Download osha`s bloodborne pathogens standard 29 cfr part 1910.1030

CENTRAL PIEDMONT COMMUNITY
COLLEGE OSHA TRAINING FOR
1ST YEAR STUDENTS
Revised 2011
LEARNING OBJECTIVES
STUDENTS SHOULD BE ABLE TO UNDERSTAND,
DISCUSS, AND IMPLEMENT OSHA STANDARDS &
REQUIREMENTS AND CDC’S GUIDELINES FOR:

TRAINING AND TERMINOLOGY
 EXPOSURE CONTROL PLAN
 EXPOSURE DETERMINATION/CATEGORY
 HAZARD WARNING LABEL & COMMUNICATION
 UNIVERSAL/STANDARD PRECAUTIONS AND CDC’S
TRANSMISSION BASED PRECAUTIONS
 HAND HYGIENE
 DISEASE TRANSMISSION (e.g. Means of disease
transmission, Hep. B/C, HIV/AIDS/TB, INFLUENZE)

HEP. B VACCINATION
 PPE (personal protective equipment)
 HANDWASHING FACILITIES AND REQUIREMENTS
 SHARPS SAFETY
 LAUNDRY/HOUSEKEEPING
 MANAGEMENT OF BLOOD/BODY FLUID SPILLS
 MANAGEMENT OF EXPOSURE INCIDENTS
 MANAGEMENT OF REGULATED WASTE
 HAZARD COMMUNICATION STANDARD (hazardous
chemicals)
 RECORDKEEPING REQUIREMENTS (e.g. training and
medical records)

OTHER (e.g. CPCC requirements)
OSHA’S BLOODBORNE
PATHOGENS STANDARD
29 CFR PART 1910.1030
OCCUPATIONAL SAFETY
AND HEALTH
ADMINISTRATION
CONTENTS OF THE
STANDARD
Definitions
Exposure
Control
Plan
Information
& Training
Including
Disease
Transmission
(HIV/AIDS;
Hep.; TB)
Exposure
Determination
Universal &
Standard
Precautions
Engineering
& Work
Practice
Controls
Post
Evaluation
& FollowUp
Record
Keeping
Biohazard
Communication
Sharps
Safety
OSHA’S DEFINITIONS

BLOOD = Human blood, human blood components, and products
made from human blood.

BLOODBORNE PATHOGENS = Pathogenic microorganisms that
are present in human blood and can cause disease in humans.
These pathogens include, but are not limited to Hep. B virus; Hep.
C virus; and HIV.

ENGINEERING CONTROLS = Controls (e.g. sharps disposal
containers, self-sheathing needles, safer medical devices, such as
sharps with engineered sharps injury protections and needleless
systems) that isolate or remove the bloodborne pathogens hazard
from the workplace.

EXPOSURE INCIDENT = A specific eye, mouth, other mucous
membrane, non-intake skin, or parenteral contact with blood or
other potentially infectious materials that results from the
performance of an employee’s duties.
OSHA’S DEFINITIONS

NEEDLELESS SYSTEM = A device that does not use needles for (1)
the collection of bodily fluids or withdrawal of body fluids after initial
venous or arterial access is established; (2) the administration of
medication or fluids; or (3) any other procedure involving the potential
for occupational exposure to bloodborne pathogens due to
percutaneous injuries from contaminated sharps.

OCCUPATIONAL EXPOSURE = Reasonably anticipated skin, eye,
mucous membrane, or parenteral contact with blood or other
potentially infectious materials that may result from the performance
of an employee’s duties.

PARENTERAL= Piercing mucous membranes or the skin barrier
through such events as needlesticks, human bites, cuts, and abrasions.

SHARPS WITH ENGINEERED SHARPS INJURY PROTECTIONS =
A non-needle sharp or a needle device used for withdrawing body
fluids, accessing a vein or artery, or administering medications or other
fluids, with a built-in safety feature or mechanism that effectively
reduces the risk of an exposure incident.
OSHA’S DEFINITIONS

SOURCE INDIVIDUAL = Any individual, living or dead, whose
blood or other potentially infectious materials may be a source of
occupational exposure to the employee.

UNIVERSAL PRECAUTIONS = Is an approach to infection
control. According to the concept of Universal Precautions, all
human blood and certain human body fluids are treated as if
known to be infectious for HIV, HBV, HCV, and other bloodborne
pathogens/infectious diseases.

