Bloodborne Pathogens Training

1. Bloodborne PathogensTraining Columbus County Schools (June 2017)

2. INTRODUCTION • Mandatory training for all CCS employees • Complies with OSHA regulations • Purpose: to eliminate or minimize on-the-job exposure to blood & other potentially infectious materials which could cause disease

3. OBJECTIVES • Bloodborne pathogens & diseases • Spread of bloodborne diseases • Tasks that may involve bloodborne pathogen exposure • Ways to reduce the chance of exposure • Hepatitis B Vaccine • Procedure to follow if exposure is suspected

4. What are Bloodborne Pathogens? • Microorganisms that are present in human blood and can cause disease. • Including, but not limited to: • Hepatitis B Virus (HBV) • Hepatitis C Virus (HCV) • Human Immunodeficiency Virus (HIV) • Ebola

5. What is Hepatitis B? • A serious disease that affects the liver caused by the Hepatitis B virus (HBV) • Can cause acute (short-term) illness • Loss of appetite • Tiredness • Pain in muscles, joints and stomach • Diarrhea and vomiting • Jaundice (yellow skin or eyes) (Acute illness is more common among adults)

6. Hepatitis B (continued) • HBV can cause chronic (long-term) infection which can be very serious, and often leads to: • Liver damage (cirrhosis) • Liver cancer • Death • About 30% of persons have no signs or symptoms

7. How is Hepatitis B spread? • Hepatitis B virus is spread through contact with the blood or other body fluids of an infected person. A person can become infected by: • Contact with a mother’s blood and body fluids at the time of birth • Contact with blood through breaks in the skin such as bites, cuts, or sores

8. Spread of Hepatitis B (continued) • Contact with objects that could have blood on them such as toothbrushes or razors • Having unprotected sex with an infected person • Sharing needles when injecting drugs • Contact with contaminated tattoo and body piercing needles • Being stuck with a used needle on the job • HBV is durable and can survive in dried form on surfaces for at least 7 days (cdc.gov)

9. Hepatitis B Prevention • Get vaccinated against Hepatitis B • Wear gloves when touching blood • Cover any broken skin and rashes with bandages • Do not share razors or toothbrushes • Consider risk involved with tattoo or body piercing • Practice safe sex • Clean up blood spills with proper disinfectant • Good handwashing

10. What is Hepatitis C? • It is a virus that causes inflammation of the liver • It can cause liver cell damage that can lead to cirrhosis and cancer • It is a slow-progressing disease that may take 10-40 years to cause serious liver damage in some people

11. How is Hepatitis C spread? • It is spread when infected blood from an infected person enters the body of a person who is not infected by: • Sharing needles • Needle sticks or sharps exposure on the job • Infected mother to newborn • Contact with contaminated toothbrushes, razors, tattoo and body piercing tools • Rarely spread through sexual contact

12. Hepatitis C Symptoms • 80% of persons have no symptoms • If symptoms are present, they may be very mild and flu-like: • Nausea, fatigue, loss of appetite, fever, headaches, abdominal pain • Jaundice (yellowing of skin or whites of eyes) • Dark urine

13. Prevention of Hepatitis C • There is NO vaccine to prevent HCV • Wear gloves when touching blood • Use an approved disinfectant for blood spill clean-up (NABC or Eco-Lyzer) • Never share needles or syringes • Do not share personal care items such as razors, toothbrushes • Good handwashing

14. What is HIV? • HIV is the virus that causes AIDS • AIDS stands for Acquired Immunodeficiency Syndrome • AIDS weakens the body’s immune system so that it cannot fight other deadly diseases. • AIDS is a fatal disease. There is no cure and no vaccine for AIDS.

15. How is HIV spread? • Can occur when blood, semen, vaginal fluid or breast milk enters the body of an uninfected person by: • Having unprotected sex with infected person • Sharing needles or injection equipment with infected person • From infected mother to unborn child, breastfeeding • Needle stick or sharps injury on the job • Infected blood comes in contact with a persons broken skin or by splash to mucous membranes of eyes, mouth, nose • HIV is NOT spread by casual contact.

16. Symptoms of HIV • The only way to know if you are infected with HIV is to be tested for HIV • Many people who are infected with HIV do not have any symptoms at all for many years.

