispose of appropriately. • WASH YOUR HANDS! What to do if exposed?? • Immediately wash affected skin with soap and warm water. • Flush eyes and exposed mucous membranes with large amounts of water. • Report the exposure(bites, blood splash in eyes or mouth or in breaks in skin) to the Principal and School Nurse Immediately • Remember that most exposures do not result in infection. Pictures of equipment and supplies • Caddie Health room-note pocket mask and glove container Pictures of equipment and supplies • Fanny Packs on hook by outside doors at Caddie – Fanny packs for recess and PE available in all buildings. Pictures of equipment and supplies Custodial cleanup kits are labeled and are also used at athletic events. Pictures of equipment and supplies • Contents of cleanup kits • Cleanup supplies also given to coaches. Pictures of equipment and supplies • Bloody items that are drippable and pourable must be labeled with a biohazard label and placed in biohazard waste containers. Pictures of equipment and supplies • Appropriate disinfectant • Follow directions carefully. • Bleach and water 1:10 dilution are effective too. DHS First Aid Supplies located in First Aid Room 112 . Extra supplies located in Whirlpool Room(lower left ) and in High School Office Bathroom(above),Teachers lounge also has a first aid kit accessible to staff when main offices are locked. Summary: • Low exposure risk at school. • Rare cases of HBV transmission reported but NO cases of HIV transmission reported from school exposure. • Remember to treat all body fluids as if they are infected. • Use gloves, sanitizers, wash hands, follow all other recommendations. • DO NOT avoid administering first aid due to fears - utilize Universal Precautions. TRUE 1. Blood is the single most important source of HIV, hepatitis B virus and hepatitis C virus in the workplace. FALSE 2. HIV poses a greater risk to school personnel than hepatitis B or hepatitis C because it is transmitted more easily. TRUE 3. Most people infected with hepatitis B do recover and clear the infection. TRUE 4. Most people infected with hepatitis C virus become chronically infected. TRUE 5. Universal Precautions means I treat all body fluids as if they are infected. FALSE 6. Fortunately, there are vaccines to prevent both hepatitis B and hepatitis C. TRUE 7. If I need more gloves to keep in my classroom or office I ask the school nurse or heath room secretary in my buiding. TRUE 8. Hepatitis B virus can survive in dried blood on surfaces for at least one week. TRUE 9. You should treat all blood and body fluids as though infected with some pathogen. TRUE 10. The risk of exposure to bloodborne pathogens in the school setting is low. Web links Wisconsin Division of Public Health Selected Handwashing Resources for Schools Immunization Resources for All Ages Questions ?????? Please contact Kathy Dahl if you have any questions about blood borne pathogens, the Hepatitis B vaccine or anything else. [email protected] or by phone in your building or cellphone 495-2922 References • • • • • • Centers for Disease Control and Prevention. (1999) Issues in Health Care Settings: Universal precautions for prevention of transmission of HIV and other bloodborne pathogens. Retrieved November 15, 2002, from http://www.cdc.gov/ncidod/hip/blood/universa.htm Chin, J., MD, MPH (2000), Control of Communicable Diseases Manual (17th ed.) Washington D.C.: American Public Health Association. (Original work published 1917) Coastal Training Technologies Corp. (1999). Bloodborne Pathogens in Schools [Brochure]. Virginia Beach, VA Coastal Video Communications Corp. (1992). Bloodborne Pathogens [Brochure]. Virginia Beach, VA Grier, E. C., & Hodges, H. F. (1998). HIV/AIDS: A challenge in the classroom. Public Health Nursing, 15(4), 257-262. Hootman, J., RN, PhD. (1996). Quality Interventions in the School Setting. Scarborough ME: National Association of School Nurses. Middlemas, D. A., Jessee, B., Mulder, D. K., & Rehberg, R. S. (1997). Exposure of athletic trainers to potentially infectious bodily fluids in the high school. Journal of Athletic Training, 32(4), 320-322.