WELCOMEWELCOME

OSHA OSHA UPDATEUPDATE

20122012BLOODBORNE PATHOGENSBLOODBORNE PATHOGENS

Rock Hill SchoolsRock Hill Schools

OBJECTIVESOBJECTIVES

To have a basic understanding of To have a basic understanding of bloodborne pathogens and the role of bloodborne pathogens and the role of OSHA.OSHA.

To understand how to report an To understand how to report an exposure.exposure.

To understand the role of the employee To understand the role of the employee in an exposure.in an exposure.

To properly dispose of medical waste.To properly dispose of medical waste.

WHY TRAIN?WHY TRAIN?

1.1. Through education and understanding, the Through education and understanding, the employee will be protected and the risk of employee will be protected and the risk of an exposure can be reduced. an exposure can be reduced.

2.2. IT IS AN OSHA FEDERAL and STATE IT IS AN OSHA FEDERAL and STATE REQUIREMENTREQUIREMENT

WHAT IS OSHA?WHAT IS OSHA?

OCCUPATIONAL OCCUPATIONAL SAFETY AND SAFETY AND

HEALTH HEALTH ADMINISTRATIONADMINISTRATION

OSHA STANDARD OSHA STANDARD ADDRESSESADDRESSES::

RULES FOR PROTECTING RULES FOR PROTECTING WORKERS FROM OCCUPATIONAL WORKERS FROM OCCUPATIONAL EXPOSURE TO BLOOD AND EXPOSURE TO BLOOD AND CERTAIN OTHER BODY FLUIDS CERTAIN OTHER BODY FLUIDS POTENTIALLY CONTAINING POTENTIALLY CONTAINING BLOODBORNE PATHOGENS.BLOODBORNE PATHOGENS.

SCHOOL DISTRICT’S EXPOSURE SCHOOL DISTRICT’S EXPOSURE CONTROL PLAN (ECP) MUST BE CONTROL PLAN (ECP) MUST BE

BASED ON :BASED ON :

29 CFR 1910.103029 CFR 1910.1030

Bloodborne Bloodborne Pathogens StandardPathogens Standard

Federal Register - December 6, 1991Federal Register - December 6, 1991

EXPOSURE CONTROL EXPOSURE CONTROL PLAN is written to:PLAN is written to:

MINIMINZE exposure to blood and MINIMINZE exposure to blood and other potentially infectious materials other potentially infectious materials (OPIM)(OPIM)

MANAGE exposures properly and MANAGE exposures properly and medicallymedically

DESCRIBE engineering and work DESCRIBE engineering and work practice controls which reduce risk.practice controls which reduce risk.

SCHOOL EXPOSURE SCHOOL EXPOSURE CONTROL PLANCONTROL PLAN

Must be reviewed and updated at least Must be reviewed and updated at least annually and whenever necessary to annually and whenever necessary to reflect new or modified tasks and reflect new or modified tasks and procedures which affect occupational procedures which affect occupational exposure and to reflect new or revised exposure and to reflect new or revised employee positions with occupational employee positions with occupational exposure.exposure.

At the time of initial assignment to At the time of initial assignment to tasks where occupational exposure tasks where occupational exposure may take place (e.g. upon hire)may take place (e.g. upon hire)ANNUALLY for employees in ANNUALLY for employees in positions with occupational exposurepositions with occupational exposure

BBP TRAINING IS BBP TRAINING IS MANDATORY!!MANDATORY!!

BBP TRAINING INCLUDES:BBP TRAINING INCLUDES:

NEW HIRE EDUCATION AND NEW HIRE EDUCATION AND TRAININGTRAINING

ANNUAL EDUCATION AND TRAININGANNUAL EDUCATION AND TRAINING AVAILABILITY OF PPEAVAILABILITY OF PPE OFFERING OF HEPATITIS B TO AT OFFERING OF HEPATITIS B TO AT

RISK EMPLOYEESRISK EMPLOYEES PROPER REPORTING OF PROPER REPORTING OF

NEEDLESTICK AND BLOOD/BODY NEEDLESTICK AND BLOOD/BODY FLUID EXPOSURESFLUID EXPOSURES

OFFERING HEPATITIS B OFFERING HEPATITIS B IMMUNIZATIONIMMUNIZATION

High risk employees determined by Local High risk employees determined by Local Education Agency (LEA) policyEducation Agency (LEA) policy

BBP Training – offer Hep B series within 10 BBP Training – offer Hep B series within 10 days of BBP training (OSHA)days of BBP training (OSHA)

