Download Bloodborne PathogenTraining

Elena Fracassa
993-5702
[email protected]
www.oehs.wayne.edu
Bloodborne diseases are only
spread when blood (or certain
other body fluids) from an
infected person gets into the
bloodstream of an uninfected
person.
This can happen when infected material
enters through cuts or breaks in the skin,
mucous membranes (eyes, nose), or directly
into bloodstream, as with a needlestick.
Universal Precautions
 Specific
to blood & body fluids visibly
contaminated with blood
 Applies to anyone regardless of infection
status
 Does not apply to all body
excretions/secretions
 Designed to reduce the risk of
transmission of bloodborne pathogens
(OSHA Standard)
Bloodborne Diseases
 HIV:

causes AIDS - no cure or vaccination
 HBV:

Hepatitis B virus causes liver disease
vaccination available
 HCV:

Human Immunodeficiency Virus
Hepatitis C virus causes liver disease
no vaccination available
Means of Transmission –
Must Enter Body
 HBV,
HIV virus present in blood, body fluids
 Sexual contact with an infected partner
 Sharing infected needles
 Accidentally cut/needlestick with a sharp object
contaminated with infected blood, body fluids
 Infected blood or body fluid on skin especially
with open cuts, sores
 Infected blood or body fluid splash to the eyes,
nose, mouth.
Bloodborne Diseases are
NOT spread by:
 Kissing
or hugging
 Sneezing
 Food
or coughing
or water
 Sharing
 Casual
eating utensils, cups, etc.
contact
HIV Transmission
 Blood




 IV
and body fluids
serum
semen
vaginal secretions
fluids around interenal organs/systems
drug use
 vaginal or anal intercourse
 mother to child in utero
HIV Symptoms
 night
sweats
 loss of appetite
 weight loss
 fever
 skin rashes
 diarrhea
 fatigue
 swollen
lymph nodes
 lack of resistance to
infections
HIV Transmission
As of June 2004, there were 57
documented cases and 139 possible
cases of occupationally acquired HIV
among healthcare workers in the
U.S. since reporting began in 1985.
Centers for Disease Control
Healthcare personnel with documented and possible occupationally acquired
AIDS/HIV infection, by occupation, as of December 2002.
No new documented cases of occupationally acquired HIV/AIDS have been reported since December 2001. One new case of
possible occupational transmission has been reported.
Occupation
Documented
Possible
Nurse
24
35
Laboratory worker, clinical
16
17
Physician, nonsurgical
6
12
Laboratory technician, nonclinical
3
-
Housekeeper/maintenance worker
2
13
Technician, surgical
2
2
Embalmer/morgue technician
1
2
Health aide/attendant
1
15
Respiratory therapist
1
2
Technician, dialysis
1
3
Dental worker, including dentist
-
6
Emergency medical technician/paramedic
-
12
Physician, surgical
-
6
Other technician/therapist
-
9
Other healthcare occupation
-
5
57
139
Total
HIV Exposure Risk
 Rate
of seroconversion after needlestick
exposure to infective material from HIV+
person is 0.3% or about 1 in 300.
 HIV
in high concentration during period prior
to antibody development.
 Much
less infective than HBV, HCV, Herpes
HIV Transmission in
Healthcare Workers
 Factors
 Deep
associated with HIV transmission:
injury
 Device visibly contaminated with source
patient’s blood
 Procedures involving a needle placed directly
in a vein or artery
 Terminal illness in source patient
 No zidovudine prophylaxis
Hepatitis A Facts
 Fecal-oral
transmission – NOT bloodborne
 Spread
through contaminated water, seafood,
or infected food handlers.
 Incubation
 Children
period from 15-45 days.
