Bloodborne Pathogens

Introduction

Welcome to this training presentation on Bloodborne Pathogens.

Please use the forward and backward buttons at the bottom of this page to navigate through the training at your own pace.

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Course Outline

1. Why Take Bloodborne Pathogens Training?2. Definition3. At-Risk Employees4. Types of Bloodborne Pathogens5. Bloodborne Pathogen Transmission6. Engineering Controls7. Exposure Control Plan8. Training Requirements9. Work Practice Controls10.Regulated Waste11.HBV Vaccination12.Emergency Response13.Medical Recordkeeping14.Summary

Why Take Bloodborne Pathogens Training?

Employees in many industries are at risk:

• Approximately 5.6 million employees in the health care, dentistry, hospitality and other industries can reasonably be expected to come into contact with blood or other potentially infectious materials (OPIM). They are at risk for bloodborne pathogen exposure.

Regulations and standards have been set:

• The Occupational Safety and Health Administration (OSHA) has set a bloodborne pathogens standard which mandates safeguards to protect employees against the health hazards associated with the exposure to blood, needles, bodily fluids and OPIM.

Why Take Bloodborne Pathogens Training?

Introductory training:

•This training will satisfy the training requirements for initial employee training and annually thereafter.

•For those employees who work with cultures of HIV, hepatitis B, hepatitis C, human blood or other potential infectious material known to be infected with the above bloodborne pathogens, this is an introductory training and will not satisfy the additional requirements for working with these specimens.

•For additional training on working with human blood and OPIM, contact your supervisor.

Definition

What are bloodborne pathogens?

Bloodborne pathogens are pathogenic micro-organisms that may be present in human blood and can cause disease in humans.

Pathogens found in blood and OPIM include the following: human immunodeficiency virus (HIV), which causes AIDs; hepatitis B virus (HBV); hepatitis C virus (HCV); syphilis and malaria.

There are many bloodborne pathogens and although this training only specifically addresses a few, they should all be considered.

At-Risk Employees

The Bloodborne Pathogens Standard:

•Covers all employees who could be “reasonably anticipated” to face contact with blood and other potentially infectious materials as the result of performing their job duties.

•Does not cover those who engage in “Good Samaritan” acts, such as assisting a coworker with a nosebleed, because it is not considered an occupational exposure.

However, if an employer allows trained employees to assist with first aid treatment on a “Good Samaritan” basis, it is considered best practice to implement the key elements of a bloodborne pathogen program.

At-Risk Employees

Who is at risk for exposure?

• Physicians, nurses and emergency room personnel

• Orderlies, housekeeping personnel and laundry employees

• Dentists and other dental employees

• Laboratory and blood bank technologists and technicians

• Medical examiners

• School employees

• Law enforcement personnel

• Firefighters

• Paramedics and emergency medical technicians

• Anyone providing first-response medical care

• Medical waste treatment employees

• Home healthcare employees

Types of Bloodborne Pathogens

Bloodborne pathogens include:

• Malaria

• Syphilis

• Brucellosis

• Hepatitis B (HBV) and C

• Human immunodeficiency virus (HIV)

Human immunodeficiency virus (HIV)

Types of Bloodborne Pathogens

Hepatitis B virus (HBV):

• Is a viral infection and causes inflammation of the liver.

• Transmits primarily through blood to blood contact.

• Can also cause jaundice, vomiting and, in rare cases, death.

• Leads to serious conditions such as cirrhosis and liver cancer.

• Can survive in dried blood for up to seven days.

• Has no known cure or treatment.

• Has an available vaccine.

Hepatitis B virus

Types of Bloodborne Pathogens

HBV symptoms:

• Mild flu-like symptoms

• Fatigue

• Possible stomach pain

• Loss of appetite

• Nausea

• Jaundice

Types of Bloodborne Pathogens

Hepatitis C virus (HCV):

• Similar to HBV, can cause jaundice, fatigue, abdominal pain, loss of appetite, intermittent nausea and vomiting.

• Can lead to chronic liver disease and death.

• Has no cure or vaccine. Medications can suppress the virus, but treatments have a low success rate.

• Survives outside the body for several days.

• Can be carried by people, called carriers, who do not have symptoms of the disease.

Types of Bloodborne Pathogens

Human Immunodeficiency Virus (HIV):

• Attacks the body's immune system, weakening it so that it cannot fight other deadly diseases.

• Causes acquired immunodeficiency syndrome (AIDS). AIDS is a fatal disease and, while treatment for it is improving, there is no known cure.

