Bloodborne Pathogens

1. Bloodborne Pathogens Lander University Employee Training

2. Introduction • To progress through the presentation simply use the directional arrows at the bottom left of the screen. • At the end of this presentation click on the quiz link on the home page. Please print the quiz, complete it and forward to your supervisor.

3. Introduction • This training module is designed to provide a basic understanding of bloodborne pathogens, common modes of their transmission, methods of prevention, and other pertinent information. This program is designed to meet the requirements of the Occupational Safety and Health Administration's (OSHA's) Bloodborne Pathogen Standard, 29 CFR 1910.1030.

4. Introduction • The Federal OSHA Bloodborne Pathogen Standard was published in 1991. It was designed to reduce and minimize the potential for occupational exposure to the Human Immunodeficiency Virus (HIV), the Hepatitis B Virus (HBV) and other human bloodborne pathogens. • This training program is a direct result of the requirements of this regulation.

5. Introduction • All Lander University employees with the potential for exposure to bloodborne pathogens in their workplace environment must by law receive special training.  • For the purposes of this training anyone who receives payment from the University and who is exposed as part of their job is an employee. • In this training program, you will learn methods of protecting yourself from potential exposure to blood borne pathogens in your workplace. It also covers the very important procedures that must be carried out should accidental exposure occur.

6. Introduction – Methods of Compliance • Exposure Control Plan: • The OSHA Standard requires that Lander prepare an Exposure Control Plan which is designed to document procedures that minimize employee exposure to bloodborne pathogens. • The Plan contains two parts: • Exposure Determination • Methods of Compliance • The plan must be updated annually or when new tasks are added.

7. Introduction – Methods of Compliance • Exposure Determination: Lander University conducted a survey of all departments to determine which employees were at a risk for exposure. That survey resulted in three categories of risk depending on daily tasks that would place the employee at risk of occupational exposure.

8. Exposure Determination • Category I – Tasks that involve exposure to blood, body fluids, or tissues. • Category II – Tasks that involve no exposure to blood, body fluids, or tissues but employment may require performing unplanned Category I tasks. • Category III – Tasks that involve no exposure to blood, body fluids, or tissues, and Category I tasks are not a condition of employment.

9. Exposure Determination • The following is a listing of employees within each class. • Category I – Athletic Trainers, Nursing Faculty, Staff Nurses, University Police Officers • Category II – Faculty Laboratory Instructors, Physical Plant Custodians and Plumbers, PEES Faculty, Athletics Dept. Coaches, Campus Recreation Employees, and Resident Assistants • Category III – All other employees

10. Common Tasks and Procedures • The following is a list of tasks and procedures in which occupational exposure may occur at the University and that are performed by categorized employees. • Cleaning of blood or OPIM • Collecting, handling or disposing of blood or OPIM • Rendering first aid or CPR • Finger Sticks • Assisting in emergency situations • Oral Assessments

11. Introduction • In order to fully understand the Bloodborne Pathogens Standard and Lander’s policy you will need to know some common terms. These terms are regulatory definitions, not necessarily common words.

12. Vocabulary • Universal Precautions: An approach to infection control that involves: Assuming that all blood, blood products, and body fluids are contaminated. 

13. Vocabulary • Blood: • Blood  • Blood Components  • Products made from Human Blood • Bloodborne Pathogen:  Pathogenic microorganisms present in human blood that can cause disease in humans. These pathogens include, but are not limited to, Hepatitis B Virus (HBV), Hepatitis C Virus (HCV), and Human Immunodeficiency Virus (HIV). Hepatitis B can survive in dried blood specimens for several days.

14. Vocabulary • Other Potentially Infectious Materials (OPIM): • Human Body Fluids: • Semen  • Vaginal Secretions  • Cerebrospinal Fluid  • Synovial Fluid  • Pleural Fluid  • Pericardial Fluid  • Peritoneal Fluid  • Amniotic Fluid  • All body fluids that are of undetermined nature or are visibly contaminated with blood are also considered to be as OPIM.

15. Vocabulary • OPIM also refers to: • Unfixed tissue or organs.  • HIV-containing cells, tissue, or organ cultures.  • HIV- or HBV-containing culture medium.  • Blood, organs, etc. from animals with HIV or HBV. 

16. Vocabulary • Contaminated: • Blood or OPIM on a Surface  • Blood or OPIM on Clothes, Equipment, etc.  • Decontamination: • To remove, inactivate, and destroy infectious material.  • To make surface or equipment safe for handling, use, or disposal. 

