Protecting Employees from Bloodborne Pathogens: Module 1

1. Protecting Employees from Bloodborne Pathogens:Module 1

2. Course Objectives After completion of Module 1 of this course, attendees should be able to: • Describe three bloodborne diseases: HIV, hepatitis B, and hepatitis C • Review occupational risks for exposure to bloodborne diseases • Discuss how germs can enter the body • Describe the risk of getting an infection if exposed to a bloodborne disease

3. The Facts Anyone, regardless of age, race, or socioeconomic status, can carry a disease in his or her blood or body fluids. Often, without knowing it. However, the risk of getting a disease can be decreased with a few basic steps that will be discussed in this training.

4. Assisted Living Facilities (ALFs) By definition, ALFs are non-medical facilities that provide assistance with activities of daily living. By design, ALFs provide unique services to residents who want to live as independently as possible for as long as possible. Some of these services may involve contact with blood or body fluids that have the ability to spread disease.

5. Daily Tasks May Contain Some Risk Daily tasks in the healthcare or residential setting pose some risk of exposure to germs. • Assisting with bathing or oral care • Handling incontinence pads, linens, and contaminated trash • Cleaning rooms, common areas, and equipment Occasionally, these tasks may involve exposure to germs found in the blood or body fluids (bloodborne pathogens).

6. Tasks Related to Direct Resident Care That Pose More Risk for Exposure to Germs Found in Blood or Body Fluids • Assisting with wound care • Monitoring blood glucose • Giving an injection of medication • Cleaning blood/body fluid spills • Helping with nail or skin care • Providing first aid such as managing nose bleeds or abrasions

7. Bloodborne Pathogens Germs that are carried in the blood and can be transmitted by contact with infected blood or body fluids are called bloodborne pathogens. The most common types include the following viruses: • Hepatitis B • Hepatitis C • HIV

8. Hepatitis B • Serious liver disease that can cause cirrhosis or cancer • 18,800 new infections in US in 2011 (estimated) • Most cases resolve • ~10% of adult cases can be chronic • 800,000 - 1.4 million chronically infected • Testing recommendations to identify persons with chronic HBV infection: http://www.cdc.gov/hepatitis/HBV/TestingChronic.htm • 30% of people infected don’t have symptoms

9. Hepatitis B • Symptoms include loss of appetite, fatigue, jaundice (yellowing of the skin), abdominal pain, and nausea • Can be prevented by vaccination • Workers in healthcare and residential settings are at increased risk • Treatment available to keep the virus under control

10. Hepatitis C • Serious liver disease that can lead to cirrhosis or liver failure • 16,500 new infections in 2011 (estimated) • Chronic infection: 75-85% of cases • 2.7-3.9 million chronically infected (estimated) • 70-80% of people do not have any symptoms. • Many people do not have symptoms for 20 years after first infected. • When symptoms do occur, they are similar to those of hepatitis B virus.

11. Hepatitis C • Increased risk for liver cancer • 60-70% of cases develop chronic liver disease • Treatment available to keep the virus under control • No vaccine available • Testing recommended for persons born from 1945 through 1965 • Other CDC testing recommendations: http://www.cdc.gov/hepatitis/HCV/GuidelinesC.htm

12. HIV • Disease that causes the immune system to lose its ability to fight infection • 1.15 million infected (~18% undiagnosed) • Some people progress to Acquired Immunodeficiency Syndrome (AIDS) • Symptoms vary; initial infection may cause flu-like illness • Medications available to treat illness, but there is no cure or vaccine • Testing recommendations: http://www.cdc.gov/hiv/basics/testing.html

13. Transmission (How Diseases are Spread) Bloodborne pathogens are spread by contact with blood or other potential infectious materials such as: • Saliva • Semen and vaginal fluids • Normally sterile fluids (body sites) • Cerebrospinal fluid (spinal cord) • Synovial (joint) and pleural fluid (lung) • Peritoneal (abdominal), pericardial (heart), and amniotic fluid (uterus)

14. In Other Words… Blood can be present with nearly any human bodily fluid. If it’s warm, wet, and not yours, DON’T TOUCH IT without wearing gloves and any other appropriate types of personal protective equipment!

