Bloodborne Pathogen Training: Preventing Disease Transmission

1
Bloodborne Pathogen Training Preventing Disease
Transmission
2
Introduction

• Objectives
• Describe how infections occur
• Identify how bloodborne pathogens are spread
• Identify tasks that have potential for exposure
  to infectious materials
• Recognize the importance of hand washing and
  personal hygiene in reducing risk
• Recognize importance of personal protective
  equipment
• Describe procedures for exposure incidents

3
OSHA Bloodborne Pathogen Standard

• 1991 Occupational Safety and Health
  Administration issued standard (29 CFR part
  1910.1030
• issued to protect employees by reducing or
  removing the hazards of bloodborne pathogens in
  the workplace
• Applies to all who have potential to occupational
  exposure
• Basically provides safeguards

4
Definitions

• Pathogen any virus, microorganism, or other
  substance that causes disease an infecting
  agent.
• Bloodborne found in blood or certain blood
  products
• Universal Precautions treat all human blood and
  certain bodily fluids as if they were known to be
  infected with HIV, HBV or other bloodborne
  pathogens. Also called Standard Precautions.

5
Means of Transmission of Bloodborne Pathogens

• Contacting a contaminated object or surface and
  transferring the infectious material to your
  mouth, eyes, nose or open skin.
• Open cuts, nicks, abrasions, dermatitis and acne.

6
Potentially Infectious Materials
Non-infectious Body Fluids

• Human Blood
• Saliva in dentistry
• Semen/Vaginal Secretions
• Cerebrospinal fluid, synovial fluid, pleural
  fluid, amniotic fluid
• Unpreserved human tissue or organ samples
• Any body fluid visibly contaminated with blood

• Feces
• Saliva
• Urine
• Vomit
• Nasal Secretions
• Sweat
• Tears

7

Viral Hepatitis - Overview

Type of Hepatitis
A
B
C
D
E
Source of
feces
blood/
blood/
feces
blood/
virus
blood-derived
blood-derived
blood-derived
body fluids
body fluids
body fluids
Route of
fecal-oral
percutaneous
percutaneous
percutaneous
fecal-oral
transmission
permucosal
permucosal
permucosal
Chronic
no
yes
yes
yes
no
infection
Prevention
pre/post-
pre/post-
blood donor
pre/post-
ensure safe
exposure
exposure
screening
exposure
drinking
immunization
immunization
risk behavior
immunization
water
modification
risk behavior
modification
8
Serious Bloodborne Pathogens

• Hepatitis B
• Liver infection cause by virus Hep B
• Symptoms include
• Flu-like symptoms, abdominal pain, vomiting
• Fatigue, loss of appetite, nausea, joint pain,
  jaunidice
• May also show no signs or symptoms and spread
  unknowingly
• Blood test may be positive 2-6 weeks after
  symptoms develop
• Meds available
• Prevention
• Personal hygiene
• Vaccination

9
Hepatitis B Vaccine School Entry Laws, 2003
No School Entry Laws
Implemented
10
Serious Bloodborne Pathogens

• Hepatitis C
• Spread by direct contact by another persons
  blood via sharing needles and syringes
• Also personal care items (razors, toothbrushes)
• Liver disease caused by Hep C
• 3.9 million Americans affected
• 25,000 new cases in 2001
• Most common chronic bloodborne infection in US
• Leading indication for liver transplant
• Symptom
• 80 have no signs or symptoms
• Jaundiced, mild abdominal pain in upper right
  quadrant, other symptoms similar to Hep B
• No Vaccine for prevention
• Treatment interferon and ribavirin can control
  disease

11
Estimated Incidence of Acute Hepatitis C United
States, 1982-2000
Source Sentinel Counties
12
Serious Bloodborne Pathogens

• HIV
• Come in contact with infected blood, body fluids,
  intimate sexual contact
• Virus attackes white blood cells destroying
  ability to fight infection
• AIDS (Arnheim Table 14-1)
• 850,000 950,000 people infected
• 40,00 new infections per year
• 502,000 people die from AIDS as of 2002
• Remember cannot tell if someone has this
• Late Stage Symptoms
• Fever, fatigue, diarrhea, skin rashes, night
  sweats
• Appetite loss, swollen lymph glands, weight loss
• Management
• 10 years after HIV infection 50 develop AIDS
• No prevention vaccine
• No treatment to cure
• Prevention
• Avoid bodily fluids
• Safe sex
• Regular tests for STDs

13
Conditions Necessary for Disease Transmission

• Four conditions must be met
• Pathogen present
• Enough of pathogen present to cause disease
• Pathogen passes through correct entry site
• Person suspectible to pathogen

14
How do pathogens enter the body?

• Direct Contact
• Occurs when infected blood or body fluids from
  one person enter another persons body at correct
  entry site
• Blood splashing in eye
• Indirect Contact
• Occurs when person touches an object that
  contains the blood or body fluid of an infected
  person, and then that fluid enters at correct
  entry site
• Picking up blood soaked bandages with bare hands
  and pathogen enters through breaks in skin

15
Exposure Control Plan

• OSHA requires this plan to be a written document
  which an employer specifies how each standard is
  met and which employees in the workplace are
  covered
• Purpose?
• Exposure Control Plan should include
• Exposure determination
• Methods for implementing other parts of OSHA
  standard
• Procedures for evaluating details of an exposure
  incident

16
Exposure Control Plan

• Immunizations
• Very important
• Employers must make HEP B vaccine available at no
  cost to employees at risk to exposure

17
Precautions and Guidelines to Prevent Disease
Transmission

• Personal Hygiene
• Hand washing
• Avoid wearing jewelry
• Avoid artificial nails and keep natural nails
  
• Personal Protective Equipment
• Protect from direct contact
• Disposable gloves, masks, breathing barriers
  gowns
• Engineering and work place controls
• Engineering Controls -- Sharps containers
• Work place Controls washing hands
• Equipment cleaning and disinfecting
• 1 part bleach/10 parts water

18
Engineering Control Examples

• Sharps disposable containers
• Self-sheathing needles
• Biohazard bags and containers
• Personal protective equipment

19
Work practice controls

• The things you do
• Place sharp items in leak proof,
  puncture-resistant and labeled container
• Must be at point of use
• Avoid splashing, spraying or splattering of blood
  material
• Remove and dispose of soiled protective clothing
• Athletes with saturated uniforms must have
  removed before re-entering participation
• Clean and disinfect all equipment and work
  surfaces possibly soiled by blood
• One part bleach to ten parts water or with
  disinfectant approved by EPA
• Wash hands thoroughly and immediately after
  giving care
• Can use alcohol based rubs
• DO NOT eat, drink, smoke, apply cosmetic or lip
  balm, handle contact lenses or touch your mouth,
  nose, or eyes when in an area where may be
  exposed to infectious materials

20
Exposure Incidents

• OSHA defines exposure incidents as a specific
  eye, mouth, other mucous membrane, non-intact
  skin or parenteral (needle stick) contact with
  blood OPIM that results from performance of
  employees duties

21
What should you do if exposed?

• Wash needle sticks with soap and water
• Flush splashes of blood or OPIM to nose, mouth,
  or skin with water
• Irrigate eyes with clean water, saline or sterile
  irrigants
• Report exposure incident
• Follow steps of exposure control plan for
  confidential medical evaluation and follow-up by
  a health care professional
• If a needle stick, employer must record info in a
  sharps injury log