• The HIV virus is very fragile and will not survive for more than a few hours outside of the human body.

• Employees providing first aid or medical care in situations involving fresh blood or other potentially infectious materials are particularly at risk.

Types of Bloodborne Pathogens

HIV symptoms:

• Symptoms of HIV infection can vary, but often include the following:

– Weakness

– Fever

– Sore throat

– Nausea

– Headaches

– Diarrhea

– White coating on the tongue

– Weight loss

– Swollen lymph glands

Bloodborne Pathogen Transmission

Pathogen sources:

Generally, bloodborne pathogens are transmitted through contact with infected human blood and other potentially infectious materials (OPIM), such as:

Semen. Vaginal secretions. Cerebrospinal fluid (brain spinal cord). Synovial fluid (joints). Pleural fluid (chest cavity). Peritoneal fluid (abdomen). Amniotic fluid (fluid around fetus). Saliva (if blood is present).• Any unfixed tissue or organ from a human, living or

dead, except intact skin.• Any blood, cultures or animal tissue infected with or

containing HIV, HBV or HCV.

Bloodborne Pathogen Transmission

Entry methods:

Unbroken skin forms an impervious barrier against bloodborne pathogens. However, infected blood can enter your system through the following:

Open sores

Small cuts or scratches

Abrasions

Acne

Damaged or broken skin, such as sunburn or blisters

Dried and cracked skin

Bloodborne Pathogen Transmission

A splash or splatter of human blood or OPIM coming into contact with mucous membranes, such as the eyes, nose, mouth or broken skin.

Parenteral contact. This is when

the pathogen enters directly into blood or muscle tissue andcan occur via:

Injection from a needle. Cuts from other contaminated

sharps like scalpels, broken glass, etc.

Common exposure routes:

Engineering Controls

Engineering controls:

These controls reduce exposure by removing the hazard or isolating the employee. Examples of engineering controls include:

•Sharps disposal containers.

•Self-sheathing or retracting needles.

•Medical safety devices.

•Needleless systems, as shown here.

•Sharps with engineered injury protection.

Engineering Controls

A sharps container must be:

•Red or labeled with a biohazard sign.•Leak-proof.•Puncture-resistant.•Located as close as possible to the work surface.•Kept upright during use.•Inspected and replaced when two-thirds full.•Closed when full.•Transported in a secondary container if leakage is possible.•Disposed of as regulated waste, following local and federal requirements.

Engineering Controls

Medical safety devices:

• Needleless systems: Devices that do not use needles, such as Luer taper systems, for the collection or withdrawal of body fluids or for the administration of medication or fluids.

• Sharps that have engineered sharps injury protection: These have a built-in safety feature or mechanism that reduces the risk of an exposure incident. They include non-needle sharps and needle devices used for withdrawing body fluids, accessing a vein or artery or administering medications or other fluids.

Your program must review these devices to determine the safest approach.

Exposure Control Plan

An exposure control plan:

•Is a written document that describes how the employer will comply with requirements and implement policies and procedures.

•Identifies the jobs and tasks where occupational exposure to blood or other potentially infectious material occurs.

•Describes how the employer will: Use engineering and work practice controls. Assure use of personal protective equipment. Provide training. Provide medical surveillance. Provide hepatitis B vaccinations. Use signs and labels.

Must be accessible and communicated to employees.

Exposure Control Plan

Reviewing the plan:

• The exposure control plan is reviewed at least annually and updated to reflect the relevant changes in:

Tasks Procedures Assignments Technology

• The annual review documents how the employer considers and implements safer medical devices.

• The review must solicit input from potentially exposed employees on the identification, evaluation and selection of engineering and work practice controls.

St. Francis School District Exposure Control Plan

Training Requirements

Training must be:

•Provided at no cost to employees during working hours.

•Provided at the time of the initial assignment to a job with occupational exposure and at least annually thereafter.

•Provided additionally when existing tasks are modified or new tasks are required which affect an employee’s occupational exposure.

•Recorded and maintained for three years.

Work Practice Controls

Using universal precautions involves:

•Treating all human blood or OPIM as contaminated with bloodborne pathogens.

•Treating all materials that have been contaminated with human blood or OPIM as potentially infectious with bloodborne pathogens.

•Minimizing handling and manipulation of materials contaminated with human blood or OPIM.

Following universal precautions is an integral part of preventing exposure to bloodborne pathogens.

