Bloodborne Pathogen Safety

2 Could You Contract a Disease at Work? Administering first aid? Cleaning the restrooms? Using a tool covered with dried blood? A co-worker sneezes on you? Changing diapers? Tube feeding? Catheterization?

3 What is a Bloodborne Pathogen  A micro-organism that lives in your blood and causes disease. Some bloodborne pathogens include: Hepatitis B Hepatitis C HIV-AIDS  Other diseases of concern for educators: Hepatitis A Tuberculosis (TB) Common Cold

4 What is Hepatitis A?  Hepatitis A is a liver disease caused by Hepatitis A virus.  33% of Americans have evidence of past infection (immunity)  Cases increasing slightly during past several years.  Estimated 125, ,000 total infections/yr in United States

5 How is Hepatitis A Virus Transmitted? Hepatitis A virus is spread from person to person by putting something in the mouth that has been contaminated with the stool of a person with hepatitis A. This type of transmission is called "fecal-oral.“ The virus is more easily spread in areas where there are poor sanitary conditions or where good personal hygiene is not observed.

6 What are the Signs and Symptoms of Hepatitis A?  Persons with hepatitis A virus infection may not have any signs or symptoms of the disease.  Older persons are more likely to have symptoms than children.  If symptoms are present, they usually occur abruptly and may include fever, tiredness, loss of appetite, nausea, abdominal discomfort, dark urine, and jaundice (yellowing of the skin and eyes).  Symptoms usually last less than 2 months; a few persons are ill for as long as 6 months.  The average incubation period for hepatitis A is 28 days.

Hepatitis B (HBV) 1—1.25 million Americans are chronically infected Symptoms include: jaundice, fatigue, abdominal pain, loss of appetite, intermittent nausea, vomiting May lead to chronic liver disease, liver cancer, and death 300,000 new cases every year 90% Infection rate HBV can survive for at least two weeks in dried blood

8 HEPATITIS B SYMPTOMS Jaundice, fatigue, abdominal pain, loss of appetite, intermittent nausea, vomiting

9 Hepatitis B Vaccination Offered to all potentially exposed employees Provided at no cost to employees Declination form

10 Viral Hepatitis C Hepatitis C is a disease of the liver caused by the hepatitis C virus. You should contact your medical care provider for a blood test if you: were notified that you received blood from a donor who later tested positive for hepatitis C. have ever injected illegal drugs, even if you experimented a few times many years ago received a blood transfusion or solid organ transplant before July, 1992 received a blood product for clotting problems produced before 1987 have ever been on long-term kidney dialysis have evidence of liver disease

11 Hepatitis C (HCV) Hepatitis C is the most common chronic bloodborne infection in the United States Symptoms include: jaundice, fatigue, abdominal pain, loss of appetite, intermittent nausea, vomiting. 85% Infection rate – only 25% will show symptoms upon infection. The “Stealth Disease” – some may have no symptoms for 20 years or more. May lead to chronic liver disease and death

12 Hepatitis C virus (HCV) 25-30% of infections are symptomatic Chronic infection >85% of infected persons Chronic liver disease: 70% of infected persons Deaths from chronic liver disease: 8, ,000/yr Leading indication for liver transplantation Estimated 3.9 million (1.8%) Americans have been infected with HCV of whom 2.7 million are chronically infected

13 Hepatitis D and Hepatitis E  Hepatitis D is a co-virus associated with Hepatitis B (HBV).  Patients with HBV and HDV have an increased chance of developing liver cancer or cirrhosis of the liver.  IV drug use or unprotected sex with multiple partners.  HEV is transmitted primarily by the fecal-oral route and fecally contaminated drinking water is the most commonly documented vehicle of transmission  Virtually all cases of acute Hepatitis E in the United States have been reported among travelers returning from high HEV- endemic areas

14 Human Immunodeficiency Virus (HIV) HIV is the virus that leads to AIDS HIV depletes the immune system HIV does not survive well outside the body

15 # of AIDS Cases by Age at Diagnosis

16 Trends in AIDS Epidemic Today, 42 million people are estimated to be living with HIV/AIDS. Of these, 38.6 million are adults million are women, and 3.2 million are children under 15. An estimated 5 million people acquired the human immunodeficiency virus (HIV) in 2002, including 2 million women and 800,000 children under 15. During 2002, AIDS caused the deaths of an estimated 3.1 million people, including 1.2 million women and 610,000 children under 15. Women are becoming increasingly affected by HIV. Approximately 50%, or 19.2 million, of the 38.6 million adults living with HIV or AIDS worldwide are women.

