Bloodborne Pathogens

1. Bloodborne Pathogens 2014 Annual CE Condell Medical Center EMS System Site Code: 107200E-1214 Prepared by: Sharon Hopkins, RN, BSN, EMT-P

2. Objectives • Upon successful completion of this module, the EMS provider will be able to: • 1. Define the involvement of federal agencies related to bloodborne pathogens. • 2. Describe employer responsibilities to employees per OSHA Standards • 3. Define bloodborne pathogen (BBP). • 4. List an example of potential bloodborne pathogens. • 5. Define the term standard precautions.

3. Objectives cont’d • 6. Define personal protective equipment (PPE) available for use. • 7. Define & list examples of engineering controls. • 8. Define & list examples of work place controls. • 9. Describe benefits of hand washing versus use of antiseptic hand products • 10. Recognize signs or labels used to indicate the presence of a bloodborne pathogen hazard.

4. Objectives cont’d • 11.List transmission routes of bloodborne pathogens in the workplace. • 12. Describe the phases of the infectious process. • 13. List factors affecting disease transmission • 14. Describe characteristics of the immune system. • 15. Discuss definition, incubation period, transmission route, signs and symptoms, and PPE to use for a variety of infectious diseases.

5. Objectives cont’d • 16.Describe components of housekeeping and when they are performed • 17.Describe necessary recordkeeping related to bloodborne pathogens. • 18.Review the CMC EMS System Operating Guideline (SOG) policy for infection control and exposure. • 19.Describe the “Notification of Significant Exposure” form and how to complete and forward the form. • 20.Successfully complete the post quiz with a score of 80% or better.

6. Why Take A BBP Program? • Increase your awareness of hazards • Increase your knowledge base • Understand steps to take for prevention of contracting or spreading illness • Understand your role in the healthcare environment • Know how to make your environment as safe as possible for all

7. Federal Agency Involvement • CDC • Monitors national disease data • Disseminates information to all health care providers • NIOSH works with OSHA • Sets standards & guidelines for workplace and worker controls to prevent infectious diseases in workplace

8. Federal Agency cont’d • OSHA • Occupational Safety and Health Administration • Protects the health of workers • Bloodborne Pathogen (BBP) Standards protects employees at risk of exposure to blood or other potentially infectious material (OPIM) • Requires employers to develop written documents regarding implementation and training of the Standard

9. Employer Responsibilities – Written Exposure Control Plan • Plan must be in writing and accessible 24/7 • Plan is to be updated annually • Plan is to be written including all elements required by OSHA BBP Standard 29 CFR 1910.1030 • Plan needs to be tailored to the individual requirements of your department

10. Written Exposure Control Plan cont’d • Identify hazards in the workplace • Identify which tasks could expose employees • Identify which employees could have potential exposure based on tasks expected • Identify and provide appropriate PPE • Train employee in use & care of PPE’s • Maintain PPE’s and replace worn or damaged PPE’s

11. Written Exposure Control Plan cont’d • Implement various methods of exposure control • Standard precautions • Engineering and work practice controls • Housekeeping • Make available Hepatitis B vaccination • Offer post-exposure evaluation and follow-up • Evaluate circumstances surrounding an exposure • Maintain recordkeeping

12. Bloodborne Pathogen (BBP) • Microorganisms carried in blood that can cause disease in humans • Disease transmitted by contact with blood or body fluids of an infected person • Risk of exposure increases in presence of open wounds, active bleeding, or increased secretions

13. Normal Flora • Microorganisms that live in and on our bodies without causing disease • Part of host defenses • Help keep us free of disease • Normal flora creates an environment not conducive to disease-producing microorganisms (pathogens) • Opportunistic pathogen • Usually non-harmful pathogens that cause disease in unusual situations (i.e.: weakened immune systems)

14. Examples BBP • HIV/AIDS • Hepatitis B (HBV) • Hepatitis C (HCV) • Hepatitis D (HDV) • Syphilis • Malaria • Brucellosis

15. Other Potentially Infectious Agents • Cerebrospinal fluid • Synovial fluid • Pleural fluid • Amniotic fluid • Pericardial fluid • Peritoneal fluid • Semen • Vaginal secretions • Any body fluid contaminated with blood or saliva in dental procedures • Body fluids in emergency situations that cannot be recognized – blood, saliva, vomit, urine

