Annual Bloodborne Pathogen Training

1. Annual BloodbornePathogen Training 2019 Frostburg State University Frostburg, Maryland 21532

2. OSHA Bloodborne Pathogens 29 CFR 1910.1030 • FSU plan can be found @http://www.frostburg.edu/fsu/assets/File/Administration/pplant/safety_exposurecontrolplan.pdf • Or….just go to FSU web page and Plan reviewed annually, or as necessary to reflect changes in technology, engineering controls, etc

3. What are Bloodborne Pathogens? Viruses found in human blood and other body fluids including but not limited to HIV, Hepatitis B, Hepatitis C Can be spread when blood/body fluids containing these viruses are introduced into the bloodstream of another person either by piercing/puncturing the skin or splash to mucous membranes such as in the mouth.

4. Body fluids NOT likely to be infectious unless visibly contaminated with blood • Tears • Feces • Vomit • Urine • Sweat • Sputum • Nasal Secretions

5. Risks Highest Risk Puncture Wound - Infected blood/body fluid is introduced directly into your body through a break in the skin such as a needle-stick injury or a cut with a piece of broken, contaminated glass. Lower Risk • Non-intact skin or mucous membrane exposure- Infected blood/body fluid contacts open areas on skin (cuts, abrasions) or mucous membranes of eyes, nose or mouth

6. HIV • HIV ( Human Immunodeficiency Virus) is the virus that can lead to AIDS (Acquired Immune Deficiency Syndrome) • HIV damages a person’s immune system which helps the body fight disease. • First info published in medical journal about this virus was May 20, 1983

7. Primary way these viruses are spread? Sexual contact (White gay males continued to account for the largest number of new HIV infections followed closely by black gay males) & Illegal IV drug Use

8. Diagnoses of HIV Infection among Adults and Adolescents, by Transmission Category, 2015—United States and 6 Dependent Areas N = 39,920 Note. Data include persons with a diagnosis of HIV infection regardless of stage of disease at diagnosis. Data for the year 2015 are preliminary and based on 6 months reporting delay. Data have been statistically adjusted to account for missing transmission category. “Other” transmission category not displayed as it comprises less than 1% of cases. a Heterosexual contact with a person known to have, or to be at high risk for, HIV infection.

9. HIV • The only way to know if you are infected with HIV is to be tested. • CDC recommends everyone between 13-64 year olds get tested at least once • Some newer lab tests can find HIV as soon as 2-3 weeks after exposure to the virus • In-home tests are available at many drug stores however blood tests find infection sooner that oral fluid tests • There is a new instant finger stick HIV screening test that gives results in a minute-available at the local health dept

10. Stages of HIV

11. UPDATE ON HIV • Development of vaccine has been very difficult. Researchers still trying! • HIV remains a significant cause of death for certain populations. In 2014, it was the 8th leading cause of death for those aged 25-34 and 9th for those aged 35-44 • Pre-exposure prophylaxis (or PrEP) is when people at very high risk for HIV take HIV medicines daily to lower their chances of getting infected. New federal guidelines recommend PrEP be considered for people who are HIV negative and at substantial risk for HIV. Now available through local health dept.

12. Hepatitis • Attacks the liver • Fatigue, stomach pain, loss of appetite, nausea, yellow jaundice, darkened urine • Sometimes no symptoms • Growing awareness of Hepatitis in last few years • Better treatment available • Hepatitis B & C are “bloodborne pathogens”

13. Hepatitis B Virus • Hepatitis B virus (HBV) can live outside the body for at least 7 days. Even dried blood can pose a risk! • HBV is 50-100 times more infectious than HIV • Many people with Hepatitis B can have no symptoms but can still spread the virus

14. Hepatitis B vaccine first licensed in 1981 Routine vaccination of all infants began in November, 1991

15. Since 2014, there has been an increase in the rate of new HBV infections, which is likely due to increasing injection drug use Source: CDC

16. Hepatitis B Vaccine • Three shots over a 4-6 month time period •  Since the vaccine became available in 1982, more than 100 million people have received Hepatitis B vaccine in the United States and no serious side effects have been reported. • Booster dose still not needed after recent study tracked vaccine’s effectiveness after 30 years • If you have previously declined the vaccine and you are considered at risk according to FSU Exposure Control Plan, you can still receive it at no cost • BEST WAY TO PROTECT AGAINST HEPATITIS B !

17. Hepatitis C • Mortality among Hepatitis C Virus (HCV)-infected persons—primarily adults aged 55-64 years—is increasing • A recent study suggested that screening all baby boomers (adults born between 1945-1965) for Hepatitis C virus could save tens of thousands of lives • New cases of HCV infection are predominately among young persons who are white, live in non-urban areas (particularly in Eastern and Midwestern states), have a history of injection drug use, and previously used opioids, such as oxycodone

18. Reported number of acute hepatitis C cases — United States, 2000–2014 Source: CDC, National Notifiable Diseases Surveillance System (NNDSS)

19. Hepatitis C There is no vaccine to prevent Hepatitis C The Hepatitis C virus can survive outside the body at room temperature, on environmental surfaces, for up to 3 weeks.

