Bloodborne Pathogens

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Bloodborne Pathogens
2009 Clinical Mandatory Education Infection
Control
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Infection Control Resources

• OSHA (Occupational Safety and Health
  Administration) states that Associates must have
  direct access to a qualified trainer for
  questions they may have while completing self
  study education. Please use the following
  resources, listed below, in the event you have
  questions regarding Infection Control practices.
  
• Contact your Manager/Supervisor
• Sharon Selby, Manager X11695 Pager 1806
• Deirdra Pearce IC Practitioner X11407 Pager
  2582
• Stephanie Combs IC Practitioner X11553 Pager
  1186

This computer-based learning (CBL) course
outlines important aspects of exposure to
bloodborne pathogens in the workplace, a major
concern to both workers and employers. OSHA has
a standard to address this concern and requires
both employers and workers to prevent the spread
of bloodborne diseases.
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Table of Contents
You may click the underlined link to jump to the
content.
Bloodborne Pathogen Exposure Bloodborne Diseases
HIV, Hepatitis B and Hepatitis C OSHA
Exposure Control Plan, Exposure
Determination Protect Yourself Regulated Medical
Waste Engineering Controls Hand Hygiene Workplace
Practices If You Are Exposed Definitions
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Bloodborne Pathogens
 What is a Bloodborne Pathogen? Bloodborne
pathogens are germs that may be present in blood
that are capable of causing disease.
How Are People Exposed to Bloodborne
Pathogens? By performing a task or being in an
area where you might come in contact with blood
or other potentially infectious materials. The
majority of exposures to bloodborne diseases in a
hospital is by direct exposure from needle sticks
or other injuries from sharps.  Some people
(though not as many) have been infected from
splashing blood or other body fluid on broken
or scraped skin into the eyes, nose, or mouth
Use caution when you come in contact with any
bodily fluids.
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Exposure
What Happens If You Are Exposed to a Bloodborne
Pathogen? Even one exposure to a bloodborne
pathogen can lead to serious and disabling
diseases. Three bloodborne diseases of major
concern to healthcare workers are HIV, Hepatitis
B and Hepatitis C. Needle sticks from used
needles or other sharps injuries are the primary
means of transmission of these diseases to
healthcare providers in the workplace. You may
not know you are infected with a bloodborne
disease at the time of exposure. You may not
realize it until years later. Does Everyone
Exposed to a Bloodborne Pathogen Become
Infected? No, whether or not you become infected
depends on the number and strength of the germs,
your resistance to disease and the germ having an
entrance into your body.
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What is HIV?

• HIV is a viral infection of the immune system.
  This infection robs a person of the ability to
  fight off other disease-causing germs.
• HIV CAN be contracted by
• homosexual or heterosexual contact
• IV drug users who share needles
• an unborn baby from its mother (though the risk
  is lowered with appropriate prenatal treatment).
  Infection to the baby can also occur through
  breast feeding.
•  HIV CANNOT be contracted by
• telephones, door knobs, toilet seats, or mosquito
  bites
• shaking hands, hugging, being coughed on or
  sneezed on
• eating food prepared by an HIV positive
  individual
• donating blood -you CANNOT get HIV from donating
  blood.

The risk of contracting HIV from a blood
transfusion is extremely low. The blood supply is
carefully tested.
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Exposure to HIV
What Happens If You Are Exposed to HIV? If you
are exposed to HIV through a needle stick or
other sharps injury, your risk of contracting the
disease is about 0.3. The risk is less for
blood splashes into mucous membranes or on broken
or scraped skin. Symptoms do not usually occur
until several years after the infection. A
person can infect others even though he does not
look or feel sick. HIV is usually spread to
others when the infected person does not yet know
he has the disease.
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Important Notice Regarding HIV Exposure
It is the current hospital policy to recommend
that in the event of an exposure to known HIV
contaminated blood or body fluids or highly
suspect HIV, medication be made available to the
Associate for prevention of infection. This
medication can initially be obtained through the
hospital pharmacy or Medical Arts Pharmacy on the
recommendation of the Infectious Disease
physician, Emergency Department physician or
Health and Wellness nurse. The decision to start
taking medication will depend in part on the
circumstances of the exposure and the health
status of the Associate. MWH follows the U.S.
Public Health Services guidelines. In the event
that you have a blood or body fluid exposure, you
must go to Health and Wellness or the Emergency
Department immediately for evaluation and
treatment recommendations. If the Associate is
exposed in the OR in the middle of a case, the
first dose of prophylactic medication may be
obtained from the OR Pyxis if the Associate
desires. However, follow-up with Health and
Wellness or the Emergency Department must occur
immediately after the case is completed.
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What is Hepatitis B?