Hep B Series: 0 – 1 month – 5 monthsHep B Series: 0 – 1 month – 5 months Hep B Titer: 4 to 6 weeks post 3Hep B Titer: 4 to 6 weeks post 3 rdrd vaccine vaccine FormsForms

– Consent Consent – Refusal /Declination Refusal /Declination ((OSHA 1910.1030 Appendix A)

– Vaccine Information Statement (CDCVaccine Information Statement (CDC))

NO DIFFERENCE IN NO DIFFERENCE IN STATUSSTATUS

ALL AT RISK EMPLOYEES ALL AT RISK EMPLOYEES DEPENDING ON JOB DEPENDING ON JOB

DESCRIPTIONDESCRIPTION

PART TIMEPART TIME FULL TIMEFULL TIME TEMPORARYTEMPORARY ““Per Diem” or “Leased” Healthcare WorkersPer Diem” or “Leased” Healthcare Workers

REVIEW SOME TERMS THAT REVIEW SOME TERMS THAT ARE LOCATED IN THE ECPARE LOCATED IN THE ECP

STANDARD PRECAUTIONSSTANDARD PRECAUTIONS AT-RISK EMPLOYEESAT-RISK EMPLOYEES PPEPPE WORK PRACTICE CONTROLSWORK PRACTICE CONTROLS ENGINEERING CONTROLSENGINEERING CONTROLS OPIMOPIM PEPPEP

STANDARD PRECAUTIONSSTANDARD PRECAUTIONS

TREAT ALL BLOOD AND TREAT ALL BLOOD AND BODY FLUIDS AS IF THEY BODY FLUIDS AS IF THEY ARE KNOWN TO BE ARE KNOWN TO BE INFECTIOUSINFECTIOUS

AT-RISK EMPLOYEESAT-RISK EMPLOYEES

Those employees who by Those employees who by nature of task have the potential nature of task have the potential to be exposed to blood, body to be exposed to blood, body fluids or other potentially fluids or other potentially infectious materials.infectious materials.

PPE = PERSONAL PPE = PERSONAL PROTECTIVE EQUIPMENTPROTECTIVE EQUIPMENT

GLOVESGLOVES MASKSMASKS EYE PROTECTIONEYE PROTECTION FACE SHIELDSFACE SHIELDS RESPIRATORS – WHAT KIND?RESPIRATORS – WHAT KIND? GOWNS, APRONS, LAB COATGOWNS, APRONS, LAB COAT

WORK PRACTICE WORK PRACTICE CONTROLSCONTROLS

HAND WASHINGHAND WASHING PROPER USE OF SHARPS PROPER USE OF SHARPS

CONTAINERCONTAINER STORAGE and SHIPPING of STORAGE and SHIPPING of

CONTAMINATED EQUIPMENTCONTAMINATED EQUIPMENT NO EATING, DRINKING, SMOKING, NO EATING, DRINKING, SMOKING,

HANDLING CONTACT LENSES and HANDLING CONTACT LENSES and APPLYING MAKE-UP at work areas, APPLYING MAKE-UP at work areas, including school health officeincluding school health office

RESPIRATORRESPIRATOR MEDICAL SAFETY DEVICESMEDICAL SAFETY DEVICES SHARPS CONTAINERS – SHARPS CONTAINERS –

DISINFECTANTSDISINFECTANTS

ENGINEERING CONTROLSENGINEERING CONTROLS

OPIM = OTHER POTENTIALLY OPIM = OTHER POTENTIALLY INFECTIOUS MATERIALINFECTIOUS MATERIAL

ANY BODY FLUID THAT IS ANY BODY FLUID THAT IS GROSSLY CONTAMINATED WITH GROSSLY CONTAMINATED WITH BLOOD OR ANY INTERNAL BODY BLOOD OR ANY INTERNAL BODY

CAVITY FLUIDCAVITY FLUID

PEP = POST EXPOSURE PEP = POST EXPOSURE PROPHYLAXISPROPHYLAXIS

MEDICATION REGIMEN AVAILABLE MEDICATION REGIMEN AVAILABLE TO EXPOSED PERSON IF SOURCE TO EXPOSED PERSON IF SOURCE IS POSITIVE FOR:IS POSITIVE FOR:– HEP B – NON-RESPONDER (HEP B HEP B – NON-RESPONDER (HEP B

VACCINE = IMMUNITY)VACCINE = IMMUNITY)– HIV – SEVERAL MEDICATIONS HIV – SEVERAL MEDICATIONS

AVAILABLEAVAILABLE– HEP C – NO PEP AVAILABLEHEP C – NO PEP AVAILABLE

Infectious Waste Biohazard Infectious Waste Biohazard SymbolSymbol

BBP’s: BLOOD/BODY BBP’s: BLOOD/BODY FLUIDSFLUIDS

If saliva, tears, urine, feces, If saliva, tears, urine, feces, vomitus, sweat or sputum is vomitus, sweat or sputum is grossly bloody then . . . it is grossly bloody then . . . it is considered contaminated.considered contaminated.

