1. Bloodborne Pathogens Training Adapted by V.M. Warnock RN, BSN from slides by Heidi Toth RN, MSN

2. Some occupations put workers at risk for occupationally acquired infection. Policies and Procedures that minimize your health risks. OSHA Standard Exposure Control Plan Infectious Disease Process Bloodborne Diseases Potential Exposure Risks Exposure Control Strategies

3.  "Bloodborne Pathogen Rule” Those at risk of occupational exposure to blood or other potentially infectious materials must be trained in universal precautions and other exposure control strategies.  At risk employees are individuals whose work responsibilities bring them in contact with blood and body fluids.  Training is done upon initial employment and updated annually. Occupational Safety & Health Administration (OSHA) Standard Internet link to regulation: www.osha.gov/pls/oshaweb/owadisp.show_document?p_table=STANDARDS&p_id=10051

4. What is the Exposure Control Plan? Bloodborne Pathogens Exposure Control Plan. Where ?: Health Office. All employees have access to the exposure control plan. What? Identifies those occupations at risk You may consult this document if you think you are at risk. Freehold Borough School District Exposure Control Plan

5. Infectious Disease Process- What are microorganisms?? Classifications: bacteria, viruses, fungi, algae, yeasts, and protozoa. Too small to be seen by the unaided human eye.  in the soil  in the water,  on plants and animals.  billions on human skin and the nasal & intestinal tracts. Found;

6. Infectious Disease Process- What are pathogens? Most microorganisms live in harmony with the human body. Pathogens—can infect the body and cause disease. Infectious diseases range from mild illnesses, such as a cold, to fatal illnesses, such as AIDS.

7. The Infectious Disease Process. CHAIN OF INFECTION

8. The chain begins,,,,,,,,,,, Second link:………. An environment in which the pathogen can survive: * Water * soil * inside someone already infected with the germ. Microorganism & Reservoir

9. Next link …….. From the reservoir to the host. If water is the reservoir, its mode of transmission could be our drinking water supply. ……. T hird link. Escape from the reservoir If we are the reservoir, the pathogenic microorganism can escape when we cough or sneeze. Escape & Transmission

10. Last link …. host's susceptibility Depends on the germ and the disease it causes..… Some hosts are easier to infect than others. NEXT…. Means of entry into the host. A pathogen in water would enter us if we drank the water it was in. A pathogen in the air would enter us if we inhaled it. Entry & Susceptibility

11. For an infectious disease to occur, each link in the chain must be connected. CHAIN OF INFECTION

12. . Here the chain is broken at the point of host susceptibility. YOU can break the chain of infection by following standard precautions/universal precautions. If even one link of the chain is missing: Interrupted process=No infection

13. Bloodborne pathogens …….. are microorganisms that are present in blood that can cause disease. blood or body fluid from an infected individual Enters another persons body How do you get infected? 2 examples of Bloodborne pathogens: Hepatitis B (HBV) Human Immunodeficiency Virus (HIV)

14. Any body fluid with visible blood is potentially infectious. Other body fluids like semen and vaginal secretions are considered potentially infectious fluids. The risk of transmission from these body fluids in the school setting is considered extremely low.

15. Contact alone does not ensure infection! Pathogens must enter the bloodstream to cause infection. In the workplace, an employee may be exposed to bloodborne pathogens such as Hepatitis B Virus or HIV when infected blood or body fluid is allowed to enter the body by means of penetration. Exposure may occur through:  a needlestick  a cut or break in the skin  contact with mucous membranes such as the eye, nose, or mouth POTENTIAL EXPOSURE RISK

16. HBV causes inflammation of the liver and may lead to complications of:  Lifelong infection (>200 million carriers worldwide  Hospitalization  Cirrhosis (scarring) of the liver  Liver cancer (cause of 80% of cases)  Death HBV virus can live up to a week on a dried environmental surface. For more information about Hepatitis B: www.liverfoundation.org www.liverfoundation.org HEPATITIS B VIRUS (HBV)

17. is one way to minimize your risk  Three shots in upper arm over a 6-month period (0, 1, 4-6 months)  Low incidence of side effects, people should not get the vaccine if they have had a life threatening allergic reaction to baker’s yeast or to a previous dose of hepatitis vaccine  Routine booster doses are NOT recommended for any group  Post vaccination blood testing is recommended for certain healthcare workers Hepatitis B shots are required for all school-age children. HEPATITIS B VACCINATION

18. Freehold Borough School District offers hepatitis B shots to employees who are likely to incur occupational exposure to blood or other body fluids. See The Exposure Control Plan for more details, or speak with the School Nurse. If you decide against vaccination, you need to sign a declination form. However, you remain eligible for vaccination if you desire it at a later time. For more information about the vaccine, check this website: www.cdc.gov/ncidod/diseases /hepatitis/b/factvax.htm

