Infection Control/universal precautions/ bloodborne pathogens/HAZARDOUS MATERIALS

1. Infection Control/universal precautions/bloodborne pathogens/HAZARDOUS MATERIALS Infection Control for Health Care Workers

2. Objectives • What to do to prevent the spread of infection. • Proper hand washing • Review of standard, transmission-based precautions and OSHA’s Blood borne Pathogen standard • Review of Be Alert program, Cover your Cough, Employee Illness, Hepatitis, and TB programs. • Handling Hazardous Waste

3. OSHA • OSHA’s Hazardous Communication • To ensure that employers and employees know about work hazards and how to protect themselves so that the incidence of illnesses and injuries due to hazardous chemicals is reduced. • Hazardous Chemicals Must Include Labels which Indicate: • The identity of the chemical • Appropriate hazard warning • Name and address of the responsible party

4. Material Safety Data Sheet (MSDS) MSDSs are prepared by the chemical manufacturer or importer and describe: • Physical hazards, such as fire and explosion • Health hazards, such as signs of exposure • Routes of exposure • Precautions for safe handling and use • Emergency and first aid procedures • Control measures MSDS are readily accessible to all employees

5. What is Infection Control? Infection control is a term used that describes ways we can prevent the spread of infection.

6. How to Prevent the Spread of Infection • The most common health care associated infections and risks are: • Urinary tract infection • Respiratory Infections • Pressure ulcers • Many times these infections and ulcers are preventable by basic and simple interventions. Intervention Examples: • Ambulation • Cough/Deep Breathing • Turn/Re-positioning

7. Universal/Standard Precautions ALL BLOOD, BODY FLUIDS, EXCRETIONS AND SECRETIONS OF RESIDENTS, STAFF, AND VISITORS ARE TREATED AS POTENTIALLY HAZARDOUS. • The Center for Disease Control, recommends that all workers follow “Universal/Standard Precautions”. • Universal/Standard Precautions” is an approach to infection control, in which all human blood and body fluids are treated as if known to be infectious for HIV, HBV, HCV and other bloodborne pathogens, regardless of the perceived "low risk" status of a patient or patient population.

8. Standard Precautions

9. These precautions were intended to prevent occupational exposure to human blood or body fluids by utilizing: • Engineering controls – example: sharps containers, hand washing facilities, Biosafety cabinet and safer medical devices. • Work practice controls – example: hand washing, handling sharps, NO recapping needles, specimen handling. • Personal protective equipment –example: gloves, eyewear, lab coats, face shields, respirators.

10. Engineering Controls Minimize or eliminate employee risk by isolating or removing the hazards from the workplace. These controls include: • Sharps containers • Handwashing facilities • Biosafety cabinets • Safety medical devices • Needleless systems

11. Handling Sharps • Sharps containers shall be readily accessible in areas where sharps waste may be generated. • Needles shall not be bent, recapped, or removed, sheared or broken. The entire assembly must be disposed into a sharps container. • A mechanical device or using a one-handed technique may be used to recap or remove contaminated needles from disposable syringes when medically necessary. • Use tongs, a dustpan, or broom, to clean up broken glassware that may be contaminated. • Never handle contaminated broken glass with gloved or bare hands.

12. Work Practice Controls Wash hands: • Wash with adequate soap to lather up the hands completely and rinse them with water. • After removing gloves or other personal protective equipment. • Before and after every patient • After handling potentially infectious material, even if you have been wearing gloves. • Before eating, drinking, smoking, applying cosmetics, handling contact lenses or using the bathroom. • Waterless antiseptic hand cleansers or antiseptic towelettes must be available, if running water is not readily available. If cleanser or towelettes are used the employee must wash with soap and water as soon as feasibly possible.

13. HAND WASHINGTo be performed before and after caring for a patient, before and after eating, after coughing, sneezing into the hand and after using the bathroom. • Sanitizing gel is available in the facility and may be used if hands are not visibly soiled. • All employees should use the alcohol hand sanitizer after clocking in/out for work.

14. Personal Protective Equipment (PPE): PPE must protect employee’s street clothes, skin, eyes, and mucous membranes from coming in contact with blood or other potentially infectious materials. It is the supervisor’s responsibility to ensure that PPE, in the appropriate sizes, is readily accessible at the work site or is issued to employees free of charge. PPE may include: • Gloves • Lab coats, aprons or gowns • Eyewear • Face shields • Respirators

15. Personal Hygiene • Do not eat, drink, smoke, apply cosmetics, handle contact lenses in work areas where there is a reasonable likelihood of an occupational exposure. • Do not keep food and drinks in refrigerators, freezers, cabinets or on shelves, countertops or bench tops where blood or infectious materials may be present. • Do not put pencils, pens or other objects in your mouth where potentially infectious materials may be present. • Never mouth pipette. • Avoid petroleum-based lubricants (hand lotion) that may disintegrate latex gloves.