17 RISK GROUPS Injection drug users Sexually active heterosexuals Men who have sex with men Infants/children of immigrants from disease-endemic areas Hemodialysis patients Low socioeconomic level Sexual/household contacts of infected persons Infants born to infected mothers Health care workers

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19 Potentially Infectious Bodily Fluids Blood Saliva, vomit, urine (with visible blood) Semen or vaginal secretions Skin, tissue, cell cultures Other body fluids

20 PREVENTION OF TRANSMISSION OF BLOODBORNE PATHOGENS  UNIVERSAL PRECAUTIONS Wear Personal Protective Equipment, like Gloves Good hygiene and sanitation

Universal Precautions Proper cleanup and decontamination Treat all blood and bodily fluids as if they are contaminated Wash your hands

22 Wear gloves if you might come in contact with blood. Have first aid supplies handy on the playground by keeping a zip-lock plastic bag stocked with disposable gloves, sterile wipes, gauze wrap, and bandaids in your pocket. First Aid

Protective Equipment Gloves (Latex, Vinyl, or Plastic) Apron Face shield CPR mask **Whatever you need must be provided by the district

24 Safe Work Practices Remove contaminated PPE or clothing as soon as possible Clean and disinfect contaminated equipment and work surfaces Thoroughly wash up immediately after exposure Properly dispose of contaminated items

25 HOW TO WASH HANDS (CONTINUED)  Turn the faucet off using the towel.  Discard the used towel in a trash can lined with a fluid-resistant (plastic) bag.  Consider using hand lotion to prevent chapping of hands.  When assisting a child in handwashing, either hold the child (if an infant) or have the child stand on a safety step at a height at which the child's hands can hang freely under the running water.  Assist the child in performing all of the above steps and then wash your own hands.

26 How to Wash Hands  Always use warm, running water and a liquid, soap. Antibacterial soaps may be used, but are not required.  Wet the hands and apply a small amount of liquid soap to hands.  Rub hands together vigorously until a soapy lather appears and continue for at least 15 seconds. (Sing a tune to pass the time!!) Be sure to scrub between fingers, under fingernails, and around the tops and palms of the hands.  Rinse hands under warm running water. Leave the water running while drying hands.  Dry hands with a clean, disposable towel.

27 When Hands Should Be Washed Upon arrival at work. Immediately before handling food, preparing bottles, or feeding children. After using the toilet, assisting a child in using the toilet, or changing diapers. After contacting a child's body fluids, including wet or soiled diapers, runny noses, spit, vomit, etc. Whenever hands are visibly dirty or after cleaning up a child, the room, bathroom items, or toys. After removing gloves used for any purpose. Before giving or applying medication or ointment to a child or self. Before going home.

28 Decontamination Wear protective gloves Disinfectant/cleaner provided in bodily fluid disposal kit Solution of 1/4 cup bleach per gallon of water Properly dispose of contaminated PPE, towels, rags

29 Labels and Signs Labels must include the universal biohazard symbol, and the term “Biohazard” must be attached to: containers of regulated biohazard waste refrigerators or freezers containing blood or OPIM containers used to store, transport, or ship blood or OPIM

30 Exposure Incident A specific incident of contact with potentially infectious bodily fluid If there are no infiltrations of mucous membranes or open skin surfaces, it is not considered an occupational exposure Report all accidents involving blood or bodily fluids Post-exposure medical evaluations are offered

Potential Transmission Contact with another person’s blood or bodily fluid that may contain blood Mucous membranes -- eyes, mouth, nose Non-intact skin Contaminated sharps/needles

32 Potential Exposure Administering first aid Post-accident cleanup Custodial or maintenance work

33 Post Exposure Evaluation Confidential medical evaluation Document route of exposure Identify source individual Test source individuals blood (with consent) Provide results to exposed employee

34 What is an exposure? What do I do?  An exposure is: When someone else’s blood gets into your blood through a cut or open wound. Needle stick Human bite that breaks the skin  If you are exposed: Wash the exposed area thoroughly with soap and water. Report it to your supervisor, IMMEDIATELY Seek immediate medical attention

35 Things to Remember A person could be HIV or HBV positive and have no symptoms at all. You can’t tell by looking. Treat every person, every needle, and every body fluid as if it’s infected. USE UNIVERSAL PRECAUTIONS EVERY TIME.

36 Summary Universal precautions Use PPE and safe work practices Decontaminate contaminated surfaces Report Exposure incidents

37 Use Universal Precautions! Let’s break the chain of infection.