Bloodborne Pathogens & TB
Annual refresher Training Program 2011
1
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OSHA requirement….
 Refresher training must cover topics listed in the
standard to the extent needed and must emphasize
new information or procedures
Comp. Dir., pg. 61
2
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Discuss common citations and current exposure
statistics

Review some infection control concepts.

Review updated information on infectious diseases

Discuss basic safety protection measures to keep you
safe

Explain what to do and what will happen if you get an
exposure.
3
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Failure to update Exposure
Control Pan annually
Failure to have a sharps injury
log
Failure to have an Exposure
Control Plan
Failure to use engineering /work
practice controls.
Failure to document
consideration and
implementation of safety
medical devices to reduce
exposure risk





Failure to have vaccine
declination forms
Failure to offer training at no
cost and during work hours.
Failure to offer hepatitis B
vaccine to at risk employees and
post-exposure follow up.
Failure to have an
implementation schedule for the
Exposure Control Plan.
Failure to discard sharps into
sharps containers as close as
possible to site of use.
OSHA Jan. 2010
4
National
 AIDS – NA
 Hepatitis B – 3,022
 Hepatitis C – 652
 Syphilis – 12,833
 TB – 11,540
 WNV- 663
Virginia






AIDS – 698
Hepatitis B – 130
Hepatitis C – 8
Syphilis –789
TB – 292
WNV- 0
CDC, 4/2010
5
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AIDS – 184 (117 living)

Hepatitis B – 37

Hepatitis C – 53

Syphilis – 7

TB – 15

WNV- 0

Lyme – 203 (Not BBP)
6
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


Measles cases – 74
Mumps – 1,991
Pertussis (whooping cough) – 16,858
Chickenpox – 20,480
August 19, 2010
8

Ryan White
Notification Law - is
back!

Now listed under Part G
9

“Remains current with the latest information
and scientific knowledge pertaining to
bloodborne pathogens”

LCFR Exposure Control Plan has been revised.
Found on the LCFR website.
Paragraph ©(1)(iv), CPL 2-2.69, OSHA
10

A disease is an illness caused by a microorganism, also
known as a pathogen.

An infection is the growth of an organism in a host.

A communicable disease is an infectious organism that
can pass readily from person to person.
Therefore, all diseases are infectious, but not all
diseases are communicable.
11
Virulence
Dose
Organism
Mode of Entry
Host Resistance
12
13


Primary Risk
 Blood
 Semen
 Vaginal Secretions
Secondary Risk






Synovial Fluid
Pericardial Fluid
Pleural Fluid
Amniotic Fluid
Cerebrospinal Fluid
Any other body fluid
containing visible blood
“O.P.I.M.”
14
Tears, sweat, urine, stool,
vomitus, nasal secretions,
and sputum do not pose a
risk unless they contain
visible blood!
15
NOT AN EXPOSURE




Blood on intact skin
Vomit on your face
Urine on your skin
Patient coughs in the
ambulance.
AN EXPOSURE



Blood on broken skin
Vomit (with visible blood in
it) in your eyes
Blood coughed in eyes
and/or mouth while
suctioning
16
17
18

0.4%
CDC, September, 2008
19

Offers protection via “immunologic memory”

There is NO formal requirement or
recommendation for a booster
CDC, 1992,1997, June 29, 2001
20

If titer was never performed, DO NOT go back
and do one

Titer would be done if an exposure occurs

Once you have a positive titer, you never have to
titer test again even if an exposure occurs
•CDC, 1997, June 29, 2001
21
Incident rate continues to
decline

Rate in US- 1.3%
•September, 2008
22
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

Contamination of multi-use vials
Reuse of syringes
Needle-sharing use by HCWs
Miriam Alter, MD, HIC, May 2010
23

15% - 20% of acute infections
 Sexual exposure
24

Risk for contracting
HCV from a
contaminated sharps
injury
 Down to 1.5%
25

If you are exposed to a hepatitis C positive
patient, you should have a blood test in 4- 6
weeks