17. Vocabulary - Diseases • Hepatitis B (HBV) • In the United States, approximately 300,000 people are infected with HBV annually. Of these cases, a small percentage are fatal. • "Hepatitis" means "inflammation of the liver," and, as its name implies, Hepatitis B is a virus that infects the liver. While there are several different types of Hepatitis, Hepatitis B is transmitted primarily through "blood to blood" contact. Hepatitis B initially causes inflammation of the liver, but it can lead to more serious conditions such as cirrhosis and liver cancer. • There is no "cure" or specific treatment for HBV, but many people who contract the disease will develop antibodies which help them get over the infection and protect them from getting it again. It is important to note, however, that there are different kinds of hepatitis, so infection with HBV will not stop someone from getting another type.

18. Vocabulary - Diseases • The Hepatitis B virus is very durable, and it can survive in dried blood for up to seven days. For this reason, this virus is the primary concern for employees such as housekeepers, custodians, laundry personnel and other employees who may come in contact with blood or potentially infectious materials in a non first-aid or medical care situation. • Symptoms: The symptoms of HBV are very much like a mild "flu". Initially there is a sense of fatigue, possible stomach pain, loss of appetite, and even nausea. As the disease continues to develop, jaundice (a distinct yellowing of the skin and eyes), and a darkened urine will often occur. However, people who are infected with HBV will often show no symptoms for some time. After exposure it can take 1-9 months before symptoms become noticeable. Loss of appetite and stomach pain, for example, commonly appear within 1-3 months, but can occur as soon as 2 weeks or as long as 6-9 months after infection.

19. Vocabulary - Diseases • Human Immunodeficiency Virus (HIV) • AIDS, or acquired immune deficiency syndrome, is caused by a virus called the human immunodeficiency virus, or HIV. Once a person has been infected with HIV, it may be many years before AIDS actually develops. HIV attacks the body's immune system, weakening it so that it cannot fight other deadly diseases. AIDS is a fatal disease, and while treatment for it is improving, there is no known cure. • Estimates on the number of people infected with HIV vary, but some estimates suggest that an average of 35,000 people are infected every year in the US (in 2000, 45,000 new infections were reported). It is believed that as of 2000, 920,000 persons were living with HIV/AIDS in the United States. These numbers could be higher, as many people who are infected with HIV may be completely unaware of it.

20. Vocabulary - Diseases • The HIV virus is very fragile and will not survive very long outside of the human body. It is primarily of concern to employees providing first aid or medical care in situations involving fresh blood or other potentially infectious materials. It is estimated that the chances of contracting HIV in a workplace environment are only 0.4%. However, because it is such a devastating disease, all precautions must be taken to avoid exposure. • AIDS infection essentially occurs in three broad stages. The first stage happens when a person is actually infected with HIV. After the initial infection, a person may show few or no signs of illness for many years. Eventually, in the second stage, an individual may begin to suffer swollen lymph glands or other lesser diseases which begin to take advantage of the body's weakened immune system. The second stage is believed to eventually lead to AIDS, the third and final stage, in all cases. In this stage, the body becomes completely unable to fight off life-threatening diseases and infections.

21. Modes of Transmission • It is important to know the ways exposure and transmission are most likely to occur in your particular workplace, be it providing first aid to an athlete, handling blood samples in the laboratory, or cleaning up blood from a hallway. • HBV and HIV are most commonly transmitted through: • Sexual Contact • Sharing of hypodermic needles • From mothers to their babies at/before birth • Accidental puncture from contaminated needles, broken glass, or other sharps • Contact between broken or damaged skin and infected body fluids • Contact between mucous membranes and infected body fluids

22. Modes of Transmission • In most work or laboratory situations, transmission is most likely to occur because of accidental puncture from contaminated needles, broken glass, or other sharps; contact between broken or damaged skin and infected body fluids; or contact between mucous membranes and infected body fluids. For example, if someone infected with HBV cut their finger on a piece of glass, and then you cut yourself on the now infected piece of glass, it is possible that you could contract the disease. Anytime there is blood-to-blood contact with infected blood or body fluids, there is a slight potential for transmission.

23. Modes of Transmission • Unbroken skin forms an impervious barrier against bloodborne pathogens. However, infected blood can enter your system through: • Open sores • Cuts • Abrasions • Acne • Any sort of damaged or broken skin such as sunburn or blisters

24. Modes of Transmission • Bloodborne pathogens may also be transmitted through the mucous membranes of the • Eyes • Nose • Mouth • For example, a splash of contaminated blood to your eye, nose, or mouth could result in transmission.

25. Personal Protective Equipment • It is extremely important to use personal protective equipment and work practice controls to protect yourself from bloodborne pathogens.

26. Personal Protective Equipment • Universal Precautions: a prevention strategy where blood and all OPIM is treated as if it is infectious. • This strategy is used in all situations where exposure to blood or potentially infectious materials is possible. This also means that certain engineering and work practice controls shall always be utilized in situations where exposure may occur.