20. Which One is Highest Risk? **If completed Hepatitis B vaccine series and have immunity-virtually no risk for infection * June 2015

21. www2a.cdc.gov/hepatitis/RiskAssessment/start.html

23. What can you do to reduce your risks of an exposure? • Know your exposure control plan - There are specific training, engineering, and work controls for those potentially at risk for exposure to BBP at work. • Use Universal precautions – Treat all human blood and other potentially infectious fluid as if they are infectious • Attend training programs • Get involved – Participate in your staff meetings • Take advantage of the Hepatitis B Vaccine

24. What is an Exposure Incident? Exposure Incident is a specific eye, mouth, other mucous membrane, non-intact skin or parental (puncture/needle stick) contact with blood or other potentially infectious material (OPIM) that results from performance of an employees duties

25. These practices/controls reduce the likely hood of exposure by altering how a task is performed Don’t recap needles, safer medical devices Do not pick sharps up with hands Clean and decontaminate equipment and surfaces Do not eat, drink, or apply cosmetics in work area Work Practice Controls

26. These controls reduce employee exposure by removing the hazard Needles and other sharps must be discarded in rigid, leak proof, puncture resistant containers Safer medical devices – such as safety glide needles and retractable needles Hazardous waste containers – red bags (only place those items that are contaminated with a BBP!) Remember broken glass is a sharp and must be handled as such! Engineering Controls

27. When occupational exposure remains after engineering and work practice controls are put in place, PPE must be used. Level of protection required is determined by the task being performed Always check PPE for defects before using Remove before leaving work area, wash hands after removal and properly dispose of PersonalProtective Equipment Employer is responsible to make available and replace as needed

28. Warning labels required on: Containers of regulated waste – red bags and sharp containers Refrigerators and other equipment containing blood and other potentially infectious material(OPIM) Other containers used to store, transport blood or OPIM Biohazard labeled red bags or containers may be substituted for sticker labels Labeling

29. Waste Disposal • When emptying trash containers, do not use your hands to compress the trash in the bag • Lift and carry the trash bag away from your body • Regulated waste in medical waste carrier containers

30. Housekeeping– Clean up • Use PPE – appropriate for the clean up situation • Use appropriate disinfectants • Household bleach ¼ c bleach per one gallon of water (make fresh daily), contact time is air dry • Current disinfectant BISM (Maxima 256) – contact time “treated surfaces must remain wet for 10 minutes. Fresh solution is prepared daily or more often if it becomes diluted or soiled” • Dispose of waste properly by separating regulated waste • Separating regulated waste • Laundry Discuss specifics with your supervisor

31. Spill Clean Up https://www.youtube.com/watch?v=Vkzr3mmOvjg

32. Spill Clean up • Area should be decontaminated following manufacturer’s guidelines • Once the area has been disinfected, dry area with absorbent towels and dispose of towels in regular trash • Remember: Contact time is vital • Get spill kit from closet, storage area, etc • Put on gloves • If splashing is anticipated, wear protective eyewear, mask, and gown Clean Up • Remove visible material with absorbent towels

33. Glove Removal and Disposal Grip one glove near the cuff and peel it down until it comes off inside out. Cup it in the palm of your gloved hand Place 1-2 fingers of your bare hand inside the cuff of the remaining glove. Peel that glove down so that it also comes off inside out and over the first glove Properly dispose of the gloves ALWAYS wash hands after glove removal Reducing Exposure After a Cleanup https://www.youtube.com/watch?v=xTYioOo__6U

34. Proper Hand Hygiene CDC recommendations for indications for hand hygiene: • Hands are visibly soiled – use soap and water • Hands not visibly soiled, can use alcohol-based hand rub – cover all surfaces and rub hands together until dry • Before direct contact with client • After contact with patients intact skin • After contact with body fluids, mucous membranes, excretions and wound dressings • Contact with inanimate objects • After removing gloves or any PPE • Before eating • After using restroom

35. Why are alcohol based hand rubs so great? • Alcohol- based hand rubs (foam or gel) kill more effectively and more quickly than handwashing with soap and water, must be at least 60% alcohol • They are less damaging to skin than soap and water, resulting in less dryness and irritation • They require less time than handwashing with soap and water, hands need to be rubbed together until they are dry • More likely to be used due to convenience • Bottle/dispensers can be placed at the point of care so they are more accessible

36. Handwashing with soap and water • Rub hands vigorously together for at least 20 seconds • Avoid using hot water, can increase risk of contact dermatitis, use warm water • Multiple-use cloth towels not to be used – dry hands with disposable towels • Antimicrobial soaps recommended instead of antibacterial soap, no abrasive soap

37. Hand washing is very effective when done properly!

38. Exposure summary • There are only three routes of exposure with potentially infectious body fluid • Needle stick/Sharp puncture • Non-intact skin • Mucous membrane

39. What do you do if you have been exposed to blood or body fluids???

40. Immediate response to an exposure: Always take care of yourself first! Incident • Eye Exposure – Wash with water 15-20 mins (eye wash station, eye wash bottle or faucet) • Skin contact or puncture – soap and water, shower if indicated • Mouth – wash out with water

41. Post exposure reporting • Report the exposure to your Supervisor immediately • Supervisor will notify Safety Officer • http://www.frostburg.edu/fsu/assets/File/Administration/pplant/safety_exposurecontrolplan.pdf • Page 24-25 sample of form to be completed - Identify and document source and circumstances of exposure

42. Post Exposure evaluation • Post Exposure Evaluation and Follow-up – immediately available. • Report to local Emergency Department WMHS – preferably within 1-2 hours for a confidential medical evaluation • FSU must send paperwork • Written opinion regarding exposure will be made to the employee within 15 days of the completion of the evaluation • Post-exposure monitoring, counseling and preventative treatment

43. Please click on link below to view video • Bloodborne Pathogens Training Video - Overview of Safe Practices - YouTube

44. If you have any questions please contact us • Darlene Smith or Amy Kiddy • dcsmith@frostburg.edu • akiddy@frostburg.edu • Or Call us at 301 687 4310 • Your questions are important to Us! • Please complete the quiz • Remember – if you have initially declined the Hepatitis B vaccine and you would now like to receive it, please notify your supervisor who will notify BHC.