19. Life-threatening virus compromises the body's immune system  spread most commonly through sexual contact or by contact with infected blood and body fluids HUMAN IMMUNODEFICIENCY VIRUS (HIV) Early symptoms may be similar to those of the flu (fever, diarrhea, fatigue) This virus can be carried for several years without showing symptoms (asymptomatic)

20. Eventually, Aids will develop.. AIDS destroy the body’s ability to fight infections, and certain cancers, and will lead to death. There is no vaccine to prevent AIDS For more information about AIDS : www.aegis.com www.aegis.com

21. · Does my job put me at risk for occupational exposure? Being at risk for occupational exposure means: There is a reasonably anticipated contact with blood or other potentially infectious materials that may result from the performance of an employee's duties. The blood or infectious materials can enter a body through the · Non-intact skin · eyes · mucous membranes · parenterally (piercing mucous membranes or the skin barrier through such events as needlestick, human bites, cuts and abrasions) All staff are trained in ways to reduce their risk of occupational exposure. Staff at risk for occupational exposure: Healthcare staff (MD, Nurse, Health Assistant) and Athletic Trainers. Staff in this category will be offered Hepatitis B shots from the district. Staff who may be at risk for occupational exposure include, but are not limited to: Special education staff, therapists, secretaries, 1:1 Inst. Asst's, coaches and PE teachers, custodians, food service workers, van drivers, epinephrine trained staff, and staff with playground duty, provided they do the following tasks on a regular basis: · First aid for injuries · Diapering/toileting · Tooth brushing · Feeding (oral and gastrostomy) · Emesis cleanup · Change ostomy bags · · Being at risk for occupational exposure at a job means: The performance of the employee's duties have anticipated contact with blood or other potentially infectious materials (OPIM). The blood or infectious materials can enter a body through · non-intact skin · mucous membranes (eyes, nose or mouth) · parenterally (piercing mucous membranes or the skin barrier through such events as needlestick, human bites, cuts and abrasions) Does my job put me at risk for occupational exposure?

22. Healthcare staff ( Nurse)Building & Grounds Services, preschool disabled staff, coaches, special education paraprofessionals, assistant and building principals, epinephrine delegates – STAFF AT RISK FOR OCCUPATIONAL EXPOSURE You may be at risk If you do the following tasks on a regular basis: Involved in biting incidents First aid for injuries Diapering/toileting Tooth brushing Feeding Body Fluid cleanup Epinephrine administration If your job duties include any of the above, you must be very careful about practicing standard/universal precautions.

23. EXPOSURE CONTROL STRATEGIES Universal & or standard precautions good personal work habits personal protective equipment (PPE) decontamination procedures for accidental exposures

24. UNIVERSAL PRECAUTIONS Treating all blood and body fluids as potentially infectious for HIV, HBV and other bloodborne pathogens Applies to bloodborne pathogens while Standard Precautions…

25. Standard Precautions Applies to all body fluids (not just those affected by bloodborne pathogens). Affects all employees, includes the following:  Avoidance of body fluid exposure  Glove use and handwashing  Good Samaritan Law- act promptly to the best of your training and ability and act until help arrives or exhaustion Training is done annually by school nurse

26. Interrupt the chain of infection by using the following preventive measures: Wash your hands (remove pathogens before they can enter the body). Use personal protective equipment (PPE) (prevent contact with infectious materials.) Use caution when handling needles and other sharp objects. Contaminated sharps must be placed in puncture resistant containers labeled with a biohazard label. Do not recap! Sharps containers are in the Health Offices. EXPOSURE CONTROL STRATEGIES

27. . Additional information on needlestick prevention at: http://www.cdc.gov/niosh/2000-108.html Finally, Receive a Hepatitis B vaccination to decrease your susceptibility to the disease. Presently, no vaccine for HIV is available. Exposure Control Strategies cont…

28. Washing your hands with soap under running water for at least 30 seconds of friction rubbing, then dry thoroughly. Shut off the faucet with the items you were drying with- not with your clean hands. Remember, you turned it on with dirty hands! No access to running water?: Instant gel hand sanitizer,containing alcohol, or towelettes, Remember: Handwashing is the best way to avoid the spread of any infection! Hands unconsciously touch the eyes, nose, and mouth numerous times throughout the day. These body areas are potential portals of entry for infectious organisms. HANDWASHING

29. Because of potential infection, it is extremely important to wash your hands frequently. Wash hands immediately if you contact contaminated material. Wash them after: handling infectious waste, even if it is properly contained removal of gloves using the restroom wash your hands before going on breaks and before l leaving work at the end of the day. Wash your hands frequently. Encourage your students to do the same. Handwashing cont…

30. · Table of Contents Next "Personal protective equipment (PPE)" Previous "Ways to isolate or remove the bloodborne pathogens hazard from the workplace"  Always wear gloves when giving first aid for wounds.  Allow students to cleanse their own bloody wounds when possible. Direct them to self care when possible.  Wash hands as soon as possible after removal of gloves or other personal protective clothing/ equipment or after contact with blood or body fluids.  Wear protective equipment if splattering of body fluids is anticipated.  Dispose of sharps (hypodermics, needles, lancets, scalpel blades, etc.) in sharps containers located in the health office.  Do not eat, drink, apply cosmetics or handle contact lenses in locations where there is a likelihood that an occupational exposure could occur.  Call the custodian to clean up contaminated areas immediately. How can you minimize your risk?

