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Bloodborne Pathogens for the Lay Rescuer and First Responder Instructor Barry Ponder Introduction • Approximately 5.6 million workers in health care and other facilities are at risk of exposure to bloodborne pathogens such as human immunodeficiency virus (HIV – the virus that causes AIDS), the hepatitis B virus (HBV), and the hepatitis C virus (HCV) • OSHA’s Bloodborne Pathogens standard prescribes safeguards to protect workers against the health hazards from exposure to blood and other potentially infectious materials, and to reduce their risk from this exposure 2 Methods of Compliance • • • • Universal Precautions Engineering and Work Practice Controls Personal protective equipment Housekeeping • More information at www.cdc.gov 3 Who is covered by the standard? • All employees who could be “reasonably anticipated”, as the result of performing their job duties, to face contact with blood and other potentially infectious materials • “Good Samaritan” acts such as assisting a co-worker with a nosebleed would not be considered occupational exposure • Designated first aid and/or CPR/AED responders are subject to the standard 4 Some Workers Who are at Risk • • • • • • • • • • • • Physicians, nurses and emergency room personnel Orderlies, housekeeping personnel, and laundry workers Dentists and other dental workers Laboratory and blood bank technologists and technicians Medical examiners Morticians Law enforcement personnel Firefighters Paramedics and emergency medical technicians Anyone providing first-response medical care Medical waste treatment employees Home healthcare workers 5 Bloodborne Pathogens • Bloodborne Pathogens are microorganisms (such as viruses) transmitted through blood, or other potentially infectious material such as certain bodily fluids (semen, breast milk, etc.) or tissues. 6 Bloodborne Pathogens • Bodily fluids, especially those visibly contaminated with blood, are capable of causing disease. • Pathogens can enter your body through a cut in the skin, through absorption through membranes of the eyes or mouth. • Can also be transmitted sexually. • Main diseases of concern are Hepatitis B (and C) virus, and HIV (AIDS virus). 7 Human Immunodeficiency Virus (HIV) • HIV attacks your body’s ability to protect itself against disease • Initially no visible signs of having the virus • There is no vaccination for HIV 8 HIV Transmission • Virus lives outside the body only a few hours • 5 modes of transfer: 1 blood 2 semen 3 vaginal secretions 4 breast milk 5 amniotic fluid 9 HIV Transmission • NOT BY • • • • • • • Door knobs Drinking fountains Mosquitoes Oral secretions Sneezes Toilets Shaking hand 10 Hepatitis B Hepatitis B Virus • Up to 100 times easier to catch than HIV • Unlike HIV, can live outside of body for several days 11 HBV • Liver is located behind the lower ribs on the right side of your abdomen • Weighs about 3 pounds and is roughly the size of a football. • If infected with HBV, the liver often becomes tender and enlarged 12 Some signs and symptoms of HBV and HCV include: • Flu-like symptoms • fatigue • jaundice • severe pain in joints normal Yellow from jaundice • lung disease • inflammation of liver • inflammation on and ulcers of the colon • may be asymptomatic (i.e. no symptoms indicated) 13 Concentration of Hepatitis B Virus in Various Body Fluids High Moderate Low / Not Detectable Blood Semen Urine Serum Vaginal fluid Feces Wound exudates Saliva Sweat Tears Breastmilk 14 Hepatitis B • “Approximately 10% of those infected become chronic carriers who can infect their families and friends. They have up to 300 times greater than normal risk of developing liver cancer.” • “Every year, approximately 5,000 Americans, die of HBV or its complications. 15 Hepatitis B Acute: 6-8 weeks, 90% – 30-40% with acute HBV have no idea how or when they became infected – 10% of infected carry virus for longer than 6 months (carriers) Chronic: Life, 10% – Hepatitis B carriers are people infected with HBV and never fully recover. They carry the virus and can infect others for the rest of their lives – Approximately one million people in the US carry HBV 16 Hepatitis B Vaccination • Available since 1981 • Recombinant DNA technology- no human materials used so no risk of HIV or HBV • 85%-95% effective for healthy adults 17 Hepatitis B Vaccination • Three doses at 0, 1, 6 months • Must receive all three doses • Free to collateral duty employees after an incident where blood or OPIM is present • Division’s procedure in offering vaccinations • May decline vaccine (but must sign waiver) • May receive vaccine later 18 HIV vs. Hepatitis B HIV Hepatitis B Transmitted through blood, semen, vaginal secretions, and breast milk Transmitted through blood, semen, and vaginal secretions 10-50 virus particles per ml of blood 1,000,000 – 1,000,000,000 virus particles per ml of blood Virus lives outside the body only a few hours Virus lives outside the body for up to 7 days Up to 100 times easier to catch than HIV No vaccination available Vaccinations available – 3 doses 19 Hepatitis C • 3-4 million carriers • Disease can incubate for decades • By 2010 may affect more Americans each year than AIDS • HCV not related to the viruses that cause HBA and HBV 20 Hepatitis C 21 Hepatitis C • Risk Factors: – Long-term kidney dialysis – Sex with multiple partners – Tattooing or body piercing with shared needles or unsterilized equipment – Intranasal cocaine use with shared straws 22 How to Handle Needles • You can be exposed to a BBP if a sharp object cuts or punctures your skin. • Never re-cap a needle Employees who self-administer medication may have needles in the workplace. 