1. 1 Preventing Exposures to Blood Borne Pathogens Updated 10/06 All Staff

2. 2 What is exposure control? Exposure control is an approach to eliminate employee contact to a potential health hazard.

3. 3 Elements of an exposure control plan Exposure determination Methods of compliance: –universal precautions –work practices –engineering controls –use of personal protective equipment

4. 4 Elements of an exposure control plan Hepatitis B vaccination program Procedure for evaluation of exposure incidents Post-exposure evaluation and follow-up Inclusion of evaluation of safer engineering devices

5. 5 Where is your exposure control plan located? A copy of your exposure control plan should be maintained by your employer. It should be reviewed and updated annually. You should have access to the plan for review.

6. 6 Why is an exposure control plan important ? l Identifies employees at risk for exposure to bloodborne pathogens l Provides for the education of employees regarding the bloodborne pathogen risk and how to avoid this risk l Provides a mechanism to educate employees about the uses and limitations of engineering controls, work practices and personal protective equipment l Provides a plan for post-exposure follow-up

7. 7 What is an occupational exposure? An “occupational exposure is a reasonably anticipated skin, eye, mucous membrane, non-intact skin or parenteral contact with blood and other potentially infectious materials that may result from the performance of an employee’s duties.” OSHA

8. 8 How can exposures be prevented? 1) Your employer should identify job categories at risk for exposure. 2) Consistent use of universal precautions for all clients. 3)Use of personal protective equipment. 4) Use of engineering controls. 5) Use of safe work practices.

9. 9 Prevention is the key!

10. 10 How are bloodborne pathogens transmitted? Hepatitis B and C and HIV are transmitted in a healthcare setting: l by needle stick injuries l contact with blood or body fluids through cuts, scrapes and breaks in the skin l splashes to the eye, nose and mouth area

11. 11 What are the symptoms of Hepatitis B and C? l Hepatitis attacks the liver and may cause serious liver disease. l Sometimes jaundice occurs with these infections. l Hepatitis can feel like a flu-like illness for months.

12. 12 Do people with hepatitis always have symptoms? l Some people never have symptoms. l Others are considered in a chronic carrier state - no symptoms but can pass the disease to others l HBV can lead to cirrhosis, liver cancer and death. l Hepatitis C may lead to cirrhosis of the liver.

13. 13 How many cases of Hepatitis B occur each year? l Approximately 140,000 - 320,000 cases occur each year. l 20,000 people go on to be chronic carriers l 850 people will develop chronic liver problems l 140-320 people will die from active Hepatitis B each year

14. 14 How many cases of Hepatitis C occur each year? l 35, 000 - 180,000 Americans become infected with HCV per year l HCV is associated with 8,000 - 10,000 deaths each year (chronic liver disease l > 85% of people who become infected with HCV will go on to develop chronic infection

15. 15 HIV l The number of people with HIV and AIDS continues to increase. l Total number of people living with HIV/AIDS is 40 million as of 2003 l Approximately 5 million people were newly infected with HIV in 2003

16. 16 What are the symptoms of HIV? l HIV attacks the body’s immune system l Many people are infected but do not know they have been infected. l Early symptoms of AIDS may include fever, loss of appetite, weight loss, chronic fatigue and skin rashes.

17. 17 Prevention Approaches

18. 18 Contact task categories l Category I - Routine contact with blood and body fluids l Category II - Occasional contact with blood and body fluids l Category III - No contact with blood and body fluids

19. 19 Written Policies which: l prohibit recapping, breaking or shearing needles l specify safe practices when handling reusable sharps l require use of mechanical means to clean up broken glassware l disposal of contaminated sharps

20. 20 Standard Precautions l All blood and body fluids are treated as if known to be infectious for HIV, HBV and HCV l Consistently used with all clients

21. 21 Engineering Controls Engineering Controls controls that either remove the hazard or isolate the worker from the hazard l Examples of controls are sharps disposal containers, self-sheathing needles, or biosafety cabinets. l Employees must be instructed in the use of engineering controls. l There must be regular inspection and replacement of engineering controls.

22. 22 Safe Work Practices These practices prevent exposures. l HANDWASHING facilities should be close to the work area. l Handling of contaminated equipment and processing of specimens. l Identification of high risk areas by use of biohazard labeling.

23. 23 Safe Work Practices l no eating, drinking, smoking, applying lip balm or cosmetics, or handling of contact lenses in the work areas where there is a risk of exposure. l handwashing alternatives when running water is not available l universal precautions when handling all specimens l all contaminated equipment must be decontaminated prior to servicing

24. 24 Personal Protective Barriers l Must be provided at no cost to the employee nor can cost be past on to clients. l Include barriers such as fluid-resistant gloves, gowns, face shields, and masks. l Employees must be trained in the proper use and selection of PPE. l Must be easily accessible

25. 25 Hepatitis B immunization l Educate employee on risk of BBP l Free to employee l Voluntary l If employee declines, a declination form must be signed. l Offer within 10 days of beginning employment l Three injections over 6 months l Verify sero-conversion 30 days post immunization

26. 26 Hepatitis B immunization Hepatitis B immunization Non-converters l Re-immunize with the complete series l Retest 30 days post completion of the second series. If employee does not demonstrate immunity, consider as “non responder” and not immune to Hepatitis B. l If exposed to active HBV, administer Hepatitis B Immune globulin

27. 27 Contaminated Materials l procedures must be followed to decontaminate the environment,equipment, laundry and work surfaces l procedure for collecting, transporting and disposal of waste l schedule for cleaning and decontamination of worksite based on location, type of surface, soil and tasks involved

28. 28 Handling Contaminated Material l universal precautions l label with biohazard labeling or use red bags for disposal l requirements for disposal include: close-able, labeled containers, constructed to prevent leakage during handling, storage, or transporting.

29. 29 Compliance Monitoring l Employers are required to ensure that employees are following the practices. l Employee health/infection control programs l Management monitoring l Investigation of exposure circumstances

30. 30 Post exposure follow-up

31. 31 Post exposure follow-up l Determination as to who will be the provider l Compliance with Maryland state laws and OSHA regulations l Written informed consent of employee and source prior to HIV testing l Evaluation of incident to prevent re-occurrence

32. 32 Post Exposure Follow-up After signed informed consent of employee and source: l employee baseline testing to include: Hepatitis B surface antibody Hepatitis C antibody HIV l source testing to include: Hepatitis B antigen Hepatitis C antibody HIV

33. 33 What should be sent with the employee? l Copy of the OSHA BBP regulations l Description of duties and responsibilities as related to the exposure l Documentation of routes of exposure and circumstances under which the incident occurred

34. 34 What should be sent with the employee? l source and employee’s blood work (should be confidential and sent directly to the outside provider) l relevant employee records regarding immunization

35. 35 Elements of healthcare professionals evaluation l Healthcare professional’s opinion stating the employee was counseled and advised will be sent to the employer l Employee should anticipate a written opinion of the visit within 15 days. Opinion should contained detailed information.

36. 36 Related issues Communicable disease reporting and notification

37. 37 l COMAR regulations require reporting of clients with communicable diseases l A call to your local health department will meet the requirements and provide an opportunity for additional information sharing e.g., staff followup; l EMS notification in circumstances were identification of a communicable disease is communicated to the office

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