osha-bloodborne pathogens & infection control …osha-bloodborne pathogens & infection...

OSHA-Bloodborne Pathogens & Infection Control Update

All Rights Protected for BCMS, Inc 1

OSHA Infection Control

&Bloodborne Pathogens

Mary R. Daulong, PT, CHC, CHPBusiness & Clinical Management Services

[email protected]

Part IISeptember 25, 2016

9/12/2016

Bloodborne Pathogens

Pathogenic organisms that are present in human blood and other potentially infectious materials and can cause diseases in humans

They include but are not limited to” Hepatitis B virus (HBV)

Hepatitis C virus (HCV)

Human immunodeficiency virus (HIV)

BCMS, Inc. All Rights Protected Current as of 9.11.2016

9/12/2016

Scope of Bloodborne Pathogen (BBP)

Standard

BBP applies to all employees/agents with potential occupational exposure to blood and other potential infectious materials (OPIM).




Occupational Exposure (OE)

OE means reasonably anticipated skin, eye, mucous membrane, or parenteral contact with blood or other potentially infectious materials (OPIM) that may result from the performance of an employee’s duties.


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Other Potentially Infectious Material (OPIM)

Includes but not limited to: Semen

Vaginal secretions

Saliva

Any bodily fluid visibly contaminated with blood


Contaminated

The presence or the reasonably anticipated presence of blood or OPIM on an item or surface




Exposure Control (EC) Plan

OSHA requires employers to have an EC that: Establishes engineering/work

practice controls

Specifies Personal Protective Equipment (PPE) to be used

Identifies job positions & training

Requires the utilization of Standard Precautions

Provides education & HBV vaccine opportunities


Standard Precautions

Applies to all patients

Applies to all contact with:

Blood

Body fluids

Secretions

Excretions, except sweat

Non-intact skin

Mucous membranes


Standard Precautions

For the purpose of this course “standard precautions” means that all patients’ blood, bodily fluids and other potentially infectious material (OPIM) are considered biohazards and treated as if known to be infected with HIV, HAV, HBV, HCV or other bloodborne pathogens.




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Why Use Standard Precautions?

Patients do not have to disclose if they have a bloodborne pathogen

HBV HCV HIV


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Exposure Determination (ED)

To carry out ED the employer must consider:

All job classifications in which all employees in those job classifications have occupational exposure.

Job classifications in which some employees have occupational exposure.

All tasks and procedures…in which occupational exposure occurs and that are performed by the above listed employees


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Exposure Incident Reports

OSHA requires the following information: Date & time

Job title/classification

Location of exposure

Activity being performed at the time of exposure

Training for the activity

Devices/equipment being used at the time of exposure

Preventive work practice controls used at the time of exposure

PPE being used at the time of exposure BCMS, Inc. All Rights Protected

Current as of 9.11.2016



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What Have You Touched?


Most Effective Tool!

The single most important measure to reduce the risk of infection is:

HANDWASHING for at least 20-30 seconds

9/12/2016 BCMS, Inc. All Rights Protected Current as of 9.11.2016

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Hand Washing Before & after donning and doffing gloves

Before, during, and after preparing food

Before eating food

Before and after caring for someone who is sick

Before and after treating a cut or wound

After using the toilet

After changing diapers or cleaning up a child who has used the toilet

After blowing your nose, coughing, or sneezing

After touching an animal, animal feed, or animal waste

After touching garbageBCMS, Inc. All Rights Protected




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THINK!


