Bloodborne Pathogens &

Infection ControlSearch and Rescue Council, Inc

SARCI

Purpose

• As a SAR Volunteer you may be “occupationally” exposed to blood, other body fluids, and other potentially infectious materials.

• Exposure could result in the transmission of bloodbornepathogens, which could lead to disease and/or death.

• Purpose of this program is to minimize exposure and risk of disease transmission.

Bloodborne Pathogens (BBP)

• Microorganisms that can cause disease when transmitted from an infected individual to another individual through blood and certain other body fluids.

• Many are capable of causing serious illness and/or death.

• Include human immunodeficiency virus (HIV), hepatitis C virus (HCV), and hepatitis B virus (HBV).

Viruses

• Very small infectious agent containing genetic material (DNA or RNA)

• Replicate only inside the living cells of other organisms

• Antibiotics have no effect on viruses

• Viruses are able to change and mutate over time

• HIV and HCV are particularly good at mutating, making development of a vaccine difficult

Modes of Transmission

• Primarily through contact with blood or body fluids of infected patients via:

• Needle stick

• Broken Skin

• Scratches

• Lesions

• Abrasions

• Mucous membranes

• Eyes

• Nose

• Mouth

• These viruses do not spontaneously penetrate intact skin, they need a place to enter

HIV

• Virus invades the cells of the immune system weakening them and allowing other, opportunistic infections to occur

• Treatments are available to extend the life of those infected, but there is no cure

• No vaccine is available

HIV Infection

• Occupational transmission of HIV is very rare

• Exposure to a needle stick involving HIV infected blood has only a 0.23% risk of becoming infected.

• Smaller risk when exposed to blood or fluid splashes onto mucous membranes or broken skin.

• Risk of infection from exposure to blood or fluid splashes onto intact skin is nearly zero.

• HIV can live outside the body for only a few hours.

http://www.cdc.gov/hiv/workplace/occupational.html

Stages of HIV

• Acute Onset HIV

• In the weeks following initial infection many (but not all) individuals experience flu- or mono-like symptoms

• Extremely high viral load during this phase

• Clinical Latency

• Following the acute phase many patients enter a period with no (or very mild) symptoms

• Lasts average of 10 years

• Virus is still active, but with a lower viral load

• Transmission is still possible

• Acquired Immunodeficiency Syndrome (AIDS)

Hepatitis

• Inflammation of the liver

• Most commonly caused by viral infection

• At least seven distinct hepatitis viruses identified by letters A-G

• Each virus can have numerous strains or sub-types

• Most are not bloodborne

Hepatitis C

• Most common chronic bloodborne infection in the US

• Over 2000 reported cases of acute infection each year (many more cases believed to go unreported)

• CDC estimates 3.5 million people currently infected in the US

• Can be acute or chronic

• 15-25% of infected individuals spontaneously clear the infection without treatment

• Infection can lead to chronic liver disease, cirrhosis, and death

• Many infected individuals do not know they are infected

• HCV infection can be asymptomatic for years or decades

• No vaccine is available

http://www.cdc.gov/hepatitis/hcv/hcvfaq.htm

HCV Infection

• Highly viremic

• Primarily transmitted through large or repeated percutaneous exposures to infected blood

• Injection drug use

• Formerly, receipt of blood or organ donations

• Birth to infected mother

• Health care or occupational exposures are primarily from needle stick injuries

• Risk of infection approximately 1.8%

• Infection from other occupational exposures (including to broken skin or mucous membranes) is exceedingly rare

• HCV can live outside the body for only a few hours

http://www.cdc.gov/hepatitis/hcv/hcvfaq.htm

Hepatitis B

• Much more contagious than HIV or HCV

• Infection can be acute or chronic

• 1.4 million people have chronic infection in the US

• Symptoms and severity depend on many factors

http://www.cdc.gov/hepatitis/hbv/hbvfaq.htm

Acute Hepatitis B

• Acute infection usually lasts several weeks but can persist up to 6 months

• Symptoms can be mild, and are more severe in patients >60 years old

• Fatality rate 0.5-1%

http://www.cdc.gov/hepatitis/hbv/hbvfaq.htm

Chronic Hepatitis B

• Risk of chronic infection varies by age

• Infants 90%

• Children 25-50%

• Adults 5%

• Most patients remain asymptomatic until onset of end-stage liver disease

• 25% of those infected during childhood will die

• 15% of infected adults will die

http://www.cdc.gov/hepatitis/hbv/hbvfaq.htm

HBV Infection

• HBV can be transmitted extremely easily

• Can easily enter the body through broken skin or mucous membranes

• Unlike HCV and HIV, contact with an infected person’s saliva is a significant risk for transmission

