Bloodborne Pathogen Fun Facts from the Infection Control Center • During an hour's swimming at a municipal pool you will ingest 1/12 liter of urine. • In an average day your hands will have come into indirect contact with 15 penises (touching door handles, etc.) • An average person's yearly fast food intake will contain 12 pubic hairs. • In a year you will have swallowed 14 insects while you slept! Fun Facts from the Infection Control Center • Annually you will shake hands with 11 women who have recently masturbated and failed to wash their hands. • Annually you will shake hands with 36 men who have recently masturbated and failed to wash their hands. • Daily you will breath in 1 liter of other peoples' anal gases. What is OSHA? • A federal agency of the US Department of Labor • Created by Congress in 1971 under the Occupational Safety and Health Act • Mission: • To prevent work-related injuries, illnesses, and death What is “The Standard”? 29 CFR 1910.1030 • In 1990, OSHA issued a standard (Bloodborne Pathogen Standard) designed to prevent healthcare workers and others from being exposed to bloodborne pathogens such as hepatitis B and HIV Who does the Standard cover? All employees who could "reasonably anticipate" contact with blood contact with other potentially infectious materials while performing their job duties Compliance with the Standard • The Bloodborne Pathogen Standard specifies methods that are to be used to minimize the transmission of bloodborne pathogens in the work place. • These methods include: Standard Precautions Engineering and Work Practice Controls Personal Protective Equipment (PPE) Appropriate Housekeeping Measures Training • Employees must be provided information When first assigned a task with potential exposure Repeated annually During work hours When new tasks or procedures are added •New exposure risk created must be addressed Definition Bloodborne Pathogen • Microorganisms that: are present in human blood can infect and cause disease in people who are exposed to blood containing the pathogen can be transmitted through contact with contaminated blood and body fluids Standard Precautions • A strategy designed to reduce the risk of transmission of microorganisms from known and unknown sources You can’t tell if material is infectious or not so treat all materials as if they are infectious! • Take precautions with every patient exposure Handwashing Simple Effective practice • Prevents transfer of contamination from your hands to other areas of your body, to other persons, or to other surfaces you may contact later Handwashing As soon as possible following an occupational exposure to blood or other potentially infectious materials After removal of gloves Before and after every patient contact After toileting Before and after preparing food Before and after eating or smoking After coughing or sneezing into hands or blowing nose Handwashing How-to Take off rings Turn on faucet Wet hands Apply soap Scrub your hands - minimum 15 seconds Rinse Dry hands Turn off faucet – use paper towel Antiseptic Hand Cleaner • Antiseptic hand cleaners may be used as an appropriate hand washing practice IF: Your gloves remained intact You have had no occupational exposure to blood or other potentially infectious materials Material can be left to air dry on your skin • Choose product with at least 60% alcohol Did You Know? • Washing with soap and running water every time you remove your gloves is the recommended practice over hand sanitizers • Liquid soap is preferred • Bar soap can transfer microorganisms • Antimicrobial or plain soap? • Plain soap good enough for ordinary washing • Antimicrobial is preferred during patient care Personal Protective Equipment PPE • The type of protective equipment appropriate for your job or research varies with the task and the degree of exposure you anticipate PPE – Eye Protection • Bloodborne pathogens can be transmitted through the mucous membranes of the eyes. • Use eye protection whenever there is a risk of splashing or vaporization of contaminated fluid • Airway control (ie: intubation, suctioning) • Cleaning up spills • Cleaning equipment Mask and Face Shields • Masks and face shields provide additional protection for potential eye, nose, or mouth contamination • Used during tasks that may generate blood or other potentially infectious materials via: Splashes Spray Spatter Droplets Protective