Blood-borne Pathogens, TB and Universal Precautions

1. Blood-borne Pathogens, TB and Universal Precautions

2. Objectives • Blood-borne disease exposure awareness • Self protective measures • PPE • Exposure Training • Effective Infection Control

3. Introduction Concerns about AIDS can make needle sticks, slips and spills alarming if you work in healthcare. Yet AIDS isn’t the only blood-borne threat you face. In fact, you are more likely to be infected by the hepatitis B virus (HBV), which is just as deadly. The Occupational Safety and Health Administration (OSHA) has issued a standard that, if followed, is designed to protect you. It details ways that you and Advanced Tissue can work together to substantially reduce your risk of contracting a Blood-borne disease. You are covered by the standard if it is reasonably anticipated that you could be exposed to Blood-borne pathogens as a result of performing your job duties.

4. Blood-Borne Diseases Blood-borne diseases that you are more prone to be exposed to include non-A hepatitis, non-B hepatitis and delta hepatitis, as well as syphilis, malaria and Human Immunodeficiency Virus. The two most significant are hepatitis B (HBV) and Human Immunodeficiency Virus (HIV).

5. HBV • Hepatitis means “inflammation of the liver”. Hepatitis B virus (HBV) is a major infectious Blood-borne hazard you face. It infects approximately 9000 healthcare workers a year, resulting in more than 400 hospitalizations and 200 deaths. If you become infected with HBV: • You may suffer from flu-like symptoms becoming so severe that you may require hospitalization. • You may feel no symptoms at all, feeling as if you were not infected. • Your blood, saliva and other body fluids may be infectious. • You may spread the virus to sexual partners, family members and even unborn infants. HBV may severely damage your liver, leading to cirrhosis and almost certain death.

6. HIV • The Human Immunodeficiency Virus (HIV) attacks the body’s immune system, causing the disease knows as AIDS, or Acquired Immune Deficiency Syndrome. Currently, there is no vaccine to prevent infection. A person infected with HIV: • May carry the virus without developing symptoms for several years. • Will eventually develop AIDS. • May suffer from flu-like symptoms, fever, diarrhea and fatigue. • May develop AIDS-related illnesses including neurological problems, cancer and other opportunistic infections. HIV is transmitted primarily through sexual contact, but may also be transmitted through contact with blood and some body fluids. HIV is not transmitted by touching, feeding or working around anyone who carries the disease.

7. Workplace Transmission HBV, HIV and other pathogens may be present in: • Body fluids such as saliva and any other body fluid visibly contaminated with blood.

8. Means of Transmission Blood-borne pathogens may enter your body and infect you through a variety of means, including: • An accidental injury by any sharp object, contaminated with infectious material, which can pierce, puncture or cut your skin. • Open cuts, nicks and skin abrasions, even dermatitis and acne, as well as the mucous membranes of your mouth, eyes or nose. • Indirect transmission, such as touching a contaminated object or surface and transferring the infectious material to your mouth, eyes, nose or open skin.

9. Means of Transmission (cont’d.) Contaminated Surfaces Contaminated environmental surfaces are a major mode of HBV spread. HBV can survive on environmental surfaces dried and at room temperatures for at least one week. Surfaces and objects can be heavily contaminated without visible signs. Clean and decontaminate all surfaces that had contact with potentially infectious materials with appropriate disinfectants. Refer to policy HME-IC-C-1 on cleaning and disinfecting and policy HME-IC-E-1 on product management and universal precaution.

10. Exposure Control Plan The risks of Blood-borne diseases in the work place are quite serious. Yet you can learn effective ways of minimizing them. A good place to start is with Advanced Tissue’s Infection Control policies. They cover: • Identification of employees covered by the standard. • Specific measures to take and that will be taken by Advanced Tissue to minimize your risk of exposure. • Procedures to follow if there is an exposure incident.

11. Universal Precautions You cannot tell for sure who carries a Blood-borne pathogen. HIV and HBV infect people of all ages and socioeconomic classes are from every state and territory. They are from rural areas as well as cities. • Many people carry Blood-borne infections without visible symptoms. • Many people carry Blood-borne infections without even knowing it. • You must treat all human blood and human body fluids as if they are infected with HIV, HBV, or other Blood-borne pathogens. You can’t identify every patient who may transmit infection. Yet you can’t afford not to, since it takes just one exposure to become infected. Universal precautions resolve this uncertainty by requiring you to treat all human body fluids as if they are infected with HIV, HBV or other Blood-borne pathogens.

12. Reducing Your Risk There are five major ways to reduce your risk of exposure to Blood-borne pathogens on the job: • Engineering controls • Employee work practices • Personal protective equipment • Housekeeping • Hepatitis B Vaccine Alone, none of these approaches are 100% effective. They must be used together, like five protective barriers against infection.

