FHM TRAINING TOOLS

1. FHM TRAINING TOOLS This training presentation is part of FHM’s commitment to creating and keeping safe workplaces. Be sure to check out all the training programs that are specific to your industry.

2. ID #16 Bloodborne Pathogens Awareness Disclaimer: This material is being provided as part of our organization’s on-going commitment to ensuring a safe, respectful and legally-compliant workplace. These materials have been developed in accordance with applicable federal laws and regulations and recognized best practices in force at the time the materials were created. The materials do not render any legal or professional advice; they are being provided for educational and informational purposes only. These materials should not be used as a substitute for legal or professional advice or services.

3. At the conclusion of this presentation, you will: • Understand the risk presented by bloodborne pathogens • Know the procedures for responding to the potential exposure to blood and other potentially infectious materials during the performance of your job Learning Objectives

4. Presentation Agenda: • Overview of the Issue • Responding to an Exposure • Your Responsibilities Agenda

5. Section 1 Overview of the Issue

6. Pathogenic microorganisms present in human blood or other potentially infectious materials (OPIM) • OPIM = semen, vaginal secretions, cerebrospinal fluid, synovial fluid, pleural fluid, pericardial fluid, peritoneal fluid, amniotic fluid, saliva in dental procedures, any body fluid that is visibly contaminated with blood, and all body fluids in situations where it is difficult or impossible to differentiate between body fluids • These microorganisms can infect other people and cause various diseases • Hepatitis C virus (HCV) is the most common chronic bloodborne infection in the United States Bloodborne Pathogens

7. According to the CDC: • An estimated 75,000 people become infected with HBV each year • An estimated 3.9 million Americans have been infected with HCV, of whom 2.7 million are chronically infected • By the end of 2003, approximately 1.1 million persons in the United States were living with HIV/AIDS, with 24-27% undiagnosed and unaware of their HIV status • OSHA estimates that 800 healthcare workers are infected with HBV every year through occupational exposure Bloodborne Pathogens Incidence Rates

8. Workers whose job requires them to perform tasks with potential exposure to blood or infectious materials • OSHA estimates approximately 5.6 million workers in healthcare and other facilities are at risk • However, workers who voluntarily provide first aid and CPR to injured co-workers also face this risk • Those workers must also understand risk and protective measures Who is at Risk?

9. 29 CFR 1910.1030, Occupational Exposure to Bloodborne Pathogens • Goal of Standard is to minimize or eliminate hazard by using a combination of: • Engineering and work practice controls • Personal protective clothing and equipment • Training • Medical surveillance • Hepatitis B vaccinations • Signs and labels The OSHA Standard

10. Many jobs involve potential exposure to blood or body fluids • Exposure to these materials may also involve exposure to pathogens • These pathogens can cause a variety of diseases • The three main issues of concern are: • HIV/AIDS • Hepatitis B • Hepatitis C Epidemiology of Bloodborne Pathogens

11. Hepatitis B is the most common serious liver infection in the world • It is caused by a virus that attacks the liver • Most healthy adults that are infected will recover: • Only about 10% will develop chronic infection • 90% of children will develop chronic infection • Symptoms include: • Fever, fatigue, muscle pain • Loss of appetite, nausea, vomiting Hepatitis B

12. An estimated 3.9 million Americans (1.8%) are infected with HCV • 2.9 million chronically infected • 80% have no symptoms • Symptoms include jaundice, fatigue, dark urine, abdominal pain, loss of appetite, nausea • Chronic infection occurs in 55-85% • Chronic liver disease occurs in about 70% of infected persons • Leading cause of liver transplants Hepatitis C

13. Human Immunodeficiency Virus is the virus that causes Acquired Immune Deficiency Syndrome • HIV infection weakens the immune system over time leading to opportunistic infections • Time between HIV infection and the appearance of signs that could lead to an AIDS diagnosis is 8 to 11 years • The CDC estimates that: • As many as 900,000 people are living with HIV • Through 2002 more than 880,000 cases of AIDS in the United States and more than 500,000 deaths HIV and AIDS

14. The term means any pathogenic microorganism that is present in human blood and can cause infection • Other diseases caused by pathogenic microorganisms include: • Malaria • Syphilis • Brucellosis • Relapsing Fever • Universal Precautions prevents exposure to all infected materials Other Bloodborne Pathogens

15. Section 2 Responding to an Exposure

16. Pathogens spread from person to person through contaminated blood and body fluids • Direct or indirect contact • Healthcare setting: • Needlesticks most common • Cuts from other contaminated sharps • Contact of mucous membranes or broken skin with contaminated blood • Any worker performing first aid, CPR, or splashed during an accident Modes of Transportation

17. Written plan that identifies: • Employees covered by the Standard • What activities involve potential exposure • How to protect employees from exposure • Reviewed annually to: • Reflect changes in procedures • Document consideration of safer medical devices Exposure Control Plan

18. Tasks with potential exposure are identified in the Exposure Control Plan • Again, consider indirect contact such as handling red bag waste, contaminated countertops, blood samples • Universal Precautions employed for all such tasks Tasks that may Involve Exposure

19. Controls that isolate or remove the hazard from the workplace • Examples include sharps with engineered sharp injury protection and needleless systems • Must be the primary means of eliminating or minimizing exposure • Comprehensive program includes engineering controls and proper work practices • Personal protective equipment usage only after engineering controls and work practices have been incorporated Use of Engineering Controls

20. Utilized after engineering controls and work practices have been implemented • Employer must purchase, provide, and launder • If lab coats and ‘scrubs’ are intended to protect the employee’s body from contamination, they are considered PPE and cannot be taken home by the employee for cleaning • Employer must state the personal protective equipment requirements for each task that involves potential exposure Personal Protective Equipment

21. Required to be offered to employees working in jobs with potential exposure • Not required to be offered to workers unless their job requires them to perform work with potential exposure • Employees make choice on whether to receive vaccination • The protocol is established by the U.S. Public Health Service – currently three shots over a six-month period Hepatitis B Vaccination Program

22. Disinfection issues: • Efficacy • Contact time • Frequency • Spill response procedures: • Secure the area • Access spill response kit • Wear the right protective equipment • Disinfect the area Disinfection and Spill Response

23. If an exposure does occur on the job: • If a puncture wound, force wound to bleed • Wash exposed area with soap and water • Flush splashes to nose, mouth, or skin with water • Irrigate eyes with water or saline • Report the exposure • Seek medical help immediately Responding to an Exposure

24. Employer must provide for an immediate confidential medical evaluation following an occupational exposure • Same requirement does not apply to “Good Samaritan” acts • Employer not required to provide vaccine, training, post-exposure consultation, and other measures • OSHA encourages employers to do so Post-Exposure Follow Up

25. Required for: • Containers of regulated waste • Refrigerators and freezers used to store blood • On containers used to store, transport, or ship blood or OPIM • Not required for: • Blood and blood products bearing a label specified by the Food and Drug Administration • Individual containers used for blood draw or lab procedures on blood samples provided larger container used for transport is labeled Signs and Labels

26. Section 3 Your Responsibilities

27. Exposure to blood and body fluids is not anticipated during the performance of your job: • Understand the situations where exposure might occur • Follow Universal Precautions • Report any exposure incident immediately Your Responsibilities

28. Some additional references: • OSHA website http://www.osha.gov • Guideline for Environmental Infection Control for Health-Care Facilities. Centers for Disease Control and Prevention (CDC), (2003) • Guidelines for Protecting the Safety and Health of Health Care Workers. National Institute for Occupational Safety and Health (NIOSH) Publication No. 88-119, (1988) Additional Reading