2011 Bloodborne Pathogen Training

1. 2011 Bloodborne Pathogen Training To be completed by all UMC Employees, Contract Staff and Volunteers

2. Bloodborne Pathogens (Germs) You Don’t Want to Pass These Around

3. Transmission of Bloodborne Pathogens • Healthcare personnel are at risk for occupational exposure to bloodborne pathogens, including hepatitis B virus (HBV), hepatitis C virus (HCV), and human immunodeficiency virus (HIV). • Exposures occur through needle sticks or cuts from other sharp instruments contaminated with an infected patient's blood or through contact of the eye, nose, mouth, or skin with a patient's blood.

4. Exposure to Bloodborne Pathogens • Important factors that influence the overall risk for occupational exposures to bloodborne pathogens include the number of infected individuals in the patient population and the type and number of blood contacts. • Most exposures do not result in infection. • Following a specific exposure, the risk of infection may vary with factors such as these: • The pathogen involved • The type of exposure • The amount of blood involved in the exposure • The amount of virus in the patient's blood at the time of exposure

5. What is the risk of infection after an occupational exposure? Hepatitis B Virus (HPV) - Epidemiology • Healthcare personnel who have received hepatitis B vaccine and developed immunity to the virus are at virtually no risk for infection. • While there is a risk for HBV infection from exposures of mucous membranes or nonintact skin, there is no known risk for HBV infection from exposure to intact skin.

6. What is the risk of infection after an occupational exposure? Hepatitis C Virus (HCV) - Epidemiology • The average risk for infection after a needle stick or cut exposure to HCV infected blood is approximately 1.8%. The risk following a blood exposure to the eye, nose or mouth is unknown, but is believed to be very small; however, HCV infection from blood splash to the eye has been reported. • There also has been a report of HCV transmission that may have resulted from exposure to nonintact skin, but no known risk from • exposure to intact skin.

7. What is the risk of infection after an occupational exposure? Human Immunodeficiency Virus (HIV) - Epidemiology • The average risk of HIV infection after a needle stick or cut exposure to HlV-infected blood is exposures do not lead to infection. • The risk after exposure of the eye, nose, or mouth to HIV-infected blood is estimated to be 1 in 1,000. • There have been no documented cases of HIV transmission due to an exposure involving a small amount of blood on intact skin (a few drops of blood on skin for a short period of time).

8. Symptoms of Bloodborne Diseases HBV • The presence of signs and symptoms varies by age and prior medical conditions. Some patients have no symptoms during the initial infection period. When present, signs and symptoms can include: • Fever • Fatigue • Loss of appetite • Nausea • Vomiting • Abdominal pain • Dark urine • Clay-colored bowel movements • Joint pain • Jaundice Hepatitis B Virus

9. Symptoms of Bloodborne Diseases HCV • Fever • Fatigue • Loss of appetite • Nausea • Vomiting Approximately 20%–30% of those newly infected with HCV experience fatigue, abdominal pain, poor appetite, or jaundice. In those persons who develop symptoms, the average time period from exposure to symptom onset is 4–12 weeks (range: 2–24 weeks). • Abdominal pain • Dark urine • Clay-colored bowel movements • Joint pain • Jaundice

10. Symptoms of Bloodborne Diseases HIV • The only way to know if you are infected is to be tested for HIV infection. You cannot rely on symptoms to know whether or not you are infected. Many people who are infected with HIV do not have any symptoms at all for 10 years or more. • The following may be warning signs of advanced HIV infection: • Rapid weight loss • Dry cough • Recurring fever or profuse night sweats • Profound and unexplained fatigue • Swollen lymph glands in the armpits, groin, or neck • Diarrhea that lasts for more than a week • White spots or unusual blemishes on tongue, mouth or throat • Pneumonia • Red, brown, pink or purplish blotches on or under the skin or inside the mouth, nose or eyelids • Memory loss, depression and other neurological disorders

11. OSHA Bloodborne Pathogen Standard The OSHA Bloodborne Pathogen Standard is available on the OSHA website at http://www.osha.gov/pls/oshaweb/owadisp.show_document?p_table=standards&p_id=10051 or on Sharepoint in the Infection Control Manual under Resources http://umc-sp/UMC%20Policy%20Site/Infection%20Control/Resources/OSHA%20standards.aspx

12. OSHA Bloodborne Pathogen Standards • The standard covers all employees in jobs where occupational exposure to bloodborne pathogens is anticipated. • The guidelines define procedures and required training for employees in the topics of – • Bloodborne Diseases • Exposure Control Plan • PPE • Work Practice and Engineering Controls • Standard Precautions • Hepatitis B Immunization • Exposure Incidents • Biohazard labeling

