Protecting Employees from Bloodborne Pathogens:

Module 1

Course Objectives

After completion of Module 1 of this course, attendees should be able to:

Describe three bloodborne diseases: HIV, hepatitis B, and hepatitis C

Review occupational risks for exposure to bloodborne diseases

Discuss how germs can enter the body Describe the risk of getting an infection if exposed to a

bloodborne disease

The Facts

Anyone, regardless of age, race, or socioeconomic status, can carry a disease in his or her blood or body fluids. Often, without knowing it.

However, the risk of getting a disease can be decreased with a few basic steps that will be discussed in this training.

By definition, ALFs are non-medical facilities that provide assistance with activities of daily living.

By design, ALFs provide unique services to residents who want to live as independently as possible for as long as possible.

Some of these services may involve contact with blood or body fluids that have the ability to spread disease.

Assisted Living Facilities (ALFs)

Daily Tasks May Contain Some Risk

Daily tasks in the healthcare or residential setting pose some risk of exposure to germs. Assisting with bathing or oral care Handling incontinence pads, linens, and

contaminated trash Cleaning rooms, common areas, and equipment

Occasionally, these tasks may involve exposure to germs found in the blood or body fluids (bloodborne pathogens).

Tasks Related to Direct Resident Care That Pose More Risk for Exposure to Germs Found in Blood or Body Fluids

Assisting with wound care Monitoring blood glucose Giving an injection of medication Cleaning blood/body fluid spills Helping with nail or skin care Providing first aid such as managing nose bleeds or

abrasions

Bloodborne Pathogens

Germs that are carried in the blood and can be transmitted by contact with infected blood or body fluids are called bloodborne pathogens. The most common types include the following viruses:

Hepatitis B Hepatitis C HIV

Hepatitis B

Serious liver disease that can cause cirrhosis or cancer

18,800 new infections in US in 2011 (estimated)

Most cases resolve– ~10% of adult cases can be chronic

800,000 - 1.4 million chronically infected– Testing recommendations to identify persons with chronic

HBV infection: http://www.cdc.gov/hepatitis/HBV/TestingChronic.htm

30% of people infected don’t have symptoms

Hepatitis B

Symptoms include loss of appetite, fatigue, jaundice (yellowing of the skin), abdominal pain, and nausea

Can be prevented by vaccination

Workers in healthcare and residential settings are at increased risk

Treatment available to keep the virus under control

Hepatitis C

Serious liver disease that can lead to cirrhosis or liver failure

16,500 new infections in 2011 (estimated) Chronic infection: 75-85% of cases

– 2.7-3.9 million chronically infected (estimated) 70-80% of people do not have any symptoms.

– Many people do not have symptoms for 20 years after first infected.

– When symptoms do occur, they are similar to those of hepatitis B virus.

Hepatitis C

Increased risk for liver cancer

60-70% of cases develop chronic liver disease

Treatment available to keep the virus under control

No vaccine available

Testing recommended for persons born from 1945 through 1965– Other CDC testing recommendations:

http://www.cdc.gov/hepatitis/HCV/GuidelinesC.htm

HIV

Disease that causes the immune system to lose its ability to fight infection

1.15 million infected (~18% undiagnosed) Some people progress to Acquired

Immunodeficiency Syndrome (AIDS) Symptoms vary; initial infection may

cause flu-like illness Medications available to treat illness, but

there is no cure or vaccine Testing recommendations:

http://www.cdc.gov/hiv/basics/testing.html

Transmission (How Diseases are Spread)

Bloodborne pathogens are spread by contact with blood or other potential infectious materials such as: Saliva Semen and vaginal fluids Normally sterile fluids (body sites)

– Cerebrospinal fluid (spinal cord)– Synovial (joint) and pleural fluid (lung)– Peritoneal (abdominal), pericardial (heart), and amniotic

fluid (uterus)

In Other Words…

Blood can be present with nearly any human bodily fluid.

If it’s warm, wet, and not yours,

DON’T TOUCH IT without wearing gloves and any other appropriate

types of personal protective equipment!

How Bloodborne Pathogens Are NOT Spread

Bloodborne pathogens such as HBV, HCV, and HIV are not spread by many common behaviors that may occur in the assisted living setting, including:– Hugging– Holding or shaking hands– Coughing – Sneezing– Using the same toilet seat

Needles Broken glass (broken blood tubes) Non-intact skin exposure through cuts, skin

abrasions, and mucous membranes of mouth, eyes and nose– Includes human bites, splashes or sprays of blood/body

fluids Touching your mouth, eyes, nose or open skin

after touching surfaces or equipment contaminated with blood or contaminated body fluids

How Germs Can Enter Your Body

Your Risk For Getting An Infection from Blood or Body Fluids

Depends on: The germ involved How you are exposed The amount of germ in the infected blood/body fluid at the

time of exposure The amount of infected blood/body fluid involved in the

exposure Your immune response Your vaccination status (if vaccine is available) Whether you get treatment after exposure and how quickly

you get treatment

If I’m Exposed, What’s My Risk?

