Bloodborne Pathogen Training 2011

1. Bloodborne Pathogen Training2011 Advocate Condell Medical Center Condell EMS System Prepared by: Sharon Hopkins, RN, BSN, EMT-P

2. Objectives • Upon successful completion of this module the EMS provider will be able to: • Define the mission of OSHA • Describe what the OSHA Standard was designed for • Describe the training program for bloodborne pathogens • Define bloodborne pathogen • Provide an example of potential bloodborne pathogens • Define the term standard precautions

3. Objective cont’d • Define the term body substance isolation (BSI) • List examples of engineering control • List examples of a work place control • List PPE products available to use • Describe when PPE’s should be used • Recognize signs or labels that indicate the presence of a bloodborne pathogen hazard • Describe components of housekeeping and when they are performed

4. Objective cont’d • Describe necessary recordkeeping related to bloodborne pathogens • Define an exposure incident • Review the CMC EMS System Operating Guideline (SOG) policy for infection control and exposure • Describe the “Notification of Significant Exposure” form and how to complete • List routes of exposure to potential BBP

5. Objective cont’d • List transmission routes of bloodborne pathogens in the workplace • List factors affecting disease transmission • Describe the phases of the infectious process • Discuss definition, incubation period, transmission route, signs and symptoms, and PPE to use for a variety of infectious diseases • Successfully complete the post quiz with a score of 80% or better

6. What is OSHA? • A federal agency of the US Department of Labor • Created by Congress in 1971 under the Occupational Safety and Health Act • Mission: • To prevent work-related injuries, illnesses, and death

7. What is NIOSH? • National Institute for Occupational Safety and Health (NIOSH) created by the OSH Act • Functions as a research agency focusing on occupational health and safety

8. What is “The Standard”? • In 1990, OSHA issued a standard (Bloodborne Pathogen Standard) designed to prevent healthcare workers and others from being exposed to bloodborne pathogens such as hepatitis B and HIV

9. Who does the Standard cover? All employees who could "reasonably anticipate" • contact with blood • contact with other potentially infectious materials while performing their job duties

10. Compliance with the Standard • The Bloodborne Pathogen Standard specifies methods that are to be used to minimize the transmission of bloodborne pathogens in the work place. • These methods include: • Standard Precautions • Engineering and Work Practice Controls • Personal Protective Equipment (PPE) • Appropriate Housekeeping Measures

11. Training • Employees must be provided information • When first assigned a task with potential exposure • Repeated annually • During work hours • When new tasks or procedures are added • New exposure risk created must be addressed • See Notes section for details

12. Definition Bloodborne Pathogen • Microorganisms that: • are present in human blood • can infect and cause disease in people who are exposed to blood containing the pathogen • can be transmitted through contact with contaminated blood and body fluids

13. Examples Bloodborne Pathogens • Human Immunodeficiency Virus (HIV) • Hepatitis B (HBV) • Hepatitis C (HCV) • Non A, Non B Hepatitis • Syphilis • Malaria • Babesiosis • Brucellosis

14. Examples cont’d • Leptospirosis • Arboviral infections • Relapsing fever • Creutzfeld-Jakob disease • Human T-lymphotrophic Virus Type 1 • Viral hemorrhagic fever

15. Standard Precautions • A strategy designed to reduce the risk of transmission of microorganisms from known and unknown sources You can’t tell if material is infectious or not so treat all materials as if they are infectious! • Take precautions with every patient exposure

16. Controls in Place • The objective of engineering controls and work practice controls is the same: • to reduce or minimize employee exposure to bloodborne pathogens

17. Engineering & Work Practice Controls • Differences • One control isolates or removes the hazard from the workplace • Engineering control • One reduces the risk of exposure by altering how tasks are performed • Work practice control

18. Engineering Controls • Examples: • labeled sharps disposal containers • self-sheathing needles • safer medical devices • sharps with engineered sharps injury protections and needleless systems • handwashing facilities • antiseptic hand cleanser • cleaning supplies and equipment

