Bloodborne Pathogens

1. Bloodborne Pathogens

2. TOSHA believes the information in this presentation to be accurate and delivers this presentation as a community service. As such, it is an academic presentation which cannot apply to every specific fact or situation; nor is it a substitute for any provisions of 29 CFR Part 1910 and/or Part 1926 of the Occupational Safety and Health Standards as adopted by the Tennessee Department of Labor and Workforce Development or of the Occupational Safety and Health Rules of the Tennessee Department of Labor and Workforce Development.

3. Bloodborne Pathogens • Pathogenic micro-organisms present in human blood that can lead to diseases • Most common in US • Human immuno-deficiency virus (HIV) • Hepatitis B (HBV) • Hepatitis C (HCV)

4. Hepatitis • Hepatitis A • Hepatitis B • Hepatitis C • Hepatitis D • Hepatitis E • Viruses which attacks the liver • Liver performs many functions vital to life • Blood reservoir, blood filter, carbohydrate, fat, protein metabolism, storage of vitamins, iron, etc.

5. Hepatitis A • Caused by infection with Hepatitis A virus (HAV) • Virus is found in the stool of infected persons • HAV is usually spread from person to person by putting something in the mouth (even though it may look clean) that has been contaminated with the stool of a person with hepatitis A • Hepatitis A infection occurs in epidemics both nationwide and in communities • Hepatitis A is NOT bloodborne and, therefore, is NOT covered by the bloodborne pathogen standard

6. Hepatitis A--Symptoms • Jaundice • Fatigue • Abdominal pain • Loss of appetite • Nausea • Diarrhea • Fever

7. Hepatitis A Prevention • Good personal hygiene and proper sanitation can help prevent infection with the hepatitis A virus • Always wash your hands with soap and water after using the bathroom, changing a diaper, and before preparing and eating food • Vaccine is available

8. Hepatitis B • Hepatitis B is a disease of the liver caused by infection with the hepatitis B virus (HBV) • Infection occurs when blood or body fluids from an infected person enters the body of a person who is not immune  • HBV is spread through: • Sex with an infected person without using a condom (the efficacy of latex condoms in preventing infection with HBV is unknown, but their proper use may reduce transmission) • Sharing drugs, needles, or "works" when "shooting" drugs • Exposure to blood and body fluids on the job • From an infected mother to her baby during birth

9. Hepatitis B • HBV can cause lifelong infection, cirrhosis (scarring) of the liver, liver cancer, liver failure, and death • Symptoms • Jaundice • Fatigue • Abdominal pain • Loss of appetite • Nausea, vomiting  • Joint pain

10. Hepatitis B--Prevention • A safe and effective vaccine is available • Use latex condoms correctly and every time you have sex • If you are pregnant, get a blood test for hepatitis B • Never share drugs, needles, syringes, or "works“ • Do not share personal care items that might have blood on them (razors, toothbrushes) • Do not come into contact with another person’s blood or body fluids at work

11. Hepatitis C • Hepatitis C is a disease of the liver caused by infection with the hepatitis C virus (HCV) • Infection occurs when blood or body fluids from an infected person enters the body of a person who is not infected  • HCV is spread through • Sharing needles or "works" when "shooting" drugs, • Exposure to blood and body fluids on the job • From an infected mother to her baby during birth • 55%-85% of infected persons are chronically infected • 70% of chronically infected persons develop chronic liver disease

12. Hepatitis C • Hepatitis C infection is the leading indication for liver transplant • Symptoms • Jaundice • Fatigue • Dark urine • Abdominal pain  • Loss of appetite • Nausea • 80% of infected persons have no signs or symptoms

13. Hepatitis C--Prevention • There is no vaccine to prevent hepatitis C • Do not “shoot” drugs and never share needles, syringes, or "works" • Do not share personal care items that might have blood on them (razors, toothbrushes) • Do not come into contact with another person’s blood or body fluids at work

14. Hepatitis D • Hepatitis D is a liver disease caused by infection with the hepatitis D virus (HDV) • It is a defective virus that needs the hepatitis B virus to exist

15. Hepatitis E • Hepatitis E is a liver disease caused infection with the hepatitis E virus (HEV) • It is transmitted in much the same way as hepatitis A virus through the fecal/oral route • Hepatitis E virus is NOT bloodborne and is NOT covered by the bloodborne pathogen standard • Hepatitis E virus does not occur often in the United States

16. Viral Hepatitis - Overview Type of Hepatitis A B C D E Sourceof blood/ blood/ blood/ feces feces virus blood-derived blood-derived blood-derived body fluids body fluids body fluids Route of fecal-oral percutaneous percutaneous percutaneous fecal-oral permucosal transmission permucosal permucosal no Chronic yes yes yes no infection pre/post- Prevention blood donor pre/post- ensuresafe pre/post- exposure exposure screening; exposure drinking risk behavior water immunization immunization immunization; risk behavior modification modification

