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BLOODBORNE PATHOGEN TRAINING INTRODUCTION On December 6, 1991, the Occupational Safety and Health Administration (OSHA) published their standard for occupational exposure to bloodborne pathogens. OSHA website www.osha.gov These standards require the employer to provide annual education regarding the occupational hazard of bloodborne pathogens. There are 14 required components of this education which will be covered today. OSHA standards are federal law and compliance is mandatory. However, it is more important to recognize that this standard was established to help protect the school employee from the serious workplace hazard of bloodborne pathogens. WHAT ARE BLOODBORNE PATHOGENS? Viruses, bacteria and other microorganisms that are carried in the bloodstream and can cause disease If a person comes in contact with blood infected with a bloodborne pathogen he or she may become infected EXAMPLES OF BLOODBORNE PATHOGENS HUMAN IMMUNODEFICIENCY VIRUS (HIV) HEPATITIS B (HBV) HEPATITIS C (HCV) NON A, NON B HEPATITIS SYPHILIS MALARIA POTENTIALLY INFECTIVE BODILY FLUID Exposure to human blood carries the greatest risk for acquiring a bloodborne pathogen Other body fluids have demonstrated a viral load sufficient to potentially transmit infection. These fluids are: cerebrospinal fluid synovial fluid pleural fluid amniotic fluid pericardial fluid peritoneal fluid semen vaginal secretions any body fluid contaminated with blood saliva in dental procedures body fluids in emergency situations that cannot be recognized TRANSMISSION HIV and Hepatitis B virus are transmitted “blood to blood” by the following routes: Sexual contact Sharing HIV or HBV contaminated needles or syringes From mother to unborn child HCV is transmitted by: “Blood to blood” through broken skin (scratch, cut, chapped hands) The risk of HCV transmission by household contact and sexual activity is believed to be low Transmission from mother to unborn child is uncommon. TRANSMISSION In the workplace HIV, HBV and HVC are transmitted by the following routes: Through skin injuries (needlestick/sharp puncture) By contact with broken skin (scratch, cut, chapped hands) Spray or splash into mucous membrane (mouth, nose or eyes) RISK OF INFECTION In order for a person to become infected after exposure: A pathogen must be present There must be enough of the pathogen present to cause disease The pathogen must have an entry site The recipient must be susceptible to the pathogen RISK OF INFECTION AFTER OCCUPATIONAL EXPOSURE (INFECTION RISK FROM A PERCUTANEOUS EXPOSURE) Hepatitis B Viral particles/mL of serum/plasma 102 - 108 Hepatitis C 100 - 106 3% HIV 100 - 103 0.3% Virus Infection risk 30% HUMAN IMMUNODEFICIENCY VIRUS (HIV) First cases of HIV/AIDS were reported in 1981 25 million people have died of AIDS since 1981 33 million living with HIV/AIDS in 2007 (over one million in the US) 38,000 newly diagnosed cases of AIDS each year in US SYMPTOMS OF HIV INFECTION Range from no symptoms to severe immunodeficiency or Acquired Immune Deficiency Syndrome (AIDS) Initial infection can be followed by an acute flu-like illness. Symptoms include: fever swollen neck glands sweats rash malaise sore throat headache HUMAN IMMUNODEFICIENCY VIRUS The risk for disease progression increases with the duration of infection. Less than 5% of HIV-infected adults develop AIDS within 2 years of infection 20-25% will develop AIDS within 6 years after infection and 50% within 10 years. When an HIV-infected person develops certain diseases or conditions, they are then classified as having AIDS. Three of the most common clinical conditions are P. carinnii pneumonia, HIV wasting syndrome, and candidiasis of the esophagus. WHAT IS HEPATITIS? Inflammatory liver disease Caused by a virus Causes scarring of the liver tissue Increases liver cancer risk HEPATITIS B VIRUS (HBV) Hepatitis B In the United States 12 million Americans have been infected (1 out of 20 people) More than one million people are chronically infected Up to 40,000 new people will become infected each year 5,000 people will die each year from hepatitis B and its complications Approx. 1 health care worker dies each day from HBV SYMPTOMS OF HEPATITIS B VIRUS Ranges from no symptoms to hepatic (liver) failure. The disease has a long incubation period from 30 to 180 days. Initial symptoms are nonspecific, typically include: Fatigue Loss of appetite Vomiting Fever Rash and joint pain These symptoms last 3-10 days. This is followed by the onset of jaundice (yellowing of the skin) or dark urine. Fulminant viral hepatitis is defined as the development of severe acute liver failure with hepatic encephalopathy within 8 weeks of the onset of symptoms with jaundice. Can lead to hepatocellular cancer HEPATITIS B VIRUS (HBV) Treatable if acquired Preventable through vaccination HEPATITIS C VIRUS (HCV) Actual incidence of Hepatitis C infection is not known Prior to donor screening for anti-HCV, HCV was the most common cause of post-transfusion hepatitis HCV accounts for about 20% of acute viral hepatitis cases in US Prevalence is highest among injecting drug users and hemophilia patients About one quarter of HIV-infected persons in the U.S. are also infected with HCV. SYMPTOMS OF HEPATITIS C Similar to Hepatitis B (jaundice, fatigue, loss of appetite, vomiting) 50% and possibly 60-70% of acute HCV infections lead to chronic infection Chronic Hepatitis C is one of the most common indications for liver transplantation in adults There is no vaccine for prevention of Hepatitis C infection and no post-exposure prophylaxis EXPOSURE CONTROL PLAN Contains the policies and procedures to protect GDS employees from acquiring a bloodborne pathogen Contains a complete listing of all job categories that have been identified as having the risk of occupational exposure to blood and body fluids A copy of the Exposure Control Plan is located in the Health Room and the Training Room. JOB CLASSIFICATIONS The following positions at GDS are identified at risk for exposure to bloodborne pathogens: BCC Child Care staff Science teachers Bus Drivers Janitorial Staff PE teachers, athletic coaches & athletic trainer First Responders Health Room Staff PREVENTION All employees identified as being “at risk” for occupational exposure to bloodborne pathogens are offered Hepatitis B vaccine There is no cost to the employee for the vaccine Vaccination is a series of three injections The HBV vaccine can be obtained from Health Services PREVENTION Employees who are eligible to receive the vaccine but decline, must sign a declination statement form Employees who initially decline the vaccine but later elect to receive it may have the vaccination provided at no cost PREVENTION: WORK AREA PRACTICES In work areas where there is exposure to infectious materials employees are not to eat, drink, apply cosmetics, smoke, or handle contact lenses Food and beverages are not to be kept in refrigerators, cabinets or on counters where exposure to infectious material may result PREVENTION: WORK AREA PRACTICES Universal Precautions: All blood or other potentially infectious materials will be treated as infectious “If it’s ooey gooey and not yours don’t touch it!” Universal Precautions will be observed at GDS in order to prevent contact with blood or other potentially infectious materials. UNIVERSAL PRECAUTIONS Universal Precautions also means that all GDS employees practice appropriate handwashing and use personal protective equipment to prevent direct contact with a person’s blood or body fluids. Consistent practice of Universal Precautions is the best method that employees can use to protect themselves from occupationally acquiring a bloodborne disease. PERSONAL PROTECTIVE EQUIPMENT Personal protective equipment (PPE) is specialized clothing and equipment worn to prevent direct contact with blood or other body substances PPE should be readily available and is provided to the employee at no cost PERSONAL PROTECTIVE EQUIPMENT PPE includes: Disposable, single-use gloves in first-aid kits, AED cases, Science classrooms, janitorial supplies, and Trainers office Protective eyewear in laboratory classrooms, janitorial supplies and the nurse’s office CPR resuscitation masks with one-way valve in first-aid kits and AED cases and health room PPE DISPOSAL PPE should be carefully removed immediately after use and hands thoroughly washed. Soiled gowns and gloves should be disposed of in the regular trash and then double-bagged Employees are responsible for using PPE when instructed and whenever clinically indicated to prevent exposure to blood and body fluids. ENGINEERING CONTROLS Engineering controls are items that remove the bloodborne pathogen hazard from the workplace. Sharps containers labeled with the biohazard symbol will be located in the Health Room and athletic training room. The containers are to be utilized for the disposal of all sharps such as needles, glass, or other sharp instruments contaminated with blood or other potentially infectious materials. They are considered regulated waste. Return full containers to nurse for proper disposal. ENGINEERING CONTROLS Contaminated needles and other contaminated sharps shall not be bent, recapped or removed. If for any reason it is necessary that a contaminated needle or other sharp be recapped or removed, such recapping or needle removing must be accomplished through the use of a mechanical device or a one-handed technique. All contaminated sharps are to be disposed of in sharps containers. All procedures involving blood or other potentially infectious materials shall be performed in such a manner as to minimize splashing, spattering, and generation of droplets of these substances. UNIVERSAL BIOHAZARD SIGN The universal biohazard sign is used to alert employees when containers contain infectious materials. CONTAMINATED PERSONAL CLOTHING As soon as possible clothing should be carefully removed, avoiding contact with the garment's outer surface to prevent skin contamination. Students/staff may not return to class with soiled clothing. No exceptions. The contaminated garment should be placed in a fluid resistant bag and marked “biohazard.” Take bag to the nurse’s office. (Clothes may be sent home with individual if blood and clothes belong to the same person). SPILLS OF BLOOD/BODY FLUID All spills must be safely and properly cleaned up as soon as possible. Do not clean the spill yourself, call the office to have janitorial staff clean the area. Hepatitis B virus can survive on surfaces dried and at room temperature for at least 7 days SPILLS OF BLOOD/BODY FLUID Janitorial staff should use the following guidelines: Wear gloves and other appropriate PPE as indicated A solution of 1:10 bleach and water or an EPA-approved disinfectant detergent (i.e. Vesphene) should be used. Small spills are cleaned by first wiping the spill then cleaning the area with the disinfectant. Large spills should first be flooded with the disinfectant, the spill wiped or mopped up, then the area cleaned with the disinfectant. SPILLS OF BLOOD/BODY FLUID If broken glass is involved, it should be carefully removed using a mechanical device such as tongs or forceps and the broken glass placed in the sharps container. Never pick up broken glass by hand. EXPOSURE INCIDENTS You are considered potentially exposed to a bloodborne pathogen if you contact blood or other infectious body substances in any of the following ways: Needlestick/sharp injury that punctures the skin Splash to the mucous membranes of the eyes, nose and/or mouth Potentially infectious fluid that contacts broken or abraded skin EXPOSURE FOLLOW-UP Knowing the right steps to take after an exposure incident is critical in reducing the likelihood of acquiring a bloodborne pathogen. Immediately after any exposure incident: Wash the exposed area with soap and water; if the exposure involves the eyes, you should flush with tap water Report the incident to your supervisor Report to the School Nurse or Athletic Trainer POST EXPOSURE FOLLOW UP The school nurse will evaluate your exposure incident. A Post-Exposure Evaluation and Follow-Up Form shall then be completed by the employee. After the report is completed and filed with the School Nurse, a confidential medical evaluation and follow-up shall be given by or under the supervision of a licensed physician at no cost to the employee. If the exposed employee refuses the post-exposure evaluation and follow-up, the employee shall complete and sign a Post-Exposure Refusal Form.