Bloodborne and Airborne pathogens

1. BloodborneandAirborne pathogens Ruth Weiscarger, BSN, RN

2. Pathogen A pathogen is any agent that causes disease

3. Bloodborne Pathogens • Disease causing microorganisms (viruses, bacteria, or parasites) carried in human blood. • Common bloodborne pathogens include: Hepatitis A Hepatitis B HIV • Pathogens may be transmitted through unprotected contact with human blood or body fluids.

4. Airborne Pathogens Airborne pathogens are disease-causing agents that spread infection through droplets or dust. Eg. Coughing, sneezing.

5. Chain of Transmission Several elements must exist for a pathogen to cause illness or disease: • Source-infected person or animal • Route of Transmission-contact, air, etc. • Portal of entry-cut, nose etc. • Susceptible host

6. OSHA • US Department of Labor’s Occupational Safety and Health Administration (OSHA) • Regulations issued to protect employees of certain jobs from BLOODBORNE/AIRBORNE pathogens. • Regulations are known as OSHA Bloodborne Pathogen Standard • Employee safety is insured by training, education, safety measures and exposure control.

7. OSHA Regulations • OSHA Bloodborne Pathogen Standard was first issued in 1991 to protect employees from occupational exposure to bloodborne pathogens.

8. OSHA Regulations Regulations require employers to use a combination of engineering and work practice controls such as protective clothing and equipment, safety precautions in the workplace.

9. Engineering Controls • Controls/products protective barriers designed/developed to create a safer working environment. • Ex. Needleless systems, sharps containers, eye stations.

10. OSHA Training • Goal of training is to educate employees regarding bloodborne pathogen issues and how to minimize or eliminate the exposure to bloodborne pathogens by using a combination of standard precautions, personalprotectiveequipment (PPE) , work practice controls, and engineering controls • Training is initiated upon hire and must be done within the first year of employment. • Standards must be updated yearly and when new standards are implemented.

11. OSHA EXPECTATIONS • Objective is to minimize or eliminate the hazard posed by the exposure. • Prevent infection by immunization when possible. • Knowledge of symptoms of infection. • Counseling after exposure incident. • Post exposure treatments and follow-up.

12. WHO NEEDS OSHA TRAINING • Anyone who has the potential for exposure to blood or other potentially infectious materials (OPIMs). • Ex. Physicians, nurses, physician’s assistants, nurse practioners, other healthcare employees.

13. ROUTE OF TRANSMISSION • Contact • Droplet • Food • Air • vector

14. Hierarchy of controls Both OSHA and the CDC believe that preventing pathogen exposures requires a comprehensive program of strategies: Administrative controls eg, providing vaccinations and prompting infection prevention and control training programs Engineering controls eg, needless devices, plastic capillary tubes Work practice controls eg; hand hygiene, no needle recapping

15. Engineering Controls • Hand washing stations • Eye wash stations • Sharps containers • Biohazard labels • Needless devices and self sheathing needles

16. Contaminated Sharps Any contaminated object that can penetrate skin, including but not limited to needles, scalpels, broken capillary tubes, exposed ends of dental wires.

17. Contaminated Sharps Contaminated needles or sharps must NOT be bent, recapped, or removed unless no alternative is feasible. Reusable sharps must be placed in clearly labeled, puncture-resistant, leak-proof containers immediately or as soon as possible after use. Reusable sharps must be decontaminated before reuse.

18. Sharps Containers The Federal Food and Drug Administration (FDA) regulates sharps disposal containers as Class II Medical devices. OSHA’s Bloodborne Pathogens Standard establishes minimum design performance elements for sharps disposal containers. A sharps container must have a warning label affixed to it.

19. Sharps Containers A sharps container must meet certain criteria to meet the Standard: • Must be closable • Puncture resistant • Leak proof on sides and bottom • Labeled or color coded

20. Sharps Containers Duct tape may be used to secure a lid but may not be used to serve as a lid. Sharps containers must be maintained in an upright position and not be overfilled. Whatever goes into a sharps container stays in the sharps container, do not attempt to remove it.

21. Transmission of pathogens • Transmission occurs when blood or other potentially infected materials come in contact with mucous membranes or non-intact skin.

22. Transmission of pathogens • May also be transmitted by blood splashes, handling contaminated items and injection by a contaminated needle.

23. Respiratory Hygiene Respiratory hygiene/Cough etiquette helps to minimize the transmission of aerosol-transmissible pathogens, these include: • Covering mouth/nose during coughing and sneezing using tissues or masks to contain secretions. • Disposing of tissues/masks contaminated with secretions properly. • Hand hygiene • Ensuring spatial-separation of at least 3’ from others when coughing.

24. Clean Work Surfaces • The term clean work area indicates an area in which you work involving exposure or potential exposure to Blood or Body fluids, along with the contamination of surfaces. • The employer will identify which areas may become contaminated with blood or body fluids.

25. Standard Precautions An aggressive standardized approach to infection control. These infection control practices apply to all patients and animals in the research setting regardless of suspected or confirmed infection status. Treats all bodily substances as if they contain pathogens.