Work Practice Controls

Implementing work practice controls:

These are steps to take in order to complete job tasks safely by reducing the likelihood of exposure through choices. Recommended controls include:

•Covering any cuts or abrasions, especially those near your hands.

•Not touching the face or mouth when a potentially infectious material is present.

•Not eating, drinking, smoking or applying cosmetics, including lip balm when a potentially infectious material is present.

•Following universal precautions: employees should assume that all human blood is infectious.

Work Practice Controls

Sharps safety:

•Do not bend or break needles.

•Do not recap needles.

•Place needles in a sharps container as soon as possible.

•Use forceps or another device to pick-up sharps, such as broken glass or a loose needle.

If a sharps injury does occur, report it to your supervisor and record the incident on the Sharps Injury Log

Work Practice Controls

• Containers of regulated waste.

Containers used to store, transport or ship blood or other potentially infectious materials.

Refrigerators, freezers and other storage locations that contain blood and other potentially infectious materials.

Laundry containers being sent for cleaning.

Sharps containers.

Red bags or containers may be substituted for labels.

Biohazard warning labels must be placed on:

Work Practice Controls

Housekeeping:

• A written schedule must be developed for cleaning and decontamination at the work site based on:

– The location within the facility.

– The type of surface to be cleaned.

– The type of soil present.

– The tasks or procedures being performed.

Work Practice Controls

Housekeeping (continued):

• Work surfaces must be decontaminated with an appropriate disinfectant:

– After the completion of procedures.

– When surfaces are contaminated.

– At the end of the work shift.

• Follow instructions on the product label for dilution, contact time on the surface and required personal protective equipment (PPE).

• A diluted bleach solution, 1% household bleach, is considered to be an effective disinfecting agent.

Work Practice Controls

Spill clean up:

•If a spill occurs, cordon off the area.

•Put on the required personal protective equipment (PPE).

•Place absorbent materials, such as paper towels, on the spill.

•Pour disinfectant on and around the spill area, allowing the disinfectant to flow into the spill.

•Allow the disinfectant to sit for the required contact time.

•At the end of the contact time, collect the absorbent material.

•Wipe up excess disinfectant with absorbent material.

•Place absorbent material and disposable PPE in a red bag or bag with a biohazard symbol to be disposed of as regulated waste.

Work Practice Controls

Personal protective equipment (PPE):

• PPE is specialized clothing or equipment that is worn by an employee for protection against infectious materials.

• Always wear personal protective equipment (PPE) in potential exposure situations.

• Replace PPE that is torn, punctured or soiled.

• Reusable PPE must be properly cleaned, laundered, disinfected, repaired and disposed of at no cost to employees.

• Wash hands immediately after removing PPE.

Work Practice Controls

Examples of PPE:

• Gloves

• Gowns or laboratory coats

• Face shields

• Eye protection

• Boots

• Mouth barriers

Employees must receive training on the use, maintenance, care and limitations of the PPE that they

are expected to use.

Work Practice Controls

Proper procedures when using PPE:

•Remove PPE prior to leaving the work area.

•Follow universal precautions when removing PPE, being careful to not contaminate other areas.

•Wash hands immediately after removing PPE.

Work Practice Controls

Hand washing:

• Hand washing is one of the most important (and easiest) practices used to prevent the transmission of bloodborne pathogens.

• Wash hands or other exposed skin thoroughly as soon as possible following an exposure incident.

• Wash hands after removing gloves.

• Use antimicrobial soap.

• Do not use harsh or abrasive soap.

Work Practice Controls

Laundry:

• Remove clothing that is contaminated with blood as soon as possible.

• Use universal precautions when handling contaminated laundry by handling laundry as little as possible and protecting yourself with the proper PPE.

• Place clothing in approved and labeled bags or containers with the biohazard symbol.

• If the laundry will soak through the container, place in a secondary container and label with the biohazard symbol.

• Water soluble bags provide the greatest protection.

− They dissolve in laundry to minimize handling of contaminated items.

• Sorting or rinsing before transportation is not allowed.

Regulated Waste

Regulated waste items include:

Blood or other potentially infectious materials (OPIM) in a liquid or semi-liquid form.

Contaminated items that could release blood or other potentially infectious materials in a liquid or semi-liquid state if compressed.

Items with dried blood or other potentially infectious materials.

Regulated Waste

Disposing of regulated waste:

•Place items in closeable, leak-proof containers. These are:

– Built to contain all contents during handling, storing, transporting or shipping.