17. HIV • Human immunodeficiency virus • Infection occurs when blood or body fluids from an infected person enters the body of a person who is not infected  • HIV is spread through: • Sex with an infected person without using a condom (the efficacy of latex condoms in preventing infection with HIV is unknown, but their proper use may reduce transmission) • Sharing drugs, needles, or "works" when "shooting" drugs • Exposure to blood and body fluids on the job • From an infected mother to her baby when she is pregnant, when she delivers the baby, or if she breast-feeds her baby • Leads to the disease AIDS • Destroys the immune system

18. HIV/AIDS Symptoms • You cannot rely on symptoms to know whether or not you are infected • The only way to know if you are infected is to be tested for HIV infection • Many people who are infected with HIV do not have any symptoms at all for 10 years or more • You also cannot rely on symptoms to establish that a person has AIDS • The symptoms of AIDS are similar to the symptoms of many other illnesses • AIDS is a medical diagnosis made by a doctor based on specific criteria established by the CDC

19. HIV Prevention • Use latex condoms correctly and every time you have sex • Don’t share, syringes, or “works” used to inject drugs, steroids, vitamins, etc. • If you are pregnant or think you might be soon, talk to a doctor or your local health department about being tested for HIV. Drug treatments are available to help you and reduce the chance of passing HIV to your baby if you have it • Don’t share razors or toothbrushes because of the possibility of contact with blood • Do not come into contact with another person’s blood or body fluids at work

20. You Cannot “Catch” Hepatitis B, C, or HIV • By working with or being around someone who has the disease • From sweat, spit, tears, clothes, drinking fountains, phones, toilet seats, or through everyday things like sharing a meal • From insect bites or stings • From donating blood • From a closed-mouth kiss (but there is a very small chance of getting it from open-mouthed or "French" kissing with an infected person because of possible blood contact)

21. Other Bloodborne Diseases • Syphilis • Malaria • Brucellosis • Babeosis • Leptospirosis • Arborviral Infections • Relapsing Fever • Creutzfeld-Jacobs Disease--Mad-cow • Viral Hemorrahgic Fever--Ebola

22. The Bloodborne Pathogen Standard29 CFR 1910.1030 • 1. Written Exposure Control Program • 2. Engineering Controls (safer medical devices) and work practice controls • 3. Personal Protective Equipment • 4. Housekeeping • 5. Hepatitis-B vaccine and antibody test • 6. Confidential follow-up and evaluation of circumstances in event of a needlestick or other exposure incident • 7. Labeling • 8. Initial and Annual training. • 9. Sharps Injury Log • 10. Recordkeeping

23. Scope of the Standard • Covers all employees with reasonable anticipation of exposure to potentially infectious materials (bloodborne pathogens) • Applies to general industry situations only • Does not apply to the construction industry • 5.6 million workers in health care and public safety occupations are covered

24. Blood (human) Semen Vaginal secretions Cerebrospinal fluid Pleural fluid Pericardial fluid Peritoneal fluid Amniotic fluid Saliva in dental proc. Any visibly contaminated body fluid Any body fluid where differentiation is difficult Any unfixed tissue or organ Aqueous and vitreous humors in the eyes Potentially Infectious Materials--

25. Modes of Transmission • Stick or Cut • Splash to mucous membranes of the eyes, nose, mouth • Non-intact skin exposure

26. Universal Precautions • Must be observed • All blood and body fluids are treated as if known to be infected with HIV, HBV, HCV, etc. • Key to Prevention of Infection • Do not come into contact with another person's blood or body fluids

27. Exposure Control Plan • Employer's plan describing how compliance with the standard is achieved • Describes what employees are covered • Describes tasks that are covered • Describes post-exposure follow-up procedures • Must be reviewed and updated annually • Must be accessible to employees • Each employee should know the procedure to follow to obtain a copy

28. Exposure Control Plan • Safer Medical Devices • The Exposure Control Plan must be updated every 12 months to reflect evaluation, consideration, and selection of appropriate devices • Document in the plan the devises evaluated and those currently used • Front line employees must be involved in the selection of devices and their involvement must be documented

29. Handwashing • The single most important aspect of infection control • Wash hands when contaminated with blood or body fluids and after removing personal protective equipment • Use antiseptic hand cleaner clean paper/cloth towels or antiseptic towelettes when "in the field" • Wash hands with soap and water asap

30. Needles/Sharp Objects • Use sharps with sharps injury prevention or needleless systems for all procedures involving sharps • Place in puncture resistant, labeled, leak-proof containers for transport, storage, and/or disposal • Keep the container closed • Do not bend, break, recap, or remove needles • Do not pick up contaminated broken glass directly with the hands • Do not reach by hand into containers where contaminated sharps are placed • Do not overfill sharps containers

31. Eating/Drinking • Do not eat or drink in areas where there is exposure to blood or body fluids • Do not store food in refrigerators, freezers, cabinets, on shelves or countertops where blood or other body fluids are present

32. Personal Protective Equipment (PPE) • Wear PPE to prevent blood or body fluids from getting on your clothes, skin, underclothes, etc. • Must be provided at no cost to the employees • Must be accessible to the employees • Employer must enforce the use • Must be removed prior to leaving the work area and placed in designated area