WORK PRACTICE CONTROLS = Controls that reduce the
likelihood of exposure by altering the manner in which a task is
performed (e.g., prohibiting recapping of needles by a two-handed
technique, handwashing, etc.)
OSHA’S DEFINITIONS





REGULATED WASTE = MEANS LIQUID OR SEMILIQUID
BLOOD OR OTHER POTENTIALLY INFECTIOUS
MATERIALS.
MEANS CONTAMINATED ITEMS THAT WOULD RELEASE
BLOOD OR OTHER POTENTIALLY INFECTIOUS
MATERIALS IN A LIQUID OR SEMILIQUID STATE IF
COMPRESSED.
MEANS ITEMS THAT ARE CAKED WITH DRIED BLOOD OR
OTHER POTENTIALLY INFECTIOUS MATERIALS AND ARE
CAPABLE OF RELEASING THESE MATERIALS DURING
HANDLING.
MEANS CONTAMINATED SHARPS.
MEANS PATHOLOGIC AND MICROBIOLOGIC WASTES
CONTAINING BLOOD OR OTHER POTENTIALLY
INFECTIOUS MATERIALS.
EXPOSURE CONTROL
PLAN

THE EXPOSURE CONTROL PLAN IS
THE EMPLOYER’S WRITTEN
EXPLANATION ON HOW THE
FACILITY COMPLIES WITH OSHA’S
BLOODBORNE PATHOGENS.
STANDARD. THE PLAN MUST BE
MADE AVAILABLE TO ALL
EMPLOYEES AT RISK OF EXPOSURE.
TRAINING

MUST TAKE PLACE WITHIN 10 DAYS
OF STARTING JOB
 MUST HAVE ANNUAL TRAINING
THEREAFTER
 TRAINER MUST BE PRESENT TO
ANSWER QUESTIONS
REQUIREMENTS

TRAINING
 DISEASE TRANSMISSION
 PPE
 HANDWASHING FACILITIES
 SHARPS SAFETY
 LAUNDRY/HOUSEKEEPING
 BLOOD/BODY FLUID SPILLS
 EXPOSURES
 REGULATED WASTE
 HAZARD COMMUNICATION
 RECORDKEEPING

OTHER
OSHA REQUIREMENTS

NEW ENGINEERING REQUREMENTS
TO AGGRESSIVELY MOVE TOWARDS
THE USE OF NEEDLESS IV SYSTEMS
AND PROTECTED NEEDLE DEVICES.
 POST-EXPOSURE EVALUATION
INCORPORATES CDC’S GUIDELINES
ON POST-EXPOSURE EVALUATION
AND FOLLOW-UP FOR HIV, HEP. B,
HEP. C VIRUS.
OSHA REQUIREMENTS

REGULATED MEDICAL WASTE
CONTAINERS MUST BE LABELED
WITH THE BIOHAZARD SYMBOL TO
WARN EMPLOYEES WHO MAY HAVE
CONTACT WITH THE CONTAINERS
OF THE POTENTIAL HAZARD POSED
BY THEIR CONTENTS.
OSHA REQUIREMENTS

REQUIRES EFFECTIVE TRAINING
AND EDUCATION FOR EMPLOYEES
WHENEVER SAFER DEVICES ARE
IMPLEMENTED.
OSHA REQUIREMENTS

EMPLOYEES MUST BE TRAINED IN
HOW TO REMOVE A BLOOD
CONTAMINATED PULL-OVER SCRUB
TOP WITHOUT ALLOWING SKIN
CONTACT.
 HAND TO HAND TRANSFER OF
SHARPS SHOULD BE ELIMINATED
WHENEVER POSSIBLE.
OSHA REQUIREMENTS

ANNUAL REVIEW OF EXPOSURE
CONTROL PLAN TO ENSURE THAT THE
PLAN REFLECTS CONSIDERATION AND
USE OF COMMERICALLY AVAILABLE
SAFER MEDICAL DEVICES.
 EMPLOYER MUST MONITOR
ENGINEERING CONTROLS TO ENSURE
THEIR EFFECTIVENESS.
EXPOSURE DETERMINATION

TASK/CATEGORY I: Employees/students
will perform tasks/duties that will put them
at risk for exposure to blood and other
potentially infectious materials, therefore,
Universal/Standard Precautions required.
 TASK/CATEGORY II: Employees/students
will perform tasks/duties that normally do
not put them at risk but they could be asked
to perform tasks/duties that would put them
at risk, therefore, Universal/Standard
Precautions required.
EXPOSURE DETERMINATION

TASK/CATEGORY III:
Employees/students will perform
tasks/duties that will not put them at risk
for exposure to blood and other potentially
infectious materials, therefore,
Universal/Standard Precautions are not
required.
BIOHAZARD WARNING
COMMUNICATION
PERSONAL PROTECTIVE
EQUIPMENT (PPE) AND
OTHER REQUIREMENTS
MASK
GLOVES
EYE
OUTER
PROTECTION GARMENT
HEAD & CPR
NIOSH-N95
DEVICES APPROVED
SHOE
RESPIRATOR
COVERS
FOR TB
MEANS
FOR
HAND
WASHING
UNIVERSAL PRECAUTIONS
–VSSTANDARD PRECAUTIONS

OSHA = UNIVERSAL PRECAUTIONS

CDC = STANDARD PRECAUTIONS
OSHA’S UNIVERSAL
PRECAUTIONS APPLY TO:

BLOOD
 SEMEN/VAGINAL SECRETIONS
 CEREBROSPINAL FLUID
 SYNOVIAL FLUID
 AMNIOTIC FLUID
 PERICARDIAL FLUID
 PERITONEAL FLUID
OSHA’S UNIVERSAL
PRECAUTIONS APPLY TO:

INFECTED BREAST MILK
 ANY BODY FLUID WITH VISIBLE
BLOOD
 ANY UNIDENTIFIABLE BODY FLUID
 SALIVA (ALL DENTAL PROCEDURES)
 UNFIXED TISSUE/ORGANS
 CULTURES: HIV/HEP. INFECTED
OSHA’S UNIVERSAL
PRECAUTIONS APPLY TO:

BLOOD, ORGANS, TISSUES FROM
EXPERIMENTAL ANIMALS INFECTED
WITH HIV/HEP.
UNLESS BLOOD IS PRESENT
OSHA’S UNIVERSAL
PRECAUTIONS DO NOT APPLY
TO:

FECES
 NASAL SECRETIONS
 SPUTUM
 SWEAT
 TEARS
 URINE
 VOMITUS
CDC’S STANDARD
PRECAUTIONS APPLY TO:

ALL BODY FLUIDS WHETHER THERE IS
VISIBLE BLOOD OR NOT.
 THE ONLY EXCEPTION IS SWEAT:
SWEAT IS THE ONLY BODY FLUID NOT
CONSIDERED INFECTIOUS.
 STANDARD PRECAUTIONS IS THE
COMBINATION OF UNIVERSAL
PRECAUTIONS AND BODY SUBSTANCE
ISOLATION AND ARE STRICTER THAN
OSHA’S REQUIREMENT.
SHARPS SAFETY

EVALUATION AND USE OF SAFER
SHARPS DEVICES REQUIRED BY
OSHA.
 MUST BE PART OF THE EXPOSURE
CONTROL PLAN.
 IF NEEDLES MUST BE RECAPPED
USE ONE-HANDED SCOOP METHOD
OR RECAPPING SAFETY DEVICE.
SHARPS SAFETY

EVALUATION AND USE OF SAFER
SHARPS DEVICES
 FOR DENTAL:THE DENTIST SHOULD
RECAP AND RELOAD CONTAMINATED
SYRINGES
 IF OFFICE USES SAFETY NEEDLES
STUDENT SHOULD RECEIVE TRAINING
AND INSTRUCTIONS PRIOR TO USE
 SHOULD A SHARPS INJURY OCCUR A
SEPARATE SHARPS INJURY REPORT
FORM MUST BE FILLED OUT
CDC’S TRANSMISSION
BASED PRECAUTIONS
CDC’S TRANSMISSION
BASED PRECAUTIONS

AIRBORNE-NIOSH APPROVED
RESPIRATOR/HEPA MASK REQUIRED
(E.G. TB/SARS PATIENTS)
 AIRBORNE (ALL OTHER PATIENTS
WITH AIRBORNE TRANSMITTED
DISEASES): SURGICAL MASK
REQUIRED
CDC’S TRANSMISSION
BASED PRECAUTIONS

DROPLET PRECAUTIONS: SPREAD
THROUGH AIR WITHIN 3 FEET OF
SOURCE. REQUIRES SURGICAL
FACE MASK.
CDC’S TRANSMISSION
BASED PRECAUTIONS

CONTACT PRECAUTIONS: REQUIRES
PPE (E.G. GLOVES & GOWNS)
 OTHER TRANSMISSION
PRECAUTIONS AS ESTABLISHED BY
FACILITY:
(E.G. IMMUNOCOMPROMISED
PRECAUTIONS)
RECORDKEEPING

TRAINING RECORDS: MUST BE KEPT
FOR 3 YEARS FROM DATE OF
TRAINING.
 MEDICAL RECORDS: MUST BE KEPT
FOR LENGTH OF EMPLOYMENT PLUS
30 YEARS.
HAND HYGIENE
 THE
MOST COMMON MODE OF
TRANSMISSION OF PATHOGENS IS VIA
THE HANDS
 DO NOT “TOP-OFF” PARTIALLY EMPTY
DISPENSERS
 DO NOT USE PRODUCT BEYOND
EXPIRATION DATE
 DO NOT WEAR HAND/ARM JEWELRY
 DO NOT WEAR ARTIFICIAL NAILS/NAIL
POLISH
FINGERNAILS
 Natural
nail tips should be kept to ¼
inch in length
 Artificial
nails should not be worn when
having direct contact with high-risk
patients
Guideline for Hand Hygiene in Health-care Settings. MMWR 2002; vol. 51, no.
RR-16.
HAND HYGIENE DEFINITIONS