17. HIV symptoms (continued) • Rapid weight loss • Dry cough • Recurring fever or profuse night sweats • Profound and unexplained fatigue • Swollen lymph glands • Diarrhea that lasts for more than a week • White spots or unusual blemishes on the tongue, in the mouth, or in the throat • Pneumonia • Red, brown, purplish blotches on skin or inside mouth, nose • Memory loss • Depression • Neurological disorders

18. Prevention of HIV • Wear gloves when touching blood • Cover breaks in skin with bandages • Clean up blood spills with approved disinfectant • Needles and other sharp instruments should be handled very carefully • Dispose of needles in puncture-proof Sharps Container • Practice safe sex • Good handwashing

19. Workplace Transmission • Bloodborne Pathogens are spread through: • Infected human blood • Other potentially infectious materials (OPIM): • Body fluids containing visible blood • Semen • Vaginal secretions • Cerebrospinal fluid • Synovial fluid • Pleural fluid • Peritoneal fluid • Pericardial fluid • Amniotic fluid

20. Basics of Infections • All of these factors must be present for a potential exposure to occur: • Infected source must be present • Entry site must be present • Route of transmission must be present – such as a contaminated sharp object • Unprotected, susceptible person

21. Exposure Control Plan • Designed to prevent BBP exposure and to protect employees • Provides appropriate treatment and counseling if an exposure occurs • Copy of plan available: • School office • CCS website • Copy may be obtained by contacting: • Pupil Personnel Director • School Nurse

22. Exposure Control Plan • Addresses: • Employee responsibilities • Exposure determination • Safe work practices & engineering controls • Personal protective equipment • Housekeeping • Communication of hazards to employees • The Hepatitis B vaccination • Post exposure follow-up • Record keeping and surveillance

23. Employee Responsibilities • To comply with the guidelines of plan • To review the plan at least annually • Any employee who fails to follow the provisions of the plan: • May be retrained • May receive personnel counseling • May be subject to disciplinary action

24. How am I exposed at work? • Potential for transmission exist anytime there is “blood-to-blood” contact with infected blood or other potentially infectious materials • Direct transmission – through open cut, abrasion, sore, acne, broken skin, mucous membranes of the eyes, mouth, nose • Indirect transmission – touch contaminant and transfer to mouth, nose or open skin • Accidental injury – injure yourself with a contaminated sharp object such as broken glass, sharp metal, needle, or knife

25. Exposure Determination • Work environment is evaluated for actual and potential hazards for exposure • An identifying list of job classifications that have actual and collateral risk for occupational exposure has been made • Tasks have been identified with recommendations made to reduce the potential of exposure to blood through use of workplace controls and personal protective equipment

26. At-Risk positions (Category I) • “At-risk employees” means employees identified as being at risk for occupational exposure to blood and other potentially infectious materials (OPIM) • Because of their usual duties, they might be exposed to blood as an integral part of performing occupational tasks • It is reasonable to anticipate that exposure could occur

27. Category I Positions • Principals/Assistant Principals • Athletic Trainers • Coaches • Custodians • Diabetic Care Managers • First-Responders • School Nurses • EC Teachers and EC Teacher Assistants • Plumbers

28. Category II positions (possible risk of occupational exposure) • Biology/Chemistry lab teachers • Maintenance workers • Teachers, substitute teachers and teacher assistants • Cafeteria Staff • Pre-K teachers and teacher assistants • Bus Drivers • Secretaries (if responsible for first aid) • Shop/Trade/Industry teachers • Speech Therapists

29. Examples of tasks causing risks: • Emergency first aid • Handling contaminated laundry • Blood spill clean up • Waste disposal • Assisting with blood sugar monitoring • Administering CPR • Repair/handling contaminated equipment

30. Examples of Protective barriers/engineering controls • Universal precautions • Use of personal protective equipment (gloves, masks, etc.) • Correct use of approved disinfectants • Use of appropriate disposal containers • Handwashing

31. Universal Precautions • Shall be observed to prevent contact with blood or other potentially infectious materials • If differentiation between blood and body fluid types is difficult or impossible, all body fluids shall be considered potentially infectious materials.

32. Handwashing • When: • must be performed as soon as possible to flush contaminated material from the skin adequately • after handling soiled items and equipment, immediately after gloves are removed • Proper technique (Germ Buster sign) • Antiseptic hand cleanser shall be provided when hand washing facilities is not feasible (available from Pupil Personnel Services Director)

33. Contaminated Sharps • Shall be handled with caution • Contaminated needles shall not be bent, recapped or removed • Shearing or breaking of contaminated needles is prohibited • Immediately after use, contaminated sharps shall be placed in appropriate container for disposal (Sharps container) • Sharps container shall be easily accessible & located closely to immediate area where sharps are being used • Container shall be puncture resistant, leak proof and labeled with biohazard warning symbol • Container shall be maintained upright throughout use and not be allowed to overfill

34. In areas of likely exposure: • Never eat, drink, apply cosmetics/lip balm, handle contact lenses, or put food or drink in refrigerators, freezers, shelves, cabinets or counter tops where blood or potentially infectious materials are present • Minimize blood splashing and splattering in emergency situations