16. Exposure Potential • Contact with another person's blood or bodily fluid that may contain blood • Mucous membranes – eyes, mouth, nose • Non-intact skin • Contamination via sharps or needles

17. Most Common Exposures • Needlesticks • Cuts from contaminated sharps – scalpels, broken glass • Contact with mucous membranes – eyes, nose, mouth, broken/cut/abraded skin with contaminated blood/fluid

18. Safe Practice Everyone’s got something that you don’t want Take precautions with every potential exposure – seen and unseen

19. Standard Precautions • Term includes universal precautions and body substance isolation (BSI) • Includes a group of infection prevention practices applied to all patients in the delivery of healthcare • Based on principle that everyone may have something you don’t want • You can’t always “tell” what infectious process someone may have • Application of Standard Precautions dictated by task being performed related to potential for exposure

20. Standard Precautions cont’d • Routine use of appropriate PPE taken to prevent exposure to any contact of blood or other body fluids • Protects skin and mucous membranes • Frequent handwashing performed • Hand sanitizer acceptable in absence of soap & water especially in absence of gross material • Precautions taken to avoid needle sticks

21. Personal Protective Equipment - PPE • The type of protective equipment appropriate for your job or research varies with the task and the degree of exposure you anticipate

22. PPE’s • Eye and face protection • Hand protection (i.e.: gloves) • Protective clothing (i.e.: gowns) • Employee needs to be informed: • When and what PPE to use • How to put PPE on, adjust it, wear it, and take it off • Limitations of PPE • Maintenance, care, useful life, and disposal of PPE

23. Using PPE’s • Why do you think hand washing is promoted so much? • Most pathogens are transferred via our contaminated hands • When wearing gloves, are you aware of when they come into contact with potential pathogens? • Are you aware of what you do with your gloved hands and how many times you touch and potentially cross contaminate?

24. Gloves – intact Utility gloves – broken glass & sharps Gowns – impervious to fluids Tyvek suit – gross contamination anticipated Face shield – invasive procedures Goggles – shields front, sides, top of eyes Surgical mask – worn with eye protection Booties – to cover shoes/boots Head covering - splashing PPE Use

25. PPE’s • To be worn/used in potential exposure situations • Removed & replaced if not functioning due to puncture or tearing • Contaminated clothing removed as soon as possible • PPE removed before leaving work area • Handle contaminated laundry as little as possible • Know where PPE’s are kept

26. PPE’s • Can only be useful if worn • Know how to use your PPE’s • IF not sized and used appropriately, it’s like not using one at all

27. Removing Gloves • Place fingers of one hand under cuff of 2nd glove and avoid contact with skin • Slowly pull glove off turning it inside out as it removed • Place removed glove into palm of gloved hand • Slowly pull remaining glove off turning it inside out as you remove it and capturing 1st glove inside 2nd glove • Dispose of properly • Wash hands including wrist area

28. Engineering Controls • Devices that isolate or remove bloodborne pathogen hazards from the workplace to minimize exposure • Sharps disposal containers • Needleless systems • Self-sheathing needles • Devices only good if & when they are used

29. Work Practices • Practices that reduce the likelihood of exposure by altering how a task is performed • Handwashing (preferably frequent!!!) • Recapping a needle with the one-handed technique, if at all • Not eating or drinking in ambulance • Disinfecting equipment and vehicle • Changing from soiled clothing • Keeping work area clean and decontaminated

30. Handling Sharps • Avoid recapping needles • If necessary, recap with the one handed technique • Never break shear needles • Use mechanical devices to move or pick up used needles (i.e.: forceps, pliers) • Dispose of needles in labeled sharps container • Do not overfill sharps container • To transport sharps container, close to prevent spilling

31. Handwashing • Single, most effective means of work practice control that is highly effective • Performed before and after every patient exposure • Performed after removal of gloves • Performed prior to eating • Performed after toileting • Wash hands for 15 – 20 seconds including all surfaces of hands and up to wrists