Risk of infection following an occupational needlestick or cut from a known positive source: HBV: 6% - 31% HCV: 1.8% HIV: 0.3%

Another Way to Think About Risk

Or, out of every 1,000 people exposed via a needlestick or cut from a known positive source:

60 – 310 people could get HBV 18 could get HCV 3 could get HIV

Bloodborne Pathogens Standard (BBP)

Written by the Occupational Safety and Health Administration (OSHA) – Title 29 of the Code of Federal Regulations

(29 CFR 1910.1030) Purpose: To protect you and reduce

your risks for occupational exposure to disease

Describes policies and practices that employers must establish to protect employees who have contact with blood/body fluids in their job

Module 1: Summary

Certain job duties can put employees at risk for coming into contact with blood or body fluids

Sometimes people have germs in their blood and don’t know it

Germs can be spread by coming into contact with blood or body fluids

Employers are responsible for protecting their employees from exposure to disease on the job

Protecting Employees from Bloodborne Pathogens:

Module 2

Course Objectives

After completion of Module 2 of this course, attendees should be able to:

Discuss the components of Occupational Health and Safety Administration (OSHA) Bloodborne Pathogens Standard

Define engineering and work practice controls Describe appropriate personal protective equipment Define an occupational exposure and discuss the steps to

take if you are exposed

A Recap of Module 1

Certain job duties can put employees at risk for coming into contact with blood or body fluids

Sometimes people have germs in their blood and don’t know it

Germs can be spread by coming into contact with blood or body fluids

Employers are responsible for protecting their employees from exposure to disease on the job

Bloodborne Pathogens Standard (BBP)

Written by the Occupational Safety and Health Administration (OSHA) – Title 29 of the Code of Federal Regulations

(29 CFR 1910.1030) Purpose: To protect you and reduce

your risks for occupational exposure to disease

Describes policies and practices that employers must establish to protect employees who have contact with blood/body fluids in their job

Bloodborne Pathogens (BBP) Standard

The Bloodborne Pathogens Standard describes important strategies that can reduce the risk of infection on the job. These include: Exposure Control Plan Engineering Controls Work Practice Controls Standard Precautions/Personal Protective Equipment Housekeeping Hepatitis B Vaccine Occupational Exposure Follow-up

Exposure Control Plan

The Plan is a document that describes howyour employer will address the components of the Bloodborne Pathogens Standard. Itincludes: Who is covered under the standard Ways to reduce the risk of exposure What to do if there is an occupational exposure

Example: www.vdh.virginia.gov/epidemiology/surveillance/hai/documents/word/BloodbornePathogensExposureControlPlanTEMPLATE.doc

Writing the Plan

Determine exposures– Employer prepares lists of job classifications

Classifications in which all workers have occupational exposure

Classifications in which some workers have occupational exposure

Includes a list of the tasks and procedures performed by those workers that result in their exposure

Describe methods of protecting employees against exposures

Make written plan available to employees Update the plan annually

Engineering Controls

Systems or mechanical devices that minimize hazards in the workplace.

Examples: Self-sheathing or retractable needles Sharps disposal containers Single-use fingerstick devices

Sharps Safety Rules

Use needles with safety devices Never recap, break or bend

needles Never leave needles unattended Never reuse disposable sharps Dispose of all needles in a

regulated, color-coded, labeled sharps container

Sharps containers should be changed when ½ - ¾ full.

Work Practice Controls

Practices in the workplace that protect you from disease and prevent transmission to your residents and coworkers.

These include: Hand hygiene

Personal hygiene

Personal protective equipment

What is Hand Hygiene?

Hand hygiene involves the following:

Hand washing: Washing hands with soap and water. Includes applying friction and drying hands thoroughly.

Alcohol-based hand rub: Rubbing hands with an alcohol-containing preparation.

Recommended Hand Hygiene Techniques

Hand rubs– Apply to palm of one hand, rub hands

together covering all surfaces until dry. – Manufacturer will instruct how much to

use.

Hand washing – Wet hands with water, apply soap, rub

hands together for at least 15 seconds.– Rinse and dry with disposable towel.– Use towel to turn off faucet.

Hand Hygiene: When

If hands are visibly dirty, contaminated, or soiled, wash with soap and water.– After using the restroom– Before eating or preparing food

If hands are not visibly soiled, you may choose to use an alcohol-based hand rub for routinely decontaminating hands.

