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Bloodborne Pathogens

Bloodborne Pathogens. Natural Defenses. Intact skin and mucous membranes in eyes, nose and mouth keeps germs out. Mucous membranes trap & force out germs. Mucous membrane less effective than skin at keeping germs out of the body.

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Bloodborne Pathogens

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  1. Bloodborne Pathogens

  2. Natural Defenses • Intact skin and mucous membranes in eyes, nose and mouth keeps germs out. • Mucous membranes trap & force out germs. • Mucous membrane less effective than skin at keeping germs out of the body. • Inside body germs detected & surrounded white blood cells, which release antibodies to fight infection.

  3. Natural Defenses • Germs sub-classified as: - bacteria (tetanus) which are non-dependant & treated with antibiotics. - virus (measles) which are dependent & few medications available. • Germs overwhelm immune system and infection develops.

  4. What is a BB Pathogen? • Microorganisms (e.g., bacteria & viruses) carried in blood and causing diseases: - Malaria - Brucellosis - Syphilis - Hepatitis B(HBV) - Hepatitis C(HCV) - Human Immunodeficiency Virus (HIV)

  5. Statistics and Standards • Annually millions of workers at risk of exposure to bloodborne pathogens – human immunodeficiency virus (HIV – virus causes AIDS), hepatitis B virus (HBV), & hepatitis C virus (HCV) • OSHA’s Bloodborne Pathogens standard (1910.1030) prescribes exposure safeguards to reduce exposure risks. • Hepatitis A not included, not carried in blood. • No MSHA or OSHA-Construction standard

  6. Exposure Determination • Employees “reasonably anticipated” in job performance to contact blood and other potentially infectious materials. • Designated first-aid and CPR trained employees • “Good Samaritan” acts such as assisting a co-worker with a nosebleed would not be considered occupational exposure.

  7. BB Pathogen Spread • All four of the following must be met: - pathogen Present, - pathogen Quantity sufficient to cause disease, - pathogen through correct Entry site, & - person Susceptible. • PQES

  8. Infection Risk • Risk of infection from accidental bloodborne exposure varies with: - pathogen involved, - exposure type, - route of infection, - immune status of recipient, - amount of involved blood, - amount of virus in blood, &- ability of organism to produce disease.

  9. Pathogen Transmission • Direct contact with infected human blood, unfixed tissues, & other potentially infectious bodily fluids such as: - Saliva - Vomit - Urine - Semen or vaginal secretions, - Blood transfusion, & - Bodily fluid visibly contaminated with blood.

  10. Pathogen Transmission • Indirect contact with infected human blood, unfixed tissues, & other potentially infectious bodily fluids on: - soiled dressing, - equipment or working surfaces, - PPE, - other first-aid items.

  11. Pathogen Transmission • HBV, HCV and HIV most commonly transmitted through: - sexual contact, - needles or other sharp instruments, - mothers to babies at/before birth, - contact between broken/damaged skin & infected bodily fluids, & - contact between mucous membranes & infected bodily fluids.

  12. Pathogen Transmission • Infected blood or bodily fluid enters through: - open sores, - cuts, - abrasions, - acne, or - any sort of damaged or broken skin (e.g. sunburn or blisters).

  13. Pathogen Transmission • Through mucous membrane of: - eyes, - nose, & - mouth. • Example – blood/fluids splash to eyes. • HBV, HCV & HIV share common transmission mode but risk differs. • Most exposures do not result in infection. • No evidence mosquitoes can transfer virus from person to person.

  14. HBV Infection Risk • No risk following receipt of vaccine & immunity development. • Post exposure treatment 24 hours – 7 days. • Susceptible person after cut exposure to blood: - single exposure 6-30%, & - positive antigen status means more virus. • Possible risk from exposure of mucous membrane or nonintact skin. • No known risk from exposure to intact skin.

  15. HCV Infection Risk • Susceptible person after cut exposure to blood: - approximately 1.8%. • Unknown following exposure to eyes, nose or mouth; believed to be very small. • Reported infection from: - blood splash to eye, & - nonintact skin exposure. • No known risk from exposure to intact skin.

  16. HIV Infection Risk • After cut exposure to blood: - approximately 0.3%. • After exposure to eyes, nose or mouth: - estimated on average at 0.1%. • After exposure to nonintact skin: - less than 0.1%. • From needle stick: - estimated on average at 0.3 – 0.4%. • No cases with small blood amount on intact skin.