23 How to Dispose of Needles Needles and other sharps must be discarded in rigid, leak-proof, puncture resistance containers Do not dispose of needles in regular garbage 24 How Bloodborne Pathogens Spread on the Job • During a first aid or CPR/AED response incident, the potential for exposure to bloodborne pathogens exists if there is blood or other potentially infectious material (OPIM) present • If blood or OPIM is present in the workplace from an unreported accident or illness, there’s potential for exposure 25 How Bloodborne Pathogens Spread on the Job • When a contaminated object touches inflamed skin, acne, skin abrasions • When you touch a contaminated surface and then touch your eyes, nose, mouth, or open wounds or inflamed skin 26 How to Reduce Your Risk When emptying trash containers, do not use your hands to compress the trash in the bag. Red biohazard bags cannot be disposed of in regular garbage. Contact your EHS coordinator for guidance. 27 How to Reduce Your Risk Do not eat, drink, smoke, apply cosmetics or handle contact lenses in areas where there is the possibility of exposure to BBP 28 How to Reduce Your Risk UNIVERSAL PRECAUTIONS – A system of infection control which assumes that all human blood and certain body fluids are treated as if known to be infectious. 29 Personal Protective Equipment Gloves, eye protection, CPR mouthpiece or pocket mask, face shields, lab coats, coveralls… Know how to use and limitations Mask with One-Way Valve Kit with each AED 30 Personal Protective Equipment • PPE needed for CPR is located with each AED • Additional PPE is available through the EHS Coordinator (i.e. for First Aid) • Responders shall use PPE • Replace PPE if contaminated, torn, punctured, or barrier is compromised • Most PPE is disposable and must be disposed of properly (Biohazard) 31 CPR Response Scenario • Is the scene safe? • What are the dangers at the scene? • What can you do to help this person and still be protected? Use your PPE. 32 Glove Removal and Disposal Grip one glove near the cuff and peel it down until it comes off inside out. Cup the removed glove in the palm of your other gloved hand. 33 Glove Removal and Disposal •Place two fingers of your bare hand inside the cuff of the remaining glove. •Peel that glove down so that it also comes off inside out and over the first glove. 34 Glove Removal and Disposal Dispose of gloves in labeled biohazard bag or give to EMS for disposal 35 Proper Hand Washing •Wash hands well with antibacterial soap •May use antiseptic cleansers or towelettes until soap and water are available 36 Clean-Up Procedures If Blood or Other Potentially Infectious Material (OPIM) is present after an emergency, special clean-up procedures must be followed. Special Clean-up Procedures FYI: • Special kit required • Special PPE required • Specific disinfection procedure Your actions: • Secure the area • Contact your EHS Coordinator 38 Our Facility Exposure Control Plan (available from EHS Coordinator) • Exposure Determination • Universal Precautions & Work Practices • Engineering Controls • PPE • • • • Housekeeping Regulated Waste Labels & Signs Reporting Procedure • HBV Vaccinations • Post Exposure Evaluation 39 Our Facility Exposure Control Plan Example Reporting Procedure • Employees must promptly report any potential exposure to blood, OPIM, or contaminated materials to the EHS Coordinator. This shall occur immediately if medical attention is needed, and always before the end of the work shift. 40 Our Facility Exposure Control Plan Example Reporting Procedure (cont.) • The EHS Coordinator must record specifics of the occurrence and determine if blood or OPIM was present.* • If it is determined that blood or OPIM was present, a confidential medical evaluation will be provided under the supervision of a licensed physician * Procedure for collateral duty employees 41 Our Facility Exposure Control Plan Example Post Exposure Evaluation Process • • • • Done in accordance with CDC guidelines Review of exposure incident details Testing of source individual after consent Results of testing provided to exposed employee • Provisions for testing and treating exposed employee • Maintain patient confidentiality 42 Prompt Reporting is Key • Immediate post-exposure follow-up further reduces risk • Highly effective post-exposure procedures for HIV and Hepatitis C exposure can virtually eliminate risk 43