Bloodborne Pathogen Training: Preventing Disease Transmission

1. Bloodborne Pathogen Training: Preventing Disease Transmission

2. Introduction Objectives Describe how infections occur Identify how bloodborne pathogens are spread Identify tasks that have potential for exposure to infectious materials Recognize the importance of hand washing and personal hygiene in reducing risk Recognize importance of personal protective equipment Describe procedures for exposure incidents

3. OSHA Bloodborne Pathogen Standard 1991 Occupational Safety and Health Administration issued standard (29 CFR part 1910.1030 issued to protect employees by reducing or removing the hazards of bloodborne pathogens in the workplace Applies to all who have potential to occupational exposure Basically provides safeguards

4. Definitions Pathogen: any virus, microorganism, or other substance that causes disease; an infecting agent. Bloodborne: found in blood or certain blood products Universal Precautions: treat all human blood and certain bodily fluids as if they were known to be infected with HIV, HBV or other bloodborne pathogens. Also called Standard Precautions.

5. Means of Transmission of Bloodborne Pathogens Contacting a contaminated object or surface and transferring the infectious material to your mouth, eyes, nose or open skin. Open cuts, nicks, abrasions, dermatitis and acne.

6. Potentially Infectious Materials Human Blood Saliva in dentistry Semen/Vaginal Secretions Cerebrospinal fluid, synovial fluid, pleural fluid, amniotic fluid Unpreserved human tissue or organ samples Any body fluid visibly contaminated with blood Feces Saliva Urine Vomit Nasal Secretions Sweat Tears

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8. Serious Bloodborne Pathogens Hepatitis B Liver infection cause by virus � Hep B Symptoms include Flu-like symptoms, abdominal pain, vomiting Fatigue, loss of appetite, nausea, joint pain, jaunidice May also show no signs or symptoms and spread unknowingly Blood test may be positive 2-6 weeks after symptoms develop Meds available Prevention Personal hygiene Vaccination

10. Serious Bloodborne Pathogens Hepatitis C Spread by direct contact by another person�s blood via sharing needles and syringes Also personal care items (razors, toothbrushes) Liver disease caused by Hep C 3.9 million Americans affected 25,000 new cases in 2001 Most common chronic bloodborne infection in US Leading indication for liver transplant Symptom 80% have no signs or symptoms Jaundiced, mild abdominal pain in upper right quadrant, other symptoms similar to Hep B No Vaccine for prevention Treatment � interferon and ribavirin can control disease

11. Estimated Incidence of Acute Hepatitis C United States, 1982-2000 [Slides 7] Estimated Incidence of Acute Hepatitis C United States, 1982-2000 The estimated incidence of acute clinically diagnosed hepatitis C remained constant through much of the 80�s but declined by >80% between 1989 and 1995. The number of cases of transfusion-associated acute hepatitis C declined significantly after 1985 but this change had little impact on overall disease incidence. The substantial decline observed since 1989 correlates to a decrease in acute cases associated with injection drug use. Since clinical disease is apparent in 30% of acute HCV infections, the estimated total number of acute HCV infections ranges from 240,000 in the mid-80�s to 40,000 in 1998. Most acute cases of hepatitis C occur in young adults, 20 � 39 years old.[Slides 7] Estimated Incidence of Acute Hepatitis C United States, 1982-2000 The estimated incidence of acute clinically diagnosed hepatitis C remained constant through much of the 80�s but declined by >80% between 1989 and 1995. The number of cases of transfusion-associated acute hepatitis C declined significantly after 1985 but this change had little impact on overall disease incidence. The substantial decline observed since 1989 correlates to a decrease in acute cases associated with injection drug use. Since clinical disease is apparent in 30% of acute HCV infections, the estimated total number of acute HCV infections ranges from 240,000 in the mid-80�s to 40,000 in 1998. Most acute cases of hepatitis C occur in young adults, 20 � 39 years old.

12. Serious Bloodborne Pathogens HIV Come in contact with infected blood, body fluids, intimate sexual contact Virus attackes white blood cells destroying ability to fight infection AIDS (Arnheim Table 14-1) 850,000 � 950,000 people infected 40,00 new infections per year 502,000 people die from AIDS as of 2002 Remember cannot tell if someone has this Late Stage Symptoms Fever, fatigue, diarrhea, skin rashes, night sweats Appetite loss, swollen lymph glands, weight loss Management 10 years after HIV infection 50% develop AIDS No prevention vaccine No treatment to cure Prevention Avoid bodily fluids Safe sex Regular tests for STD�s Good hygeine

13. Conditions Necessary for Disease Transmission Four conditions must be met Pathogen present Enough of pathogen present to cause disease Pathogen passes through correct entry site Person suspectible to pathogen

14. How do pathogens enter the body? Direct Contact Occurs when infected blood or body fluids from one person enter another person�s body at correct entry site Blood splashing in eye Indirect Contact Occurs when person touches an object that contains the blood or body fluid of an infected person, and then that fluid enters at correct entry site Picking up blood soaked bandages with bare hands and pathogen enters through breaks in skin

15. Exposure Control Plan OSHA requires this plan to be a written document which an employer specifies how each standard is met and which employees in the workplace are covered Purpose? Exposure Control Plan should include Exposure determination Methods for implementing other parts of OSHA standard Procedures for evaluating details of an exposure incident

16. Exposure Control Plan Immunizations Very important Employers must make HEP B vaccine available at no cost to employees at risk to exposure

17. Precautions and Guidelines to Prevent Disease Transmission Personal Hygiene Hand washing Avoid wearing jewelry Avoid artificial nails and keep natural nails <1/4 inch Personal Protective Equipment Protect from direct contact Disposable gloves, masks, breathing barriers gowns Engineering and work place controls Engineering Controls -- Sharps containers Work place Controls � washing hands Equipment cleaning and disinfecting 1 part bleach/10 parts water

18. Engineering Control Examples Sharps disposable containers Self-sheathing needles Biohazard bags and containers Personal protective equipment

19. Work practice controls The things you do Place sharp items in leak proof, puncture-resistant and labeled container Must be at point of use Avoid splashing, spraying or splattering of blood material Remove and dispose of soiled protective clothing Athletes with saturated uniforms must have removed before re-entering participation Clean and disinfect all equipment and work surfaces possibly soiled by blood One part bleach to ten parts water or with disinfectant approved by EPA Wash hands thoroughly and immediately after giving care Can use alcohol based rubs DO NOT eat, drink, smoke, apply cosmetic or lip balm, handle contact lenses or touch your mouth, nose, or eyes when in an area where may be exposed to infectious materials

20. Exposure Incidents OSHA defines exposure incidents as a specific eye, mouth, other mucous membrane, non-intact skin or parenteral (needle stick) contact with blood OPIM that results from performance of employee�s duties

21. What should you do if exposed? Wash needle sticks with soap and water Flush splashes of blood or OPIM to nose, mouth, or skin with water Irrigate eyes with clean water, saline or sterile irrigants Report exposure incident Follow steps of exposure control plan for confidential medical evaluation and follow-up by a health care professional If a needle stick, employer must record info in a sharps injury log