26. Standard Precautions Standard precautions are a combination of Universal precautions and body substance isolation. Standard Precautions recommend: • Hand hygiene • Respiratory hygiene, cough etiquette, safe injection practices, use of gown, glove, mask, eye protection,

27. Hand Hygiene A general term that applies to any one of the following • Hand washing with plain soap and water • Antiseptic hand wash • Antiseptic hand rub • Surgical hand antiseptics

28. Substances requiring standard precautions • Blood • Saliva • Mucous • Sweat • Seman • Vaginal secretions • Cerebrospinal fluid • Synovial fluid • Pleural fluid • Any body fluid with visible blood

29. Transmission-based precautions Recommended to provide additional precautions beyond standard precautions to interrupt the transmission of pathogens. All healthcare personnel must adhere strictly to the isolation precautions that are ordered for patients in the healthcare facility. The following precautions should be used in addition to standard precautions.

30. Contact Precautions Contact precautions are used to protect and prevent the spread of infection. protect from infections spread by skin-to-skin contact or contact with other surfaces such as linen, doorknobs, counters. Eg staphylococcus aureus

31. Droplet Precautions Droplet precautions are used for infections caused by large droplets. They can be spread by coughing, talking, or sneezing such as influenza.

32. Airborne Precautions Airborne precautions are used for infections that spread small particles in the air such as chickenpox, and tuberculosis. Many times you will see patients in isolation, DROPLETT, and CONTACT

33. Reporting • If exposure to blood or OPIM occurs, the incident must be documented. • Information should include: name, job, classification, location of incident, engineering controls in use at time of incident, procedure being done, protective equipment, training.

34. Hepatitis • Hepatitis is an inflammation of the liver caused by drugs, poisons, toxins or bloodborne pathogens. • Viral hepatitis is the leading cause of liver cancer and liver transplants in the United States.

35. Hepatitis B • Can affect anyone. • It is estimated that 1 to 1.4 million persons in the U.S. are chronically infected with HBV. • There has been a decline since the implementation of the Hepatitis B vaccine. • Persons at higher risk for HBV are infants of mothers with HBV, those who engage in risky behaviors, have a preexisting health condition, and healthcare workers.

36. Clinical Features • Symptoms generally last from 4 to 6 weeks. • Jaundice (yellowing of eyes and skin). • Fatigue • Abdominal pain • Loss of appetite • Intermittent nausea • Vomiting • Fever • Joint pain • Gray colored stools

37. Hepatitis B • Incubation period from time of exposure averages 12 weeks with a range of 4 weeks to 6 months. • No cure, vaccination is the best protection • Approximately 90% of HBV cases resolve without further complication, about 6% to 10% will progress to chronic HBV.

38. Hepatitis B

39. Prevention • Standard Precautions protective barriers are key in preventing the spread of HBV. • Vaccination is the best protection against contracting HBV THE CDC Reports: • An unvaccinated person has the risk of contracting HBV from a single needle stick post exposure to a HBV infected blood ranges 6%-30 %. • Vaccinated person who has developed immunity there is virtually no risk.

40. HBV Vaccine • Immunization is required for all health care workers at no cost to the employee. • Series of 3 injections: • first injection • second injection one month later • third injection 5 months after the second one.

41. Treatment • Supportive care –treat symptoms • Chronic Hepatitis B, liver transplantation may be a treatment option.

42. Hepatitis C • Most common chronic bloodborne infection in the US. • It is estimated that 3.9 million Americans have been infected with HCV 2.7 million are chronically infected. • Fortunately in the last 5 years the incidence has declined. • Transmitted primarily through large or repeated direct percutaneousexposures to blood. • No vaccine for Hepatitis C. • Prevention is directed toward the use of engineering and work practice controls, and personal protective equipment

43. Clinical Features • 70% to 75% of patients with hepatitis C are asymptomatic. • Symptoms may include: • Jaundice • Fatigue • Abdominal pain • Loss of appetite • Intermittent nausea • vomiting

44. Clinical Features • Incubation period averages 7 weeks • But can be between 3-20 weeks. • Chronic infection is common, affecting more than 85% of people infected. • Chronic liver disease may occur in 70% of those infected with HCV. • 8,000 to 10,000 deaths occur each year as a result of HCV-associated liver disease.

45. Treatment • HCV is best addressed through supportive care • Antiviral medications may have some benefit in the early stages of the disease and may be used as a treatment option for chronic infection • If the liver damage is severe, a liver transplant may be a treatment option.

46. Human Immunodeficiency Virus Acquired immunodeficiency syndrome (AIDS) HIV is a condition in which the body is unable to fight off infection or destroy mutated cells. The body is vulnerable to opportunistic infections and cancer.

47. Routes of transmission Persons at higher risk include: • Infants of mothers with HIV • Those who engage in risky behaviors such as drug abuse, unprotected sexual encounters • pre-existing health conditions • Exposure to HIV

48. Clinical Presentation • Night sweats • Weight loss • Fever fatigue • Gland pain • Swelling • Muscle pain • Joint pain

49. Post Exposure • Testing done ASAP and periodically for at least 6 months. • Antibodies usually become detectable within 3 months of infection. • 99.7% of exposures do NOT lead to infection. • If treatment with antiviral medications plus a protease inhibitor is recommended, treatment should begin within hours of the exposure.

50. Prevention • There is no vaccination • Standard Precautions/Protective barriers are keys to prevention in a occupational/clinical setting