Blood-borne Pathogens, TB
and Universal Precautions
Objectives
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Blood-borne disease exposure
awareness
Self protective measures
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PPE
Exposure Training
Effective Infection Control
Introduction
Concerns about AIDS can make needle sticks, slips and spills
alarming if you work in healthcare. Yet AIDS isn’t the only
blood-borne threat you face. In fact, you are more likely to be
infected by the hepatitis B virus (HBV), which is just as deadly.
The Occupational Safety and Health Administration (OSHA) has
issued a standard that, if followed, is designed to protect you.
It details ways that you and Advanced Tissue can work together
to substantially reduce your risk of contracting a Blood-borne
disease. You are covered by the standard if it is reasonably
anticipated that you could be exposed to Blood-borne
pathogens as a result of performing your job duties.
Blood-Borne Diseases
Blood-borne diseases that you are more
prone to be exposed to include non-A
hepatitis, non-B hepatitis and delta
hepatitis, as well as syphilis, malaria
and Human Immunodeficiency Virus.
The two most significant are hepatitis B
(HBV) and Human Immunodeficiency
Virus (HIV).
HBV
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Hepatitis means “inflammation of the liver”. Hepatitis B virus
(HBV) is a major infectious Blood-borne hazard you face. It
infects approximately 9000 healthcare workers a year, resulting
in more than 400 hospitalizations and 200 deaths. If you
become infected with HBV:
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You may suffer from flu-like symptoms becoming so severe that
you may require hospitalization.
You may feel no symptoms at all, feeling as if you were not
infected.
Your blood, saliva and other body fluids may be infectious.
You may spread the virus to sexual partners, family members and
even unborn infants.
HBV may severely damage your liver, leading to cirrhosis and
almost certain death.
HIV
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The Human Immunodeficiency Virus (HIV) attacks the body’s
immune system, causing the disease knows as AIDS, or
Acquired Immune Deficiency Syndrome. Currently, there is no
vaccine to prevent infection. A person infected with HIV:
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May carry the virus without developing symptoms for several years.
Will eventually develop AIDS.
May suffer from flu-like symptoms, fever, diarrhea and fatigue.
May develop AIDS-related illnesses including neurological
problems, cancer and other opportunistic infections.
HIV is transmitted primarily through sexual contact, but may
also be transmitted through contact with blood and some body
fluids. HIV is not transmitted by touching, feeding or working
around anyone who carries the disease.
Workplace Transmission
HBV, HIV and other pathogens may be
present in:
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Body fluids such as saliva and any other
body fluid visibly contaminated with blood.
Means of Transmission
Blood-borne pathogens may enter your body and infect
you through a variety of means, including:
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An accidental injury by any sharp object,
contaminated with infectious material, which can
pierce, puncture or cut your skin.
Open cuts, nicks and skin abrasions, even dermatitis
and acne, as well as the mucous membranes of your
mouth, eyes or nose.
Indirect transmission, such as touching a
contaminated object or surface and transferring the
infectious material to your mouth, eyes, nose or open
skin.
Means of Transmission (cont’d.)
Contaminated Surfaces
Contaminated environmental surfaces are a major
mode of HBV spread. HBV can survive on
environmental surfaces dried and at room
temperatures for at least one week. Surfaces and
objects can be heavily contaminated without visible
signs. Clean and decontaminate all surfaces that had
contact with potentially infectious materials with
appropriate disinfectants. Refer to policy HME-IC-C-1
on cleaning and disinfecting and policy HME-IC-E-1
on product management and universal precaution.
Exposure Control Plan
The risks of Blood-borne diseases in the work
place are quite serious. Yet you can learn
effective ways of minimizing them. A good
place to start is with Advanced Tissue’s
Infection Control policies. They cover:
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Identification of employees covered by the
standard.
Specific measures to take and that will be taken
by Advanced Tissue to minimize your risk of
exposure.
Procedures to follow if there is an exposure
incident.
Universal Precautions
You cannot tell for sure who carries a Blood-borne pathogen.
HIV and HBV infect people of all ages and socioeconomic
classes are from every state and territory. They are from rural
areas as well as cities.
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Many people carry Blood-borne infections without visible
symptoms.
Many people carry Blood-borne infections without even knowing it.
You must treat all human blood and human body fluids as if they
are infected with HIV, HBV, or other Blood-borne pathogens.
You can’t identify every patient who may transmit infection. Yet
you can’t afford not to, since it takes just one exposure to
become infected. Universal precautions resolve this uncertainty
by requiring you to treat all human body fluids as if they are
infected with HIV, HBV or other Blood-borne pathogens.
Reducing Your Risk
There are five major ways to reduce your risk of
exposure to Blood-borne pathogens on the job:
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Engineering controls
Employee work practices
Personal protective equipment
Housekeeping
Hepatitis B Vaccine
Alone, none of these approaches are 100% effective.
They must be used together, like five protective
barriers against infection.