• Hepatitis B (HBV) is a virus that affects the
  liver. Many people who are infected with the
  virus do not have symptoms.
• An infected person with no symptoms is still
  contagious.
• Symptoms Of Hepatitis B may include

• Hepatitis B can be contracted by
• sexual contact
• IV drug users who share needles
• an unborn baby from its mother. Infection can
  also occur through breast feeding. Prenatal
  screenings check for HBV infection. If the mother
  has HBV, treatment may begin on the baby at
  birth.

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Exposure to Hepatitis B

• What Happens If You Are Exposed to Hepatitis B?
• Of the people who show symptoms, most have a full
  recovery. Ten percent of people who contract the
  virus develop a chronic infection, placing a
  person at higher risk for cirrhosis of the liver
  and liver cancer.
• There is a vaccine for HBV and at least six drugs
  available for treatment of chronic HBV. Your
  risk drops to almost 0 if you have had a
  successful series of vaccinations.
• If you are exposed to HBV through a needle stick
  or other sharps injury, your risk of contracting
  the disease is about 5 to 30 if you have not had
  a series of three vaccinations.
• The risk is less for blood splashes into mucous
  membranes or on broken or abraded skin.

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What is Hepatitis C?
Hepatitis C (HCV) is a virus that is similar to
Hepatitis B. Seventy percent of Hepatitis C
patients appear to have no symptoms. The virus
may remain dormant 10-20 years before patients
experience fatigue, loss of appetite, and
abdominal pain. People who have the infection
are contagious even if they have no symptoms.
Approximately 15 of people who become infected
with HCV fight off the infection and are no
longer contagious. How Is Hepatitis C
Contracted? If you are exposed to HCV through a
needle stick or other sharps injury, your risk of
contracting the disease is about 3 to 10. Blood
transfusions were formerly a major means of
transmission of HCV, but that is no longer the
case. Screening tests were put into place in the
early 1990s. The chance of acquiring HCV by
sexual transmission is low. Unlike Hepatitis B,
there is no vaccine to prevent the disease.
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Developing Hepatitis C

• What Happens If You Develop Hepatitis C?
• The Hepatitis C virus causes chronic disease in
  about 85 of the people who contract it.
• HCV is a major cause of cirrhosis of the liver
  and liver cancer.
• While there is no cure, the symptoms may be
  treated with antiviral drugs. Treatment usually
  leads to long-term improvement.
• Complications of HCV account for the majority of
  liver transplants in the United States.

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OSHA-Occupational Safety and Health Administration

• What Does OSHA Require?
• Development of an Exposure Control Plan
• This plan provides protection for all hospital
  employees who might be exposed to bloodborne
  diseases during performance of expected job
  duties and must be updated annually.
• OSHA Exposure Plan, Purpose of
• Exposure Determination for the OSHA Exposure
  Control Plan
• Education, Information and Training for
  Bloodborne Pathogen (BBP) Standard.

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Exposure Determination

• Exposure Determination
• It is available to all employees.
• It identifies employee positions that may be
  exposed to blood or other potentially
  infectious materials.

• Worker Vaccinations
• MWH makes a HBV vaccine available to all
  hospital employees.
• A declination form must be signed if HBV
  vaccination is declined.