31.  Wear gloves when emptying waste receptacles and carry trash away from body. Utility gloves may be decontaminated for reuse if their integrity is not compromised. The decontamination procedure will consist of soaking in viricidal solution. Discard utility gloves when they show signs of cracking, peeling, tearing, puncturing or deterioration. New gloves may be obtained from building and grounds services.  Decontaminate work surfaces with an appropriate disinfectant (virucidal for both HIV and Hepatitis B) following directions on container, immediately after any spill of blood or other potentially infectious materials and at the end of the work shift when surfaces have been contaminated since the last cleaning.  Always use mechanical means such as tongs, forceps or a brush and dust pan to pick up contaminated broken glassware or any type of sharp instruments; never pick up with hands even if gloves are worn.  Discard contaminated sharps in sharps containers available in health office. The custodian will…

32. Always Use Mechanical Means to Clean Up a Contaminated Spill

33. Barriers you wear to prevent contact with infectious materials. Where are they located? Non latex gloves are located: health offices, custodians’ offices preschool changing area bathrooms for toileting disabled children *every staff member will be provided non latex gloves upon request, contact your school nurse Utility gloves- custodians, grounds & maintenance personnel CPR masks – nurse's key ring, emergency kit in health office and with AED Barrier gowns- health offices Face masks/shields- health offices PERSONAL PROTECTIVE EQUIPMENT

34. GLOVE REMOVAL · With the exposed hand, peel the second glove from the inside, tucking the first glove inside the second. · Dispose of the gloves promptly. · Never touch the outside of the glove with bare skin. · Every time you remove your gloves wash your hands with soap and water as soon as possible. With both hands gloved, peel one glove off from top to bottom and hold it in the gloved hand.

35. An exposure is any contact between one person’s blood or body fluids with the broken skin or mucous membranes of another person or through a needle stick, puncture wound, or bite. If an Exposure Occurs: 1. Wash hands or exposed skin immediately with soap and water. 2. Flush eyes or other exposed mucous membranes with running water. 3. Report incident immediately to your supervisor and school nurse if during regular school hours. If after school hours, contact Qual Care at 1-800 425-3222 for a referral for an immediate confidential medical evaluation. Notify the building nurse the next school day. For additional information refer to Bloodborne Pathogens Exposure Control Plan- Post Exposure Evaluation Important Note for Employees If the employee cannot contact the principal, supervisor or department manager, he or she may contact the School Nurse and Qual Care directly. WHAT IS AN EXPOSURE ?

36. to the school nurse and supervisor/administrator. You will be referred to Qual Care at 1-800-425-3222 for an immediate confidential medical evaluation. (Refer to Bloodborne Pathogens Exposure Control Plan) The confidential medical evaluation and follow up may include: · Obtaining consents for necessary testing · Necessary immunizations · Blood testing All post-exposure evaluation and follow-up is done through Qual Care. WHAT HAPPENS IF YOU ARE EXPOSED? Remember to report all exposures…..

37. “The single most important thing we can do…….. To keep from getting infectious disease and spreading them to others is to clean our hands.” -Dr J Daly, Am. Society of Microbiology  Take 30 sec to lather up  Or reach for the hand sanitizer

38. 2007 Observational Studies on Handwashing (done on behalf of ASM and the Soap & Detergent Assoc., by Harris Interactiv) : In a Separate phone survey 92 % of adultsreport washing their hands. Yet, Observed in four cities and six different locations: ONLY 77% of men and women actually washed their hands.

39. Cities ranked cleanest to dirtiest hands: Chicago on top: with 81% lathering up @ Museum of Science and Industry/Shedd Aquarium New York,second with 79% @ Penn & Grand Central Station Atlanta : 75% @ Turner Field San Francisco: 73% @ Ferry Terminal Farmers Market

40. Gender Differences? Who’s better at handwashing hygiene? Women or Men?

41. Women outwashed men: 86% to 66% Some other Gross Statistics you didn’t want to know: 50% of middle and high school students say they wash after toileting of these 33% of females and only 8% of males used soap while washing hands ; Only 34% of respondents say they wash their hands after coughing or sneezing ( up from 32% in 2005)

42. Worldwide: Infectious diseases remain the leading cause of death! Many cases of colds, flu, and foodborne illness are spread by unclean hands each year These diseases are responsible for billions of dollars each year in healthcare expenditures and productivity losses in the USA.

43. Spread the word…… Spread good hygiene! Wash you hands often.