Engineering Controls
These are physical or mechanical
systems Advanced Tissue provides to
eliminate hazards at their sources.
Examples would be the isolation or
removal of Blood-borne pathogen
hazards from the workplace.
Work Practice Controls
There are specific procedures you must
follow to reduce your exposure to
Blood-borne pathogens or infectious
materials.
Hand washing
If infectious material gets on your hands, the sooner
you wash it off, the less chance you have of
becoming infected.
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Hand washing keeps you from transferring contamination
from your hands to other areas of your body or other
surfaces you may contact later.
Every time you remove your gloves, you must wash your
hands with non-abrasive soap and running water as soon as
you possible can.
If skin or mucous membranes come in direct contact with
blood, wash or flush with water as soon as possible.
Hand-hygiene technique
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When decontaminating hands with an alcohol-based hand rub, apply product to
palm of one hand and rub hands together, covering all surfaces of hands and
fingers, until hands are dry. Follow the manufacturer's recommendations
regarding the volume of product to use.
When washing hands with soap and water, wet hands first with water, apply an
amount of product recommended by the manufacturer to hands, and rub hands
together vigorously for at least 15 seconds, covering all surfaces of the hands
and fingers. Rinse hands with water and dry thoroughly with a disposable towel.
Use towel to turn off the faucet. Avoid using hot water, because repeated
exposure to hot water may increase the risk of dermatitis.
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Liquid forms of plain soap are acceptable when washing hands with a nonantimicrobial soap and water..
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Multiple-use cloth towels of the hanging or roll type are not recommended.
Personal Protective Equipment
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Equipment that protects you from contact with
potentially infectious materials may include gloves,
masks, gowns, aprons, face shields, and protective
eye wear.
Under normal work conditions, protective equipment
must not allow potentially infectious materials to
contact your work clothes, street clothes,
undergarments, skin or mucous membranes. The
type of protective equipment appropriate for a given
task depends on the degree of exposure you
anticipate.
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Hazard: Generation of splashes, spray,
spatter or droplets of infectious material
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Protection: Mask, gloves, eye protection,
gown and face shield
Hazard: Potential clothing or skin
exposure
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Protection: Gown, gloves, apron and
other protective body clothing
If your job requires you to be exposed to Bloodborne pathogens, Advanced Tissue will:
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Provide appropriate protective
equipment.
Clean, launder, repair, replace or
dispose of protective equipment.
General Rules on Personal Protective
Equipment (PPE)
You and Advanced Tissue must follow these rules to ensure that your protective equipment does
its job.
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You must be trained to use the PPE properly.
PPE must be appropriate for the task.
You must use appropriate PPE each time you perform a
task.
Your PPE must be free of physical flaws that could
compromise safety.
Your gloves must fit properly.
When wearing PPE, if it is penetrated by blood or other
potentially infectious materials, remove it as soon as
feasible.
Before leaving the work area, remove all PPE and place
it in the designated container for disposal.
Gloves
Gloves are the most widely used
form of PPE. They act as a primary
barrier between your hands and
Blood-borne pathogens. Latex or
vinyl gloves are used for medical,
dental or laboratory procedures.
Heavy duty utility gloves may be
used for housekeeping duties.
Gloves
Here’s how to use them:
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You must wear gloves when you anticipate hand contact
with blood, potentially infectious materials, mucous
membranes or non-intact skin.
Advanced Tissue will provides hypoallergenic gloves.
Since gloves can be torn or punctured, bandage any cuts
before being gloved.
Replace disposable single-use gloves as soon as possible
if contaminated, torn, punctured or damaged in any
way. Never wash or decontaminate for reuse.
Utility gloves may be decontaminated and reused unless
they are cracked, peeling, torn, punctured or no longer
providing barrier protection.
Glove Removal
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You must follow a safe procedure for glove
removal, being careful that no substances from
the soiled gloves contact your hands:
With both hands gloved, peel the first glove from the
inside, tucking the first glove inside the second.
With the exposed hand, peel the second glove from
the inside, tucking the first glove inside the second.
Dispose of the entire bundle promptly.
Remove gloves when they become contaminated,
damaged or before leaving the work area.
Wash your hands thoroughly.
Good Housekeeping
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Do not pick up broken glass, which may be
contaminated, directly with gloved or bare
hands. Use tongs or a brush and a dust pan.
Place contaminated sharps and infectious
wastes in designated containers. They
should be labeled or color-coded, leak-proof
containers that are closable and easily
accessible to those who use them. Do not
allow containers to overfill.
Read the Label
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These warning signs protect you from
Blood-borne hazards:
Bags or containers bearing the “DIRTY”
or biohazard sign tell you when the
containers hold blood or other
potentially infectious materials.
Warning labels are also used to
designate contaminated products.
HBV Vaccination
If you may be exposed to HBV on the job, your
employer will make the hepatitis B vaccination
available to you at no cost. The vaccine is
administered by three injections over a six month
period. Today’s vaccines are safe and effective.