15. How Bloodborne Pathogens Are NOT Spread • Bloodborne pathogens such as HBV, HCV, and HIV are not spread by many common behaviors that may occur in the assisted living setting, including: • Hugging • Holding or shaking hands • Coughing • Sneezing • Using the same toilet seat

16. How Germs Can Enter Your Body • Needles • Broken glass (broken blood tubes) • Non-intact skin exposure through cuts, skin abrasions, and mucous membranes of mouth, eyes and nose • Includes human bites, splashes or sprays of blood/body fluids • Touching your mouth, eyes, nose or open skin after touching surfaces or equipment contaminated with blood or contaminated body fluids

17. Your Risk For Getting An Infection from Blood or Body Fluids Depends on: • The germ involved • How you are exposed • The amount of germ in the infected blood/body fluid at the time of exposure • The amount of infected blood/body fluid involved in the exposure • Your immune response • Your vaccination status (if vaccine is available) • Whether you get treatment after exposure and how quickly you get treatment

18. If I’m Exposed, What’s My Risk? Risk of infection following an occupational needlestick or cut from a known positive source: • HBV: 6% - 31% • HCV: 1.8% • HIV: 0.3%

19. Another Way to Think About Risk Or, out of every 1,000 people exposed via a needlestick or cut from a known positive source: • 60 – 310 people could get HBV • 18 could get HCV • 3 could get HIV

20. Bloodborne Pathogens Standard (BBP) • Written by the Occupational Safety and Health Administration (OSHA) • Title 29 of the Code of Federal Regulations (29 CFR 1910.1030) • Purpose: To protect you and reduce your risks for occupational exposure to disease • Describes policies and practices that employers must establish to protect employees who have contact with blood/body fluids in their job

21. Module 1: Summary • Certain job duties can put employees at risk for coming into contact with blood or body fluids • Sometimes people have germs in their blood and don’t know it • Germs can be spread by coming into contact with blood or body fluids • Employers are responsible for protecting their employees from exposure to disease on the job

22. Protecting Employees from Bloodborne Pathogens:Module 2

23. Course Objectives After completion of Module 2 of this course, attendees should be able to: • Discuss the components of Occupational Health and Safety Administration (OSHA) Bloodborne Pathogens Standard • Define engineering and work practice controls • Describe appropriate personal protective equipment • Define an occupational exposure and discuss the steps to take if you are exposed

24. A Recap of Module 1 • Certain job duties can put employees at risk for coming into contact with blood or body fluids • Sometimes people have germs in their blood and don’t know it • Germs can be spread by coming into contact with blood or body fluids • Employers are responsible for protecting their employees from exposure to disease on the job

25. Bloodborne Pathogens Standard (BBP) • Written by the Occupational Safety and Health Administration (OSHA) • Title 29 of the Code of Federal Regulations (29 CFR 1910.1030) • Purpose: To protect you and reduce your risks for occupational exposure to disease • Describes policies and practices that employers must establish to protect employees who have contact with blood/body fluids in their job

26. Bloodborne Pathogens (BBP) Standard The Bloodborne Pathogens Standard describes important strategies that can reduce the risk of infection on the job. These include: • Exposure Control Plan • Engineering Controls • Work Practice Controls • Standard Precautions/Personal Protective Equipment • Housekeeping • Hepatitis B Vaccine • Occupational Exposure Follow-up

27. Exposure Control Plan The Plan is a document that describes how your employer will address the components of the Bloodborne Pathogens Standard. It includes: • Who is covered under the standard • Ways to reduce the risk of exposure • What to do if there is an occupational exposure Example: www.vdh.virginia.gov/epidemiology/surveillance/hai/documents/word/BloodbornePathogensExposureControlPlanTEMPLATE.doc

28. Writing the Plan • Determine exposures • Employer prepares lists of job classifications • Classifications in which all workers have occupational exposure • Classifications in which some workers have occupational exposure • Includes a list of the tasks and procedures performed by those workers that result in their exposure • Describe methods of protecting employees against exposures • Make written plan available to employees • Update the plan annually

29. Engineering Controls Systems or mechanical devices that minimize hazards in the workplace. Examples: • Self-sheathing or retractable needles • Sharps disposal containers • Single-use fingerstick devices

30. Sharps Safety Rules • Use needles with safety devices • Never recap, break or bend needles • Never leave needles unattended • Never reuse disposable sharps • Dispose of all needles in a regulated, color-coded, labeled sharps container • Sharps containers should be changed when ½ - ¾ full.

31. Work Practice Controls Practices in the workplace that protect you from disease and prevent transmission to your residents and coworkers. These include: • Hand hygiene • Personal hygiene • Personal protective equipment

32. What is Hand Hygiene? Hand hygiene involves the following: Alcohol-based hand rub: Rubbing hands with an alcohol-containing preparation. Hand washing: Washing hands with soap and water. Includes applying friction and drying hands thoroughly.

33. Recommended Hand Hygiene Techniques • Hand rubs • Apply to palm of one hand, rub hands together covering all surfaces until dry. • Manufacturer will instruct how much to use. • Hand washing • Wet hands with water, apply soap, rub hands together for at least 15 seconds. • Rinse and dry with disposable towel. • Use towel to turn off faucet.

34. Hand Hygiene: When • If hands are visibly dirty, contaminated, or soiled, wash with soap and water. • After using the restroom • Before eating or preparing food • If hands are not visibly soiled, you may choose to use an alcohol-based hand rub for routinely decontaminating hands.

