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Bloodborne Pathogens/TB An OSHA Mandated Drill Introduction OSHA mandates that upon hire each individual who works in a high-risk environment must received bloodborne pathogens training. OSHA also mandates that this topic be reviewed annually Objectives Identify the pathogens that are transmitted via blood Identify modes of transmission of BBP Identify risks of transmission in the workplace Identify appropriate use of PPE Identify correct procedure to follow if exposed Identify requirements of HBV series Understand importance of infectious waste disposal Identify locations at both companies for decon and infectious waste disposal Objectives (cont’d) Identify those at risk for development of TB Differentiate between TB Disease and TB Infection Identify methods of diagnosing TB Understand treatment of TB Understand risks of rabies exposure to emergency responders Bloodborne Pathogens Hepatitis B,C,D,E,F,G HIV Viral Hemorrhagic Fevers (Ebola, Marburg) Hepatitis Hepatitis is an infection that occurs in the liver after exposure to the virus through blood. Symptoms of hepatitis include: jaundice, fever, weight loss, loss of appetite, fatigue, dark urine, joint pain, abdominal pain, diarrhea, nausea, and vomiting. Incubation periods vary depending on the type. HBV average is 120 days (ranges from 45160 days) HCV average is 45 days (ranges from 14180) Hepatitis (cont’d) Death from chronic liver disease occurs in 1525% of chronically infected persons. People with chronic HBV infection have a much greater risk of developing liver failure & liver cancer Chronic infection with HCV occurs in 55-85% of infected persons and 70% of chronically infected persons go on to develop chronic liver disease Those with chronic HCV have a much higher risk of suffering from liver failure and liver cancer Hepatitis Vaccine HBV series is a series of 3 shots over a period of 6 months OSHA mandates that all employees in a highrisk setting must be offered the vaccine free of charge. If you decline the vaccine, you must sign a waiver. 31-60 days after receiving the 3rd shot you should have a titre drawn to check for immunity. There is no vaccine for HCV Transmission of Hepatitis HBV is found in blood and certain body fluids. It is spread through these fluids from an infected person to a non-immune person. Spread via unprotected sex, sharing needles, exposure to needlesticks/sharps in the workplace, and from an infected mother to her child during birth HIV Human Immunodeficiency Virus is a retrovirus that causes Acquired Immune Deficiency Syndrome (AIDS). The Immune system progressively deteriorates leading to opportunistic infections that ultimately leads to death. There is no vaccine for HIV Antiretroviral medications are used to treat HIV and have been shown to prolong the lifespan of those with HIV. There is no cure. HIV (cont’d) HIV was first discovered on December 1, 1981. Since that time the World Health Organization (WHO) estimates that AIDS has killed more than 25 million people. In 2005 AIDS claimed 2.4-3.3 million lives of which, more than 570,000 were children. It is one of the most destructive pandemics in recorded history. HIV Transmission The three major routes of transmission of HIV are: Unprotected sexual intercourse Contaminated needles Infected mother to unborn child /breast milk to nursing infant Screening of blood products has virtually eliminated transmission via that route HIV Symptoms (Early) Many people do not develop symptoms when first infected. Some people develop flu-like symptoms within 3-6 weeks of exposure (Acute HIV Syndrome). There may also be enlargement of lymph nodes during this phase of illness. This phase usually lasts a week to a month & is often mistaken for another viral infection HIV Symptoms (Late) Lack of energy, swelling or hardening of glands Weight loss, long bouts of diarrhea Frequent fevers & sweats Thrush accompanied by sore throat Severe or recurring yeast infections Chronic pelvic inflammatory disease Periods of extreme & unexplained fatigue Headaches, lightheadedness, dizziness Bruising easily What are the Chances? HBV –5-30 out of 100 HIV – 1 in 300 HCV – 1.8 in 100 Precautions Standard Precautions- combines major features of universal precautions and body substance isolation (BSI). Applies to all body fluids, secretions, and excretions regardless of whether or not they contain visible blood. Transmission-Based Precautions Airborne – TB, Chickenpox Droplet – Whooping cough, measles, SARS, flu Contact – MRSA, VRE, C-Diff Personal Protective Equipment PPE Gloves Goggles Masks (N95 and surgical) Gowns/Aprons Tyvek suits BVM Post Exposure Follow up Report your exposure immediately to OIC Complete Incident report You will be sent for a confidential medical evaluation (You have the right to refuse testing) Disposal of Infectious Waste & Decontamination Procedures Work area to be kept clean & sanitary Use appropriate disinfectants and mix according to manufacturer’s directions All dressings & disposables must be bagged per infection Control policy in red biohazard bags. Company One White biohazard containers located by EMS room.