HAND HYGIENE
– Performing handwashing, antiseptic handwash,
alcohol-based handrub, surgical hand
hygiene/antisepsis
 HANDWASHING
– Washing hands with plain soap and water
 ANTISEPTIC HANDWASH
– Washing hands with water and soap or other
detergents containing an antiseptic agent
Guideline for Hand Hygiene in Health-care Settings. MMWR 2002; vol. 51, no.
RR-16.
HAND HYGIENE DEFINITIONS
 ALCOHOL-BASED HANDRUB
– Rubbing hands with an alcohol-containing
preparation
 SURGICAL HAND HYGIENE/ANTISEPSIS
– Handwashing or using an alcohol-based
handrub before operations by surgical
personnel
Guideline for Hand Hygiene in Health-care Settings. MMWR 2002; vol. 51, no.
RR-16.
INDICATIONS FOR HAND
HYGIENE
 When
hands are visibly dirty, contaminated,
or soiled, wash with
non-antimicrobial or antimicrobial soap and
water.
 If
hands are not visibly soiled, use an alcoholbased handrub for routinely decontaminating
hands.
Guideline for Hand Hygiene in Health-care Settings. MMWR 2002; vol. 51, no. RR-16.
RECOMMENDED HAND
HYGIENE TECHNIQUE
 HANDRUBS
– Apply to palm of one hand, rub hands together covering
all surfaces of hands and fingers until dry
– Volume: based on manufacturer recommendations
 HANDWASHING
– Wet hands with water, apply soap, rub hands and fingers
together for at least 15-20 seconds
– Rinse and dry with disposable towel
– Use towel to turn off faucet
Guideline for Hand Hygiene in Health-care Settings. MMWR 2002; vol. 51, no. RR-16.
RECOMMENDED SURGICAL
HAND HYGIENE TECHNIQUE

Use either an antimicrobial soap or alcohol-based
handrub

Antimicrobial soap: scrub hands, fingers, and
forearms for length of time (2-6 min.) recommended by
manufacturer

Alcohol-based handrub: Follow manufacturer’s
recommendations. Before applying, pre-wash hands
and forearms with antimicrobial soap followed by an
alcohol-based surgical hand-scrub product with
persistent activity.
Guideline for Hand Hygiene in Health-care Settings. MMWR 2002; vol. 51, no. RR-16.
UNRESOLVED ISSUES
 Routine
use of nonalcohol-based
handrubs
 Wearing
rings in healthcare settings
Guideline for Hand Hygiene in Health-care Settings. MMWR 2002; vol. 51, no.
RR-16.
ALCOHOL AND FLAMMABILITY
 Alcohols
are flammable
 Alcohol-based handrubs
should be stored
away from high temperatures or flames.
FIRE CODES APPLY
 U.S.:
one report of a nurse’s hands burned
(static electricity)
 U.S.:
one report of flash fire
 Application is
key: Let It Dry!
Guideline for Hand Hygiene in Health-care Settings. MMWR 2002; vol. 51, no. RR-16.
ALCOHOL-BASE HANDRUBS
 Require
less time
 More
effective for standard
handwashing than soap
 More
accessible than sinks
 Reduce
bacterial counts on hands
 Improve
skin condition
Guideline for Hand Hygiene in Health-care Settings. MMWR 2002; vol. 51, no.
RR-16.
ALCOHOL-BASE HANDRUBS
 CANNOT
BE USED IF HANDS ARE
VISIBLY SOILED
 EMOLLIENTS
MAY BUILD-UP
(SOME RECOMMEND AFTER 10
HANDWASHINGS WITH ALCOHOL
–BASED HANDRUBS THAT HANDS
SHOULD BE WASHED WITH
ANTIMICROBIAL SOAP)
Guideline for Hand Hygiene in Health-care Settings. MMWR 2002; vol. 51, no.
RR-16.
LATEX GLOVES: REMINDERS

NATURAL RUBBER LATEX CONTAINS OVER
260 PLANT-BASED PROTEINS (1 DOZEN ARE
ALLERGENIC)
 OVER 200 CHEMICALS ARE ADDED TO NRL
AND SYNTHETIC RUBBER GLOVES
 OTHER CHEMICALS MAY PERMEATE
GLOVES (E.G. GLUTARALDEHYDE, BONDING
AGENTS, RESINS)
 LOW-PROTEIN NRL GLOVES ARE NOT OK
FOR USE BY HEALTHCARE WORKERS
ALLERGIC TO NRL AS THRESHOLDS ARE
NOT YET WELL DEFINED
CPCC STUDENT MANAGEMENT
OF AN EXPOSURE INCIDENT
FIRST AID
FIRST AID MEASURES






SCRUB FOR MINIMUM OF 5 –10 MINUTES
APPLY ANTISEPTIC IF APPROPRIATE
OBTAIN OTHER FIRST AID IF NECESSARY
(e.g. Td booster, sutures, etc.)
EYES AND MUCOUS MEMBRANES MUST BE
FLUSHED WITH PLENTY OF RUNNING
WATER 5-10 MINUTES
IMMEDIATELY REPORT INCIDENT
FILL-OUT FORMS (CPCC MUST RECEIVE A
COPY OF THE INCIDENT REPORT)
CPCC STUDENT REPORTING