35. When to Perform Hand Hygiene • Before and after: • Contact with a resident • Be sure to perform hand hygiene between residents • Treating a cut or wound (e.g., changing dressings or bandages) • Before: • Preparing or eating food • Touching your eyes, nose, or mouth • Putting on gloves • Handling/administering medication • Insertion of invasive devices (e.g., urinary catheters)

36. When to Perform Hand Hygiene • After: • Contact with blood, body fluids, mucous membranes, secretions, excretions, or non-intact skin • Removing gloves • Touching surfaces or objects in the environment that may be contaminated with blood or body fluids • Handling garbage • Using the restroom • Blowing your nose, coughing, or sneezing

37. Work Practice Controls:Hand Hygiene and Nails • Keep fingernails short, clean, and healthy • Artificial nails should not be worn; natural nails should be no longer than ¼ inch • Long fingernails require extra effort when washing hands – harder to remove all germs • Long fingernails may tear gloves

38. Work Practice Controls:Personal Hygiene Things that you can do to protect yourself from disease: • Do not leave food or drinks on countertops where blood or potentially infectious materials can be present (e.g., nurses station) • Do not keep food or drinks in refrigerators or freezers used to hold medications or potentially infectious materials • Do not use petroleum-based lubricants with latex gloves – these weaken the protective glove barrier • Do not eat, drink, apply cosmetics, or handle lip balm in an area where you might be exposed to blood or body fluids

39. Standard Precautions • A set of precautions designed to protect staff and residents from exposure to disease • Use for ALL residents, ALL body fluids, ALWAYS • Includes: • Hand hygiene • Personal protective equipment (PPE), including resuscitation devices • Safe injection practices • Sharps injury prevention • Care of environment • Cleaning of care equipment • Respiratory hygiene/cough etiquette • Handling of linen and regulated medical waste • Special lumbar puncture procedures • Patient/resident placement

40. For More Information… • Virginia Department of Health webpage on Standard Precautions: www.vdh.virginia.gov/Epidemiology/Surveillance/HAI/StandardPrecautions.htm • 2007 Guideline of Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings www.cdc.gov/hicpac/2007IP/2007isolationPrecautions.html

41. Personal Protective Equipment Protective wear that serves as a barrier between you and blood/body fluids: • Gloves • Gowns • Masks • Goggles/Face shields • Resuscitation devices

42. Protective Equipment • Type varies with task • Adequate supplies maintained, replaced, and disposed of by facility • Fits properly and is free of flaws • Supplied at no cost to employee • Facility must offer training on use • If re-usable, must be cleaned carefully and as soon as possible to prevent contamination

43. Housekeeping • Facility cleaning schedule • Procedure for cleaning up blood/body fluid spills – clean up spills promptly and appropriately • Follow product instructions for use • Use enough product • Use for appropriate kill time • Use standard precautions when handling all linen (including sheets, clothes) • Regulated medical waste policy/procedure

44. Hepatitis B Vaccine • Single most important factor in preventing hepatitis B infection in healthcare workers • Must be offered by the employer to all employees who may have exposure to blood or body fluids on the job • Must be provided at no cost to the employee • Must be offered within 10 days of initial assignment to a job where there may be occupational exposure to blood or body fluids • Safe, effective • Series of three shots over a 6-month period • Long-term immunity

45. Occupational Exposure:Immediate Response • If you should get stuck by a needle or if you have direct skin or mucous membrane contact with blood or other body fluids: • Don’t panic • Wash the area with soap and water • Flush eyes or mucous membranes with water • Report the incident immediately (within two hours) to your supervisor and record date and time of incident • This is important so that you can get the necessary follow-up care

46. Occupational Exposure: Post-Exposure Counseling and Follow-up • After an occupational exposure, you must be provided with counseling and follow-up care • Trained medical staff will help determine your risk of acquiring a bloodborne disease • If there is a risk, appropriate testing and follow-up of the employee (and resident(s) involved) will be initiated • Remember to keep all follow-up appointments

47. Education • Training on the BBP Standard is required upon hire and annually thereafter for staff members who are covered under the OSHA BBP Standard • Training must be conducted by a person who is knowledgeable in the subject • Training must be offered at a convenient location and on company time • Training records must be kept at least 3 years

48. Recordkeeping • Training records • Medical records • Maintained for each employee with an occupational exposure • Includes vaccination status and post-exposure evaluations • Sharps injury log • Maintained for 5 years from the date of exposure • Type and brand of device involved • Department or area of incident • Description of incident

49. Example of Sharps Injury Log

50. Module 2: Summary • The OSHA BBP Standard describes policies and practices that employers must establish to protect employees who have contact with blood/body fluids in their job. • If an occupational exposure does occur, report the incident and receive follow-up care promptly. • Training upon hire and annually is important to assure that employees understand their risks and follow the appropriate policies and practices.