Clothing • Appropriate protective clothing such as, but not limited to, gowns, aprons, lab coats, clinic jackets, or similar outer garments shall be worn in occupational exposure situations • Type and characteristics will depend upon the task and degree of exposure anticipated. Employer Responsibilities Issue PPE or make it readily accessible in the work area Maintain, replace or dispose of any PPE at no cost to employees • Employer can provide the engineering controls • The employee needs to exercise the work practice controls for the process to be effective Signs, Labels & Color Coding • Signs and labels in the workplace communicate bloodborne pathogen hazards to employees. • Warning label must include the universal biohazard symbol and the term "biohazard" in a color that contrasts with the fluorescent orange, orange-red background Using Warning Labels • Warning labels must be affixed to containers of regulated waste, refrigerators and freezers containing blood or other potentially infectious material, and other containers used to store, transport, or ship blood or other potentially infectious materials. • Red bags or red containers can be substituted for labels. Cleaning and Decontamination Duties • Review product labeling for any special directions/precautions • Wear appropriate PPE for task being performed • Remove all blood and debris from surface to be cleaned • Products can’t clean the surface if they can’t be in contact with the surface • Allow disinfectant to air dry • Leave surface wet 30 seconds for HIV disinfection • Leave surface wet 10 minutes for HBV disinfection Clean Up Involving Blood or Body Fluids • Wear appropriate Personal Protective Equipment (PPE). • Carefully cover the spill with absorbent material, such as paper towels, to prevent splashing. • Decontaminate the area of the spill using an appropriate disinfectant, such as a solution of one part bleach to ten parts water. When pouring disinfectant over the area always pour gently and work from the edge of the spill towards the center to prevent the contamination from spreading out. Clean Up of Spills cont’d • Wait 10 minutes to ensure adequate decontamination, and then carefully wipe up the spilled material. • Be very alert for broken glass or sharps in or around the spill. • Disinfect all mops and cleaning tools after the job is done. • Dispose of all contaminated materials appropriately. • Wash your hands thoroughly with soap and water immediately after the clean up is complete. Recordkeeping • Medical records must be kept for each employee with occupational exposure for the duration of employment plus 30 years, must be confidential and must include name and social security number; hepatitis B vaccination status (including dates); results of any examinations, medical testing and follow-up procedures; a copy of the healthcare professional's written opinion; and a copy of information provided to the healthcare professional. Exposure Incidents • An exposure incident is an event resulting from the performance of an employee's duties in which there has been: A percutaneous injury involving a potentially contaminated needle or other sharp A splash of blood or other potentially infectious materials to the eyes, mouth, or mucous membranes Blood or other potentially infectious materials contacting broken skin Potential Exposure • An occupational exposure should always be considered an urgent medical concern to ensure timely postexposure management and administration of hepatitis B immune globulin (HBIG), hepatitis B vaccine, and/or HIV post-exposure prophylaxis (PEP). • If you are injured or exposed, tell your supervisor immediately. Your supervisor is responsible for reporting your injury correctly. Microorganisms • Disease causing organisms • Microscopic in nature • Can be part of the normal flora or pathogenic (able to cause disease) • Bacteria • Viruses • Fungi • Protozoa • Parasites Routes of Exposure • Bloodborne • HIV, HBV, HCV, syphilis • Airborne • TB, influenza, common cold, RSV, chickenpox • Droplet • Influenza, H1N1 flu, meningitis, measles, mumps, rubella, chickenpox (varicella) • Fecal-oral • HAV, food poisoning • Note: Multiple diseases could be airborne and/or droplet Disease Transmission Direct contact • Person to person • Physical transfer of microorganisms •Coughing, sneezing, kissing, sexual contact, contact with blood or body fluid Disease Transmission