IMMEDIATELY REPORT EXPOSURE TO
THE AFFILIATING FACILITY AND CPCC’S
CLINICAL SUPERVISIOR
 REPORT EXPOSURE TO PROGRAM CHAIR;
DIVISION DIRECTOR; CPCC’S HEALTH &
SAFETY OFFICER (Bob Patterson 704-330-5492 or
704-400-9951)
CPCC INCIDENT REPORT

FOLLOW WRITTEN INSTRUCTIONS FOR
COMPLETING THE INCIDENT REPORT PACKET
 SUPPLY NECESSARY GENERAL INFORMATION
 GIVE DETAILED DESCRIPTION OF INCIDENT
 COMPLETE SHARPS INJURY FORM IF APPLICABLE
 SUMMARY OF ACTION TAKEN
 STUDENT CONSENT/DECLINATION FORMS
 SOURCE PATIENT INFORMATION
 SOURCE PATIENT CONSENT FORM
 NOTIFY CPCC’S HEALTH & SAFETY OFFICE AT:
704-330-5492/400-9951 (BOB PATTERSON)
SHARPS INJURY REPORT

CASE REPORT NUMBER
 DATE OF INCIDENT
 DIVISION AND PROGRAM NAME
 TYPE AND BRAND OF DEVICE USED
 LOCATE OF FACILITY
 COMMENTS/EXPLANATION OF
HOW INCIDENT OCCURRED
 SUMMARY OF ACTION TAKEN
POST-EXPOSURE EVALUATION
AND FOLLOW-UP: STUDENT
$$$ EXPENSES $$$
OSHA DOES NOT CONSIDER
STUDENTS EMPLOYEES. CPCC AND
CLINICAL SITES/FACILITIES ARE
NOT RESPONSIBLE FOR THE
EXPENSES ASSOCIATIATED WITH
EXPOSURE INCIDENTS. STUDENTS
MUST OBTAIN HEALTH INSURANCE.
POST-EXPOSURE EVALUATION
AND FOLLOW-UP: STUDENT

IF A STUDENT SHOULD EXPERIENCE A
HIGH-RISK EXPOSURE, IT IS
IMPORTANT TO SEEK MEDICAL CARE
WITHIN ONE HOUR OF THE INCIDENT.
THERE IS A “WINDOW OF
OPPORTUNITY” THAT MUST
BE MET FOR POST-EXPSOURE
MEDICATION TO BE THE MOST
EFFECTIVE.
POST-EXPOSURE EVALUATION
AND FOLLOW-UP: STUDENT

IMMEDIATELY CALL PRESBYTERIAN
URGENT CARE TO NOTIFY THE STAFF
OF THE INCIDENT AND ARRANGE FOR
FOLLOW-UP WITHIN 1-2 HOURS OF
THE INCIDENT (NO LATER THAN 24
HOURS) 704-316-1050
 BRING COPY OF INCIDENT REPORT
CPCC EXPOSURE MANAGEMENT
PROVIDER:

PRESBYTERIAN URGENT CARE
1918 RANDLOPH ROAD
CHARLOTTE, NC
704-316-1050
OPEN 7 DAYS A WEEK 8AM TO 8PM
CONTACT PERSON: SHERRI OLIVERKIRTON; *ROSA OMER
IDENTIFY SELF AS CPCC STUDENT IN
HEALTH PROGRAM
 MUST TAKE EXPOSURE INCIDENT REPORT
POST-EXPOSURE EVALUATION
AND FOLLOW-UP: STUDENT

AFTER BASELINE TESTING:
FOLLOW-UP TESTING TAKES PLACE
AT 6 WEEKS, 12 WEEKS (3 MONTHS),
AND 6 MONTHS POST-EXPOSURE
 FOLLOW U.S. PUBLIC HEALTH
SERVICE’S RECOMMENDATIONS
FOR POST-EXPOSURE PROPHYLAXIS
POST-EXPOSURE EVALUATION
AND FOLLOW-UP

ALL FEDERAL AND STATE LAWS APPLY
 THE STUDENT AND SOURCE PATIENT
MUST RECEIVE PRE AND POST TEST
COUNSELING
 TESTING AT BASELINE INCLULDES
HIV; HEP. B; HEP. C (OTHER TEST IF
INDICATED)
 SOURCE PATIENT ONLY TESTED ONCE
SOURCE PATIENT

SOURCE PATIENT MUST BE TESTED
ACCORDING TO NORTH CAROLINA
STATE LAW
 FACILITY MUST INFORM PATIENT
 MUST BE TESTED FOR HEP. B, C, HIV
(Other testing as indicated)
 TESTING IS THROUGH RANDOLPH
URGENT CARE
VII. NORTH CAROLINA STATE
STATUES:
15A NCAC 19A.0202(4) Control
Measures HIV
15A NCAC 19A.0203(b)(3) Control
Measures Hepatitis
When a health care worker sustains an exposure
incident (in North Carolina), the source patient must
be tested with or without written consent. If a person
refuses to comply with the rules/requirement for
testing, the local health director, who is charged with
ensuring compliance with the rules shall be
notified. The local health director may be able to gain
compliance through discussion or by an official
public health ordinance by obtaining a court
order. Blood should not be forcibly obtain. However,
if blood is stored in a laboratory, it may be used if the
patient cannot be located or does not comply with the
public health ordinance. A person who violates a
provision of these laws or the rules adopted by
the Health Commission or a local board of
health shall be guilty of a misdemeanor.
HEALTHCARE PROVIDER’S
WRITTEN OPINION

