Infection Control & Prevention

1. Infection Control & Prevention Bloodborne Pathogens, Tuberculosis,Methicillin-Resistant Staphylococcus Aureusand Respiratory Protection Juvenile Health ServicesHealth Care Agency

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3. Introduction This self-study module is intended to provide mandatory initial and annual training on bloodborne pathogens, methicillin-resistant Staphylococcus aureus (MRSA), tuberculosis control and respiratory protection. Employees should refer to the Infection Control manual for more information.

4. Introduction (continued) All employees should know where and how to: • Access our program’s BBP Exposure Control Plan and report a bloodborne pathogen exposure.

5. Bloodborne Pathogens

6. Definition Bloodborne pathogens are microorganisms that are present in human blood and can infect and cause disease in people who are exposed to blood containing the pathogen. These microorganisms can be transmitted through contact with contaminated blood and body fluids.

7. Examples of Bloodborne Pathogens Examples include but are not limited to: • Human Immunodeficiency Virus (HIV) • Hepatitis B (HBV) • Hepatitis C (HCV) • Non-A, Non-B Hepatitis • Syphilis • Malaria

8. Cal/OSHA The Division of Occupational Safety and Health, better known as Cal/OSHA, protects workers and the public from safety hazards through it’s Occupational Safety and Health programs.

9. Bloodborne Pathogens Standard The Bloodborne Pathogens Standard provides the regulations that relate to the response, prevention, protection and control of blood borne pathogens. The standard can be found in Title 8, Section 5193 of the California Code of Regulations: www.dir.ca.gov/title8/5193.html There is an Exposure Control Plan for Bloodborne Pathogens located in the Safety Manual.

10. Other Potentially Infectious Materials (OPIM) • Semen • Vaginal secretions • Cerebrospinal fluid • Synovial fluid • Amniotic fluid • Pericardial fluid • Peritoneal fluid • Any body fluid contaminated with blood or saliva in dental procedures • All body fluids in emergency situations that cannot be recognized

11. Quiz Question Which of the following materials could contain bloodborne pathogens? • amniotic fluid • cerebrospinal fluid • semen • all of the above

12. Transmission HIV, hepatitis B virus, and hepatitis C virus are the viruses most likely to be transmitted via the following routes in an occupational setting: • Needle stick / sharps injuries • Skin or eye contact • Mucous membrane and non-intact skin (scratches, cuts, bites, wounds) exposure to blood or OPIM

13. Human Immunodeficiency Virus (HIV) HIV is the virus that causes acquired immuno-deficiency syndrome (AIDS). Initial infection can be followed by an acute flu-like illness, with symptoms such as: • Fever • Lymphadenopathy • Sweats • Myalgia • Rash • Sore throat

14. HIV (continued) The risk of disease progression increases with the duration of the infection. Without therapy, approximately 20-25% of infected adults develop AIDS within 2 years of infection, and 50% within 10 years. With treatment, onset can be delayed beyond 15 years.

15. Hepatitis B (HBV) Acute viral hepatitis is a common and sometimes serious viral infection of the liver that can lead to inflammation and necrosis. Hepatitis B is present in very high concentrations in the blood of infected persons.

16. 2 Phases of HBV Acute Phase: Occurs just after a person becomes infected and can last from a few weeks to several months. Some will recover after the acute phase, but others remain infected for the rest of their lives. Of those who become infected, only about ⅓ become symptomatic. Chronic Phase: Those who remain infected become chronic carriers. The virus remains in their liver and blood. Nearly 10% of adult victims become carriers.

17. Vaccines Hepatitis B vaccines, given as a series of 3 injections, produce a high antibody titer in over 90% of recipients under the age of 40-50 years. Hepatitis B vaccines are offered for free through Employee Health Services (EH) to employees who have reasonably anticipated exposure to blood or OPIM. The phone number for EH is: 714-565-3780. The website for EH is: http://intra2k3.ocgog.com/ehealth/. There are no vaccines for HIV or Hepatitis C.

18. Hepatitis C (HCV) • Hepatitis C is a non-A, non-B virus • The period of communicability ranges from one or more weeks before onset of symptoms to months/years • HCV is the leading cause of liver transplants • Chronic infections occur in 75-85% of infected persons • Chronic liver disease occurs in 70% of infected persons

19. HCV (continued) Early signs: • Fatigue • Fever • Headaches • Nausea, vomiting • Abdominal pain • Dark urine • Clay-colored stools

20. Safety and Efficacy of the Hepatitis B Vaccine “Hepatitis B vaccines are highly effective and safe and have been incorporated into national immunization programs in over 150 Countries.” Zuckerman, JN (2006) Protective efficacy, immunotherapeutic potential and safety of hepatitis B vaccines. Journal of Medical Virology. 78(2): 169-77

21. Risk of Transmission (per needlestick) • HIV 0.3% • HBV 30% • HCV 3-10%

22. Quiz Question Bloodborne pathogens may enter your system through: • Open cuts • Skin abrasions • Dermatitis • Mucous membranes • All of the above

23. Quiz Question A vaccine exists for which of the following bloodborne pathogens? • HIV • Syphilis • Hepatitis B • Hepatitis C

24. Methods to Prevent Transmission The different methods of prevention used in the workplace are: • Administrative Controls • Standard Precautions • Engineering Controls • Work Practice Controls • Personal Protective Equipment

25. Administrative Controls Administrative Controls consist of an Exposure Control Plan. The Exposure Control Plan is a written plan that identifies the tasks and procedures where occupational exposure to blood occurs. This plan can be found in the Bloodborne Pathogen Section in the Safety Manual.