Indirect contact • Susceptible person infected from contact with contaminated surface • Person most likely brings contaminated hands to their face •Telephones, door knobs, steering wheels, B/P cuffs, EKG cable, handrails, pens •Via food products, water, soil Bloodborne Exposure • Direct or indirect contact with blood or infected body fluids • Needle stick • Splash on broken skin • Splash on mucous membranes • Eyes, nose, mouth Airborne Exposure • Particles remain suspended in air a long time and float a distance • At risk when less than 6 feet from patient • Transmitted via sneezing, coughing, talking, shedding of skin • Healthcare worker should wear a N95 mask • Patient should wear a tight fitting surgical mask • TB, polio, pneumonia, influenza, chicken pox Droplet Exposure • Droplet of moisture expelled from the upper respiratory tract and then inhaled into the respiratory system or contacts the mucous membranes • Droplets too heavy to remain airborne for long • Transmitted during sneezing, coughing, talking • Most at risk when within 3 feet of patient • Wear surgical masks when threat of droplet exposure • Common cold, influenza, H1N1, meningitis, rubeola (measles), whooping cough Fecal-oral Route • Ingestion of contaminated food or water • Contaminated hands (usually from improper handwashing or lack of handwashing) transfers microorganisms to all surfaces and objects touched • Recipient touches surface and then brings contaminated hands to their face or ingests contaminated product • HAV, food poisoning Factors Affecting Disease Transmission • Mode of entry • Intact skin an excellent barrier • Mucous membranes often the point of entry • Eyes, nose, mouth • Virulence • Organism strength (ability to infect) • HBV infectious for weeks • HIV die when exposed to air and light • Dose • Number of organisms • Host resistance – general health HIV • A fragile virus that attacks the immune system • Eventually leads to AIDS – a collection of signs and symptoms • Incubation is variable and can be in years • Transmission • Sexual contact • Contact with contaminated blood • Mother to newborn HIV cont’d • Signs & symptoms • Fatigue, fever, sore throat, lymphadenopathy, splenomegaly, rash, diarrhea, secondary infections, weight loss, dementia, psychosis • No vaccine • PPE – gloves, goggles, mask, gown as needed to avoid blood contamination • HIV rarely presents life threatening • Is more often a psychosocial challenge Hepatitis B (HBV) • Viral infection; can develop into chronic state; affects the liver • Incubation 4 - 25 weeks • Transmitted by direct contact with blood or body fluids • Complaints start as flu-like symptoms • Dark urine, light colored stools, fatigue, fever, jaundice • PPE’s – gloves, goggles, mask, avoidance of needlesticks Hepatitis B Virility • The CDC states that Hepatitis B Virus can survive for at least one week in dried blood on environmental surfaces or on contaminated instruments. Hepatitis B Vaccine • Highly effective means of protection from the virus • Must be offered within 10 days of assignment to task with exposure risk involved • If employee declines, must sign declination form • Kept on file • Employee may, at any time, request the hepatitis B vaccine after initial declination • 3 injection series • Given IM in deltoid • Once started, 2nd dose is in 1 month; 3rd dose 6 months from 1st dose Hepatitis C (HCV) • Viral infection causing inflammation of liver • Can lead to cirrhosis and cancer • Leading reason for liver transplants in the USA • Incubation 2-25 weeks • Transmission – contact with contaminated blood • Contagious throughout course of infection HCV cont’d • Symptom onset slow (up to 20 years for chronic infection) • Loss of appetite • Vague abdominal discomfort • Nausea and/or vomiting • Jaundice less common than with HBV • No vaccine is available • PPE’s – gloves, mask, goggles, avoidance of needle sticks Tuberculosis (TB) • Bacterial infection most commonly affecting the lungs • TB infection • Person has the bacteria but is not ill; cannot spread disease • TB disease • Person ill, can spread TB • Incubation 4 -12 weeks • Transmission via airborne droplet • Prolonged exposure increases risk TB cont’d • Signs and symptoms • Fever • Chills • Weakness. fatigue • Night sweats • Weight loss • Dyspnea • Productive cough • Chronic cough TB cont’d • PPE’s • Respiratory isolation • Tight fitting surgical mask