33. Parental exposure stick or cut Mucous membrane splash Non-intact skin spill or splash Gloves patient care and utility gowns glasses/ goggles/faceshields masks pocket masks shoe covers PPE

34. Decontamination • Written decontamination schedule must be part of the exposure control plan • Clean and decontaminate all equipment and environmental and working surfaces after contact with blood and/or body fluids • Decontaminate with appropriate disinfectant • EPA registered tuberculocidal disinfectant • EPA registered disinfectant with label stating it is effective against HIV and HBV • Household bleach, diluted 1:10-1:100, made fresh daily

35. Contaminated Laundry • Remove contaminated clothing when it becomes contaminated • Place immediately in bag or container that is labeled • Prevent leakage

36. Regulated Waste • Sharps containers • Needles • Blades • Broken glass • Red bags • Liquid or semi-liquid blood or OPIM • Items caked with dried blood or OPIM • Items that could release blood or OPIM • Pathological waste • Microbiological waste

37. Hepatitis B Vaccination • The employer must offer the HBV vaccination to exposed employees after they have received training and within 10 working days of job assignment • At no cost to the employee • Provided by PLHCP (see next slide) • According to US Public Health Service most current recommendations • “Immunization of Health Care Workers: Recommendations of ACIP and HICPAC,” MMWR, Vol. 46, No. RR-18

38. What is a PLHCP? • PLHCP = Physician or Other Licensed Health Care Professional • In Tennessee, licensing boards have determined a PLHCP is a: • Physician • Physician’s Assistant • Advanced Practice Nurse

39. HBV Vaccination • Must be offered to all exposed employees • Exposed employees may decline to take the shots, but must sign a declination statement • Highly recommended and safe • Few contraindications • Three-shot series—titer 1-2 months after last shot • No booster currently recommended

40. Health Care Professional’s Written Opinion for Hepatitis B Vaccination • A PLHCP must determine if the shots are appropriate for each employee • The PLHCP must provide to the employer a Health Care Professional’s Written Opinion for each employee who takes the shots • A copy must be provided to the employee within 15 days of completion of the evaluation • Employee can decline now, take the shots later

41. Post-Exposure Follow-up • After exposure incident • Stick or cut • Splash • Non-intact skin exposure • At no cost to the employee • Begin ASAP after exposure incident • Report exposure incidents to your supervisor or designated personnel immediately

42. Post-Exposure Follow-up • The employer must: • Investigate the incident • ID source individual, obtain consent, and test his/her blood to determine HBV, HCV, and HIV infectivity ASAP, if possible • Give the results of source individual's test to the exposed employee • Obtain and test exposed employee's blood for HBV, HCV, and HIV serological status

43. Post-Exposure Follow-up • Provide post-exposure prophylaxis to the exposed employee as indicated by the CDC • “Updated U.S. Public Health Service Guidelines for the Management of Occupational Exposures to HBV, HCV, and HIV and Recommendations for Postexposure Prophylaxis,” June 29, 2001, Vol 50, No. RR-11 • “Updated U.S. Public Health Service Guidelines for the Management of Occupational Exposures to HIV and Recommendations for Postexposure Prophylaxis,” September 30, 2005, Vol 54, RR-09 • Provide counseling to the exposed employee • Provide evaluation of illness reported by the employee Hepatitis HIV

44. Health Care Professional’s Written Opinion for Post-Exposure Follow-Up • The post–exposure follow-up must be provided by or under the supervision of a PLHCP • The PLHCP must provide to the employer a Health Care Professional’s Written Opinion for each employee who has a post-exposure follow-up • The employee must be provided a copy of the Health Care Professional's Written Opinion for Post-Exposure Follow-up within 15 days of completion of the evaluation

46. On refrigerators, freezers, and other containers with contaminated items Can substitute red containers Labels

47. Training • For all employees listed in the Exposure Determination • At no cost to employees • During working hours • At the time of initial assignment • Annually--within 12 months of last training date • Must be an opportunity for interactive questions and answers • Train employees on adopted safer needle devices before implementation

48. How TOSHA Evaluates Employee Training • Recall • Employees must be able to answer simple questions about bloodborne pathogens, the bloodborne pathogen standard, and other material as specified in 29 CFR 1910.1030, paragraph (g)(2)(vii).

49. Recall Questions • Five Easy Questions • What is universal precautions? • What do you do when there is a blood spill? • Personal protection • Clean-up and disposal procedures • Disinfection (hazard communication applies) • What do you do with contaminated sharps and laundry? • Have you been offered the HBV vaccination free of charge? • Where is the Exposure Control Plan?

50. Additional Training • Copy of the BBP standard, 29 CFR 1910.1030, must be accessible to employees • Epidemiology, symptoms, and modes of transmission of bloodborne diseases • Engineering and work practice controls in practice • Explanation of methods of recognizing tasks that may involve exposure to blood and/or body fluids • Information on types, use, location, removal, handling, decontamination, and disposal of personal protective equipment (ppe)