(Lids must be on at all times) Contaminated equipment cleaned in decon shower at far end of bay in decon shower. Contaminated gear & clothing washed in machines under stairwell at far end of bay Biohazard shed kept locked at all times. Company Two White biohazard containers located next to bay storage doors. Medical waste transported back to Company 1 medical waste shed Contaminated gear & clothing transported to Company 1 for proper handling. Protecting Yourself On Scene USE YOUR HEAD!!! Take an extra few seconds to survey the scene for potential exposure hazards & choose your PPE accordingly. Be efficient but don’t rush. (Fools rush in!) You are ultimately accountable for your own protection. Tuberculosis Tuberculosis is spread by the airborne route. Primarily associated with the lungs, but can be found in other parts of the body such as the kidney and the bone. It is reportable to the CT DPH by law. There are specific laws that dictate how it should be managed. Symptoms of TB •Feeling weak or sick •Weight loss •Fever •Night Sweats •Persistent Cough •Chest Pain •Coughing Up Blood Who is at Risk? •People who share the same breathing space as someone with TB disease. •Poor people •Homeless People •Foreign born people from countries with high incident of TB •Nursing Home Residents •Prisoners •Alcoholics and IV Drug abusers •People with diabetes, certain types of cancer, and being underweight •People with HIV TB Disease vs. TB Infection TB Disease: •Person is sick with germs that are active in the body •Usually have one or more symptoms of TB •Can pass disease on •Permanent body damage and death can occur •Medicine is prescribed that can cure TB TB Infection: •Person is healthy •Strong immune system •No Symptoms •Cannot spread the infection •Can develop TB disease in the future •Medicine prescribed to prevent development of TB disease Diagnosis of TB •Skin Test •Doctors Office or local Health Department •If positive other tests will be done to see if you have infection vs. disease •Small needle used to implant tuberculin under the skin •Usually done inside of your forearm •Test is read in 48 to 72 hours to check for reaction •Size of reaction is measured •Less than 10mm is negative Negative vs. Positive Negative Test: •Usually means person is not infected •Maybe falsely negative if person has been recently infected •Usually takes 2 to 10 weeks after exposure for test to become positive Positive Test: •Usually means the person has been infected with the TB germ •Does not necessarily mean person has TB disease •Other testing such as X-Ray or Sputum testing will be ordered Treatment of TB •Compliance with medications is mandatory •Common medications include INH and Rifampin •Routine follow up Chest X-Rays •Routine follow up with Physician Rabies Virus spread by warm blooded mammals (raccoons, skunks, foxes, coyotes, woodchucks and bats. A Bat’s teeth & claws are so small that a bite may not bleed or even hurt People sleeping in a room where a bat is found, or children who may have been alone in a room with a bat, should see a doctor. If possible the bat should be saved for testing, but never handle it without protective gloves. Domestic Pets Dogs, cats, ferrets & farm animals can act as a bridge between wild animals and people. If pets appear to have been in a fight, use caution, and handle with gloves. Cover pet with fluid impervious material & see Vet. How Does Rabies Work? Attacks brain cells & nerves Slowly & painfully kills its victim if not treated quickly. Prevention vaccine available for bite victims Incubation period is 4-6 weeks Rabies Vaccine Involves a total of 5 shots over several days & 1 shot of Human Rabies Immune Globulin (HRIG) which is given immediately. On Scene Fire & EMS personnel should be wary of stray or roaming animals If bitten, you must report it immediately & seek medical attention…untreated rabies can be & usually is fatal. Transmission Transmitted through a bite, scratch, lick, and even petting. The virus is in the animal’s saliva. Myths All Rabid dogs froth at the mouth. A rabid dog will be vicious & snap at everything A rabid dog will not drink water & will exhibit fear of water If a suspected dog acts friendly, its not rabid. The dog had his shots, it doesn’t have rabies Avoiding Rabies Avoid being bitten Treat any animal bite as a potential rabies exposure. If bitten, immediately wash area with soap & warm water then wash wound with 1% providone-iodine. Capture/confine the animal Avoiding Rabies cont’d Suspect strays should be destroyed & tested by health officials. Pets who’s owner can’t provide proof of vaccine should be confined for 10 days. All animal corpses should be treated as HIV contaminated (Use PPE when handling) Notify proper authorities of any suspected rabid animal Remember Who’s Number 1! Test Select “TEST” From the Main Menu