1. Bloodborne Pathogen Training

2. Introduction to the problem of Bloodborne Pathogens  Healthcare Providers and those working with potentially infectious fluids need to be especially concerned with three major bloodborne pathogens:  Hepatitis B Virus: HBV  Hepatitis C Virus: HCV  Human immunodeficiency virus: HIV

3. Facts about HBV Definitely a risk for healthcare providers Definitely a risk for healthcare providers The risk is directly related to the degree of contact with blood The risk is directly related to the degree of contact with blood The greatest risk is with percutaneous exposure (needlestick) The greatest risk is with percutaneous exposure (needlestick) The risk of developing “clinical hepatitis” is approximately 22-31% The risk of developing “clinical hepatitis” is approximately 22-31% The risk of developing serologic evidence of HBV is approximately 37-62% The risk of developing serologic evidence of HBV is approximately 37-62%

4. HBV (cont.) HBV can survive on environmental surfaces, in dried blood, for at least one (1) week. HBV can survive on environmental surfaces, in dried blood, for at least one (1) week. Therefore, percutaneous exposure is not the ONLY way to contract HBV Therefore, percutaneous exposure is not the ONLY way to contract HBV Other means of exposure: through the mucous membranes &/or non-intact skin. Other means of exposure: through the mucous membranes &/or non-intact skin. Approximately 5,000 people each year die due to HBV Approximately 5,000 people each year die due to HBV Approximately 10% of those exposed develop chronic infection Approximately 10% of those exposed develop chronic infection

5. HBV (cont.)  Up to 50% of those infected have no symptoms  Signs/Symptoms of HBV:  Jaundice, fatigue  Abdominal pain, loss of appetite  Occasional nausea or vomiting *** There IS a vaccine for HBV

6. HCV Facts  NOT efficiently transmitted by way of occupational exposures to blood  The incidence of HCV seroconversion after and accidental percutaneous exposure from a positive HCV source is approximatey 1.8 %  There is no documentation, to date, of transmission of HCV to a healthcare worker from blood exposure with INTACT skin.

7. HCV (cont.)  Approximately 75% of those infected with HCV have no signs or symptoms  Approximately 10,000 people die each year from HCV infection  Approximately 85% of those that are exposed develop chronic infection  HCV is the leading indicator for liver transplants  There IS NO VACCINE for HCV

8. Facts about HIV  Approximately 900,000 people are infected with HIV in the U. S.  The average risk of HIV transmission after a percutaneous exposure to HIV infected blood is 0.3%  The average risk of HIV transmission after mucous membrane exposure is approximately 0.09%  There IS NO VACCINE for HIV

9. Exposure Facts  HBV, HCV, and HIV are most easily spread via contact with infected blood.  Can also spread with contact through other potentially infected materials (OPIM)  OPIM include: semen, vaginal secretions, other body tissues or fluids that contain visible blood

10. Examples of OPIM  Cerebrospinal fluid, synovial fluid  Pleural, peritoneal, pericardial fluids  Amniotic fluid  Saliva in dental procedures  Non-intact skin or organs from living or dead humans  Cell tissue or organ cultures or other biological matter from lab. experiments

11. Workplace Exposures  Exposure to a bloodborne pathogen occurs when a contaminated needle or other sharp punctures the skin  Can also occur if blood or OPIM splashes in the mucous membranes of the nose, eyes, or mouth

12. Exposure Control Plan  The exposure control plan details safety precautions that are taken to decrease chances of exposure.  The exposure control plan also details a method of identifying and evaluating safety devices

13.  The exposure control plan is based on the Occupational Safety and Health Administration (OSHA) Bloodborne Pathogens Standards and Centers for Disease Control (CDC) Guidelines

14. Example of a Safety Precaution:  HBV Vaccination series was promoted in 1985. Since then, exposure has dropped from 1200/year to 800/ year in 1995.  To be effective, one must complete the full series must be completed.

15. Standard Precautions  Means to treat all blood, body fluids, excretions, secretions, non-intact skin, mucous membranes as though infected.  To follow the Standard Precaution, use personal protective equipment (PPE) when touching blood, body fluids, secretions, excretions, and contaminated surfaces

16. Personal Protective Equipment PPE  PPE include: gowns, gloves, face shields or masks, lab. coats, eye protection, resuscitation equipment, pocket masks, mouth pieces, or other ventilatory devises  Disposable gloves are the most common type of PPE  You should wear PPE that is appropriate for the job at hand

17. PPE: Gloves  With gloves: cover open areas with a bandaid first before putting on gloves  Gloves should fit snug and the cuff should extend above the wrists.  Wear disposable gloves only once  Change gloves between patients  If a glove becomes torn or ripped, remove it as soon as possible and discard  Never reuse gloves

18. PPE  Do not touch the outside of the gloves when removing used gloves.  Always wash hands after glove removal  Wear surgical cap and shoe covers when large amounts of blood or bodily fluids are expected; such as surgery  Use PPE during resuscitation of patients

19. PPE  Make sure PPE fit properly, are free of tears and blood or bodily fluids  Always discard of PPE before leaving the work area  Wash hands immediately after PPE removal

20. PPE (cont.)  If work activities could possibly generate splatters of blood or other potentially infectious materials (OPI), a mask, eye protection and gown should be used.  If your skin is punctured by a contaminated sharp (even through a glove), wash the area well with soap and water only and report the incident according to your institution’s policy.

21. Handwashing  THE SINGLE MOST important precaution for preventing the spread of infection.  The worker MUST wash their hands before putting on gloves AND after removing gloves- even if there is no visible secretions.  The worker MUST wash their hands before and after every patient contact.

22. Handwashing  Wash hands thoroughly with soap and running water for 10-15 seconds  Dry thoroughly, use a dry paper towel to turn faucet off  Use a waterless handwashing solution as a temporary measure, wash with soap and water as soon as possible

23. Engineering Controls  Engineering controls attempt to design safety into the tools of everyday work and the workplace.  Using appropriate equipment, as provided, is an example of engineering controls: *Ex. use of PPE, use of sharps containers, use of needleless devices *Ex. use of PPE, use of sharps containers, use of needleless devices

24. Other Safety Precautions  Do Not eat, drink, handle contact lenses, use cosmetics, store food or drinks in areas where exposure is possible  Never mouth pipette or mouth suction blood or OPIM  Minimize splashes when handling blood or OPIM  Transport blood or OPIM in closed leak- proof containers and wear gloves

25. Other Safety Precautions  Do not let contaminated patient equipment touch you, other people or objects.  After use, make sure equipment is properly cleaned or discarded before using on another patient  Clean all blood/fluid spills promptly according to your facilities policy  Wear gloves when handling dirty laundry, and keep laundry away from your body

26. Other Safety Precautions  Do not use hands or feet to push trash down in disposal can. Shake trash down from top, carry from the top and away from your body  Red labels, bags, containers, and warning signs ALERT you that they contain contaminated blood or OPIM

27. Needle Safety  Never reuse sharps, Never recap needles  If recapping is required, use hands off re- sheathing devices  Place sharps in an easy to reach and slightly below eye level, puncture proof container  Never reach in the container or overfill  Clean broken glass with broom and dust pan or forceps

28. Exposures  If exposure occurs: immediately wash area with soap and water, or flush eyes with large amounts of water.  Exposures should be reported immediately to immediate supervisors, noting date, time, and type of sharp  Evaluation should be made as to type of safety device used and if injury could have been prevented