MUST BE RECEIVED WITHIN 15 DAYS
 MUST BE LIMITED TO IT’S CONTENTS
BLOODBORNE DISEASES
 HIV/AIDS
 HEPATITIS
B
 HEPATITIS C
HIV/AIDS


HIV is spread by sexual contact with an infected person, by sharing
needles and/or syringes (primarily for drug injection) with someone who
is infected, or, less commonly (and now very rarely in countries where
blood is screened for HIV antibodies), through transfusions of infected
blood or blood clotting factors. Babies born to HIV-infected women may
become infected before or during birth or through breast-feeding after
birth.
In the health care setting, workers have been infected with HIV after
being stuck with needles containing HIV-infected blood or, less
frequently, after infected blood gets into a worker’s open cut or a mucous
membrane (for example, the eyes or inside of the nose). There has been
only one instance of patients being infected by a health care worker in the
United States; this involved HIV transmission from one infected dentist to
six patients. Investigations have been completed involving more than
22,000 patients of 63 HIV-infected physicians, surgeons, and dentists, and
no other cases of this type of transmission have been identified in the
United States.
HIV/AIDS
As of December 2001, occupational exposure
to HIV has resulted in 57 documented cases
of HIV seroconversion among healthcare
personnel (HCP) in the United States. To
prevent transmission of HIV to healthcare
personnel in the workplace, the Centers for
Disease Control and Prevention (CDC) offers
recommendations.
OCCUPATIONAL ACQUIRED
HIV FROM CDC 2001
Occupation
Documented
0
24
26
Possible
6
35
17
Physician, non-surgical
6
12
Lab Tech, non-clinical
3
-
Other
Total
8
57
74
138
Dental (3 dentist, 1 surgeon, 2 assistants)
Nurse
Lab Tech, clinical
HIV/AIDS PREVENTION FOR HCW
Healthcare personnel should assume that the blood
and other body fluids from all patients are
potentially infectious. They should therefore follow
infection control precautions at all times. These
precautions include:
 The routine use of barriers (such as gloves and/or
goggles) when anticipating contact with blood or
body fluids
 Washing hands and other skin surfaces immediately
after contact with blood or body fluids, and
 The careful handling and disposing of sharp
instruments during and after use.
HIV/AIDS PREVENTION FOR HCW

Safety devices have been developed to help prevent needlestick injuries. If used properly, these types of devices may
reduce the risk of exposure to HIV. Many percutaneous
injuries are related to sharps disposal. Strategies for safer
disposal, including safer design of disposal containers and
placement of containers, are being developed.

Although the most important strategy for reducing the risk
of occupational HIV transmission is to prevent occupational
exposures, plans for postexposure management of health care
personnel should be in place. CDC has issued guidelines for
the management of HCP exposures to HIV and
recommendations for postexposure prophylaxis (PEP).
HEPATITIS B

Concentration of Hepatitis B Virus in Various Body Fluids
High:
blood; serum; wound exudates
Moderate:
semen; vaginal fluid; saliva
Low/Not Detectable: urine; feces; sweat; tears; breastmilk
HBV is transmitted by percutaneous or permucosal exposure to infectious
blood or body fluids from persons who have either acute or chronic HBV
infection. The highest concentrations of virus are in blood and serous fluids;
lower concentrations are found in semen, vaginal fluid, and saliva. Therefore,
blood exposure and sex contact are relatively efficient modes of transmission.
Saliva can be a vehicle of transmission through bites; however, transmission
has not been documented to occur as a result of other types of exposure to
saliva, including kissing. HBsAg has also been detected in low concentrations
in other body fluids, including tears, sweat, urine, feces, breast milk,
cerebrospinal fluid, and synovial fluid; however, these fluids have not been
associated with transmission.
HEPATITIS B