HCV-RNA (blood test)
 Cost - $65.00
26

If only slight liver abnormalities, treatment
may not be needed
Mayo Clinic, 2009
27

There is no recommendation for the routine
screening of healthcare workers

Hepatitis C is not efficiently transmitted
occupationally
• AJIC, 1999, Vol.. 27 (1):54-55
• CDC, 1998, CDC, 6/29/01
28

HCV testing of the source patient

HCV testing of the employee
(ALT, if patient positive HCV-RNA 4-6 weeks)
• CDC, June 29, 2001
29
30

1978 - December 2006

57 documented cases
▪ 0 in fire/EMS personnel
▪ 24 Nurses
▪ 18 Lab Techs
▪ 49 were sharps related exposures
•HIV/AIDS Surveillance Report
31

OSHA states that “an employers failure to
use rapid HIV testing when testing is required
by paragraph (f) (3)(ii)(A) would usually be
considered a violation of that provision”
OSHA Letter, July 21, 2006
32
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California
Illinois
Iowa
Louisiana
Maine
Maryland

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
New Hampshire
New Mexico
North Carolina
North Dakota
Rhode Island
Virginia
33

If source patient is negative with rapid testing = no
further testing of health-care worker

Use of rapid testing will prevent staff from being
placed on toxic drugs for even a short period of time
•CDC, May , 1998, CDC June 29, 2001, September 2005
34
35

Follow target populations

Immigrant screening

Active involvement in global efforts
36

75% of cases
 California
 New York
 Illinois
 Texas
 Florida
 Georgia
 New Jersey
37

Foreign Born

Children

Inmates

HIV Positive

Homeless
CDC, MMWR, November 4, 2005
38

The Commonwealth of Virginia identified 245
confirmed cases of active TB disease.
 Correction facilities poses as a large risk to
employees, inmates and surrounding communities

21 TB cases in Loudoun County
39

With drug treatment 10% become noninfectious
 2 days after start of drugs
 14 days 100% become non-infectious
• CDC, MMWR, Nov. 4, 2005
40

HIPPA permits disclosure of TB information
within health care community.
41

Mask patient with a surgical mask

EMS risk is low
Dr. Jensen, CDC personal communication with K. West, Jan. 25, 2006
42

TB
 Initial and annual
 OSHA 1910.134

Exemption for fit testing N95- Emergency
Escape
43

QuantiFERON (QFT-Gold)
 Blood test for latent TB infection
 This test is being performed during County
physicals
CDC, December 16, 2005
44

OSHA 1996 Enforcement Directive still in effect
 Writing a new one

OSHA enforcement – CDC 2005 TB Guidelines
45
46

Airborne virus transmitted by droplet contact

Respiratory tract infection caused by the influenza virus.

Fever, cough, sore throat, runny nose, muscle aches, extreme
fatigue are common. (Clear up in 1 to 2 weeks)

20,000 deaths nationwide and more than 100,000
hospitalizations, annually.

The elderly and people with chronic health problems are much
more likely
47

EMS to receive vaccine as – High Risk

“Direct patient care”

Signed Declination form must be kept on file
if vaccination declined.
48

For healthy persons ages 5 - 49
49

Incubation period: 2-8 days

No rapid human to human cases
50

Human Cases
 Fever, cough, sore throat
 Muscle aches
 Eye infections
 Bloody diarrhea
 Pneumonia (antibiotics not effective)
 Respiratory Distress, 4-13 days after onset
51

Virus deep in the lungs

Not spread via coughing or sneezing

Droplet transmission – not airborne
CDC, March 2006
52

Surgical mask on the patient

Droplet transmission
CDC, pandemicflu.gov DHHS
53

Planning
 Family
 Work
▪ Pandemicflu.gov


Participate in annual flu vaccine program
During patient care, travel history on patient
assessment
 Should be done on anyone with trouble breathing
54

In production

Tested against Avian Flu in humans
 Not effective in 50%
 Requires a higher dose
55

FDA –
 Monitor for signs of
behavioral changes
▪ Delirium
▪ Hallucinations
▪ Other psychotic behavior
FDA, November, 2006
56
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If you have signs or symptoms stay home

Do not come to work and get others sick
57
58

Continue to rise in the U.S.