• Risk of infection from needle stick exposures can be as high as 40%

• Environmental transmission is possible

• HBV can live outside the body for more than a week

• A series of vaccinations is available to reduce risk of infection

HBV Vaccination

• Aggressive immunization campaigns have significantly reduced the number of new cases in the US

• Most people born in the US since the vaccine has been available receive the vaccine during childhood

• Generally it is given as a three shot series over 6 months

• Immunization rate is very high, and is long-term

• Vaccine is recommended for almost everyone, very few contraindications exist

• SAR Volunteers should check their medical records to determine if they have not already received this vaccine

HBV Vaccination Requirements

• State and Federal regulations require employers to offer the vaccine at no cost to employees who may have occupational exposure

• If you would like PCSD/SARCI to provide the vaccine, make the request to a SAR Coordinator

• Those who do not wish to have PCSD/SARCI provide them with the vaccine will be required to sign a declination form

• Most health insurance plans in the US will also cover the vaccine

Review: Occupational Exposure Risk

• Routes of Exposure

• Needle stick (most-serious)

• Hollow bore puncture

• Injury from other contaminated sharp

• Mucous membrane

• Splash to eyes, nose, mouth

• Broken/Non-intact skin

• Absorbed through the opening

• Risk of infection following needle stick

• HIV 0.23%

• HCV 1.8%

• HBV 30-40%

• HBV can live on surfaces outside the body for more than seven days

• HIV and HCV for only a few hours

Methods to Reduce Transmission

• Hand Washing

• Personal Protective Equipment (PPE)

• Engineering Controls

• Safe Work Practices

• Decontamination

• Waste Disposal

Hand Washing

• Our own skin is a very good barrier to keep BBPs and other infectious pathogens out of our bodies.

• Frequent and proper hand washing significantly reduces risk of infection

• Soap and water is most effective, but if that is not available alcohol-based hand sanitizers can be used

• Wash hands again with soap and water as soon as they become available

• If skin other than the hands has been potentially contaminated, a thorough shower should be taken as soon as possible, and before returning home

Hand Washing

When?• After removing gloves or other PPE

• After touching potentially contaminated objects

• After using the toilet

• After blowing your nose, coughing, or sneezing

• Before eating, drinking, or preparing food

• Before/After each patient encounter

How?• Wet your hands with clean, running

water (hot or cold)

• Apply soap and lather by rubbing hands together

• Scrub your hands for at least 20 seconds

• Be sure to scrub back of hands, between fingers, and under nails

• Rinse thoroughly under clean, running water

• Dry with a clean towel, or air dry

Universal Precautions

• Bloodborne Pathogens can be transmitted by ANY bodily fluid including blood, saliva, urine, feces, semen, vaginal secretions, vomitus, cerebrospinal fluid, etc.

• Universal Precautions means to treat all body fluids (and other materials contaminated with them) as if they are known to be infectious with HIV, HBV, HCV, and other BBPs.

• Maintain a barrier (PPE) between yourself and body fluids of another person

PPE - Gloves

• Exam gloves, usually Latex or Nitrile, should be worn anytime there is a risk of exposure to body fluids

• Usually includes anytime you are treating a patient, even if there is no visible blood

• If you have a Latex allergy, ask a SAR Coordinator to provide non-Latex gloves

• Always wear both gloves

• Change as soon as possible if gloves are torn or soiled

• Change between touching different patients

• Don’t cut the tips off of fingers

Removing Gloves Properly

Removing Gloves Properly

Removing Gloves Properly

Removing Gloves Properly

Removing Gloves Properly

Removing Gloves Properly

Removing Gloves Properly

Removing Gloves Properly

Removing Gloves Properly

Removing Gloves Properly

Additional PPE

• Masks, Eye Protection, & Gowns should be worn if you anticipate splashing, spraying, or large quantities of body fluids to could soak clothing or skin

• Generic surgical masks are sufficient in most cases, but N95 rated masks should be used in suspected airborne disease (TB, Flu, etc.) cases

• Shoe covers should be worn when there is large amounts of body fluid present

Engineering Controls

• Methods to reduce exposure by removing or isolating the hazard from the employee

• Resuscitation bags

• Self-sheathing needles

• Needleless systems

• Proper sharps disposal containers

• Medical devices that can be properly decontaminated, or are disposable

Safe Work Practices

• Using appropriate PPE and Handwashing

• Avoid eating, drinking, smoking, applying cosmetics or lip balm, and handling contact lenses in areas where potential exposure exists

• Avoid storing food or drink near, or in the same refrigerator as, potentially infectious or contaminated items

• Sharps safety

• Avoid cross contamination

Cross Contamination

• Can occur when a rescuer touches a patient and then reaches into a medical kit, uses a radio, writes with a pen, etc.