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Those now used in the US are made from yeast and cannot
be infected with HIV or other Blood-borne pathogens. Over
2 million US healthcare workers have already been
vaccinated.
The complete series of HBV vaccinations is 85 to 97 percent
effective at protecting you from getting the disease or
becoming a carrier for nine years or longer.
HBV Vaccination
You should not be vaccinated if:
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You have already received the complete
hepatitis B vaccination series
Antibody testing reveals you are immune
You should not receive the vaccination for
other specific medical reasons
Facts about TB
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“TB” is short for a disease called tuberculosis. Unlike the Blood-borne diseases we
have discussed, tuberculosis is spread by tiny germs that are dispersed into the air
when a person with tuberculosis disease of the lungs or throat coughs, sneezes,
shouts or sings. Because the germ is spread by these airborne particles, a person
who shares the same airspace with a person who has infectious TB disease (such
as a home health care provider for such an infectious person) is at risk for
infection. They get the infection by inhaling these germs into their lungs where
they can become established and spread throughout the body. The TB germ can
live in your body without making you sick. This is called a TB infection. Your
immune system traps TB germs so that they will not spread and make you sick.
But sometimes, the TB germs can break away, spread and cause TB disease. The
germs can then attack the lungs and other parts of the body. They can go to the
kidneys, brain, or spine. If anyone has TB disease, they need medical help. If
they don’t get help, they can die.
If you have TB disease, you may feel week, lose your appetite, lose weight, have a
fever, or sweat a lot at night. If the TB disease is in your lungs, you may cough a
lot, cough up mucous or phlegm, cough up blood, or have chest pain when you
cough. You should always cover your mouth when you cough. If you get TB
disease in another part of the body, the symptoms will be different. Only a doctor
can tell if you have TB disease.
TB Infection Control
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The key to preventing the spread of TB is early detection,
isolation and treatment of persons with infectious TB.
Precautions must be taken to prevent the airborne transmission
of the disease as soon as TB is suspected.
Personnel entering a shared airspace with a patient having
suspected or confirmed active infectious TB disease must take
precautions to protect themselves from infection. In addition to
standard universal precautions, staff members must don a
NIOSH N95 approved respirator to meet OSHA requirements
and CDC guidelines for TB exposure control, before entering the
patient’s client’s home and will not remove the respirator until
after exiting the patient’s home. This respirator will prevent
from inhaling TB germs.
How do I know if I have
TB infection or TB disease?
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All direct patient care personnel must have an annual TB skin test. All direct
patient care personnel who do not have documentation of previous TB testing
must undergo a two part testing procedure, the first time and then annually
thereafter. A skin test is the only way to tell if you have a TB infection. The test
is “positive” if a bump the size of a pencil eraser or bigger appears on the arm.
This bump means you probably have TB infection.
Other tests can be done to show if you have TB disease. All direct patient care
personnel who have a positive skin test must have a chest x-ray done every five
years and the x-ray interpretation must be kept in the employee’s medical file.
TB germs may be deep inside your lungs. Phlegm that you cough up will be
tested in a laboratory to see if the TB germs are present in your lungs.
If the TB germs are in your lungs and throat, you can give the TB infection to
your family, friends, co-workers and patients / clients. They, in turn, can get
sick with TB disease. If you ever get TB disease, you may have to be separated
from other people until you can’t spread TB germs. This probably won’t be for
very long, if you take your medicine as prescribed.
Can TB disease be cured?
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Yes! TB can be cured by using special drugs that kill
TB germs. But TB germs are strong. It takes at
least six to nine months of medication to wipe them
all out. It is very important that you take all of your
medicine.
If you stop taking your medicine too soon, it is a big
problem. The TB germs that are still alive become
even stronger. You may even need stronger drugs to
kill these “super” TB germs. This doesn’t need to
happen. If you take all of your medicine, the TB
germs will die. A few people have side effects to
anti-TB drugs. You will get tests to check on this.
TB Reporting
Reporting of TB is required by law in all 50
states. All new and suspected TB cases are
reported to the appropriate health
department immediately.
Playing It Safe
Additional facts you should know:
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If you are exposed due to direct patient care, report the
incident immediately to your supervisor.
If you consent, Advanced Tissue will provide you with a
confidential medical evaluation, including blood tests, any
available post-exposure preventive treatment and follow-up
counseling.
Advanced Tissue will provide you with a free training program
during working hours and annually thereafter.
Training tells you more about Blood-borne diseases, how to use
PPE and how to report an exposure incident. It also details
your rights and responsibilities as a worker.
Rise to the Challenge
It is possible to protect yourself from
Blood-borne pathogens on the job by
knowing the facts and taking proper
precautions. Working together with
Advanced Tissue , you can do it. As a
healthcare worker, you can be confident
in your ability to safely care for the
well-being of others and yourself.