Post exposure follow up if source is HIV
positive or Hepatitis C positive

Low risk
59
California
New York
Texas
Florida
60

Update plan to eliminate syphilis by 2015
61
62

Communicable – Mosquito to person
 Blood transfusion
 organ donation
 In utero
 Sharps injury

“Incubation” = 3 – 14 days

Infectious – not transmitted person to person
63


Cases have moved westward
Highest Cases
 Colorado
 Texas
 Nebraska
 Illinois
64
65
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Methicillin-resistant staphaureus (MRSA)

Caused more than 94,000 life-threatening infections and nearly 19,000
deaths in 2005

Most associated with healthcare settings

Most frequent among people with weakened immune systems
66

Clusters among athletes, military
recruits, children, prisoners

May live on surfaces contaminated
with body fluids containing MRSA

Treated with antibiotic and/or
having your doctor drain the
infection
67
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Skin-to-skin contact
Crowded conditions
Poor hygiene
Sharing of Personal Items
68
69
70

Vaccine – Menactra
 11 -17 year old
 High School
 College freshmen entering dorm living
 Military recruits
 Microbiologists working with N. meningitides
CDC, MMWR, May 27, 2005
71



Close contacts/household members
Child-care contacts
Persons in direct contact with patient oral
secretions
 Kissing
 Mouth-to-mouth resuscitation
 Endotracheal intubation/tube management
 Prolonged contact – flight lasting > 8 hours
CDC, MMWR, May 27, 2006
72
73

CDC Guidelines
 Work Restrictions
 Immunizations/Vaccinations
 Post exposure
74
CDC defines: Health care personnel
All paid and unpaid persons working in health care
settings who have the potential for exposure to
infectious materials, including body substances,
contaminated medical supplies and equipment,
contaminated environmental surfaces or contaminated
air
75

MMR

Tdap

Chickenpox vaccine

Flu Vaccine

Hepatitis B vaccine
76
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
100 Health Care Workers infected
Immunity
 History of physician diagnosis
 Receipt of at least 1 dose of mumps vaccine
 Positive mumps IgG
77
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Within 3 feet of infected person

No surgical mask used
78
2 doses needed for coverage
1 dose = 80% protection
CDC, 2006
79

Must exclude from work 13th -26th day

Vaccine cannot be used post exposure
80

Standard Precautions

No procedure changes-just change in name
81

BSI – aka Standard Precautions

Good hand washing

NRB or Surgical mask on the patient

Protective eyewear

N-95 respirator for care provider
82
83
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Hand washing  after touching blood/body fluids/contaminated objects
 after glove removal
 Provide 15 sec. of friction
▪ DO NOT squeeze the site to express blood
84

No antibacterial soap

Alcohol based foam
or gel

No artificial nails or
extensions
• CDC, October,2002
85

Practical and feasible Gloves must be used when there is reasonable
anticipation of contact with contaminated surfaces or
when performing vascular access procedures, direct
contact with patient mucous membranes or non- intact
skin
86

CDC  Avoiding latex remains the cornerstone for eliminating
latex sensitivity- 1997
 8% -12% health care workers have latex related
health problems- April 2003
87

Mask Use - Eye
Protection
 For procedures that may
generate splash/splatter
of blood/body fluids
88

Surgical mask
 Filters what goes out

Respirator
 Filters what comes in
 Never put a
respirator on a
patient
89
Genie™ safety
Lancets
Baxa Multi-dose vial adapters
Filter Straws
Micro Pin Blunt cannula
90

If Source patient tests Positive
 HIV antibody
 Hepatitis C antibody
 Hepatitis B titer if not on file as a positive
91