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Exposure Determination
What is my risk of exposure while performing my
job duties? Jobs are divided into different
groups or "categories" according to the amount of
risk involved while doing daily work.
Categories I and II (patient care and clinical
support) involve jobs with greater exposure risk
while Category III (non-clinical) is not
expected to have routine exposure.
It is strongly recommended that you get the
Hepatitis B vaccine especially if you are in
Category I or II. If you decline to take this
vaccine, you must document your decision by
signing a form that will be retained in your
Associate Wellness file.
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Protecting Yourself

• It's Your Responsibility!
• You are responsible for understanding the risk of
  exposure to blood or other potentially infectious
  materials at your workplace.
• When working with blood or other potentially
  infectious materials
• avoid splashing, spraying, spattering and
  generation of droplets
• mouth pipetting/suctioning is prohibited

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Protecting Yourself Standard Precautions
Standard Precautions treats all blood, body
fluid, mucous membrane or breaks in skin
integrity as a potential source of infection. A
barrier should be placed between you and any of
these items.   All patients are treated as though
they have a bloodborne pathogen regardless of age
or diagnosis.
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Protecting Yourself PPE

• Personal Protective Equipment (PPE) is
  specialized clothing and equipment which provides
  protection against contact with blood or other
  potentially infections materials.
• Wear a mask and eye protection when you might get
  splashed in the face (especially in the Operating
  Room, Emergency Room, Critical Care, LDRP).
• Use a CPR mask when performing CPR.
• Wear a gown when your clothing could be soiled
  with blood or other body fluids.
• Use gloves any time you have contact with blood
  or other body fluids (For example, when you
  treat an open wound, draw blood or handle dirty
  laundry).

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Regulated Medical Waste (RWM)
Regulated Medical Waste Blood or other
potentially infectious materials, contaminated
items that could release blood or other
potentially infectious materials, contaminated
sharps, and pathological/microbiological wastes.
Sometimes called "infectious waste." Place
regulated medical waste in a receptacle (bag,
box, etc.) that exhibits a biohazard symbol a
color-coded container with a biohazard symbol
Regulated waste includes blood other
potentially infectious materials contaminated
sharps any pathological or microbiological
wastes any item with a biohazard symbol
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Regulated Medical Waste
B Blades (dispose in sharps container) Body
Fluids Amniotic, Spinal (CSF), Pericardial,
Peritoneal, Pleural, Seminal, Synovial,
Vaginal, Body Fluids if contaminated with blood
include Bile, Gastric, Sputum, Stool, and
Urine Blood products and supplies Body
Parts C Catheters Chemo waste containers Chest
tubes Chux if contaminated with blood Colostomy
bags/supplies Colostomy tips D Decontamination
bags Dialysis bag, fluid and tubing Diapers from
patient with diarrhea Disposal supplies/equipment
if contaminated with blood Dressings Drains E Ente
roclysis bags and catheters F Foley
bags/catheters if not empty
G Gastrostomy tubes Gloves if contaminated with
blood Gowns (disposable) if contaminated with
blood H Hemocult cards Human tissue specimens
I Invasive tubes/lines IV tubing if contaminated
with blood K Kick bucket liners L Laryngoscope
blades M Maternity pads containing visible
blood (Feminine hygiene products not
included) Microbiology cultures Microbiology
specimens N Needles (dispose in sharps
container) -Including safe needle devices, once
activated NG Tubes P Placenta Plasma
bags/tubing Procedural trays (disposable)
R Rectal tubes Red bags of any kind (new,
used) Ventilator circuits S Saturated
sponges Sharps Containers Specimen bags (with
Bio-med symbol) Speculum (disposable) Suction
canisters/tubing Surgical drapes
(disposable) Surgical specimens Syringes (dispose
in sharps container) T Trach tubes Trash
contaminated with regulated medical
waste V Ventilator circuits
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Engineering Controls
Engineering controls are control measures
that isolate or remove a hazard from the
workplace.
Examples are safety needles, sharps containers,
blunt suture needles, etc.
Give feedback to your supervisor about how to
improve engineering controls.  You may also
participate in the annual engineering control
evaluation held every year or call Infection
Control with any concerns between scheduled
evaluations.
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Sharps
Healthcare workers suffer nearly 600,000
percutaneous injuries annually with contaminated
sharps (exposure to fluids from needle sticks
through the skin).

