OCCUPATIONAL EXPOSURE TO BLOODBORNE PATHOGENS

1. OCCUPATIONAL EXPOSURE TO BLOODBORNE PATHOGENS ANNUAL TRAINING North Seattle Community College

2. PURPOSE OF THIS SESSION: • Protection against bloodborne pathogens • Infectious diseases • NSCC Exposure Control Plan 2

3. REGULATIONS (where it all begins!) • FEDERAL: “Occupational Exposure to Bloodborne Pathogens Standard”, Part 1910.1030, Title 29 Code of Federal Regulations (effective date: 3/6/92) • WASHINGTON STATE: “Bloodborne Pathogens Standard”, WAC 296-62-08001 (effective date: 5/26/92) 3

4. PURPOSE OF THE STANDARD • PROTECTION: Workers shall be protected from exposure to biological agents, including bloodborne pathogens, which you may come into contact with during your job duties (handling wastes and materials). 4

5. BLOODBORNE PATHOGENS Infectious germs (bacteria and viruses) that are present in human blood/body fluids and can cause disease in humans. These pathogens include, but are not limited to, Hepatitus B (HBV), Hepatitus C (HCV), and human immono-deficiency virus (HIV). 5

6. OCCUPATIONAL EXPOSURE • Contact with blood/body fluids or other potentially infectious materials on your skin or in your eye, nose, or mouth during your job duty. This includes a needle poke. 6

7. INFECTIOUS MATERIALS • Blood • All body fluids (such as diarrhea and vomit) since all can be potentially contaminated with blood or germs • Viruses and bacteria that spread communicable diseases through contact with bodily fluids. • Semen/vaginal secretions • any body fluid visibly contaminated with blood 7

8. NSCC EXPOSURE CONTROL PLAN • Exposure Determination • Control Methods • Hepatitis B Immunizations • Post-exposure evaluation/follow-up • Training and Education • Record-keeping 8

9. Exposure Determination • Risk assessment associated with different jobs - identification of tasks and potential exposures • Classification I - tasks routinely involve a potential for contact with BBP • Classification II - tasks normally do not involve exposure to BBP, but may require performing unplanned Classification I tasks • Tasks involve no exposure to BBP

10. Control Measures • Using Universal Precautions • Establishing appropriate Engineering Controls • Implementing appropriate Work Practice Controls • Personal Protective Equipment • Housekeeping

11. UNIVERSAL PRECAUTIONS A method of infection control in which all human body fluids (blood, urine, feces, vomit, etc.) and other potentially infectious materials are treated as if known to be infectious. 11

12. Universal Precautions • Wash hands • Wear gloves • Wear impervious gown or apron • Wear mask • Wear appropriate PPE - including eye and mask protection - mouth pieces for resuscitation • Handle sharp objects carefully • Dispose of all spills

13. Engineering Controls • Labeled sharp containers • Biohazard bags and containers • Specific collection site for disposal of contaminated waste and PPE • Self sheathing needles shall be used • Hand washing facilities, eyewashes and/or showers shall be provided as close as possible to work area

14. Work Practice Controls • Minimize splashing, spraying and generation of droplets of blood or OPIM • Wash hands as soon as possible after exposure incident • Do not recap or break contaminated sharps • Do not keep food or beverages or eat or drink in contaminated work areas • Use mechanical device to pick up contaminated broken glass

15. OCCUPATIONAL EXPOSURE INCIDENT • Contact with blood/bodily fluids or other potentially infectious materials on your skin or in your eye, nose, or mouth during your job duty. This includes a needle poke. 29

16. EXPOSURE INCIDENT PROCEDURES • Cleanse exposed area THOROUGHLY -if open wound, “milk” entry wound • Eyes: flush w/large amounts of running water for a minimum of 15 minutes Mouth: rinse out thoroughly Nose: blow nose; wipe inside nostrils • Report incident to your supervisor. • Complete necessary NSCC forms: • Exposure Incident Report App I • Seek Professional Medical Care immediately 30

17. Post-Exposure follow-up Evaluation • Confidential medical evaluation and follow-up • Written report on exposure incident • Tests to determine if source blood is HIV/HBV positive – results to be made available to exposed individual • Written opinion within 15 days

18. Personal Protective Equipment • Eye protection • Gloves • Protective clothing • Removal and cleaning of PPE • Availability and Accessibility

19. WHEN TO WEAR GLOVES • If you, as the care provider, have an open lesion on your hand(s). • If handling contaminated disposable items (e.g., diapers;contaminated clothing/waste). • If direct hand contact with body fluids is anticipated (e.g., when providing first aid) • If cleaning up body fluid spills. • When diapering or helping to toilet a child. • When disinfecting surfaces or articles. 25

20. Housekeeping • Cleaning equipment and surfaces • Cleanup of blood or other potentially infectious materials • Handling sharps and other wastes • Hand washing

21. HANDWASHING • before drinking, eating, or smoking • before handling clean utensils, equipment or food • before and after going to the bathroom • after contact with any body fluid • after handling soiled diapers or equipment • after caring for children, especially those with body fluid discharges • after removing disposable gloves or other protective equipment • After touching animals 24

22. DISINFECT PROPERLY • Wear disposable latex gloves and appropriate PPE • Promptly sanitize contaminated toys, equipment, or surfaces (diaper table). • Use a proper disinfectant -One part bleach to ten parts water is recipe for disinfectant. -New solution must be made daily to be effective. • Let disinfectant sit 1-2 minutes. • Use paper towels to clean up spills and place in lined waste container. If they contain blood, place in bag identified as “biohazard”. • Dispose of gloves and wash hands thoroughly. 26