When there is exposure to blood as the result
of a human bite
 The source is the patient bitten
 The biter is monitored and treated as needed
92
 Wash site with soap and water
 Seek medical attention if needed
 Contact dispatch and advise them to have the
ICO to contact you
 Advise receiving facility of exposure incident
93

Hospital grade EPA disinfectant

Bleach solutions
 Change every 24 hours
 1:100 for general areas or patient contact items
94

Per OSHA, the medical facility must either
clean the equipment or bag for pick up and
safe handling/transport

OSHA Letter October 4, 2000
95

Passed by Congress March, 2000

Requires OSHA update the bloodborne
pathogens standard

Requires employee input to evaluation and
selection of devices
96

2001 –
 50% fewer injuries than in 1993
 Phlebotomy – 70% decrease
 IV cath – 55% decrease
EpiNet 2003

There continues to be a decline on sharp injuries

Not in Loudoun County!!!
97
HIV = 0.3 %
Remember!
A glove cleans
the needle as it
punctures it – by 50%!
HBV = 6 - 30%
HCV = 1.8%
98

Reminder –
 Glass is considered a sharp
▪ Glass blood tubes
▪ Capillary tubes

These should not be used
99

Now all contaminated sharps injuries must
be listed on the OSHA 300 log

Splash/splatter events with blood/OPIM
must be recorded

Sharps are the #1 way personnel are exposed
January 18, 2001
100

Employee name

Brand of device used

Where incident happened

How incident happened

Does NOT go to OSHA
Note: If you get a sharp injury, you must complete Sharp
Injury Description Form –
101
102

Don’t Panic…did you really get exposed?

Clean the site with soap and water as soon as possible.

Contact LCFR – ECC and have the Infection Control Officer
notified as soon as possible.

Notify the receiving health care facility of the exposure.

Do not provide your personal insurance information
103

The ICO will discuss your exposure with you
and provide you with additional instructions.

Follow-up procedures may be required.

All information pertaining to your exposure
incident will be keep confidential.
104

If the source patient is identified and tested,
there is no need to draw bloods on employee.

If source patient tests are positive, then
follow up will be done.
105


All exposure forms, procedures to follow and
Exposure Control plan can be found on the
County web site:
www.Loudoun.gov
106
Link from
Home page to
Infection
Control
Procedures
and Forms
107


Complete the “Good Samaritan Handout” at
scene.
If unable to locate form, provide the Infection
Control Officer the following:
 Good Samaritan’s name
 Contact information
 Unit # the patient was transported by
 Incident # and Patient #
 Name of facility patient was transported to
108

Designated Infection Control Officer –
 Deputy Chief Jose Salazar

Back up Infection Control Officers –
 Battalion Chief Tim Menzenwerth
 Captain Mike Mahoney
 Captain Daniel Neal
109

Bed Bugs
While not a BB or AB pathogen, there has been a rising concern…
110

No evidence that bed bugs are involved in the
transmission of any disease agent.

Proper cleaning/disinfection as done after
any call must be followed.

If presence of bed bugs is confirmed, follow
additional steps…
111

Clothing:
 Wash clothes in hot water,
 Dry at high setting
 Soak delicate clothes in warm water with lots of
detergent for several hours before rinsing.
 Wool items, shoes and many other items can be
placed in hot dryer for 30 minutes
112

Equipment/Bags
 Loosely placed in a large sealable plastic bag.
 Place bag in direct sunlight for several hours.
 Temperature in bag must reach 120 F.
 Thermometer should be used to insure proper
temperature is reached.
113

Clean out vehicle of any debris

Vacuum patient area to include bench, seats,
action area, and compartments

Mop/clean floors with hot water
114
115
116

Discussed common citations and current exposure statistics

Reviewed some infection control concepts.

Reviewed updated information on infectious diseases.

Discussed basic safety protection measures to keep you safe

Explained what to do and what will happen if you get an exposure.

Provided information about bed bugs.
117
118