27. Personal Protective Equipment • Employees should always utilize PPE when working with blood or OPIM. • PPE is provided to employees at no cost to them. • Training in the use of appropriate PPE for specific tasks or procedures is provided by your supervisor.

28. Personal Protective Equipment • The types of PPE available to employees are as follows: • Safety glasses • Face shields • Gowns and foot coverings

29. Personal Protective Equipment • All employees should observe the following precautions: • Wash hands immediately or as soon as feasible after removing gloves or other PPE • Remove PPE after it becomes contaminated and before leaving the work area. • Used PPE must be disposed of in the appropriate Biohazard container, not with common trash. • Never wash or decontaminate disposable gloves for reuse. • Wear appropriate face and eye protection when splashes, sprays, splatters, or droplets of blood or OPIM pose a hazard to the eye, nose, or mouth.

30. Personal Protective Equipment • Wear appropriate gloves when it is reasonably anticipated that there may be hand contact with blood or OPIM, and when handling or touching contaminated items or surfaces; replace gloves if torn, punctured, or contaminated, or if their ability to function as a barrier is compromised. • Remove immediately or as soon as feasible any garment contaminated by blood or OPIM, in such a way as to avoid contact with the outer surface.

31. Engineering Controls • Lander University employees will utilize sharps containers as a means of an engineering control to prevent workplace exposure. • Contaminated sharps are discarded immediately in containers that are closable, puncture resistant, leak proof and appropriately labeled or color coded.

32. Engineering Controls • Sharps disposal containers must be easily accessible and located as close as feasible to the immediate area where sharps are used. • Broken glassware that may be contaminated is only picked up by using mechanical means, such as a brush and dustpan.

33. Engineering Controls • Example of Sharps Containers:

34. SHARPS • "Contaminated Sharps" means any contaminated object that can penetrate the skin including, but not limited to, needles, scalpels, broken glass, broken capillary tubes, and exposed ends of dental wires

35. SHARPS INJURIES • NIOSH recommends if you experienced a needlestick or other sharps injury or were exposed to the blood or other body fluid during the course of your work, immediately follow these steps: • Wash needlesticks and cuts with soap and water • Flush splashes to the nose, mouth, or skin with water

36. SHARPS INJURIES • Irrigate eyes with clean water, saline, or sterile irritants • Report the incident to your supervisor • Immediately seek medical treatment

37. Housekeeping • Regulated waste is to be placed in containers which are closable, constructed to contain all contents and prevent leakage, appropriately labeled or color-coded and closed prior to removal to prevent spillage or protrusion of contents during handling.

38. Signs and Labels • Regulated waste is to be placed in containers which are designated for use in biohazard disposal. • These containers may be bags, sharps containers, or bins. • All containers should be color coded red or labeled with the universal biohazard symbol

39. Signs and Labels • Examples of Biohazard symbol.

40. Hepatitis B Vaccination • The Hepatitis B Vaccination is available at no cost to employees after initial employee training and within 10 days of initial assignment to all employees identified in the exposure determination section of this plan. • Vaccination is encourage unless: • Documentation exists that the employee already received the vaccine. • Antibody testing reveals the employee is immune. • Medical evaluation shows that vaccination is contraindicated.

41. Hepatitis B Vaccination • If an employee declines the vaccination, the employee must sign a declination form. Employees who decline may request and obtain the vaccination at a later date at no cost. • Vaccination on campus is provided by the staff nurse.

42. Workplace Exposure Procedures • An exposure incident occurs if the employee has eye, mouth, or other mucous membrane, non-intact skin or percutaneous (penetrating the skin) contact with blood or other potentially infectious material in a work situation, or in the performance of their job duty.

43. Workplace Exposure Procedures • Post-exposure evaluation or follow-up will be conducted for all employees who have had an exposure incident, and will be conducted in accordance with Lander’s Exposure Control Plan and Centers for Disease Control guidelines.

44. Workplace Exposure Procedures • Following an occupational exposure to blood or body fluids through sharp object injury or mucuous membrane contact: • Immediate Site Management • Skin/sharp object injury – cleanse immediately with warm soapy water. • Mouth – Rinse mouth well with copious amounts of water or rinse well with mouth wash.

45. Workplace Exposure Procedures • Report Injury to Supervisor • Complete written report of the injury (use Appendix D of Exposure Control Plan) • Report to appropriate medical facility for follow-up. This should be done immediately as time is critical. • The supervisor will contact the Office of Human Resources, and the Infection Control Officer.

46. Workplace Exposure Procedures • Following a report of an exposure incident, the employee will immediately be given a confidential medical evaluation and follow-up.

47. Post Training Quiz • The online module is now complete. To complete the session please return to the home page and select quiz. Please print the quiz, complete it, and forward to your supervisor along with the online training documentation form.