35. Personal Protective Equipment (PPE) • Always protect yourself first before becoming exposed to blood or body fluids and have a barrier between you and the potentially infectious material • Always have PPE readily available and wear in exposure situations • Remove PPE that is torn, punctured or of poor quality • Put contaminated PPE in plastic lined container per waste disposal procedure

36. Gloves • Shall be worn when it can be reasonably anticipated that hand contact may occur with blood or other potentially infectious materials • Cover open cuts or sores on your hands before gloving • Single use gloves must be replaced ASAP when contaminated, torn or otherwise not fully protective. • Utility gloves may be decontaminated for reuse if in good condition. • Powderless, non-allergenic gloves shall be made available if needed • Keep gloves in top right hand desk drawer to ensure accessibility for substitute teachers

37. Glove removal technique • Remove contaminated gloves carefully – never touch the outside with bare skin • Dispose of them so that no one else will come into contact with them

38. Resuscitation devices • Mouthpieces, pocket masks or bag-valve mask devices must be used for CPR.

39. How do I get PPE items • Gloves are available from each school office • CPR face shields are available at each school for designated first responders • Employee must take responsibility for replacing PPEs as needed (through school office) • Notify a school administrator, school nurse or Pupil Personnel Services Director if you need PPE items

40. Housekeeping • Immediately call a custodian to clean up and decontaminate surfaces that come into contact with blood or other potentially infectious materials • An EPA-registered disinfectant solution must be used for blood clean up (NABC or Eco-Lyzer) • Treated surfaces must remain wet for 10 minutes • Gloves should always be worn for cleanup • Small spills –absorb blood with lots of paper towels or granular absorbent and then clean with approved disinfectant

41. Housekeeping (continued) • Large spills – flood area with disinfectant before cleaning, then clean with fresh disinfectant. • Mops, pails, sponges, utility gloves must be decontaminated with approved disinfectant • Broken glassware shall not be picked up directly with hands. Mechanical means must be used (broom and dust pan, tongs, etc.) and items must be placed in a rigid, puncture resistant container (e.g. sharps container, cardboard box).

42. Disposal of waste contaminated with blood and OPIM The following procedures shall be followed for handling and disposal of such items that include, but are not limited to bloody bandages, gauze, dressings, sponges, paper towels, sanitary pads, swabs and used gloves or other PPE:

43. Waste disposal (continued) • Wear gloves • Place items in a leak proof plastic bag • Remove gloves using proper technique and place in the plastic bag with the contaminated items • Securely fasten the bag and place in a second plastic leak proof bag, also securely fastened, as an extra precaution • Dispose of as regular trash

44. When to use red biohazard bags: • For disposal of regulated waste including: • Items that would release blood or other OPIM in a liquid or semi-liquid state if compressed • Items that are caked with dried blood or OPIM and are capable of releasing these materials during handling

45. Use of red biohazard bags (continued) • Wear gloves • Place items in a red biohazard bag. • Remove gloves using proper technique and place in the biohazard bag with the contaminated items. Double bag items and secure closure of both bags. • Secure and close the bag to contain all contents and prevent leakage of fluids during handling, storage and transport. • If outside contamination of the bag occurs, it must be placed in a second bag or container. • The red biohazard bag shall be placed in an outside trash container to be picked up by the county sanitation department.

46. Contaminated SharpsDisposal • Shall be discarded immediately in “Sharps Container” • Sharps container must be maintained upright throughout use, replaced when necessary and not be allowed to overfill. • Container shall be closed immediately prior to removal to prevent spillage or protrusion of contents • Contact school nurse for disposal of filled Sharps Containers

47. Biohazard Warning Label • Warning labels shall be affixed to containers used to dispose of and store regulated waste

48. Contaminated Clothing • Wear gloves to handle contaminated clothing • Use universal precautions and minimal agitation at site where generated • Place clothing in a leak proof plastic bag for transport home or to laundering area • If degree of contamination meets regulated waste definition, a red biohazard bag should be used • Can be washed with regular laundry

49. What to do if exposed • Remove PPE • Wash exposed area immediately with soap and running water • Flush exposed eye or mucous membranes with water • Immediately report the exposure to your supervisor, who will inform Pupil Personnel Services Director • The School Safety Officer will complete an Incident Report form • Take the completed form to Whiteville Urgent Care for a post-exposure medical evaluation

50. Hepatitis B Vaccine • Provides 90% protection against HBV • Given as a series of 3 shots • Gives long-term protection from HBV infection, possibly lifelong • Very safe vaccine. Mild side effects may include soreness at injection site, elevated temperature • Severe problems extremely rare • Available at no cost to Category I employees at Columbus County Health Department(authorization by Pupil Personnel Services Director required) • Vaccine Titer • Only if complete vaccine series is provided by CCS • Test for Anti-HB within 1-2 months of vaccine completion. • If no response, repeat vaccine series and Anti-HB or employee to be evaluated for HBsAg-positive status.