32. How Good Are You? • Frequently missed areas when hand washing performed

33. Antiseptic Hand Cleaner • Antiseptic hand cleaners may be used as an appropriate hand washing practice IF: • Your gloves remained intact • You have had no occupational exposure to blood or other potentially infectious materials • Material can be left to air dry on your skin • Choose product with at least 60% alcohol base

34. Hazardous Material Labels • Warning label of fluorescent orange or orange red with contrasting letter and symbols (universal symbol) • Must be used to identify presence of blood or other potentially infectious material • Use of red bags substitutes for use of labels

35. Biohazard Labels cont’d • Affixed to • Containers of regulated waste • Containers of contaminated reusable sharps • Refrigerators or freezers containing blood or OPIM • Other containers used to store, transport, or ship blood or OPIM • Contaminated equipment being shipped for servicing • Bags of contaminated laundry

36. How do we get exposed? • What is the infectious process? • What are the risk factors?

37. Factors Affecting Transmission • Correct mode of entry available for that pathogen • Virulence – strength or ability to infect or overcome body’s defenses • Number of organisms – minimal dose necessary to cause infection • Resistance of host – ability to fight off pathogen

38. Modes of Transmission • Bloodborne • Airborne • Droplet • Fecal-oral • Indirect • Opportunistic* • Sexual* • *Sexual route and opportunistic not of concern to on-the-job EMS provider

39. Bloodborne Exposure • Direct or indirect contact with blood or infected body fluids • Needle stick • Splash on broken skin • Splash on mucous membranes • Eyes, nose, mouth

40. Airborne Exposure • Particles remain suspended in air a long time and float over a distance • Most risk at less than 6 feet from source • Transmitted via sneezing, coughing, talking, shedding of skin • Patient to wear a surgical mask to minimize spread of disease • TB, polio, pneumonia, influenza, chicken pox • Healthcare worker to wear N95 to prevent exposure to particles

41. Droplet Exposure • Droplet of moisture expelled from upper respiratory tract and then inhaled into respiratory system or contact with mucous membranes • Droplets too heavy to remain airborne for long • Transmitted via sneezing, coughing, talking • Most at risk within 3 feet of source • Common cold, influenza, H1N1, meningitis, rubeola (measles), whooping cough

42. Indirect Exposure • Contact with a contaminated object or surface and then material is transferred to your mouth, eyes, nose or open skin • HBV can survive about 7 days dried on a surface • HIV does not live long outside the body

43. Fecal-Oral Exposure • Ingestion of contaminated food or water • Contaminated hands transfer microorganisms to all surfaces and objects touched • Recipient touches contaminated surface and then brings contaminated hands to face or ingests contaminated product • HAV, food poisoning

44. Phases of The Infectious Process • Latent period • Host infected but not infectious; cannot transmit the agent • Communicable period • May have some signs and can transmit to another host • Incubation period • Time between exposure and presentation of signs and/or symptoms; can range from days to months to years

45. Phases Cont’d • Seroconversion • The point in time when antibodies are developed and a previously negative lab test is now positive • Window phase • Time between exposure to disease and seroconversion • Disease period • Time from onset of signs and symptoms until resolution or death

46. Factors Affecting Disease Transmission • Mode of entry • Point of entry available (i.e.: non-intact skin, mucous membrane) • Virulence • Strength of organism (ability to infect) • Dose • Number of organisms • Host resistance • Is host healthy or not?

47. Stopping a Potential Infection • Break the cycle at any one of 4 points: Infectious agent Means of transmission Host Routes of exposure

48. The Immune System • Protects body from foreign invaders • Needs to differentiate self from nonself • Can recognize antigens of most bacteria and viruses as foreign material • Series of actions put into motion to eliminate the foreign material or antigen • The inflammatory response initiates defense mechanisms for release of special chemicals, processes and formation of antibodies all to fight disease

49. Infectious Disease Discussion • The following slides discuss a few select diseases that may be problematic for the healthcare worker or at least something to be aware of • Reminder: • Assume all persons have something contagious that you don’t want!

50. Review Selected Infectious Diseases Definition Incubation Period Transmission Mode Signs & Symptoms Recommended PPE’s Special Considerations