Otherwise Otherwise NONO risk (Not a BBP risk (Not a BBP Exposure).Exposure).

FACTORS INCREASING FACTORS INCREASING TRANSMISSION PROBABILITY OF TRANSMISSION PROBABILITY OF

BBPBBP (CDC1995)(CDC1995)

DEEP INJURYDEEP INJURY VISIBLE BLOOD ON DEVICEVISIBLE BLOOD ON DEVICE DEVICE PLACED DEEPLY IN VEIN OR DEVICE PLACED DEEPLY IN VEIN OR

ARTERYARTERY TERMINAL ILLNESS IN SOURCE (DEATH TERMINAL ILLNESS IN SOURCE (DEATH

FROM AIDS WITHIN 2 MONTHS OF FROM AIDS WITHIN 2 MONTHS OF EXPSOURE)EXPSOURE)

LARGE VOLUME OF BLOODLARGE VOLUME OF BLOOD AAOHN JOURNAL, JANUARY 2003.AAOHN JOURNAL, JANUARY 2003.

ELEMENTS OF AN ELEMENTS OF AN INFECTIONINFECTION

THREE ELEMENTS NEEDED FOR AN THREE ELEMENTS NEEDED FOR AN INFECTION:INFECTION:

1.1. HOSTHOST

2.2. INFECTIOUS DOSEINFECTIOUS DOSE

3.3. ROUTE OF ENTRYROUTE OF ENTRY

TERMINOLOGY:TERMINOLOGY:

“EXPOSUREEXPOSURE” = a behavioral event/ incident (e.g. needle stick, mucous membrane splash)

“INFECTIONINFECTION” = a biologic/ immunologic event (i.e. growth of organism, antibody response = seroconversion)

“DISEASEDISEASE” = a clinical event (i.e., symptoms and/or signs of the infection)

R. Ball, MD, MPH

WHAT IS HEPATITIS B?WHAT IS HEPATITIS B? VIRAL INFECTION OF THE LIVERVIRAL INFECTION OF THE LIVER SYMPTOMS - NONESYMPTOMS - NONE/MILD//MILD/SEVERE SEVERE CHRONIC CARRIERS (5%) CAN DEVELOP CHRONIC CARRIERS (5%) CAN DEVELOP

CHRONIC LIVER DISEASE AND CAN CHRONIC LIVER DISEASE AND CAN INFECT OTHERSINFECT OTHERS

95% SPONTANEOUS RESOLUTION95% SPONTANEOUS RESOLUTION INCUBATION PERIOD – AVERAGE 60-90 INCUBATION PERIOD – AVERAGE 60-90

DAYS. RANGE 45-180 DAYS.DAYS. RANGE 45-180 DAYS. HEPATITIS B VACCINE – PROVIDES HEPATITIS B VACCINE – PROVIDES

IMMUNITY IN MAJORITY – MAY HAVE IMMUNITY IN MAJORITY – MAY HAVE NON-RESPONDERSNON-RESPONDERS

WHAT IS HEPATITIS C?WHAT IS HEPATITIS C?

VIRAL INFECTION OF THE LIVERVIRAL INFECTION OF THE LIVER CAN LEAD TO CIRRHOSIS AND CANCER. CAN LEAD TO CIRRHOSIS AND CANCER. LEADING INDICATOR FOR LIVER LEADING INDICATOR FOR LIVER

TRANSPLANTTRANSPLANT FLU-LIKE SYMPTOMS OR NO SYMPTOMSFLU-LIKE SYMPTOMS OR NO SYMPTOMS INCUBATION PERIOD – AVERAGE 6-7 INCUBATION PERIOD – AVERAGE 6-7

WEEKS. RANGE 2-26 WEEKS.WEEKS. RANGE 2-26 WEEKS. NO VACCINE OR PEP AVAILABLE.NO VACCINE OR PEP AVAILABLE.