usually have no symptoms. Adults
may have fatigue, nausea, fever, jaundice.
Hepatitis A
 Infection
clears up over a few weeks to months, no
chronic problems result.
 Vaccination
recommended if outbreak occurs or for
travel to some foreign countries.
 Routine
vaccination in all children recommended
as of May 2006 by the CDC Advisory Committee on
Immunization Practices.
Reported Cases of Hepatitis A in U.S.
45
1995: Vaccine Licensed
40
1996: ACIP recommendations
Rate per 100,000
35
30
1999 ACIP
recommendations
25
20
15
10
5
0
52
56
60
64
68
72
76
Year
Source: NNDSS, CDC
80
84
88
92
96 2002
Concentration of Hepatitis A Virus
in Various Body Fluids
Body Fluids
Feces
Serum
Saliva
Urine
100
102
104
106
Infectious Doses per mL
Source:
Viral Hepatitis and Liver Disease 1984;9-22
J Infect Dis 1989;160:887-890
108
1010
Hepatitis B Virus
of the liver – most common
bloodborne disease
 Inflammation
 Symptoms
range from flu-like to none at all
symptoms – person can still be infectious
and can spread the disease
 No
Risk Factors Associated with
Reported Hepatitis B, 1990-2000, U.S.
Other*
Injection drug use
14%
15%
Sexual contact with
hepatitis B patient
13%
Household contact of
hepatitis B patient
2%
Men who have
sex with men 6%
Unknown 32%
Blood transfusion
0%
Medical
Employee 1%
Multiple sex partners
Hemodialysis 0%
17%
*Other: Surgery, dental surgery, acupuncture, tattoo, other percutaneous injury
Source: NNDSS/VHSP
Hepatitis B Facts
 Incubation
period from 28-160 days
 Symptoms may include:
 loss
of appetite
 fatigue
 fever
 possible jaundice and dark urine
 HBV
is much greater risk on the job than HIV
Hepatitis B Facts
 How
HBV is transmitted:
 cut
with sharp, contaminated object, needlestick
 splashes
 contact
 human
to eyes/nose/mouth
with broken skin
bites
Hepatitis B Facts
 Fluids
that pose risk of infection:
 blood
 body
and blood products
fluids containing visible blood
 semen
and vaginal secretions
 breast
milk
 saliva
(through a human bite)
Concentration of Hepatitis B
Virus in Various Body Fluids
 HIGH:
blood, serum, wound exudates
 MODERATE:
 LOW
semen, vaginal fluid, saliva
/ NOT DETECTABLE: urine, feces,
sweat, tears, breast milk
Hepatitis C Virus
 Identified
in 1988, formerly called non-A
non-B hepatitis - called “silent epidemic”
 Blood
supply not tested until early 90s.
 Incubation
period from 2-26 weeks.
Most people never have symptoms
Hepatitis C Virus
 Spread
primarily through blood/blood
products. Most likely not spread sexually.
 80-85%
 There
of cases become chronic
is no vaccine for HCV.
Based on limited studies, risk for infection after
needlestick is approximately 1.8%.
Risk Factors Associated with
Transmission of HCV
• Illegal injection drug use
• Transfusion or transplant from infected donor
• Occupational exposure to blood
– Mostly needle sticks
• Iatrogenic (unsafe injections)
• Birth to HCV-infected mother
• Sexual/household exposure to anti-HCV positive
contact
• Multiple sex partners
Reported Risk Factors for Acute
Hepatitis C, 1991 – 2000
Household 3%
Occupational 3%
Sexual 21%
Transfusions *
3%
No Identified Risks
10%
Illegal Drug Use
60%
*None since 1994
HBV Vaccination
 Administered
in 3 shots over 6 months.
 Recombinant vaccine is yeast derived - no
chance of infection from vaccination.
 Provides long term protection against HBV
for 96% of healthy adults: no booster
recommendation from CDC at this time.
 Post exposure vaccination is 70-88%
effective when started within one week.
Hepatitis B in Healthcare
Workers (HCWs) in the U.S.