  17. Vaccinations • HBV: - available since 1982, - series of 3 shots over 6 months, - provides protection for 9 or more years, - 70-88% effective within 1 week of exposure, & - 90-95% effective - chronic infection in 6% persons after age 5. - death from liver disease in 15-25% of persons.

  18. Vaccinations • HCV: - treatment thru medications* and therapy, and - no vaccine currently available. • HIV: - treatment thru medications, and - no vaccine currently available.

  19. Hepatitis B (HBV) • Durable virus, able to survive in dried blood up to 7 days. • Initial inflammation of the liver, but can lead to serious conditions (e.g., cirrhosis & cancer). • 1 – 9 months before symptoms are noticeable. • Mild flu symptoms – fatigue, appetite loss, nausea, joint pain & stomach pain. • Progresses to jaundice & darkening of urine.

  20. Hepatitis B (HBV) • 300,000 U.S. individuals (8,700 health care workers) infected annually; 1 – 2% fatal • Infection does non prevent infection of HAV or HCV. • Medications available for chronic HBV; only work for some patients.

  21. Hepatitis C (HCV) • Most common chronic bloodborne infection in the United States. • Acute or Chronic • Chronic – insidious, slow & without symptoms for 2 or more decades. • Symptoms include: jaundice, fatigue, abdominal pain, loss of appetite, intermittent nausea, vomiting. • May lead to chronic liver disease, transplant & death.

  22. Human Immunodeficiency Virus (HIV) • HIV virus leading to AIDS. • Depletes immune system (white blood cells). • Opportunistic infections (e.g., TB, pneumonia). • Very fragile & not survive long outside body. • Primary concern to individuals providing first air or medical care involving fresh blood or potentially infectious materials. • No threat of contraction through casual contact.

  23. Infection Prevention • Universal Precautions: - Treat all blood and bodily fluids as infectious, - Use of proper PPE, - Personal hygiene, - Proper cleanup and decontamination, & - Proper disposal of all contaminated material.

  24. Engineering & work Practice Controls & PPE • Engineering & work practice controls primary methods used for transmission control (e.g., sharps containers), • Work practices: - Blood and bodily fluids treated as infectious, - Remove jewelry, - Personal hygiene, & - etc. • PPE used in conjunction with engineering & work place controls.

  25. Personal Hygiene • Important factor in minimizing exposure • Confine loose clothing or hair • Maintain nail length < ¼ inch long • Hand washing is one of the most important practices in transmission prevention.

  26. Hand Washing • Wash hands immediately after removing PPE. • Use a soft antibacterial soap • Min. 15 sec. including nails • Rinse thoroughly • Antiseptic cleanser, 70% ethyl alcohol, but wash with soap and water ASAP. • Frequently sanitize hands and exposed skin.

  27. PPE • Anything protecting a person from exposure • Gloves (latex, nitrile) - double glove • Face shields • Eye protection • Mask or Respirator • Mouthpieces & resuscitation devices

  28. PPE Rules to Remember • Ensure always available • Always wear in exposure situations or when there are skin openings (breaks, cuts). • Check for age, defects or tears before using • Remove & replace if torn or defective, or lost ability to function as barrier. • Remove ASAP to prevent contamination. • Cover skin openings prior to donning. • Remove properly & do not reuse

  29. Recommended PPE

  30. Glove Removal Technique

  31. Glove Removal Technique

  32. Exposure Incident • Flush site of blood or OPIM contact (e.g., splash to nose, mouth, or skin). • Irrigate eyes with water or saline • Note specifics of contact with blood or OPIM • Notify supervisor and Safety • No infiltrations of mucous membranes or open skin surfaces, not considered exposure. • Medical evaluation within 1 to 2 hours according to current medical guidelines! • Post-exposure medical evaluations

  33. Post-exposure Evaluation • Confidential medical evaluation • Document route of exposure • Identify source individual • Hepatitis B vaccination status • Test source individuals blood • Provide results to exposed employee

  34. Summary • OSHA’s Bloodborne Pathogens standard prescribes safeguards to protect against blood and OPIM exposures, & reduce their risk from this exposure. • Implementation will not only will prevent HBV cases, but also significantly reduce risk of contracting HIV, HCV, or bloodborne diseases. • Given our line of work, first aid and CRP responders are potentially exposed.

  35. Conclusions BB pathogen rules in place for your health Precautions use will remove 1 of 4 PEQS transmission conditions. Condition missing, infection not occurring

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