13. Exposure Control Plan A Copy of the UMC Exposure Control Plan can be obtained on Sharepoint in the Infection Control Policies http://umc-sp/UMC%20Policy%20Site/Infection%20Control/Infection%20Control%20Policies/IF-105.03%20Exposure%20Control.doc

14. Tasks/Activities That May Involve Exposure to Blood Regulatory Definitions Methods to recognize Exposure Incidents

15. Regulatory Definitions Blood: Blood Blood Components Products made from Human Blood Other Potentially Infectious Materials (OPIM): Human Body Fluids: • Semen • Vaginal Secretions • Cerebrospinal Fluid (in the brain and spine) • Synovial Fluid (in the joints) • Pleural Fluid (in the lung cavity) • Pericardial Fluid ( in the heart) • Peritoneal Fluid (in the abdomen) • Amniotic Fluid (in the uterus) • All body fluids that are of undetermined nature or where blood is present are also considered to be an OPIM.

16. Tasks and Activities • Any tasks or activity that involves blood or OPIM has a potential for exposure. • Use PPE when performing these tasks or activities to minimize your risk. • Activities are not limited to patient care, but can also include cleaning, laboratory testing, and security to name just a few.

17. Exposure Incident An exposure incident is an event resulting from the performance of an employee's duties in which there has been: • An injury that goes through the skin (percutaneous) involving a potentially contaminated needle or other sharp • A splash of blood or other potentially infectious materials to the eyes, mouth, or mucous membranes • Blood or other potentially infectious materials contacting broken skin

18. Engineering Controls, Work Practices and PPE

19. Engineering Controls vs Work Practice Controls Engineering Controls • Controls that isolate or remove the bloodborne pathogens hazard from the workplace. Examples: sharps disposal containers, self-sheathing needles, safer medical devices, such as sharps with engineered sharps injury protections and needleless systems, blunt sutures Work Practice Controls • Controls that reduce the likelihood of exposure by altering the manner in which a task is performed. Examples: Prohibiting recapping of needles by a two-handed technique, hands free technique for passing surgical instruments, double gloving in surgery

20. Engineering Controls • Use appropriate Red Bags for Biological Waste. Biological waste must not go into the regular trash. It must be placed in containers with red bags that display the biohazard symbol. • Always put sharps in a Sharps Container, never in the regular trash or Red Bag waste. • Work areas must be: • Cleaned and decontaminated daily with an appropriate disinfectant and after contact with blood or OPIM. • Labeled with a biohazard sticker if used for storage or processing of blood or OPIM.

21. Work Practices • Cover cuts, hangnails and scrapes • Never re-cap, bend or break needles – use a device or one-handed technique when recapping is an absolute must. • Minimize splashing by using available transfer devices or covering the specimen tube with gauze before pulling out the stopper • Food or beverages are not to be placed in refrigerators, freezers or cabinets used for infectious materials. • No eating, drinking, applying makeup, or handling contact lens in work areas. In other words, no food or drinks at desk.

22. Personal Protective Equipment (PPE) • Types of PPE Available: • Gloves • Gowns • Masks • Goggles or faceshields • Hair covers • Foot covers • PPE helps to protect against exposure, but cannot totally prevent exposure. Good work practices in conjunction with appropriate PPE minimize the risks. Guaranteed to help protect you!!

23. Personal Protective Equipment (PPE) Key Points Donning and Removal Handling, Decontamination and Disposal Location Selection

24. Key Points About PPE • Don before contact with the patient, generally before entering the room • Use carefully – don’t spread contamination • Remove and discard carefully, either at the doorway or immediately outside patient room; remove respirator outside room • Immediately perform hand hygiene with soap and water, or foam if sink not available CDC, PPE Use in Healthcare Settings

25. Sequence* for Donning PPE • Gown First Mask or • Respirator • Goggles or Gloves • Face Shield *Combination of PPE will affect sequence – be practical CDC, PPE Use in Healthcare Settings

26. How to Don a Gown • Select appropriate type and size • Opening is in the back • Secure at neck and waist • If gown is too small, use two gowns • Gown #1 ties in front • Gown #2 ties in back CDC, PPE Use in Healthcare Settings

27. How to Don a Mask • Place over nose, mouth and chin • Fit flexible nose piece over nose bridge • Secure on head with ties or elastic • Adjust to fit CDC, PPE Use in Healthcare Settings

28. How to Don a Particulate Respirator • Select a fit tested respirator • Place over nose, mouth and chin • Fit flexible nose piece over nose bridge • Secure on head with elastic • Adjust to fit • Perform a fit check – • Inhale – respirator should collapse • Exhale – check for leakage around face CDC, PPE Use in Healthcare Settings