on patient • N95 mask for providers • Obtain periodic skin testing • If positive, need chest x-ray • Provide adequate ventilation while caring for and transporting the patient with suspected or positive diagnosis Chickenpox (Varicella) • Viral infection • Transmitted via direct and indirect contact and airborne droplets • Incubation 10 - 21 days • Signs and symptoms • Sudden onset low-grade fever • Mild feeling of not being well (malaise) • Rash Chickenpox cont’d • Contagious about 2 days prior to rash and until all vesicles have scabbed over • Skin eruptions continue over 3 – 4 days • PPE’s – gloves; surgical mask on patient, mask on healthcare provider • Vaccination added to childhood immunization schedule Bacterial Meningitis • Bacterial infection causing inflammation of the covering the brain and spinal cord • Transmitted via contact with respiratory droplets • Incubation – 2 – 10 days • Sudden onset high fever, headache, stiff neck, nausea with vomiting, irritability •Infants – poor feeding, irritability Bacterial Meningitis cont’d • PPE’s – gloves, mask (patient and provider) • Vaccination provided in childhood immunization schedule • Postexposure antibiotic prophylaxis provided after exposure Influenza – The Flu • Upper respiratory viral disease • Transmitted via respiratory droplet or airborne in crowded, enclosed spaces • Incubation usually 1 – 5 days • Adults contagious 3 – 5 days after symptom onset • Up to 7 days in children • Rapid onset high fever, headache, muscle aches, sore throat, dry cough Flu cont’d • PPE – Mask the patient and provider • Frequent handwashing • Daily cleaning of environment • Phones, door handles, steering wheels, counter tops, computers • Best protection – annual flu vaccine H1N1 Influenza – Swine Flu • A new strain of influenza virus • Transmitted person to person primarily via droplets • Coughing • Sneezing • Contact with contaminated objects • Contaminated hands touch the nose and mouth and introduce the virus • Incubation could range 1 – 7 days • Considered contagious up to 7 days from symptom onset H1N1 cont’d • Symptoms similar to regular flu • • • • • • Fever Cough Sore throat Body aches Chills Fatigue • Critical situation • Respiratory difficulty • Cyanosis • Pain, pressure in chest or abdomen H1N1 cont’d • PPE • Gloves • HANDWASHING • Disinfecting surfaces after each call • Frequently disinfect surfaces likely to have hand contact General Advice • Get vaccinated • Cover mouth and nose when coughing or sneezing • Use elbow not hand • Throw tissue away after one use • Wash hands often • Avoid touching eyes, nose, mouth with hands • Practice good personal health • • • • Get plenty of rest Eat healthfully Manage stress Stay physically active 3 C’s To Stay Healthy •CLEAN – COVER – CONTAIN Wash your hands Cover your cough and sneeze Contain your germs •Stay home if sick Staph Infections • Staphylococcus aureus, often referred to simply as "staph," are bacteria commonly carried on the skin or in the nose of healthy people • Approximately 25% to 30% of the population is colonized (bacteria are present, but not causing an infection) in the nose with staph bacteria • One of the most common causes of skin infections in the United States • Most of these skin infections are minor (such as pimples and boils) and can be treated without antibiotics • Staph bacteria can also cause serious infections MRSA – Methicillin-Resistant Staphylococcus Aureus • Type of bacteria that is resistant to common antibiotics such as methicillin, oxacillin, penicillin and amoxicillin. • Consequently, MRSA infections can be far more difficult to treat quickly than traditional staph infections. • Occurs most frequently among persons in hospitals and healthcare facilities who have weakened immune systems. Community Associated MRSA • MRSA infections acquired by persons who have not been recently hospitalized or had a medical procedure (such as dialysis, surgery, catheters) are known as CA-MRSA (Community Associated MRSA) infections. • CA-MRSA infections can be transmitted in settings such as workout facilities or locker rooms • Are usually manifested as skin infections such as pimples and boils Transmission of MRSA • Spread of MRSA skin infections is direct and indirect Close skin-to-skin contact Cuts or abrasions Poor hygiene • Methods of Contraction Crowded living conditions Contaminated items or surfaces Weakened immune system