19. Work Practice Control • Examples: • Handwashing • Prohibiting recapping of needles by a two-handed technique • Handwashing • No eating, drinking, smoking in the ambulance • Handwashing • Disinfecting equipment and vehicle • Handwashing • Removing a soiled uniform • Handwashing

20. Handwashing • Simple • Effective practice • Prevents transfer of contamination from your hands to other areas of your body, to other persons, or to other surfaces you may contact later

21. Handwashing • As soon as possible following an occupational exposure to blood or other potentially infectious materials • After removal of gloves • Before and after every patient contact • After toileting • Before and after preparing food • Before and after eating or smoking • After coughing or sneezing into hands or blowing nose

22. Handwashing How-to Take off rings Turn on faucet Wet hands Apply soap Scrub your hands - minimum 15 seconds Rinse Dry hands Turn off faucet – use paper towel

23. Antiseptic Hand Cleaner • Antiseptic hand cleaners may be used as an appropriate hand washing practice IF: • Your gloves remained intact • You have had no occupational exposure to blood or other potentially infectious materials • Material can be left to air dry on your skin • Choose product with at least 60% alcohol

24. Did You Know? • Washing with soap and running water every time you remove your gloves is the recommended practice over hand sanitizers • Liquid soap is preferred • Bar soap can transfer microorganisms • Antimicrobial or plain soap? • Plain soap good enough for ordinary washing • Antimicrobial is preferred during patient care

25. Personal Protective Equipment - PPE • The type of protective equipment appropriate for your job or research varies with the task and the degree of exposure you anticipate

26. PPE – Eye Protection • Bloodborne pathogens can be transmitted through the mucous membranes of the eyes. • Use eye protection whenever there is a risk of splashing or vaporization of contaminated fluid • Airway control (ie: intubation, suctioning) • Cleaning up spills • Cleaning equipment

27. Mask and Face Shields • Masks and face shields provide additional protection for potential eye, nose, or mouth contamination • Used during tasks that may generate blood or other potentially infectious materials via: • Splashes • Spray • Spatter • Droplets

28. Protective Clothing • Appropriate protective clothing such as, but not limited to, gowns, aprons, lab coats, clinic jackets, or similar outer garments shall be worn in occupational exposure situations • Type and characteristics will depend upon the task and degree of exposure anticipated.

29. Employer Responsibilities • Issue PPE or make it readily accessible in the work area • Maintain, replace or dispose of any PPE at no cost to employees • Employer can provide the engineering controls • The employee needs to exercise the work practice controls for the process to be effective

30. Signs, Labels & Color Coding • Signs and labels in the workplace communicate bloodborne pathogen hazards to employees. • Warning label must include the universal biohazard symbol and the term "biohazard" in a color that contrasts with the fluorescent orange, orange-red background

31. Using Warning Labels • Warning labels must be affixed to containers of regulated waste, refrigerators and freezers containing blood or other potentially infectious material, and other containers used to store, transport, or ship blood or other potentially infectious materials. • Red bags or red containers can be substituted for labels.

32. Warning Labels • Contaminated equipment which is to be serviced or shipped must also have a warning label and a statement regarding which portions of the equipment remain contaminated.

33. Cleaning and Decontamination Duties • Review product labeling for any special directions/precautions • Wear appropriate PPE for task being performed • Remove all blood and debris from surface to be cleaned • Products can’t clean the surface if they can’t be in contact with the surface • Allow disinfectant to air dry • Leave surface wet 30 seconds for HIV disinfection • Leave surface wet 10 minutes for HBV disinfection

34. Clean Up Involving Blood or Body Fluids • Wear appropriate Personal Protective Equipment (PPE). • Carefully cover the spill with absorbent material, such as paper towels, to prevent splashing. • Decontaminate the area of the spill using an appropriate disinfectant, such as a solution of one part bleach to ten parts water. When pouring disinfectant over the area always pour gently and work from the edge of the spill towards the center to prevent the contamination from spreading out.