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Hand Washing Procedures

1. Wet hands with water, keeping hands lower than elbow

2. Apply soap (liquid soap dispensers vs. bar soap)

3. Use friction to clean between: Fingers, palms, back of hands, wrists,

forearms, under nails, and jewelry

4. Rinse under water

5. Use paper towel to dry hands & to turn off faucet


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Hand Sanitizing Procedure

1. Apply product to palm of one hand and rub hands together

2. Cover all surfaces of hands and fingers, until hands are dry.

3. Hand sanitizer may not be used when soil is visible and when patients have C. difficile bacteria.

4. After using the hand sanitizer 10-15 times wash hands




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Bloodborne PathogensExposure Barriers

Personal Protective Equipment (PPE)

Engineering & Work Practice Controls

Housekeeping Procedures

Education on OPIM and PPE Use


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Personal Protective Equipment (PPE)

Specialized clothing or equipment that is provided to and worn by an employee for protection against a hazard.

PPE shall be used where exposure remains after institution of engineering and work practice controls.

Employers shall provide appropriate PPE at no cost to the employee.


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Personal Protective Equipment

Gloves--disposable (sterile & non-sterile) and utility (re-useable)

Masks--surgical & N-95 ventilators

Gowns--impermeable- not patient gowns)

Eye wear--goggles, glasses, face shields, etc.

Resuscitation bags, pocket masks or other ventilation devices

NOTE: General work clothes ≠ PPE




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Engineering & Work Practice Controls

Handwashing Handwashing stations Hand sanitizing posts Sharps management & disposal

techniques Hazardous waste containers &

disposal vendors Eye wash stations Spill management & kits Area segregation/designation

(patient care/eating, etc.BCMS, Inc. All Rights Protected


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Housekeeping Practices

General public areas, kitchen/staff breakrooms, public and staff bathrooms, patient areas and patient equipment

Linen & laundry

Pest & rodent control

Housekeeping schedules by designated areas and frequencies


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General Guidance

Employers must develop and implement a written schedule for cleaning and decontamination of the worksite.

Cleaning schedule should be based on Location within the clinic

Type of surface to be cleaned

Type of soil present

Tasks or procedures being performed




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Regulated Waste

Biohazardous Waste Items that would release blood or other

potentially infectious materials in a liquid or semi-liquid state if compressed

Items that are caked with dried blood/body fluids

Contaminated sharps Pathological and microbiological wastes

containing blood or other potentially infectious material

NOTE: Dispose of in RED Biohazardous container


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What Should Go into a Biohazard Container?

Drapes, gauze or other absorbent material used to soak up blood or body fluids

Gloves contaminated with blood or body fluids (including fecal material)

Expired drugs (e.g. iontophoresis vials), control solutions and medications (excluding controlled prescription drugs—return to pharmacy)

Used urine specimen cups after the urine is discarded – preferably in the toilet.

Paper towels used to absorb blood or body fluids


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What Should Not Go into a Biohazard Container1?

Food wrappers

Beverage containers

Paper towels

Paper

Patient paper gowns or drapes

Tongue depressors

Gloves

1 Unless soiled with blood or OPIM including fecal material




9/12/2016 BCMS, Inc. All Rights Protected Current as of 9.11.2016

9/12/2016

Linen and Laundry

Keep clean linen separate from dirty linen

Label clean and dirty laundry bins; clean them regularly

Change linen between patients

Keep clean linen protected on shelves, in cabinets, etc.


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Cont. Linen and Laundry

Washing items contaminated with blood or body fluids:

Use bleach or EPA’s Registered Antimicrobial Products that are effective against mycobacterium tuberculosis, Human HIV-1 and Hepatitis B Virus

Items not contaminated:• Use detergent

• Warm water

• Hot dryer




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Hot Pack Covers & Cubicle Curtains

Hot pack covers Wash weekly for

high use Wash monthly for

light use As needed Do the ‘smell’ test

Cubicle Curtains Wash biannually As needed


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Dishes, Glasses, Mugs & Eating/Serving Utensils

The combination of hot water and detergents used in a dishwasher (DW) is sufficient to decontaminate; since you do not have a DW you should use disposables

The Do Not’s:

Do not use re-useable toweling– use single use paper towels

Do not use sponges or sponge handle tools

Do not use dish drainers

Do not stack re-usable containers/utensils on counters


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Refrigerators and Food

Keep employee food separate from patient supplies (not in same refrigerator)

Date all opened items

Post disposal dates

Keep refrigerator on a cleaning schedule

KEEP IT CLEAN!