HEPATITIS C VIRUSHEPATITIS C VIRUS CLINICALCLINICAL: :

– 60-70% - No Symptoms60-70% - No Symptoms

– 10-20% - Mild Symptoms10-20% - Mild Symptoms

– 20-30% - Symptoms (Jaundice)20-30% - Symptoms (Jaundice)

~85% become chronic (lifelong) ~85% become chronic (lifelong) carriers!carriers!

HEPATITIS C VIRUSHEPATITIS C VIRUS RISK FACTORS RISK FACTORS (90% New Acute Hep C) – diagnosed cases(90% New Acute Hep C) – diagnosed cases

– Injecting drug use (~60%) > sexual Injecting drug use (~60%) > sexual exposures (15%) > transfusions (1% - exposures (15%) > transfusions (1% - prev. 10% prior to 1992) > prev. 10% prior to 1992) > occupational occupational (HCWs – 1-2%) (HCWs – 1-2%) >>

unknown (10-20%) unknown (10-20%) ~3-4 million chronic carriers in USA (CDC)~3-4 million chronic carriers in USA (CDC) ~36, 000 new infections annually in US~36, 000 new infections annually in US 50,000 - 70,000 cases estimated in South 50,000 - 70,000 cases estimated in South

CarolinaCarolina

WHAT IS HIV?WHAT IS HIV?

HIV=VIRUS THAT CAUSES AIDSHIV=VIRUS THAT CAUSES AIDS– Human Immunodeficiency Virus that Destroys T Human Immunodeficiency Virus that Destroys T

Cells (Necessary for Healthy Immune System) Cells (Necessary for Healthy Immune System)

INCUBATION PERIOD: Conversion to HIV + INCUBATION PERIOD: Conversion to HIV + Within 25 Days to 3 months. Rarely Longer Than Within 25 Days to 3 months. Rarely Longer Than 6 Months.6 Months.

– Can Be HIV POSITIVE But Not Have AIDS.Can Be HIV POSITIVE But Not Have AIDS.

– PEP is available – initiate as soon as possible!! PEP is available – initiate as soon as possible!! Interval after which there is no benefit for humans Interval after which there is no benefit for humans is undefined.is undefined.

AIDS = ACQUIRED AIDS = ACQUIRED IMMUNODEFICIENCY SYNDROMEIMMUNODEFICIENCY SYNDROME

– ½ People who are HIV + Develop ½ People who are HIV + Develop AIDS Within 10 YearsAIDS Within 10 Years

– HIV + Opportunistic Diseases/ HIV + Opportunistic Diseases/ Destroyed T Cells = AIDSDestroyed T Cells = AIDS

RISK OF INFECTION WITH RISK OF INFECTION WITH HEP C, HEP B, and HIVHEP C, HEP B, and HIV

AFTER ONE NEEDLESTICK EXPOSURE-------AFTER ONE NEEDLESTICK EXPOSURE------- HEP B: 30% (UNLESS VACCINE IMMUNITY)HEP B: 30% (UNLESS VACCINE IMMUNITY) HEP C: 1 – 3%HEP C: 1 – 3% HIV : 0.3%HIV : 0.3%

AFTER MUCOUS MEMBRANE EXPOSURE,AFTER MUCOUS MEMBRANE EXPOSURE,

EXAMPLE - SPLASH---------EXAMPLE - SPLASH--------- HEP B: 10% (UNLESS VACCINE IMMUNITY)HEP B: 10% (UNLESS VACCINE IMMUNITY) HEP C: 1%HEP C: 1% HIV: 0.1 %HIV: 0.1 %

HEPATITIS B, HEPATITIS C, HEPATITIS B, HEPATITIS C, & HIV& HIV

Life-threatening BBPLife-threatening BBP Transmitted through exposure to blood Transmitted through exposure to blood

and other infectious body fluidsand other infectious body fluids Anyone with occupational exposure is Anyone with occupational exposure is

at riskat risk Workers must use PPE and Workers must use PPE and

engineering controlsengineering controls

OCCUPATIONAL EXPOSURES:OCCUPATIONAL EXPOSURES:HCW (HCP) RESPONSIBILITIESHCW (HCP) RESPONSIBILITIES

KNOW BASIC BBP (HBV, HCV, KNOW BASIC BBP (HBV, HCV, HIV) ISSUESHIV) ISSUES

ATTEND ANNUAL BBP TRAININGATTEND ANNUAL BBP TRAINING KNOW WHAT IS A BONA FIDE KNOW WHAT IS A BONA FIDE

EXPOSUREEXPOSURE REPORT IT!!!! Per School Policy.REPORT IT!!!! Per School Policy. If you don’t know, ASK!!!!If you don’t know, ASK!!!!