29. How to Don Eye and Face Protection • Position goggles over eyes and secure to the head using the ear pieces or headband • Position face shield over face and secure on brow with headband • Adjust to fit comfortably CDC, PPE Use in Healthcare Settings

30. How to Don Gloves • Don gloves last • Select correct type and size • Insert hands into gloves • Extend gloves over isolation • gown cuffsgown cuffs CDC, PPE Use in Healthcare Settings

31. How to Safely Use PPE • Keep gloved hands away from face • Avoid touching or adjusting other PPE • Remove gloves if they become torn; perform hand hygiene before donning new gloves • Change gloves when moving from dirty to clean body sites (wound>IV site, eyes) and between dirty sites (wound>wound) • Limit surfaces and items touched CDC, PPE Use in Healthcare Settings

32. “Contaminated” and “Clean” Areas of PPE • Contaminated – outside front • Areas of PPE that have or are likely to have been in contact with body sites, materials, or environmental surfaces where the infectious organism may reside • Clean – inside, outside back, ties on head and back • Areas of PPE that are not likely to have been in contact with the infectious organism PPE Use in Healthcare Settings

33. Sequence for Removing PPE Gloves Face Shield or goggles Gown Mask or Respirator PPE Use in Healthcare Settings

34. Where to Remove PPE • At doorway, before leaving patient room or in anteroom* • Remove respirator outside room, after door has been closed* * Ensure that hand hygiene facilities are available at the point needed, e.g., sink or alcohol-based hand rub CDC, PPE Use in Healthcare Settings

35. How to Remove Gloves (1) • Grasp outside edge near wrist • Peel away from hand, turning glove inside-out • Hold in opposite gloved hand PPE Use in Healthcare Settings

36. How to Remove Gloves (2) • Slide ungloved finger under the wrist of the remaining glove • Peel off from inside, creating a bag for both gloves • Discard CDC, PPE Use in Healthcare Settings

37. Remove Goggles or Face Shield • Grasp ear or head pieces with ungloved hands • Lift away from face • Place in designated receptacle for reprocessing or disposal CDC, PPE Use in Healthcare Settings

38. Removing a Mask • Untie the bottom tie first, then top • Remove from face • Discard CDC, PPE Use in Healthcare Settings

39. Removing a Particulate Respirator • Lift the bottom elastic over your head first • Then lift off the top elastic • Discard CDC, PPE Use in Healthcare Settings

40. Hand Hygiene • Perform hand hygiene immediately after removing PPE. • If hands become visibly contaminated during PPE removal, wash hands before continuing to remove PPE • Wash hands with soap and water or use an alcohol-based hand rub * Ensure that hand hygiene facilities are available at the point needed, e.g., sink or alcohol-based hand rub CDC, PPE Use in Healthcare Settings

41. You have to rub your hands for at least 20 sec to get rid of the bacteria Use enough to cover all the surfaces of your hands The #1 Way of Preventing Infection is Good Hand Washing!

42. Handling, Decontamination and Disposal of PPE • Remember that PPE is contaminated after use. • Dispose in trash at doorway. Must be red-bagged if visibly contaminated with blood or OPIM. • Most PPE is single-use and disposable. Reusable PPE must be decontaminated as recommended by the manufacturer. Examples of reusable PPE: • PAPR (Powered Air-Purifying Respirator) – used in Decon • Decontamination Suits, Boots

43. Location of PPE • Every department has a supply of appropriate PPE for their employees. • Please consult with your Director if you do not know the location of PPE in your department. • Materials Management maintains a supply of PPE to replenish stock in the departments. Contact Materials Management if appropriate PPE is not available in your area.

44. PPE Selection • PPE is selected based upon the task being performed, or the type of isolation. • Wear gloves (clean, nonsterile gloves are adequate) when touching blood, body fluids, secretions, excretions and contaminated items. • Wear a mask and eye protection or a face shield to protect mucous membranes of the eyes, nose and mouth during procedures and patient care activities that are likely to generate splashes or sprays of blood, body fluids, secretions and excretions. • Wear a gown (a clean, nonsterile gown is adequate) to protect skin and to prevent soiling of clothing during procedures and patient-care activities that are likely to generate splashes or sprays of blood, body fluids, secretions or excretions.

45. Isolation Precautions In the course of your work, it may become necessary for you to enter a room of a patient in isolation precautions. Patients are isolated • To protect them from pathogens (germs) we may carry, • To protect us from pathogens (germs) they may carry You should use Standard Precautions with all patients. In addition, there are 3 different types of isolation depending on the type of pathogen and the way it is transmitted. Airborne, Droplet, Contact

50. Hepatitis B Vaccine