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Environmental Cleaning

Clean and disinfect1 environmental surfaces & equipment per schedule by:

Visit Day

Week

Month

Quarter


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Appropriate Disinfectants

Household bleach (5%) NAOCI2) 1:10 ratio (do not use hot water…use warm water).

EPA registered disinfectants: use CDC recommended products that sanitize or disinfect at the HBV level.


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Handling of Sharps All healthcare workers must utilize and

activate safety devices for needles, if used. When possible use needleless devices.

All healthcare workers must routinely handle all sharps with extreme care.

When a percutaneous injury occurs due to a needle, scalpel or other sharp object, the puncture site must be washed immediately and reported.

Remember, any pointed object can become a sharp device!




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A Must---Visible & Accessible


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Regulated Waste

Other regulated wastes must be placed in containers that are:

Closable

Leak proof

Labeled or color codes

Closed prior to removal/transportation


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Spill Kit Contents(2) Imperious Gowns(2) N-95 Masks(2) Surgical Masks(2) Pair of Disposable Gloves(2) Pair of Utility Gloves(2) Pair of Shoe Covers(2) Pair of Eye Shields/Goggles(2) Red Bags(1) Container of Absorptive Material (litter)(1) Scoop(1) Roll of Paper Towels(1) Container of Decontaminate (hard surfaces)(1) Container of Decontaminate (porous surfaces)(1) Container of Hand Washing Substance (dry &/or liquid)




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Highly Contagious Diseases

Per the CDC: Tuberculosis. CDC helped reduce the number of cases of

tuberculosis in the U.S. from 25,103 in 1993 to 11,182 in 2010.

Flu. CDC identified the 2009 H1N1 virus. Our vaccine and rapid information campaign helped prevent 5-10 million infections, 150,000 hospitalizations, and 1,500 deaths in the U.S.

Cholera. CDC helped prevent 7,000 cholera deaths after the 2010 earthquake in Haiti.

Measles. The measles vaccine has saved 13.8 million lives from 2000–2012.

H7N9 Influenza A. New flu-like Middle East Respiratory Syndrome (MERS) and other emerging threats to human health keep coming and CDC must be ready.

Zika Virus. Mosquito-born virus, typically spread by an infected mosquito bite but has been discovered in urine & saliva.


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Hepatitis

Inflammation of the liver, which may be caused by a viral infection, poisons, or the use of alcohol or other drugs

Types of viral hepatitisA, B, C, D, E & G

Types of viral Bloodborne hepatitisB, C, D, G


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Hepatitis B Vaccination

Hepatitis B vaccination and post-exposure evaluation and follow-up including prophylaxis shall be:

Available to employees at a reasonable time and place at no cost to the employee

Performed by or under the supervision of a physician or healthcare professional

Provided according to current recommendation of the U. S. Public Health Service




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Cont. HB Vaccination

Must be made available:

After the employee has received the required training, AND

Within 10 days of the initial assignment for all employees with occupational exposure


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HV Vaccination Exceptions

The inoculation is not required if:

The employee has previously completed the complete HBV series, or

Immunity is confirmed through antibody testing, or

The vaccine is contraindicated for medical reasons


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HB Vaccine Miscellaneous Information

An HVB titer should be given 1-2 months after the 3 inoculation

Participation in prescreening (titer) is not required if an employee elects to receive the vaccine series.

HB vaccine series must be provided if the employee initially declines but later elects to receive it.

Employees must sign a statement when declining the HB vaccination series.

HBV boosters must be made available if recommended by USPHS.




HB Vaccination Tips Care should always be taken to

document vaccine lot, date, manufacturer, route, and vaccine dosage.

Post-vaccination testing results should also be documented, including the date serologic testing was performed.

Employees should maintain a personal copy of vaccinations.