OCCUPATIONAL EXPOSURES:OCCUPATIONAL EXPOSURES:RESPONSIBILITIESRESPONSIBILITIES

FIRST STEPS: Examine site of exposureFIRST STEPS: Examine site of exposure FIRST AID (e.g. wash off blood, use FIRST AID (e.g. wash off blood, use

standard disinfectant)standard disinfectant) IDENTIFY SOURCE PATIENT; REPORT IDENTIFY SOURCE PATIENT; REPORT

STATSTAT TO SUPERVISOR; CHECK TO SUPERVISOR; CHECK PROTOCOLS/ PROCEDURESPROTOCOLS/ PROCEDURES

GET MEDICAL CONSULTATION; GET MEDICAL CONSULTATION; FOLLOW UP per school post-exposure FOLLOW UP per school post-exposure management planmanagement plan

Test the SOURCE if possible. If source is a Test the SOURCE if possible. If source is a student, careful explanation to the parent of student, careful explanation to the parent of source. (usually negative = reassurance) source. (usually negative = reassurance)

Adapted from slide provided by R. BALLAdapted from slide provided by R. BALL

IF YOU THINK YOU HAVE IF YOU THINK YOU HAVE BEEN EXPOSEDBEEN EXPOSED

IMMEDIATELYIMMEDIATELY TAKE CARE OF TAKE CARE OF YOURSELF andYOURSELF and

IMMEDIATELY IMMEDIATELY NOTIFYNOTIFY

School AdministrationSchool Administration

School NurseSchool Nurse

PAPERWORK WILL BE PAPERWORK WILL BE DONE BY DONE BY

the employee with the the employee with the help of the school nurse .help of the school nurse .

Human Bite Management & BBPsHuman Bite Management & BBPs

Recommendations: 2009Recommendations: 2009 Red BookRed Book

American Academy of PediatricsAmerican Academy of PediatricsCDC. MMWR June 29, 2001CDC. MMWR June 29, 2001

Updated US Public Health Service Guidelines...Updated US Public Health Service Guidelines...

““Feces, nasal secretions, Feces, nasal secretions, salivasaliva, sputum, , sputum, sweat, tears, urine, and vomitus are not sweat, tears, urine, and vomitus are not considered potentially infectious unless they considered potentially infectious unless they contain (visible) blood.” – CDCcontain (visible) blood.” – CDC

BITE MANAGEMENT ISSUESBITE MANAGEMENT ISSUES

ALWAYS HAVE 2 PERSONS INVOLVED:ALWAYS HAVE 2 PERSONS INVOLVED:”BITER” & “BITEE””BITER” & “BITEE”

EVALUATE: did biter’s EVALUATE: did biter’s salivasaliva →→ bitee’s wound? bitee’s wound? EVALUATE: did bitee’s EVALUATE: did bitee’s bloodblood →→ biter’s mouth? biter’s mouth? HIV & Hep C are NOT transmitted via saliva “unless HIV & Hep C are NOT transmitted via saliva “unless

visibly grossly bloody” (prior to bite); Hep B may be if visibly grossly bloody” (prior to bite); Hep B may be if repetitiverepetitive

CONSIDER other (more likely) pathogens (i.e. CONSIDER other (more likely) pathogens (i.e. bacteria)bacteria)

Consult physician re: testing both people for BBPsConsult physician re: testing both people for BBPs

R. Ball, MD, MPH

Student ExposuresStudent Exposures

Notify the school nurse of any Notify the school nurse of any possible/definite exposures immediately!possible/definite exposures immediately!

Recommend protocol in placeRecommend protocol in place– Contacting parents of source and exposed Contacting parents of source and exposed

childchild– Determine protocol if source child needs to Determine protocol if source child needs to

be tested be tested – Notify Risk ManagementNotify Risk Management

Review with legal if needed Review with legal if needed

Any ExposureAny Exposure

If you are in a location that does not have a If you are in a location that does not have a nurse you can contact any district nurse for nurse you can contact any district nurse for direction. If you are unsure how to reach a direction. If you are unsure how to reach a nurse, contact Student Services (981-1041) nurse, contact Student Services (981-1041) and they will connect you with a nurse. and they will connect you with a nurse.

RESOURCE WEBSITESRESOURCE WEBSITES

www.cdc.govwww.cdc.gov www.osha.govwww.osha.gov www.nasn.org www.nasn.org

National Association of School NursesNational Association of School Nurses– Occupational Exposure to BBPOccupational Exposure to BBP

QUESTIONS????QUESTIONS????