Protecting Employees from Bloodborne Pathogens

Course Objectives

After completion of this course, attendees should be able to:

Discuss the components of Occupational Health and Safety Administration (OSHA) Bloodborne Pathogen Standard

Describe HIV, hepatitis B and hepatitis C Review occupational risks for exposure to bloodborne

diseases Discuss engineering and work practice controls Describe appropriate personal protective equipment Define an occupational exposure, discuss the steps to

take if you are exposed

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.

By day, many of these services carry the risk of acquiring a serious disease.

Assisted Living Facilities (ALFs)

Your Risks

Caring for the needs of your residents may expose you to bloodborne pathogens when:

Assisting with bathing and oral care Performing dressing changes Monitoring blood glucose Performing injections Managing nose bleeds and abrasions Handling diapers, linens, and trash Cleaning rooms, common areas, and equipment Cleaning blood/body fluid spills

The Facts

Anyone, regardless of age, race, or socioeconomic status, can carry a bloodborne disease.

Often, without knowing it.

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

Bloodborne Pathogens Standard (BBP)

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

Bloodborne Pathogens

Bloodborne pathogens are diseases that are carried in the blood and can be transmitted by contact with infected blood. The most common include:

Hepatitis B Hepatitis C HIV

Hepatitis B

Serious liver disease

Most cases resolve, 10% of adult cases can be chronic

800,000 - 1.4 million chronically infected

43,000 new cases in 2007

30% of people infected don’t have symptoms

Treatment available to keep the virus under control

Hepatitis B

Symptoms include loss of appetite, fatigue, jaundice, abdominal pain, and nausea

Healthcare workers (HCW) are at increased risk

Can be prevented by vaccination

Treatment available to keep the virus under control

Hepatitis C

Serious liver disease

17,000 new infections in 2007 (estimated)

Many people do not have symptoms for 20 years after first infected

3.2 million chronically infected

Chronic infection: 75-85% of cases

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

HIV

Disease that causes the immune system to lose its ability to fight infection

1.1 million infected (1 in 5 undiagnosed) Chronic infection Some people progress to Acquired

Immunodeficiency Syndrome (AIDS) Clinical symptoms vary; initial infection may

cause flu-like illness Antiviral medications available to treat illness No vaccine available

Transmission

Bloodborne pathogens are spread by contact with blood and other potential infectious materials such as: Semen and vaginal fluids Cerebrospinal fluid (spinal cord) Synovial (joint) and pleural fluid (lung) Peritoneal (abdominal), pericardial

(heart), and amniotic fluid (uterus) Saliva (dental procedures)

Bloodborne pathogens can enter the body in a variety of ways, including: Needles Broken glass (broken blood tubes) Non-intact skin exposure through cuts, skin

abrasions, and mucous membranes of mouth, eyes and nose

Touching your mouth, eyes, nose or open skin after touching surfaces or equipment contaminated with blood or contaminated body fluids

Transmission

Transmission Risk

Risk of infection depends on: The pathogen involved

The type/route of exposure

The amount of virus in the infected blood/body fluid at the time of exposure

The amount of infected blood/body fluid involved in the exposure

Specific immune response of the individual who was exposed

Presence and timeliness of post-exposure treatment

Transmission Risk

Risk of infection following an occupational needlestick or cut from a known positive source:

HBV: 6% - 31%

HCV: 1.8%

HIV: 0.3%

Exposure Control Plan

The Plan is a document that describes howyour employer will address the components of the Bloodborne Pathogens Standard. Itincludes:

Who is covered under the standard

Ways to reduce the risk of exposure

Procedures to follow if there is an occupational exposure.

Engineering Controls

Systems or mechanical devices that minimize hazards in the workplace.

Examples: Self-sheathing or retractable needles Sharps disposal containers

Engineering Controls

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.

“One-Hand” or “Scoop” Technique

Step 1: Place the cap on a flat surface, then remove your hand from the cap

Step 2: With one hand, hold the syringe and use the needle to “scoop up” the cap

Step 3: When the cap covers the needle completely, use the other hand to secure the cap on the needle hub. Be careful to handle the cap at the bottom only (near the hub).