13. Engineering Controls These are physical or mechanical systems Advanced Tissue provides to eliminate hazards at their sources. Examples would be the isolation or removal of Blood-borne pathogen hazards from the workplace.

14. Work Practice Controls There are specific procedures you must follow to reduce your exposure to Blood-borne pathogens or infectious materials.

15. Hand washing If infectious material gets on your hands, the sooner you wash it off, the less chance you have of becoming infected. • Hand washing keeps you from transferring contamination from your hands to other areas of your body or other surfaces you may contact later. • Every time you remove your gloves, you must wash your hands with non-abrasive soap and running water as soon as you possible can. • If skin or mucous membranes come in direct contact with blood, wash or flush with water as soon as possible.

16. Hand-hygiene technique • When decontaminating hands with an alcohol-based hand rub, apply product to palm of one hand and rub hands together, covering all surfaces of hands and fingers, until hands are dry. Follow the manufacturer's recommendations regarding the volume of product to use. • When washing hands with soap and water, wet hands first with water, apply an amount of product recommended by the manufacturer to hands, and rub hands together vigorously for at least 15 seconds, covering all surfaces of the hands and fingers. Rinse hands with water and dry thoroughly with a disposable towel. Use towel to turn off the faucet. Avoid using hot water, because repeated exposure to hot water may increase the risk of dermatitis. • Liquid forms of plain soap are acceptable when washing hands with a non-antimicrobial soap and water.. • Multiple-use cloth towels of the hanging or roll type are not recommended.

17. Personal Protective Equipment • Equipment that protects you from contact with potentially infectious materials may include gloves, masks, gowns, aprons, face shields, and protective eye wear. • Under normal work conditions, protective equipment must not allow potentially infectious materials to contact your work clothes, street clothes, undergarments, skin or mucous membranes. The type of protective equipment appropriate for a given task depends on the degree of exposure you anticipate.

18. Hazard: Generation of splashes, spray, spatter or droplets of infectious material • Protection: Mask, gloves, eye protection, gown and face shield • Hazard: Potential clothing or skin exposure • Protection: Gown, gloves, apron and other protective body clothing

19. If your job requires you to be exposed to Blood-borne pathogens, Advanced Tissue will: • Provide appropriate protective equipment. • Clean, launder, repair, replace or dispose of protective equipment.

20. General Rules on Personal Protective Equipment (PPE) You and Advanced Tissue must follow these rules to ensure that your protective equipment does its job. • You must be trained to use the PPE properly. • PPE must be appropriate for the task. • You must use appropriate PPE each time you perform a task. • Your PPE must be free of physical flaws that could compromise safety. • Your gloves must fit properly. • When wearing PPE, if it is penetrated by blood or other potentially infectious materials, remove it as soon as feasible. • Before leaving the work area, remove all PPE and place it in the designated container for disposal.

21. Gloves Gloves are the most widely used form of PPE. They act as a primary barrier between your hands and Blood-borne pathogens. Latex or vinyl gloves are used for medical, dental or laboratory procedures. Heavy duty utility gloves may be used for housekeeping duties.

22. Gloves Here’s how to use them: • You must wear gloves when you anticipate hand contact with blood, potentially infectious materials, mucous membranes or non-intact skin. • Advanced Tissue will provides hypoallergenic gloves. • Since gloves can be torn or punctured, bandage any cuts before being gloved. • Replace disposable single-use gloves as soon as possible if contaminated, torn, punctured or damaged in any way. Never wash or decontaminate for reuse. • Utility gloves may be decontaminated and reused unless they are cracked, peeling, torn, punctured or no longer providing barrier protection.

23. Glove Removal You must follow a safe procedure for glove removal, being careful that no substances from the soiled gloves contact your hands: • With both hands gloved, peel the first glove from the inside, tucking the first glove inside the second. • With the exposed hand, peel the second glove from the inside, tucking the first glove inside the second. • Dispose of the entire bundle promptly. • Remove gloves when they become contaminated, damaged or before leaving the work area. • Wash your hands thoroughly.

24. Good Housekeeping • Do not pick up broken glass, which may be contaminated, directly with gloved or bare hands. Use tongs or a brush and a dust pan. • Place contaminated sharps and infectious wastes in designated containers. They should be labeled or color-coded, leak-proof containers that are closable and easily accessible to those who use them. Do not allow containers to overfill.

25. Read the Label These warning signs protect you from Blood-borne hazards: • Bags or containers bearing the “DIRTY” or biohazard sign tell you when the containers hold blood or other potentially infectious materials. • Warning labels are also used to designate contaminated products.

