Cumberland County Sheriff’s Office

1. Cumberland CountySheriff’s Office BLOODBORNE & AIRBORNE PATHOGENS

2. Performance Objectives Epidemiology Of Bloodborne & Airborne Diseases Contents of the Exposure Control Plan (ECP) Methods of Compliance (including PPE) Exposure Incidents & Post Exposure Evaluations Recordkeeping

3. Introduction To provide and maintain a safe working environment for all employees in regard to Airborne & Bloodborne pathogens, employees must be familiar with the CCSO Exposure Control Plan, learn to recognize the potential for occupational exposure, demonstrate proper Biohazard communication & handling, and know what procedure to follow if an exposure incident occurs.

4. Bloodborne Pathogens Microorganisms that are present in human blood which cause disease in humans….such as • HIV • HBV • HCV • Hepatitis A, D, E,G

5. The Center for Disease control (CDC) recognizes the following as linked to the potential transmission of HIV, HBV, and other bloodborne pathogens, all of these substances shall be referred to as blood or other potentially infectious material (OPIM) • blood • semen • vaginal fluid • breast milk • any body fluid that is visibly contaminated w/ blood or other potentially infectious material

6. fluid surrounding bone joints (synovial fluid) • fluid surrounding an unborn baby (amniotic fluid) • fluid between the lung and its covering (pleural fluid) • fluid surrounding the brain & spinal cord (cerebrospinal fluid) • pericardial fluid, peritoneal fluid, and • saliva in dentistry

7. HIV – Human Immunodeficiency Virus • Passed from one person to the other through blood to blood contact, sexual contact, during pregnancy- delivery, as well as breast feeding • HIV destroys the blood’s CD4+ T cells which are crucial to the normal function of the immune system • Most people will develop Acquired Immunodeficiency Syndrome (AIDS) as a result of their HIV infection

8. A diagnosis of AIDS is made by a physician using certain clinical or laboratory standards • Advanced AIDS – CD4+ T Cell count of <50 • Low concentration in blood or OPIM • Lasts approx <72 hours outside of host on surfaces • <1% chance of seroconversion if stuck by contaminated needle

17. Hepatitis – Viral Infection of the Liver • Hepatitis A (HAV) • Found in feces of HAV infected persons • Spread from person to person by putting something in the mouth that has been contaminated with the feces of an infected person • “Employees must wash hands after using toilet” • Incubation period – 15 to 50 days • Once you’ve had it, you can’t get it again • Hepatitis A Vaccine for people 2+ years in high risk areas

18. Hepatitis B (HBV) • Found in blood and certain body fluids (OPIM) • Spread when blood or OPIM from an infected person enters the body of a person who is not immune Unprotected sex Sharing needles Sharps injuries During birth

19. Incubation period – 45 to 160 days • In the U.S. 5,000 people die each year from HBV • HBV infected persons should have a medical evaluation for liver disease every 6-12 months • HBV vaccine is the best protection, recommended for all persons 0-18 years old • Mandatory vaccination or waiver for employees with occupational exposure to bloodborne pathogens within 10 days of assignment

20. Hepatitis C (HCV) • Found in blood and certain body fluids (OPIM) • Spread when blood or OPIM from an infected person enters another person’s body Sharing needles Sharps injuries Sometimes during birth Possible from sex, but is uncommon

21. Incubation period – 14 to 180 days, average 45 days • Chronic infection - 75-85% of infected persons • Chronic liver disease – 70 % of infected persons • In the U.S. 10,000 or more people die each year • HVC infected persons have a high risk of: liver failure (cirrhosis) liver cancer

22. Chronic HCV related liver disease is the leading indication for liver transplant • HCV infected persons should have a medical evaluation for liver disease every 6 – 12 months • No vaccine to prevent HCV • HCV can live outside of the host on surfaces for up to 7 days, even in dried blood • 6-30% chance of converting if exposed

23. 3.8 million infected in U.S., 12,000 -15,000 in Maine • Fewer than 1 in 10 people who have HCV know they have it • Symptoms of HCV can take 20 to 30 years to appear • The liver “cleanses” the blood • HCV causes the liver to form tiny scars which, over time, connect and prevents blood flow through the liver

24. Airborne Pathogens • Mycobacterium Tuberculosis (TB) Spread from person to person thorough the air, effects lungs, but can effect other parts of the body (brains, kidneys, spine) TB germs are put into the air when someone coughs, shouts, or sneezes TB germs can live in body without making you sick. This is called TB Infection

25. If the TB germs break away and spread they can cause the TB Disease • Persons with the TB Disease are most likely to spread it to others they spend time with every day • A TB Skin Test is used for finding out if someone is infected with the TB germ • CCSO Corrections Officers are tested annually

26. TB exposure in Maine is a very low risk (Dept. of Public Health, Maine) • Patrol Deputies suspicious of a person who has a possible airborne precaution should wear a surgical mask and keep their windows down during transport • Notify your supervisor, CCSO medical staff, and local public health authorities

27. How do you get it? • By an exposure to blood and/or OPIM: • broken skin or dry cracked skin • needle stick • splash in the eye • contact with mucous membranes • sex with an infected partner • CANNOT CATCH FROM CASUAL CONTACT!

28. Occupational Exposure “Reasonably anticipated skin, eye, mucous membrane, or parenteral contact with blood or OPIM that may result from the performance of an employee’s duties.”

29. Exposure Incident “A specific eye, mouth, other mucous membrane, non-intact skin, or parenteral contact with blood or OPIM that results from the performance of an employee’s duties.”