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

Work Practice Controls:Hand Hygiene

Hand hygiene includes both hand washing and the use of alcohol-based hand gels.

Hand washing involves the use of soap, water, friction, and drying.

Alcohol-based hand gels decontaminate hands by removing organisms on the skin.

Work Practice ControlsHand Hygiene

Hand hygiene is appropriate:– Between residents– Every time you remove your gloves– Before and after entering a resident’s room– Whenever hands are in contact with blood or

other body fluids, WASH THEM IMMEDIATELY

Artificial nails should not be worn; natural nails should be no longer than ¼ inch

Work Practice Controls:Personal Hygiene

Self-protective practices that protect you from disease: Do not leave food and drinks in refrigerators,

freezers or on counter tops where blood or potentially infectious materials can be present, e.g., nurses station

Do not use petroleum-based lubricants with latex gloves

Do not eat, drink, apply cosmetics, or handle lip balm in an area where you might be exposed to blood or body fluids

Standard Precautions

Personal Protective Equipment

Protective wear that serves as a barrier between you and blood/body fluids:

Gloves Gowns Masks Goggles/Face shields Resuscitation devices

Protective Equipment

Varies with task Maintained, replaced, and disposed of by

facility Fit properly Supplied at no cost to employee Free of flaws Facility must offer training on use Must be cleaned carefully and as soon as

possible to prevent contamination Utility gloves can be reused if not damaged

Housekeeping

Facility cleaning schedule

Procedure for cleaning up blood spills

Use standard precautions when handling all linen (including sheets, clothes)

Regulated medical waste policy/procedure

Hepatitis B Vaccine

Single most significant factor in preventing hepatitis B infection in healthcare workers

Must be offered to all employees who have exposure to blood or body fluids on the job

Safe, effective

Series of three shots

Long-term immunity

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, you will be provided with counseling and follow-up care.

Exposures should be reported immediately (within two hours) so that appropriate care can be initiated.

Occupational Exposure:Post-Exposure Counseling and Follow-up

Don’t panic Wash the area with soap and water Flush eyes or mucous membranes

with water Report the incident immediately to

your supervisor and record date and time of incident

Occupational Exposures

You will be offered counseling by trained medical staff to determine your risk of acquiring a bloodborne disease

If there is a risk, appropriate testing and follow-up of the patient and employee will be initiated

Keep all follow-up appointments

Education

Training in the BBP Standard is required upon hire and annually thereafter

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

Recordkeeping

Medical records must be maintained for the length of employment plus 30 years

Sharps injury log must be maintained for 5 years from the date of exposure– Type and brand of device involved – Department or area of incident– Description of incident

Summary

The Bloodborne Pathogen Standard applies to anyone who has exposure to blood/body fluids while performing job duties.

Your employer must provide engineering and workplace controls to help prevent occupational exposure, including personal protective equipment and safe needle devices.

The hepatitis B vaccine must be offered to anyone who has exposure to blood and body fluids while performing their regular job duties.

Summary

Occupational exposures should be reported immediately to your supervisor because follow-up testing should be initiated as soon as possible.

You are responsible for following the policies and procedures written by your employer and for using the safety measures available to you to reduce your risk of exposure to bloodborne diseases.

Self Test (True or False)

1. The Bloodborne Pathogens Standard covers anyone who has the potential for contact with blood while working.

2. HIV, HBV, and HCV may cause no obvious symptoms.

3. Standard Precautions should be used with ALL residents.

4. Used needles and syringes should always be placed in a regulated sharps container.

5. Every employee is responsible for following the BBP Standard when performing job duties that require contact with blood and body fluids.

6. Training in the BBP Standard is only required upon hire.

Self Test (True or False)

Resources

Centers for Disease Control and Prevention– http://www.cdc.gov/HAI/organisms/organisms.html

Occupational Safety and Health Administration– http://www.osha.gov/SLTC/bloodbornepathogens/index.html

Virginia Department of Health– Contact your local health department (http://www.vdh.virginia.gov/lhd/)– Office of Epidemiology, Division of Surveillance and Investigation (804) 864-8141

Department of Environmental Quality– http://www.deq.state.va.us/