• Dispose of sharps in proper sharps containers.
  Never attempt to bend or break needles.
• Never attempt to remove needles from sharps
  containers.
• No one medical device is considered appropriate
  or effective for all circumstances.
• Avoid recapping a used needle.

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Hand Hygiene - Stop the spread of infection
Always wash hands with soap and water if visibly
dirty/contaminated or if exposed to C. difficile
or B. anthracis. When using soap, rub hands
together for at least 15 seconds, covering all
surfaces. Alcohol handrubs may be used in any
situation other than those listed above and are
just as effective. When using alcohol handrub,
press dispenser once and rub onto all surfaces of
hands until dry. Decontaminate hands before and
after any contact with patients, after contact
with inanimate objects in vicinity of patient,
when moving from contaminated to clean body site,
after PPE removal and whenever contamination with
blood/body fluids occurs. Artificial nails are
prohibited for Associates providing direct
patient care. Natural nails should be no more
than 1/4 inch long.
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Workplace Practices Cleanup of spills
Minimize your risk of exposure by containing,
removing and disinfecting all blood or body fluid
spills as quickly and effectively as possible.
Clean spills promptly. Wear utility gloves.
(available from Environmental Services or in your
PPE cabinet) If there is a risk of splash or
spray, wear fluid resistant gown/apron, and
mask/goggles or mask with face shield. Place
paper towels over spill. Block off area. Use the
spill kits and utility gloves which are located
in the PPE cabinet and other locations in your
work area. Follow the directions in the spill
kit. Do not handle any broken glass or other
sharps with your hands. Use the tools provided in
the kit, or contact EVS if supplemental tools are
needed. If blood/body fluid spill is on a
carpeted surface, contact Environmental Services
immediately for clean up as this may require
special equipment and/or solutions.
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Workplace Practice Good Housekeeping
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Workplace Practice Reduce Potential Exposures

• In work areas where exposure is likely
• Do NOT eat, drink, or put objects in your mouth
• DO NOT apply cosmetics, lip balm, or contact
  lenses

• Know and Practice Your Exposure Control Plan
• Know the risks in your work area.
• Use Standard Precautions.
• Take advantage of Personal Protective Equipment.
• Receive the Hepatitis B vaccination series when
  it is offered.
• Properly dispose of infectious waste.
• Contact your supervisor immediately if you are
  exposed to blood or other potentially
  infectious materials.
• For more information about bloodborne pathogens,
  see the Infection Control Manager or
  Practitioner.

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Workplace Practice Outbreak Investigation

• The Infection Control (IC) Department has a
  policy regarding outbreaks entitled Outbreak
  Investigation. (Click on the underlined link
  to view the policy.)
• Please notify IC if you are aware of the
  occurrence of an unusual organism or an increase
  of infection beyond the normal observed rate.

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Responding to a blood/body fluid exposure

• Unbroken skin Immediately wash the area with
  soap and running water for at least 10 seconds,
  then rinse with running water.
• Broken/cut/punctured skin or skin lesion
  Immediately wash the area for at least 10
  seconds, then put 70 isopropyl alcohol on the
  area
• Eyes, mouth or nose Flush (irrigate) them with
  large amounts of water.
• If your uniform or clothing are contaminated with
  blood or body fluids, contact Environmental
  Services and/or Infection Control. Your
  clothing will need to be removed, placed in a
  yellow bag and possibly laundered on-site.
• Caution should be used when removal of clothing
  would require passing it over the face and may
  require cutting off if an exposure cannot be
  avoided otherwise.