26. Standard Precautions Standard Precautions (formerly referred to as Universal Precautions) are essential to reducing the occupational acquisition of a bloodbornepathogen. Standard Precautions require that every patient is treated as if they are infected with a bloodbornepathogen.

27. Engineering Controls An engineering control is a device that removes the hazard from the workplace. Examples of engineering controls are: • Sharps disposable containers • Safety needles • Retractable lancets

28. Work Practice Controls Work practice controls are designed to change the way in which a task is performed to reduce the likelihood of exposure to bloodbornepathogens. Examples of work practice controls are: • Needles are not recapped • Sharps are disposed of immediately after use by placing them in a sharps container

29. General Work Practice Guidelines Employees shall: • Observe the practice of standard precautions • Wash their hands immediately after removal of gloves or other Personal Protective Equipment (PPE) • Cleanse hands with waterless hand cleanser when hand-washing facilities are not available

30. Guidelines(continued) Employees shall: • Not eat or drink, apply cosmetics or handle contact lenses in work areas where there is a likelihood of occupational exposure • Not keep food and/or drink in refrigerators or on countertops where blood or OPIM are present

31. Guidelines(continued) Employees shall: • Place specimens of blood or OPIM in a container which prevents leakage during collection, handling, processing, storage or transport • Minimize splashing, spraying or other actions when performing procedures involving blood or OPIM

32. Hand Hygiene Hand hygiene is an important part of Standard Precautions. Because many infections are transmitted on the hands of healthcare personnel, practicing good hand hygiene can help to reduce the transmission of these healthcare associated infections.

33. When should hand hygiene be practiced? • Whenever hands are visibly dirty or contaminated • Before having contact with patients, putting on gloves, inserting or manipulating any invasive device • After having contact with patient’s skin, body fluids or excretions, wound dressings, contaminated objects, inanimate objects and when removing gloves

34. Hand Hygiene (continued) Bacteria can survive for days on patient care equipment and other surfaces, even computer keyboards. It is important to practice hand hygiene, even if you only touched patient care equipment or other surfaces.

35. Steps to Effective Hand Hygiene with Hand Rub (foam and gel) • Apply to palm of one hand. • Rub hands together, covering all surfaces, focusing in particular on the fingertips and fingernails, until dry (use enough rub to require at least 15 seconds to dry).

36. Hand Washing • Wet hands with water • Apply soap • Rub hands together for at least 15 seconds, covering all surfaces, focusing on fingertips and fingernails • Rinse under running water and dry with disposable towel • Use the towel to turn off the faucet

37. Alcohol-based Hand Rubs Alcohol-based hand rubs kill more germs effectively and more quickly than hand washing with soap and water and can easily be used when running water is unavailable. Alcohol-based hand rubs can be used in all situations, except for when your hands are visibly dirty or contaminated.

38. Hand Washing Hand washing is an important part of infection control that can protect both you and your patients. Practicing good hand hygiene is providing quality care. For more information, go to: www.cdc.gov/handhygiene/training

39. Quiz Question How long should hands be washed for when using soap and water? • 5 seconds • 10 seconds • 15 seconds • 20 seconds

40. Quiz Question How long should you rub your hands together when applying an alcohol-based hand rub? • 10 seconds • 20 seconds • 1 minute • Until your hands are dry

41. Quiz Question You should wash your hands even if you only touched patient care equipment and not the patient. • True • False

42. Personal Protective Equipment Personal protective equipment (PPE) is specialized clothing and equipment worn by an employee for protection against a hazard such as blood or other potentially infectious materials. Examples of personal protective equipment: gloves, gowns, masks, goggles, face shields.

43. Disposing of Personal Protective Equipment If any PPE is penetrated by blood or OPIM, it shall be removed immediately or as soon as feasible and disposed of in an appropriate biohazardous waste container. All PPE shall be removed prior to leaving the work area. PPE that is NOT considered to be contaminated with blood or OPIM will be disposed of in the regular trash.

44. Quiz Question Which of these is an example of an engineering control? • Providing employees with self-sheathing syringes • Providing sinks and soap for employee hand washing • Allowing frequent breaks for employees with occupational exposure • Redesigning a task so it can be done more efficiently

45. Quiz Question You should always treat all body fluids as if they are infectious and avoid direct skin contact with them. • True • False

46. Quiz Question Needles should never be recapped. • True • False

47. Universal Biohazard Sign The universal BIOHAZARDsign is used to alert employees that containers, specimen refrigerators, or secondary containers used to transport specimens may contain infectious materials.

48. Biohazard(continued) Individual tubes of blood or primary specimen containers do not need to be labeled. However, secondary containers used for manually transporting specimens must display the BIOHAZARD sign.

49. Housekeeping Keeping the worksite clean and sanitary is a necessary part of controlling worker exposure to bloodbornepathogens. General guidelines include: • Clean and decontaminate equipment and work surfaces immediately after contact with blood or OPIM, at the end of the work shift, and after completing procedures

50. Response to Spill of Blood or Body Fluids • Wear appropriate PPE • Carefully cover the spill with an absorbent material (paper towels) • Decontaminate using an appropriate disinfectant (1 part bleach/10 parts water) pouring gently working from edge of spill to center • Wait 10 minutes to ensure adequate decontamination then carefully wipe up • Disinfect all cleaning tools after • Dispose of contaminated materials appropriately • Wash your hands thoroughly with soap and water immediately after