Prior to vaccination, it was estimated that more
than 12,000 HCWs were occupationally infected
with HBV annually, resulting in 250 deaths.

1983 – Incidence of HBV among HCWs was 3 times
higher than in the general population.

By 1995 it was 5 times lower.

Advent of HBV vaccine was a major advance in
preserving health and lives of HCWs.
Source: Arch Intern Med 1997; 157:2601-2605
What is an
“Occupational Exposure”
 Contact
with blood or other potentially
infectious materials through:
needlestick
or cut with sharp,
contaminated object
contact with broken skin through cuts,
rashes, other breaks in skin
splashes to eyes, nose, mouth

If there are no infiltrations of mucous membranes or open skin surfaces, it is not
considered an occupational exposure.
Responding to Exposures
 Thoroughly
wash affected area. Do not wash
with bleach or other strong cleaners
 Report
incident to supervisor and get
immediate medical attention.
 Complete
appropriate report of injury forms.
Postexposure follow-up
Medical Evaluation
 Confidential
 Route
of exposure (i.e. needlestick, splash to
eyes, etc.)
 Source individual identification and testing
 Exposed individual blood testing
 Postexposure prophylaxis as recommended
by U.S. public health service (CDC)
 Counseling
 Evaluation of illnesses
Postexposure Follow-up
 Physician
should follow the updated
U.S. Public Health Service Guidelines for the
Management of Occupational Exposures to
HBV, HCV and HIV and Recommendations for
Postexposure Prophylaxis
Postexposure Follow-up
 Health
care professionals who evaluate
employees after an exposure shall be given
the following information:
 Description
of employees duties as related to the
exposure incident
 Documentation
of the route and circumstances
surrounding the exposure
 Results
of the source individual’s blood testing
 Relevant
medical records (including vaccine)
 Description
of PPE used or to be used
Postexposure Follow-up
 Employer
shall obtain and provide to exposed
employee a copy of the health care
professional’s written opinion limited to:
 Any
limitation on employee use of PPE
 HBV vaccine information
 Statement that employee has been informed of
test results and medical conditions that may have
resulted from exposure
Personal Protective
Equipment (PPE)
 Protective
 Lab coat
clothing
 Disposable
latex or non-latex
exam gloves:
 change
when torn or
contaminated.
 Change between patients
 Wash hands inbetween
Personal Protective Equipment
 Face
protection: safety
glasses/goggles worn
with face mask if
risk of aerosols.
 Other
appropriate PPE
if necessary: gown, face shield, booties,etc.
 PPE
should not leave the work area!
Hand Washing
 Before
& after contact
 Before & after procedures
 After removing gloves
 After using restroom
 Anytime your hands are soiled
Personal protective equipment
shouldn’t leave the work area!
Good
Handwashing
 Warm,
running water w/mild, preferably liquid soap,
not required to be antibacterial
 Rub
hands together vigorously for at least 15
seconds: scrub between fingers, under nails, tops &
palms of hands
 Rinse
with warm, running water
 Dry
with disposable paper towel
 Use
lotion to prevent chapping of hands
Bacterial Reduction
Ability of Hand Hygiene
Agents to Reduce Bacteria on
Hands
%
99.9
Time After Disinfection
log
0 60
180 minutes
3.0
99.0
2.0
90.0
1.0
0.0
0.0
Alcohol-based handrub
(70% Isopropanol)
Antimicrobial soap
(4% Chlorhexidine)
Baseline
Plain soap
Adapted from: Hosp Epidemiol Infect Control, 2nd Edition, 1999.



Alcohol-based handrub is better than handwashing at killing bacteria.
Across the top of this graph is the amount of time after disinfection
with the hand hygiene agent.
Left axis shows the percent reduction in bacterial counts.
Hand Moisturizers and Lotions
ONLY USE facility-approved/supplied lotions
 Some
lotions may make medicated soaps less
effective
 Some
lotions cause breakdown of latex gloves
 Lotions
can become contaminated with bacteria if
dispensers are refilled
~ Do not refill lotion bottles ~
Survival on Surfaces
 HIV
is weak and dies rapidly upon
exposure to air. It doesn’t live in
dried material.
 Hepatitis
 Live
viruses are hardy.
hepatitis B virus has been
found in dried up to 14 days old.
Cleaning and Decontamination
 Wear
gloves and other appropriate PPE.
 Clean spills with disposable towels and a
hot soap and water solution.
 Disinfect with a FRESH 1:10 bleach
solution: inactivates HIV and hepatitis virus
 Tuberculocidal cleaners may also be used.
Alcohol doesn’t destroy HBV or HCV.
 Dispose of contaminated items properly,
remove PPE and WASH HANDS!
Needlestick Safety and
Prevention Act
 Only
needle-locking syringes
or disposable syringe-needle
units (i.e., needle is integral to
the syringe) are used for
injection or aspiration of
infectious materials.
 Syringes
which re-sheathe the
needle, needleless systems,
and other safety devices are
used when appropriate.
Examples of Safe Needle Devices
“Self-sheathing”
needle device.
“Retractable” needle
device.
Add on device – flip
over to “cap” needle
after use.
“Add-on” SHARPS
safety features
Attached to syringe needle
Attached to blood tube holder
SHARPS Precautions
 Used
disposable needles must not be
bent, sheared, broken, recapped, removed
from disposable syringes, or otherwise
manipulated by hand before disposal.
 Always
dispose of needles
in SHARPS containers!
SHARPS waste
 SHARPS
containers must be used for all
SHARPS – regardless of contamination
 Don’t
overfill containers!
 Locate
containers
conveniently.
Never recap, bend, or break
needles! Dispose of entire
unit together.
Non-Sharp Biological Waste
Waste containers must be:
 leak-proof
 labeled
with biohazard
word and symbol
 closable
Follow the rules of your workplace!
Practice Universal Precautions!

Treat all blood, body fluids, tissue, etc. as if
it is known to be infectious.

Use good hygiene - wash hands frequently!

Wear personal protective equipment.

Dispose of SHARPS properly!
Questions?
Wayne State University
Office of Environmental
Health & Safety
5425 Woodward, Suite 300
Detroit, MI 48202
313.577.1200
www.oehs.wayne.edu