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Reporting / EOR
You must complete an Employee Occurrence Report
(EOR) and notify your supervisor of any exposure.
Follow up with Health and Wellness as soon as
possible. It is imperative, if you have an
exposure to a known HIV patient, that you seek
medical treatment immediately. Medical Follow Up
and Evaluation The Post-Exposure Evaluation
consists of four steps Test the source
patient immediately. You cannot restrain the
patient to keep him from leaving the hospital.
Offer the exposed person baseline testing.
Offer the exposed person treatment as needed.
Offer counseling. The MediCorp Health System
Exposure Control Plan explains how to report an
exposure and what medical follow-up is available.
OSHA requires that an employee be notified of
the post-exposure evaluation and the follow-up
actions taken. The exposure is confidential.
The exposed person is notified of diseases that
the source patient might have had while the
patient's identity is protected.
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Deemed Consent
What is Deemed Consent for AIDS, Hepatitis B or
Hepatitis C testing? Virginia law requires health
care providers to notify patients that HIV, HBV
or HCV testing on a sample of blood may be done
if a health care worker is exposed to the
patient's blood or body fluid. The following
notice advises patients that this provision is in
effect at our facility and is usually given at
the time of admission. Notice of State Law
Compliance Assembly Section 32.1-45.1 In the
Event of Health Care Worker or Patient
Exposure DEEMED CONSENT FOR AIDS, Hepatitis B OR
Hepatitis C TESTING Such a person shall also be
deemed to have consented to the release of such
test results to the patient who was exposed.
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Bloodborne Pathogens-Definitions

• Click on the link below to view the Policy and
  Procedure document
• Definition of Terms for OSHA Exposure Control
  Plan

• Biohazard Symbol- A universal symbol placed on
  any container or area that may contain infectious
  waste.
• Bloodborne Pathogen- A disease-causing
  microorganism that is present in human blood and
  can cause disease in humans.
• Bloodborne Pathogens Rule- OSHA reference 29 CFR
  1910.1030. See your employer if you would like to
  view this information. Your employer is required
  to make this information available to you.
• Direct- Exposure which occurs when one touches or
  otherwise comes in direct contact with blood or
  other potentially infectious materials. An
  example is a stick from a needle previously used
  on an infected person.
• Engineering Controls- Control measures that
  isolate or remove a hazard from the workplace
  (i.e., sharps disposal containers self-sheathing
  needles safer medical devices such as sharps
  with engineered sharps injury protections and
  needleless systems).
• Exposure Control Plan- OSHA requires employers to
  have an Exposure Control Plan. This plan outlines
  the steps employers must take to provide
  protection against bloodborne pathogens. The
  Exposure Control Plan includes Exposure
  Determination, procedures for protecting workers
  (Standard Precautions, worker vaccinations,
  personal protective equipment, hazard
  communications, workplace practices), medical
  follow-up and evaluation when an employee is
  exposed to a bloodborne disease, and ways that an
  employer receives input from employees about
  effective engineering controls including safer
  medical devices. The Exposure Control Plan is
  located in the Policy and Procedure Manual.
• Exposure Determination- This OSHA requirement has
  employers determine and list all job
  classifications in which employees may incur
  occupational exposure to bloodborne pathogens or
  other potentially infectious materials,
  regardless of frequency or the use of PPE
  (personal protective equipment).

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Bloodborne Pathogens-Definitions continued