30. Job classifications of exposed employees How exposure incidents will be investigated How exposures will be minimized: Methods of Compliance Universal Precautions Engineering Controls Work Practice Controls Personal Protective Equipment Regulated Waste Handling & Labels, Tags & Signs Housekeeping The Exposure Control Plan Contains:

31. Exposure incident protocol Hepatitis B vaccination policy How employees will be informed of the hazards: Initial training Annual training Relationship with healthcare professional How employee records are maintained

32. The Exposure Control Plan shall be: • In writing • Checked annually • Updated as needed • Available to all employees

33. Universal Precautions An approach to infection control that treats all human blood and OPIM as if they were infectious for HIV, HBV, and other bloodborne pathogens. This shall apply to ALL public or inmate/arrestee contacts, at ALL times

34. Wear Gloves • Use Masks & Protective Eyewear • Wear a Gown • Wash Hands & Other Skin Surfaces • Cover Open Wounds • Dispose of Sharps Properly • Clean Up Spills Promptly

35. Take Care of Soiled Linen • Dispose of All Potentially Infectious Waste Carefully • Do Not Reach Blindly • Use a CPR Mask • Never Eat, Drink, or Smoke Until You Have Washed Thoroughly

36. “Engineering and work practice controls shall be used to eliminate or minimize employee exposure” Engineering controls • Isolate the hazard • Examined / maintained / replaced on a regular schedule • Alters how a task is done • Eliminate or minimize the exposure • Sharps containers – Sharp Shuttles • Self-sheathing needles • Eye Wash Stations • Handwashing facilities – when not available use an appropriate hand wash substitute

37. Hand Washing #1 Method of Infection Control Hand washing facilities • Shall be provided and readily accessible Where not feasible, antiseptic cleaners shall be provided • Hands shall be washed with soap and running water as soon as feasible Hands or other skin shall be washed • After removing gloves and contact with other other potentially infectious materials

38. Work Practice ControlsAlters how one conducts a task to minimize the risk of exposure. • Never eat, drink, smoke, apply cosmetics, or handle contact lenses in work areas where there is reasonably anticipated occupational exposure • Never keep food and drink in any type of storage area where blood or OPIM are stored • Place all contaminants in properly labeled containers (Regulated Waste)

39. Wear PPE • Wash hands after removing gloves or ASAP • Do Not Bend or Break Needles • Sharps will immediately be placed in sharps containers • All procedures shall be performed in such a manner as to minimize splashing and/or spraying of blood or OPIM

40. Personal Protective Equipment“Last Line of Defense” • Suitable for the task • Gloves (“latex-free”) • Gowns • Face shield or mask and eye protection • Shoe covers

41. Laboratory coats • One way CPR shields, resuscitation bags or other ventilation devices When there is occupational exposure, the employer shall provide, at no cost to the employee, appropriate personal protective equipment (PPE)

42. Appropriate PPE • If it does not permit blood or OPIM to pass through or to reach… street clothes, undergarments, skin, eyes, mouth, other mucous membranes • under normal conditions of use • for the duration of time forwhich it will be used Performance based • Chosen to protect … based on the type of exposure and the quantity… which can be reasonably anticipated to be encountered • Must serve as an effective barrier • Must be sized to fit properly

43. Accessible • appropriate PPE in • appropriate sizes • readily accessible or is issued • hypoallergenic • someone responsible for checking and ordering Cleaned, Laundered, & Disposed • At no cost to the employee • Contaminated PPE must remain under employer’s control. Repaired & Replaced

44. Regulated Waste • Liquid or semi-liquid blood • Items that would release blood or OPIM if compressed • Caked with dried blood capable of releasing material during handling • Contaminated sharps • When moving containers, they will be closed to prevent spillage during handling.

45. Contaminated sharps and other regulated waste must be discarded ASAP in containers that are accessible, closable, puncture resistant, leakproof, and labeled or color-coded • If leakage possible placed in a second container that meets the requirements of the first. • Disposal shall be in accordance with all applicable local, State, and federal regulations

46. Communication of Hazards Labels and Signs • Warning labels shall be affixed to items used to store, transport, or ship blood or OPIM. • Red bags or containers may be substituted. • Labels affixed as close as possible to the container. • If on contaminated equipment, label must state what is contaminated Exempted from Labeling • Blood, blood products for transfusion provided the label states what it is • Individual containers of blood or OPIM inside a labeled container • Decontaminated regulated waste

47. Housekeeping • Maintained in a clean and sanitary condition • Determine and put into practice an appropriate written schedule for cleaning and method of decontamination (based upon location, surface type, contamination, what is being done in the area). Appropriate disinfectant • EPA registered tuberculocidal agent or sterilant • Products registered against HIV/HBV • Freshly mixed (less than 24 hours) bleach solution 1 part bleach to 10 parts of water

48. Laundry • Handled as little as possible • If contaminated then place and transport in bags meeting color/label requirements • If wet, prevent seep through • If handling, employees will wear gloves and other appropriate PPE

49. Contaminated clothing • Remove contaminated clothing • Bag soiled garments • Wash exposed areas • Report to supervisor and, • Decontaminate laundry at CCSO, Intake Central Laundry NEVER TAKE LAUNDRY HOME

50. IF AN EXPOSURE OCCURS • Immediate Treatment Wound care / First Aid clean wound w/ soap & water flush mucous membranes w/ water/saline other wound care dictated by severity • Contact your immediate supervisor