16. OSHA’s Bloodborne Pathogen Standard • Standard Precautions- to be used for all residents and staff and requires the use of PPE’s, engineering controls, specific workplace practices, Hep. B vaccines, employee health management and education. • Work Practice Requirements- used to reduce risk of occupational exposure. • Exposure Control Plan- contains the OSHA compliant policies and is found in the Policy and Procedure Manual.

17. What are Bloodborne Pathogens? • Bloodborne Pathogens are any pathogenic microorganisms that may be present in human blood or other potentially infectious materials (OPIM), which can cause disease in humans. • Pathogens of concern are the Hepatitis B (HBV) and C viruses (HCV), and the Human Immunodeficiency Virus (HIV). • OtherPathogenic microorganisms that can also cause diseases include: malaria, syphilis, babesiosis, brucellosis, leptospirosis, arboviral infections, relapsing fever, Creutzfeldt-Jakob disease, adult T-cell leukemia/lymphoma (caused by HTLV-I), HTLV-I associated myelopathy, diseases associated with HTLV-II, and viral hemorrhagic fever.

18. Who is at Risk? Anyone who handles blood, blood components, blood products or body fluids, including: • Health Care Workers • Nurses • Morticians • Technicians (Clinical) • Dentist • Physician Assistants • Ph.Ds • Researchers • Research Technicians • Custodial personnel • Animal handlers • Veterinarians Engineering Staff

19. How are Bloodborne Diseases Transmitted? • Most common cause, contaminated needle-stick injuries. • Blood or body fluid contamination of eye, mouth or mucous membranes. • Blood or body fluid contact with non-intact skin, e.g., cuts, dermatitis, skin damage, etc.

20. Hepatitis B (HBV) "Hepatitis" means "inflammation of the liver," and, as its name implies, Hepatitis is a virus that infects the liver. According to the Centers for Disease Control and Prevention (CDC), Hepatitis C Virus (HCV) infection is the most common chronic bloodborne infection in the United States. (MMWR: Recommendations for Prevention and Control of Hepatitis C Virus (HCV) Infection and HCV-Related Chronic Disease, October 16, 1998/Vol.47/No. RR-19.) Hepatitis B (HBV): • Hepatitis B initially causes inflammation of the liver, but it can lead to more serious conditions such as cirrhosis, liver cancer and death. • The Hepatitis B Virus is very durable, and it can survive in dried blood for up to seven days. • Many people who contract the disease will develop antibodies, which help them get over the infection and protect them from getting it again. For more information on Hepatitis B visit the following website: http://www.cdc.gov/ncidod/diseases/hepatitis/b/index.htm

21. HBV Vaccine: Pre-exposure vaccination is the most effective preventive measure. All healthcare workers should be vaccinated for HBV before contact with blood and body fluids. Vaccinations are offered, at no charge, to all employees who have a potential exposure to bloodborne pathogens. All employees who decline the Hepatitis B vaccination must sign the OSHA required waiver. If you have patient contact and would like to receive the Hepatitis B Vaccine, make the HR Department or your Supervisor aware of your request Hepatitis B vaccination is given in a series of three shots. The second shot is given one month after the first, and the third given six months after the initial dose.

22. Hepatitis C (HCV): • 80% of persons have no signs or symptoms. • HCV occurs when blood or body fluids from an infected person enters the body of a person who is not infected. • Blood transfusion accounted for a large proportion of HCV infections acquired prior to 1990, but is now rarely a source of new infection. • Injection drug use now accounts for 60% of new cases. Multiple sexual partners, occupational exposure, and perinatal exposure are risk factors that are thought to account for most of the remaining cases. • Deaths from chronic liver disease are <3%. • Leading indication for liver transplant.

23. Symptoms of HCV Infection • Most cases of acute HCV are asymptomatic. • Some patients have jaundice or symptoms of malaise, poor appetite, nausea, vomiting or abnormal pain. • A small portion of patients with acute HCV, 15-25%, appear to resolve their acute infection. • Most patients with HCV remain chronically infected, and some progress to cirrhosis of the liver or primary liver cancer.

24. Preventing HCV in Healthcare Workers • There is no vaccine for HCV. • HCV infection in healthcare workers is best prevented by following Universal/Standard precautions. • Studies of healthcare workers with nosocomial exposure to HCV suggest early antiviral treatment may result in higher rates of resolved infections.

25. HBV, HCV and HIV are Most Commonly Transmitted Through: • Sexual Contact • Sharing of hypodermic needles • From mothers to their babies at/before birth • Accidental puncture from contaminated needles, broken glass, or other sharps • Contact between broken or damaged skin and infected body fluids • Contact between mucous membranes and infected body fluids

26. Exposure to Blood/Body Fluids If you sustain an exposure to blood, body fluids, mucous membranes, or non intact skin, you must do the following: •Wash injured/exposed area with soap and water immediately. If eyes are affected - remove contact lenses prior to flushing and flush eyes for 15 minutes in eye wash station. •Report incident to your supervisor immediately. If a serious accident/injury occurs during evenings, nights or weekends please go to the nearest emergency physician. (Employees have the right to refuse treatment) •Fill out an Employee Incident report within 24 hours of the exposure incident. THIS IS FOR YOUR LEGAL PROTECTION.