26. HBV Vaccination If you may be exposed to HBV on the job, your employer will make the hepatitis B vaccination available to you at no cost. The vaccine is administered by three injections over a six month period. Today’s vaccines are safe and effective. • Those now used in the US are made from yeast and cannot be infected with HIV or other Blood-borne pathogens. Over 2 million US healthcare workers have already been vaccinated. • The complete series of HBV vaccinations is 85 to 97 percent effective at protecting you from getting the disease or becoming a carrier for nine years or longer.

27. HBV Vaccination You should not be vaccinated if: • You have already received the complete hepatitis B vaccination series • Antibody testing reveals you are immune • You should not receive the vaccination for other specific medical reasons

28. Facts about TB • “TB” is short for a disease called tuberculosis. Unlike the Blood-borne diseases we have discussed, tuberculosis is spread by tiny germs that are dispersed into the air when a person with tuberculosis disease of the lungs or throat coughs, sneezes, shouts or sings. Because the germ is spread by these airborne particles, a person who shares the same airspace with a person who has infectious TB disease (such as a home health care provider for such an infectious person) is at risk for infection. They get the infection by inhaling these germs into their lungs where they can become established and spread throughout the body. The TB germ can live in your body without making you sick. This is called a TB infection. Your immune system traps TB germs so that they will not spread and make you sick. But sometimes, the TB germs can break away, spread and cause TB disease. The germs can then attack the lungs and other parts of the body. They can go to the kidneys, brain, or spine. If anyone has TB disease, they need medical help. If they don’t get help, they can die. • If you have TB disease, you may feel week, lose your appetite, lose weight, have a fever, or sweat a lot at night. If the TB disease is in your lungs, you may cough a lot, cough up mucous or phlegm, cough up blood, or have chest pain when you cough. You should always cover your mouth when you cough. If you get TB disease in another part of the body, the symptoms will be different. Only a doctor can tell if you have TB disease.

29. TB Infection Control • The key to preventing the spread of TB is early detection, isolation and treatment of persons with infectious TB. Precautions must be taken to prevent the airborne transmission of the disease as soon as TB is suspected. • Personnel entering a shared airspace with a patient having suspected or confirmed active infectious TB disease must take precautions to protect themselves from infection. In addition to standard universal precautions, staff members must don a NIOSH N95 approved respirator to meet OSHA requirements and CDC guidelines for TB exposure control, before entering the patient’s client’s home and will not remove the respirator until after exiting the patient’s home. This respirator will prevent from inhaling TB germs.

30. How do I know if I have TB infection or TB disease? • All direct patient care personnel must have an annual TB skin test. All direct patient care personnel who do not have documentation of previous TB testing must undergo a two part testing procedure, the first time and then annually thereafter. A skin test is the only way to tell if you have a TB infection. The test is “positive” if a bump the size of a pencil eraser or bigger appears on the arm. This bump means you probably have TB infection. • Other tests can be done to show if you have TB disease. All direct patient care personnel who have a positive skin test must have a chest x-ray done every five years and the x-ray interpretation must be kept in the employee’s medical file. TB germs may be deep inside your lungs. Phlegm that you cough up will be tested in a laboratory to see if the TB germs are present in your lungs. • If the TB germs are in your lungs and throat, you can give the TB infection to your family, friends, co-workers and patients / clients. They, in turn, can get sick with TB disease. If you ever get TB disease, you may have to be separated from other people until you can’t spread TB germs. This probably won’t be for very long, if you take your medicine as prescribed.

31. Can TB disease be cured? • Yes! TB can be cured by using special drugs that kill TB germs. But TB germs are strong. It takes at least six to nine months of medication to wipe them all out. It is very important that you take all of your medicine. • If you stop taking your medicine too soon, it is a big problem. The TB germs that are still alive become even stronger. You may even need stronger drugs to kill these “super” TB germs. This doesn’t need to happen. If you take all of your medicine, the TB germs will die. A few people have side effects to anti-TB drugs. You will get tests to check on this.

32. TB Reporting Reporting of TB is required by law in all 50 states. All new and suspected TB cases are reported to the appropriate health department immediately.

33. Playing It Safe Additional facts you should know: • If you are exposed due to direct patient care, report the incident immediately to your supervisor. • If you consent, Advanced Tissue will provide you with a confidential medical evaluation, including blood tests, any available post-exposure preventive treatment and follow-up counseling. • Advanced Tissue will provide you with a free training program during working hours and annually thereafter. • Training tells you more about Blood-borne diseases, how to use PPE and how to report an exposure incident. It also details your rights and responsibilities as a worker.

34. Rise to the Challenge It is possible to protect yourself from Blood-borne pathogens on the job by knowing the facts and taking proper precautions. Working together with Advanced Tissue , you can do it. As a healthcare worker, you can be confident in your ability to safely care for the well-being of others and yourself.