• Work in teams, someone who is not providing patient care should be available to scribe reports, handle radio comms, and retrieve supplies out of the medical kit

• Anything you touch while contaminated, or wearing contaminated gloves, is now also contaminated

• Remember, not all contamination is visible

Human Remains Recoveries

Human Remains Recoveries

Human Remains Recoveries

Human Remains Recoveries

Human Remains Recoveries

Decontamination

• Any object that has potentially become contaminated needs to be properly decontaminated as soon as possible

• Items which cannot be properly decontaminated should be disposed

• Report all contaminated objects to a SAR Coordinator

• A 1:10 mixture of household bleach with water is a good disinfectant

• Other commercial products registered by the EPA may also be used

• Contaminated clothing should not be taken home

• Shower facilities are available at the County Shops

• Remove contaminated clothing, place into red biohazard bag and give to a SAR Coordinator for proper decontamination

Waste Disposal

• Any materials which have been soiled, soaked, or caked with body fluids are regulated biohazardous waste

• Need to be placed into a leak-proof, red, biohazard bag

• Avoid contaminating outside of the bag

• Bagged waste should be given to a SAR Coordinator for proper disposal

• Sharp objects must be placed into an appropriate container, NOT into the red bags

• All biohazardous waste must be properly labeled.

Sharps

• Sharp: objects or devices having acute rigid corners, or edge points capable of cutting or penetrating the skin

• Needles

• Razor blades

• Broken glass

• Sharps cause injury through cuts or puncture wounds, and are a very efficient means for BBPs to enter the body

• Proper handling and disposal is essential

Sharps Safety

• Sharps should only be used or handled by trained personnel

• The safest practical device should be used

• Self-retracting needles, needless systems, etc.

• Never pick up broken glass with your hands, use tongs or a dust pan

• Never recap needles, unless medically necessary

• Then use a one-hand scoop technique

• When handling sharps, announce your actions to those around you to avoid accidental injury

• Do not use/handle with the intention of discarding it later

• Have an appropriate disposal container ready in advance

Sharps Disposal

• All sharps should be placed into an approved biohazard sharps container

• Do not hold the sharps container in your hand when you are depositing a sharp

• Deposit needles pointed end first

• Never reach into the opening of a sharps container

• Do not fill a sharps container to the brim, replace with a new one at about ¾ full

Sharps are Everywhere

• Never reach into trash containers, or objects you can not see into, with your hands

• Backpacks/Purses

• In areas where litter accumulates, watch where you step

• Be careful touching pockets on patients

Airborne Illnesses

• Tuberculosis (TB)

• Infectious bacterial infection of the lungs

• Many infected people have no symptoms

• Symptoms, bad cough, chest pain, hemoptysis

• Treatable with long-term antibacterial therapy

• Some strains are becoming drug resistant

• Bacterial Meningitis

• Inflammation of tissue around brain and spinal cord

• Sudden onset of high fever and other flu-like symptoms

• Intense headache or neck stiffness

• Can be fatal or disabling

• Influenza (Flu)

Airborne Illnesses Transmission

• Pathogens spread by tiny droplets exhaled by infected persons

• Coughing or sneezing increases number of droplets and distance traveled

• Droplets can remain in air for prolonged periods

• Wear a mask and/or place one on the patient when an airborne illness is suspected or symptoms are present

• Mask should be N95 rated

Post-Exposure

• Immediately flush affected area with copious amounts of water, scrub exposed skin with soap

• If you think you may have been exposed, report it to a SAR Coordinator immediately

• Document circumstances, route of exposure, date and time of exposure

• If possible document the identity of the person from whom you were exposed

• A Post-Exposure Evaluation will be performed by a health-care professional

• Evaluate if a significant exposure occurred

• Provide counseling

• Arrange for testing of the source individual if permissible by law

• Perform post-exposure testing as appropriate

• Administer post-exposure prophylaxis as appropriate

Exposure Control Plan

• Employers are required to maintain a written Exposure Control Plan (ECP)

• Identify workers at risk for occupational exposure

• Specify the methods of protecting and training the employees

• SARCI maintains an ECP and an addendum to that ECP applicable to our volunteers

• This training is part of the ECP, and is required, at least annually, of all SAR Personnel

• Any questions should be directed to a SARCI or your component group