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Hepatitis C Virus Hepatitis C is an infection of the liver

that results from the Hepatitis C virus. There is no vaccine for HBC.

Acute Hepatitis C refers to the first several months after someone is infected.

If any symptoms occur, they can include: fever, feeling tired, not wanting to eat, upset stomach, throwing up, dark urine, grey-colored stool, joint pain, and yellow skin and eyes.

Symptoms can take 2 to 6 months to develop.

There is no treatment available, currently but it can self-clear.


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Cont. Hepatitis C Virus

Chronic Hepatitis C if symptoms occur they can take decades to develop.

Over time, chronic Hepatitis C can cause serious health problems including liver disease, liver failure, and even liver cancer.

There is treatment available for HBC, but it is very expensive and many insurance companies only pay for the most seriously involved cases.




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Post Exposure & Follow-Up

Employees have rights that are detailed in the Environmental Health & Safety Manual… please acquaint yourselves with those policies & procedures.


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Human Immunodeficiency Virus

HIV is the virus that causes Acquired Immune Deficiencies Syndrome (AIDS)

AIDS is a serious condition that affects the body’s immune system i.e. the body’s natural ability to fight infection


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A Quick Update on the State of Diseases




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Multi Drug Resistant Organisms (MDRO)

MDRO’s are bacteria that have developed resistance to certain antibiotics a few examples are

MRSA - methicillin/oxacillin-resistant Staphylococcus aureus

MDR-TB- multidrug-resistant tuberculosis


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MDROMost MDROs are spread through direct contact, so it is important:

Utilize a 20-25 second hand wash Use hand sanitizer frequently Follow strict standard precautions Do not share equipment, dedicate to

patient e.g. individual mat, weights, therapy ball, etc.

Use PPE Clean equipment with germicidal before it

is used again Educate the patient and family membersMake sure the patient washes his/her

hands prior to therapyBCMS, Inc. All Rights Protected


Now the Test!!

Let’s look at those hands.




Biographical Information

Mary Daulong has a very diverse practice background which includes private practice ownership, corporate managed services and hospital based practice exceeding four decades. Her consulting company was established in 1985 and has been, for the past fifteen years, 100% dedicated to working with healthcare professionals in the areas of federal and state compliance, practice and business office operations, payment and coverage policy including billing, coding and documentation. Her company also provides Compliance Policies and Procedures Manuals specific to physical therapy and provider enrollment and credentialing services.

Mary has been certified in Health Care Compliance since 2002 and is a member of the Healthcare Compliance Association; she is also certified as a HIPAA Professional by the HIPAA Academy. She has been an active member of the APTA for over forty years during which she served on and/or chaired multiple committees at the national and component level. Mary was the chair of the Texas Physical Therapy Association’s Payment Policy Committee for ten years and held chairmanships for the TPTA of Governmental Affairs, Quality Assurance and Nominating Committees. She was appointed to the Texas Board of Physical Therapy Examiners and served on its Executive Council for PT and OT and Investigations Committee. Mary is a member of the Novitas Solution’s Provider Outreach Education Advisory Group.

Mary has presented hundreds of courses related to compliance both on a federal and state level often being the featured speaker at National, Chapter and Section Annual Conferences.

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9/12/2016

DISCLAIMER

These educational materials are current as of September 11, 2016. They have been prepared as tools to assist in teaching healthcare providers; they are not intended to create any rights, privileges, or benefits. Although every reasonable effort has been made to assure the accuracy of the information within these materials, the ultimate responsibility for complying with Federal and State laws lies with the provider of services.

Please note: These educational materials are summaries that explain certain aspects of federal laws, but are not legal documents. The official information is contained in the relevant laws and regulations.


BCMS, Inc. All Rights ProtectedCurrent as of 9.11.2016

Mary R. Daulong, PT, CHC, CHPBusiness & Clinical

Management Services, Inc.

15814 Champion Forest Drive# 240

[email protected]

www.bcmscomp.com

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