• Hepatitis B- The Hepatitis B virus (HBV) causes
  inflammation of the liver and is transmitted by
  infected blood.
• Hepatitis C- The Hepatitis C virus (HCV) causes
  inflammation of the liver and is transmitted by
  infected blood.
• HIV- The Human Immunodeficiency Virus (HIV) is a
  virus that infects human T-cells. Infection
  with this virus may ultimately lead to the
  development of AIDS (Acquired Immune Deficiency
  Syndrome).
• Medical Follow-up- This OSHA requirement ensures
  testing, evaluation, and preventative treatment
  for an employee following an exposure incident.
• Mucous Membrane- A lining of the body that
  secretes a protective lubricant for all body
  passages that come in contact with the air.
  Examples include the lining of the eyes, nose,
  and mouth.
• OSHA- Occupational Safety and Health
  Administration
• Other Potentially Infectious Materials- Blood and
  other materials that can carry pathogens that
  cause serious diseases. Materials include human
  body fluids, unfixed tissue or organs, and
  HIV/HBV-containing cell or tissue cultures.
• Percutaneous- Exposure to fluids from needle
  sticks through the skin.
• Post-Exposure Evaluation- An evaluation which
  tests both the source and the employee after an
  exposure has occurred. Counseling and treatment
  are offered for positive test results.
• Proper sharps container- A rigid, puncture
  resistant container labeled as "biohazard." It is
  designed especially for the purpose of storing
  sharps. When the container is 75 full it should
  be securely closed and incinerated.
• Regulated Medical Waste- Blood or other
  potentially infectious materials, contaminated
  items that could release blood or other
  potentially infectious materials, contaminated
  sharps, and pathological/microbiological wastes.
  Sometimes called "infectious waste."
• Sharps- Any object that can cut, puncture, or
  penetrate the skin. Examples are needles,
  scalpels, broken glass, knives, and blades.
• Standard Precautions- The approach used in
  infection control that treats all blood, body
  fluid, mucous membrane or break in skin integrity
  as a potential source of infection. A barrier
  should be placed between you and any of these
  items.

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Review Questions
Click on the question

• In a hospital, most exposures to bloodborne
  diseases occur as a result of being splashed with
  infected blood.
• HIV can be contracted by which of the following
  donating blood, toilet seats, hugging or
  needlesticks?
• Are blood, contaminated sharps, other potentially
  infectious materials, and microbiological wastes
  considered Regulated Medical Waste?
• Should a pizza box and a empty soda can be placed
  in a red trash bag?
• You should wash your hands before AND after any
  contact with patients, after PPE removal and
  whenever contamination with blood/body fluids
  occurs.

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Educational Resources

• MWH and SHC Policies Procedures Databases
• Standard Precautions
• Definition of Terms for OSHA Exposure Control
  Plan
• MHS Corporate Policy Procedures Database
• Education, Information and Training for
  Bloodborne Pathogen (BBP) Standard
• Methods of Compliance to Limit Infections Among
  Personnel
• http//www.osha.gov/SLTC/healthcarefacilities/

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Exit Page
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• We hope this Computer Based Learning course has
  been informative and helpful.
• Please feel free to review the screens of this
  course until you are prepared to test your
  knowledge.

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The majority of exposures to bloodborne diseases
in a hospital is bydirect exposure from needle
sticks or other injuries from sharps.
Bloodborne Pathogens Review Answer
Return to Review Questions
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Bloodborne Pathogens Review Answer
Return to Review Questions
HIV CAN be contracted by needlesticks.

• HIV CANNOT be contracted by
• telephones, door knobs, toilet seats, or mosquito
  bites
• shaking hands, hugging, being coughed on or
  sneezed on
• eating food prepared by an HIV positive
  individual
• donating blood -you CANNOT get HIV from donating
  blood

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Bloodborne Pathogens Review Answer
Return to Review Questions

• Yes.regulated waste includes
• blood
• other potentially infectious materials
• contaminated sharps
• any pathological or microbiological wastes
• any item with a biohazard symbol

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Bloodborne Pathogens Review Answer
Return to Review Questions

• Noa pizza box and a soda can are not considered
  regulated medical waste and you would place them
  in a regular trash container.

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Bloodborne Pathogens Review Answer
Return to Review Questions

• Yes! Always practice good hand hygiene!
• Always wash hands with soap and water if visibly
  dirty/contaminated.
• Decontaminate hands before and after any contact
  with patients, after contact with inanimate
  objects in vicinity of patient, when moving from
  contaminated to clean body site, after PPE
  removal and whenever contamination with
  blood/body fluids occurs.