Hepatitis B Virus Modes of Transmission:
Sexual
Parenteral
Perinatal
In the United States, the most important route of HBV transmission
is by sex contact, either heterosexual or homosexual, with an infected person.
Direct parenteral inoculation of HBV by needles during injecting drug use is
also an important mode of transmission. Transmission of HBV may also
occur by other percutaneous exposures, including tattooing, ear piercing, and
acupuncture, and by needlesticks or other injuries from sharp instruments
sustained by medical personnel; however, these exposures account for only a
small proportion of reported cases in the United States. In addition,
transmission can occur perinatally from a chronically infected mother to her
infant, most commonly by contact of maternal blood
to the infant’s mucous membranes at the time of delivery.
HEPATITIS B VACCINE SAFETY
•Medical, scientific and public health communities
strongly endorse using hepatitis B vaccine as a safe
and effective way to prevent disease and death.
•Scientific data show that hepatitis B vaccines are
very safe for infants, children, and adults.
•There is no confirmed evidence which indicates
that hepatitis B vaccine can cause chronic
illnesses.
•To assure a high standard of safety with vaccines,
several federal agencies continually assess and
research possible or potential health effects that
could be associated with vaccines.
HEPATITIS B VACCINE
•Vaccination Schedule: Initial first dose; 1 month
later second dose; 6 months from first dose third
dose.
•Post-vaccination testing should be completed 1-2
months after the third vaccine dose for results to be
meaningful. A protective antibody response is 10 or
more milliinternational units (>=10mIU/mL).
HEPATITIS C
Exposures Known to be Associated With HCV
Infection in the United States:
•Injecting drug use
•Transfusion, transplant from infected donor
•Occupational exposure to blood
- Mostly needle sticks
•Iatrogenic (unsafe injections)
•Birth to HCV-infected mother
•Sex with infected partner
- Multiple sex partners
HEPATITIS C
Occupational Transmission of HCV
•Inefficient by occupational exposures
•Average incidence 1.8% following needle stick from
HCV-positive source
•Associated with hollow-bore needles
•Case reports of transmission from blood splash to eye;
one from exposure to non-intact skin
•Prevalence 1-2% among health care workers
•Lower than adults in the general population
•10 times lower than for HBV infection
HEPATITIS C
HCW to Patient Transmission of HCV
•Rare
•In U.S., none related to performing invasive
procedures
•Most appear related to HCW substance abuse
•Reuse of needles or sharing narcotics used for
self-injection
•No restrictions routinely recommended for
HCV-infected HCWs
HEPATITIS C
HCV Testing Routinely Recommended Based On Increased Risk
For Infection:
•Ever injected illegal drugs
•Received clotting factors made before 1987
•Received blood/organs before July 1992
•Ever on chronic hemodialysis
•Evidence of liver disease
Based On Need For Exposure Management:
•Healthcare, emergency, public safety workers after needle
stick/mucosal exposures to HCV-positive blood
•Children born to HCV-positive women
HEPATITIS C
Postexposure Management for HCV:
•IG, antivirals not recommended for prophylaxis
•Follow-up after needlesticks, sharps, or mucosal
exposures to HCV-positive blood
•Test source for anti-HCV
•Test worker
•Confirm all anti-HCV results with RIBA
•Refer infected worker to specialist for medical
evaluation and management
HEPATITIS C
AIRBORNE/DROPLET DISEASES

TUBERCULOSIS: AIRBORNE

PANDEMIC INFLUENZA
TUBERCULOSIS
TB, or tuberculosis, is a disease
caused by bacteria called
Mycobacterium tuberculosis. The
bacteria can attack any part of your
body, but they usually attack the
lungs. TB disease was once the
leading cause of death in the United
States.
TUBERCULOSIS

TB is spread through the air from one person to
another. The bacteria are put into the air when a
person with TB disease of the lungs or throat
coughs or sneezes. People nearby may breathe
in these bacteria and become infected.

People who are infected with latent TB do not feel
sick, do not have any symptoms, and cannot
spread TB. But they may develop TB disease at
some time in the future. People with TB disease
can be treated and cured if they seek medical
help. Even better, people who have latent TB
infection but are not yet sick can take medicine
so that they will never develop TB disease.
TUBERCULOSIS

When a person breathes in TB bacteria,
the bacteria can settle in the lungs and
begin to grow. From there, they can move
through the blood to other parts of the
body, such as the kidney, spine, and
brain.

TB in the lungs or throat can be infectious.
This means that the bacteria can be
spread to other people. TB in other parts
of the body, such as the kidney or spine,
is usually not infectious.
TUBERCULOSIS
In most people who breathe in TB bacteria and become infected,
the body is able to fight the bacteria to stop them from growing.
The bacteria become inactive, but they remain alive in the body
and can become active later. This is called latent TB infection.
People with latent TB infection:

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Have no symptoms
Don't feel sick
Can't spread TB to others
Usually have a positive skin test reaction
Can develop TB disease later in life if they do not receive
treatment for latent TB infection
Many people who have latent TB infection never develop TB
disease. In these people, the TB bacteria remain inactive for a
lifetime without causing disease. But in other people, especially
people who have weak immune systems, the bacteria become
active and cause TB disease.
TUBERCULOSIS
TB bacteria become active if the immune
system can't stop them from growing. The
active bacteria begin to multiply in the
body and cause TB disease. Some people
develop TB disease soon after becoming
infected, before their immune system can
fight the TB bacteria. Other people may
get sick later, when their immune system
becomes weak for some reason.
TUBERCULOSIS
Symptoms of TB depend on where in the
body the TB bacteria are growing. TB
bacteria usually grow in the lungs. TB in the
lungs may cause:

A bad cough that lasts longer than 2 weeks
 Pain in the chest
 Coughing up blood or sputum (phlegm from
deep inside the lungs)
TUBERCULOSIS
Other symptoms of TB disease are:

Weakness Or Fatigue
 Weight Loss
 No Appetite
 Chills
 Fever
 Sweating At Night
TUBERCULOSIS
Latent TB Infection:
Have no symptoms
Do not feel sick
Cannot spread TB to
others
Usually have a
positive skin test
Chest x-ray and
sputum test normal
TB Disease SYMPTOMS INCLUDE:
A bad cough that lasts longer than
2 weeks
Pain in the chest
Coughing up blood or sputum
Weakness or fatigue
Weight loss
No appetite
Chills
Fever
Sweating at night
May spread TB to others
Usually have a positive skin test
May have abnormal chest x-ray,
And/or positive sputum smear or
Culture
CDC’S HAND HYGIENE
GUIDELINES AND OTHER
WEBSITES

http://www.cdc.gov/handhygiene/materials.htm
 http://www.cdc.gov
 http://www.cdc.gov/ncidod/hip/enviro/guide.htm
CDC’S INFLUENZA
PANDEMIC OPERATION
PLAN

http://www.cdc.gov/flu/pandemic/cdcplan.htm
NORTH CAROLINA’S
INFLUENZA PANDEMIC
OPERATION PLAN

http://www.pandemicflu.gov/plan/states/northca
rolina.html
INFLUENZA PANDEMIC

All personal protective equipment cleared by FDA
must be able to block the passage of small particles the
size of most infectious materials. FDA is not aware of
any studies that specifically test PPE with any influenza
virus, and no such data have been submitted to FDA by
manufacturers. Thus neither FDA, nor a
manufacturer, knows to what extent PPE will protect
you against bird flu. Keep in mind that other infection
control practices, such as hand-washing, isolating sick
patients, and using appropriate coughing etiquette, are
also important to minimize your risk of infection.
INFLUENZA PANDEMIC





CDC (Centers for Disease Control and Prevention), not
FDA, makes recommendations for infection control
practices, including recommendations specific to
influenza.
As part of its overall infection control
recommendations, CDC recommends that healthcare
workers wear the following personal protective
equipment during the care of a patient with suspected
or confirmed flu (influenza):
surgical masks
medical gloves
surgical gowns
INFLUENZA PANDEMIC
WHAT YOU SHOULD KNOW
FROM THE CDC

For more information about CDC’s recommendations
for controlling the spread of the flu
http://www.cdc.gov/flu
CDC’s NEW RECOMMENDATION
Flu vaccine should be administered to all people age
6 months and older unless medically contraindicated
All healthcare workers should be vaccinated unless
medically contraindicated, some healthcare facilities
may make this mandatory
Must develop new way of producing flu vaccine that will
be faster than the current use of culturing in eggs
CONTINUED CONCERNS: H5N1
H5H1 is a highly pathogenic Avian Influenza virus
It is considered an Avian Disease Although there is some
evidence of limited human-to-human transmission
Global effort is underway to control or eradicate it in
poultry and prevent human exposure in an attempt to
avoid a deadly pandemic
Ducks play a role in transmitting the virus to other birds
and has been found in some pigs, cats, dogs
(in Asia and other foreign countries)
The fear is that highly pathogenic H5N1 mutation would
result in a mortality rate higher than H1N1
Mortality rates in human cases are 60%
These cases have been the result of close contact with
infected poultry and wild birds
Efforts to produce pre-pandemic vaccine for humans that
would be effective against avian influenza A (H5N1)
viruses are ongoing. However, no H5N1 vaccines are
currently available for human use.
CDC WEBSITES
Interim Guidance For IFC With H1N1 Virus In Healthcare Settings:
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5823a2.htm
Additional Guidance For Laboratory Workers:
http://www.cdc.gov/h1n1flu/guidance_ems.htm
*SPECIAL NOTE: One should monitor CDC’s H1 N1 website daily
for updates as guidance from the CDC may change rapidly
http://www.cdc.gov/flu
CDC WEBSITES

CDC Home page: http://www.cdc.gov
 CDC Division of Health-Care Quality:
http://www.cdc.gov/ncidod/hip
 CDC Morbidity and Mortality Weekly:
http://www.cdc.gov/mmwr
 CDC Recommendations/Guidelines:
http://www.phppo.cdc.gov/cdcRecommends/Adv
SearchV.asp
 CDC’s National institute for Occupational Safety and Health:
http://www.cdc.gov/niosh/homepage.html
 CDC’S Hand Hygiene Guidelines:
http://www.cdc.gov/handhygiene/materials.htm
 CDC’s Environmental Guidelines:
http://www.cdc.gov/ncidod/hip/enviro/guide.htm
THE END-THANK YOU!
Contact Your Program Chair, Clinical Faculty Supervisor,
Division Director, Or CPCC’s Health & Safety Office Should You
Have Any Questions Or What To Do Should You Experience An
Exposure Incident.