– Appropriately labeled or color-coded.

– Closed prior to transport, storage or handling.

– Placed inside a secondary container for shipping, transport or storage, if contamination occurs.

HBV Vaccination

Hepatitis B vaccinations:

• Employees who are routinely exposed to bloodborne pathogens, such as doctors, nurses or first aid responders, must be offered the hepatitis B vaccine series.

• The vaccine series consist of three shots which build immunity to HBV. The three shot series is administered over a period of time.

HBV Vaccination

Hepatitis B vaccination requirements:

•The hepatitis B vaccine must be:

Offered free of charge.Provided at a reasonable time and in an accessible location.Included for all employees at risk of exposure. Administered within 10 working days of initial assignment.Performed by a licensed professional.

•Employees do not have to be vaccinated if:

They have already been vaccinated. An antibody testing reveals their immunity. They opt out after being offered the immunization.

HBV Vaccination

Hepatitis B vaccination requirements (continued):

• Opting out employees: Employees who decline the vaccination must sign a

declination form.

The vaccine must be made available if an employee initially declines and later decides to accept the vaccination.

• Employees are not required to participate in antibody prescreening programs to receive the vaccination series.

• Vaccination booster doses must be provided if recommended by the U.S. Public Health Service.

Emergency Response

What to do if an exposure occurs:

• Wash the exposed area thoroughly with soap and running water.

• Use non-abrasive, antimicrobial soap.

• Flush the nose, mouth or skin with splashes of water.

• Irrigate eyes with water or saline.

• Report the exposure.

• Seek medical attention.

Emergency Response

First aid procedures:

•Always use universal precautions.

• It is important to put an impermeable barrier between you and potentially infectious material. Minimize your exposure by wearing the following:

Gloves

Splash goggles

Pocket mouth-to-mouth resuscitation masks

Other barrier devices

Emergency Response

First aid procedures (continued):

When performing first aid, always use a mouth barrier to protect yourself from coming into contact with bodily fluids.

Mouth barriers should have one-way valves to keep fluids from coming up.

Commercially available products can be small enough to fit on a key chain and include latex gloves.

Emergency Response

Post-exposure follow-up:

• Routes of exposure and how the exposure occurred must be documented.

Exposure to Blood/Bodily Fluids Form

• Consent from the source individual and the exposed employee will be obtained and blood will be tested as soon as possible after the exposure incident.

• Risk counseling and post-exposure protective treatment for diseases will be provided when medically indicated. This is in accordance with current U.S. Public Health Service Guidelines.

• A written opinion of the findings will be provided to the employer with a copy to the employee within 15 days of the evaluation.

• Hepatitis B prophylaxis administration will also be available.

Medical Recordkeeping

For every incident, the following must be recorded:

• The name and social security number of the employee.

• The employee’s hepatitis B vaccination status.

• The results of examinations, medical testing and post-exposure evaluation.

• Follow-up procedures.

• Information provided to the health care professional.

• The health care professional’s written opinion.

Medical Recordkeeping

Maintain records:

• Employee medical records must be kept confidential and not disclosed or reported without the employee’s written consent (unless required by law).

• Medical records must be maintained for the employee’s duration of employment plus 30 years, according to OSHA’s rule governing access to employee exposure and medical records.

Medical Recordkeeping

Sharps injury log:

• Employers must maintain a sharps injury log for the recording of injuries from contaminated sharps.

• The log must be maintained in a way that assures employee privacy and must contain, at a minimum:

− The type and brand of device involved in the incident.

− The location of the incident.

− A description of the incident.

Summary

• All employees who could reasonably expect to come in contact with human blood or OPIM must follow universal precautions and be trained on bloodborne pathogens.

• Implementation of a bloodborne pathogen program will not only prevent hepatitis B cases, but also will significantly reduce the risk of employees contracting HIV, hepatitis C or other bloodborne diseases.

• A written exposure control plan and a training program must be in place to assure that employees are aware of hazards and work practices for bloodborne pathogens.

Summary

Best practices:

• Always know what hazards you are working with.

• Use proper PPE in situations with bloodborne pathogens.

• Report all suspected exposures.

• Don't handle sharps or broken glass with your hands.

• Never fill a sharps containers more than two-thirds full.

• Read labels on the handling of decontaminants prior to use.

• Properly dispose of pathogen waste, PPE and sharps containers as regulated waste.

All Forms May Be Access From “ Staff Resources – Staff Forms “