23. Disposal of gloves and contaminated articles • Dispose of gloves after each client contact. • Dispose of gloves and all contaminated articles containing blood or body fluids (band-aids, dressings, diapers) in red plastic bags and identify as a “biohazard”. • If child’s clothing becomes contaminated: place in plastic bag, seal, and mark (e.g., if sending home with child for parents to launder). • Wash your hands thoroughly after removing gloves! 27

24. THE HEPATITIS VIRUSES • Six known kinds of viral hepatitis: A-E, G • They differ in how they are transmitted and how they affect you. • Hepatitis A and E: mild, spread through contaminated foods or water. Not life threatening. • Hepatitis B, C, and D: spread through contact with human blood or by sexual activity (B). 25

25. HEPATITIS A • Transmission through contaminated food or water (fecal contamination). • Symptoms: fatigue, abdominal pain, loss of appetite, nausea, diarrhea. • Does not attack the liver. • Not as common and is treatable by medicine. • Prevention: proper hygiene, wash hands, use gloves 26

26. HEPATITIS B • Transmitted through direct physical contact with infected bodily fluids. Saliva is rare. • Symptoms: Flu-like, loss of appetite, weak, nausea, etc. • Attacks the liver, can have virus for many years without knowing. • Blood tests to determine if infected. • A person’s antibodies will fight the virus and can eliminate it from your system. 27

27. HEPATITIS B (cont.) • Acute: short term infection (less than 6 months) • Chronic: long term infection (more than 6 months), your body fails to fight the virus. • 300,000 new cases each year in U.S. • 6-10% of new cases become chronic carriers. • 1-1.25 million chronically infected Americans. 28

28. HEPATITIS B (cont.) • HIGH number of viruses present in blood • Vaccine: 80-90% success rate. Series of three injections - then titer is checked • Risk Groups: Drug users, homosexual males, multiple sexual partners, infants born to infected mothers, health care or child care workers exposed to blood. • Prevention: Avoid direct contact with bodily fluids. Wear gloves when administering first aid and during diaper changes. 29

29. Hepatitis B Vaccination Program • Offered to all covered employees at no cost • Made available within 10 days of initial assignment and is not mandatory • Employees may decline vaccination and accept at a later date - waiver form • All employees exposed to blood or OPIM on the job will be offered vaccination and post exposure evaluation and treatment

30. HEPATITIS C • Transmitted through direct physical contact with infected bodily fluids (also through sex but not as common) • Symptoms: Flu-like, loss of appetite, weak, nausea, etc. • Attacks the liver, can have virus for many years without knowing. • 36,000 new cases per year in the U.S. 31

31. HEPATITIS C (cont.) • >85% of new cases become chronic carriers. • 2.7 million chronically infected Americans. • No vaccine available yet. • Hepatitis C is the “new” epidemic. Doctors are just beginning to realize its impact. • Virus is reaching epidemic proportions because of the lack of testing available several years ago when people were likely infected. 32

32. HEPATITIS C (cont.) • Risk Groups: Drug users, homosexual males, infants born to infected mothers, health care or child care workers exposed to blood. • Prevention: Avoid direct contact with bodily fluids. Wear gloves when administering first aid and during diaper changes. 33

33. WHAT IS AIDS? (Acquired Immune Deficiency Syndrome) • Caused by the Human Immunodeficiency Virus (HIV) • The result of a long process that begins with HIV infection (last stage of HIV) • An acquired illness of the immune system which reduces the body’s ability to fight specific types of infections and cancers 18

34. At Higher Risk of Contacting HIV: • homosexual males or people with multiple sexual partners • IV drug users • children born to infected mothers

35. HIV TRANSMISSION • Transmitted through direct physical contact with infected bodily fluids (most common transmission is through sexual contact). • Targets the immune system. • Risk from one-time exposure: 0.5% (LOW number of viruses present in blood, the virus can not live outside of the human body). • High risk groups: homosexual males or people with multiple sex partners, drug users, infants born to infected mothers. 19

36. HIV IS NOT TRANSMITTED BY: • casual contact • hugging or kissing • mosquitoes or insects • donating or giving blood • sharing food • sharing telephones • hot tubs or swimming • being a friend 20

37. Some Statistics on AIDS Cumulative # of cases/year • United States, 1981 - 372 cases • United States, 1998 - 688,400 cases • United States, 2000 - 753,907 cases total • Washington State, 1982 - 20 cases • Washington State, 1998 - 8,733 cases • Washington State, 2000 - 9,387 cases total 21

38. You can’t tell by looking....!(or initially, even by feeling!) • It is possible to be infected with HIV for years even though you are -looking fine -feeling fine -have no knowledge of the infection

39. AIDS • Diagnosis of AIDS is reserved for those persons with life-threatening infections. • AIDS definition includes: -T-cell count of 200 or less -Presence of specific illnesses or conditions which meet criteria specified in the AIDS case definition • AIDS is the last stage of HIV infection 22

40. Prevention for all types of viruses: • PRACTICE UNIVERSAL PRECAUTIONS: Protect from direct contact (e.g., wear disposable gloves; use condoms; don’t share needles) with ANY blood or other potentially infectious materials. ALWAYS assume that such material is infectious. • PRACTICE GOOD PERSONAL HYGIENE Wash, wash, wash, wash your hands. • FOLLOW GOOD HOUSEKEEPING 23

41. ADMINISTERING FIRST AID • Follow Universal Precautions. • Treat all body fluids as if infectious. • Wear GLOVES (and other personal protective equipment, mask with one way valve if administering CPR). • Wash hands after removing gloves! 28

42. In Summary: Avoid BBP Exposures! • Practice Universal Precautions • Monitor Personal Hygiene • Practice Good Housekeeping • Dispose of Wastes Properly ANY QUESTIONS?? 31