35. Clean Up of Spills cont’d • Wait 10 minutes to ensure adequate decontamination, and then carefully wipe up the spilled material. • Be very alert for broken glass or sharps in or around the spill. • Disinfect all mops and cleaning tools after the job is done. • Dispose of all contaminated materials appropriately. • Wash your hands thoroughly with soap and water immediately after the clean up is complete.

36. Housekeeping and Waste Disposal • Keeping the worksite clean and sanitary is a necessary part of controlling worker exposure to bloodborne pathogens. • Cleaning schedules and decontamination methods depend on: • type of surface to be cleaned • type of soil that is present • particular tasks or procedures that are being performed

37. Recordkeeping • Medical records must be kept for each employee with occupational exposure for the duration of employment plus 30 years, must be confidential and must include name and social security number; hepatitis B vaccination status (including dates); results of any examinations, medical testing and follow-up procedures; a copy of the healthcare professional's written opinion; and a copy of information provided to the healthcare professional.

38. Recordkeeping cont’d • Medical records must be made available to the subject employee, and anyone with written consent of the employee, but they are not to be available to the employer.

39. Recordkeeping cont’d • Training records must be maintained for three years and must include dates, contents of the training program or a summary, trainer's name and qualifications, names and job titles of all persons attending the sessions.

40. Exposure Incidents • An exposure incident is an event resulting from the performance of an employee's duties in which there has been: • A percutaneous injury involving a potentially contaminated needle or other sharp • A splash of blood or other potentially infectious materials to the eyes, mouth, or mucous membranes • Blood or other potentially infectious materials contacting broken skin

41. Potential Exposure • An occupational exposure should always be considered an urgent medical concern to ensure timely postexposure management and administration of hepatitis B immune globulin (HBIG), hepatitis B vaccine, and/or HIV post-exposure prophylaxis (PEP). • If you are injured or exposed, tell your supervisor immediately. Your supervisor is responsible for reporting your injury correctly.

42. Advocate CMC EMS System Policy • Notification of significant exposure is to be reported immediately to the receiving hospital • Complete “Notification of Significant Exposure” form • Leave in sealed envelope for EMS coordinator • The ED MD on duty will advise the appropriate medical follow-up or need for consultation with private physician

43. EMS System Policy cont’d • Follow-up fees responsibility of the provider • If ED care is rendered to the provider, they must sign-in as a patient in the ED • Guarantees proper documentation the incident and of care rendered

44. Notification of Significant Exposure Form • Fill in information in the 1st four columns as completely as possible • Check all means of exposure that apply • Provide information on the type and brand of device, if involved • Receiving hospitals in Illinois are required to notify ambulance providers if a patient has been diagnosed as actively contagious • Notification made within 72 hours of diagnosis

46. Early treatment can significantly reduce the chance of disease transmission!

47. Postexposure Prophylaxis • The U.S. Public Health Service (PHS) has published Guidelines for the Management of Occupational Exposures to HBV, HCV, and HIV and Recommendations for Postexposure Prophylaxis", which can be accessed at: http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5011a1.htm.

48. Microorganisms • Disease causing organisms • Microscopic in nature • Can be part of the normal flora or pathogenic (able to cause disease) • Bacteria • Viruses • Fungi • Protozoa • Parasites

49. Routes of Exposure • Bloodborne • HIV, HBV, HCV, syphilis • Airborne • TB, influenza, common cold, RSV, chickenpox • Droplet • Influenza, H1N1 flu, meningitis, measles, mumps, rubella, chickenpox (varicella) • Fecal-oral • HAV, food poisoning • Note: Multiple diseases could be airborne and/or droplet

50. Disease Transmission • Direct contact • Person to person • Physical transfer of microorganisms • Coughing, sneezing, kissing, sexual contact, contact with blood or body fluid