When to Perform Hand Hygiene

Before and after:– Contact with a resident

Be sure to perform hand hygiene between residents– Treating a cut or wound

(e.g., changing dressings or bandages)

Before:– Preparing or eating food– Touching your eyes, nose, or mouth– Putting on gloves– Handling/administering medication– Insertion of invasive devices (e.g., urinary catheters)

When to Perform Hand Hygiene

After:– Contact with blood, body fluids,

mucous membranes, secretions, excretions, or non-intact skin

– Removing gloves– Touching surfaces or objects in the

environment that may be contaminated with blood or body fluids

– Handling garbage– Using the restroom– Blowing your nose, coughing, or

sneezing

Work Practice Controls:Hand Hygiene and Nails

Keep fingernails short, clean, and healthy

Artificial nails should not be worn; natural nails should be no longer than ¼ inch– Long fingernails require extra effort

when washing hands – harder to remove all germs

– Long fingernails may tear gloves

Work Practice Controls:Personal HygieneThings that you can do to protect yourself from disease: Do not leave food or drinks on countertops where blood

or potentially infectious materials can be present (e.g., nurses station)

Do not keep food or drinks in refrigerators or freezers used to hold medications or potentially infectious materials

Do not use petroleum-based lubricants with latex gloves – these weaken the protective glove barrier

Do not eat, drink, apply cosmetics, or handle lip balm in an area where you might be exposed to blood or body fluids

Standard Precautions

A set of precautions designed to protect staff and residents from exposure to disease

Use for ALL residents, ALL body fluids, ALWAYS

Includes:– Hand hygiene– Personal protective

equipment (PPE), including resuscitation devices

– Safe injection practices– Sharps injury prevention– Care of environment– Cleaning of care equipment– Respiratory hygiene/cough

etiquette– Handling of linen and

regulated medical waste– Special lumbar puncture

procedures– Patient/resident placement

For More Information…

Virginia Department of Health webpage on Standard Precautions:

www.vdh.virginia.gov/Epidemiology/Surveillance/HAI/StandardPrecautions.htm

2007 Guideline of Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings

www.cdc.gov/hicpac/2007IP/2007isolationPrecautions.html

Personal Protective Equipment

Protective wear that serves as a barrier between you and blood/body fluids: Gloves Gowns Masks Goggles/Face shields Resuscitation devices

Protective Equipment

Type varies with task Adequate supplies maintained,

replaced, and disposed of by facility

Fits properly and is free of flaws Supplied at no cost to employee Facility must offer training on use If re-usable, must be cleaned

carefully and as soon as possible to prevent contamination

Housekeeping

Facility cleaning schedule

Procedure for cleaning up blood/body fluid spills – clean up spills promptly and appropriately

Follow product instructions for use– Use enough product

– Use for appropriate kill time

Use standard precautions when handling all linen (including sheets, clothes)

Regulated medical waste policy/procedure

Hepatitis B Vaccine

Single most important factor in preventing hepatitis B infection in healthcare workers

Must be offered by the employer to all employees who may have exposure to blood or body fluids on the job– Must be provided at no cost to the employee

– Must be offered within 10 days of initial assignment to a job where there may be occupational exposure to blood or body fluids

Safe, effective

Series of three shots over a 6-month period

Long-term immunity

Occupational Exposure:Immediate Response

If you should get stuck by a needle or if you have direct skin or mucous membrane contact with blood or other body fluids:– Don’t panic– Wash the area with soap and water– Flush eyes or mucous membranes

with water– Report the incident immediately

(within two hours) to your supervisor and record date and time of incident

This is important so that you can get the necessary follow-up care

Occupational Exposure: Post-Exposure Counseling and Follow-up

After an occupational exposure, you must be provided with counseling and follow-up care– Trained medical staff will help

determine your risk of acquiring a bloodborne disease

– If there is a risk, appropriate testing and follow-up of the employee (and resident(s) involved) will be initiated

Remember to keep all follow-up appointments

Education

Training on the BBP Standard is required upon hire and annually thereafter for staff members who are covered under the OSHA BBP Standard

Training must be conducted by a person who is knowledgeable in the subject

Training must be offered at a convenient location and on company time

Training records must be kept at least 3 years

Recordkeeping

Training records Medical records

– Maintained for each employee with an occupational exposure

– Includes vaccination status and post-exposure evaluations

Sharps injury log – Maintained for 5 years from the date of exposure– Type and brand of device involved – Department or area of incident– Description of incident

Example of Sharps Injury Log

Module 2: Summary

The OSHA BBP Standard describes policies and practices that employers must establish to protect employees who have contact with blood/body fluids in their job.

If an occupational exposure does occur, report the incident and receive follow-up care promptly.

Training upon hire and annually is important to assure that employees understand their risks and follow the appropriate policies and practices.

Self Test (True or False)

1. The OSHA Bloodborne Pathogens Standard applies to anyone who may have exposure to blood/body fluids while performing job duties.

2. HIV, HBV, and HCV may cause no obvious symptoms.

3. Standard Precautions should only be used with residents who have infectious diseases.

4. Used needles and syringes should always be placed in a regulated sharps container.

5. Employers must help prevent occupational exposure by providing access to work practice controls (such as personal protective equipment) and engineering controls (such as sharps containers).

6. It is safe to store medications and employee food/drinks in the same refrigerator.

7. There is no time limit to reporting occupational exposures to your supervisor as long as follow-up testing is initiated eventually.

Self Test (True or False)

Self Test (True or False)

8. Employees are responsible for following the policies and procedures written by their employer and for using the safety measures available to them to reduce their risk of exposure to bloodborne diseases.

9. Employers must offer hepatitis B vaccine at no cost to employees with occupational exposure to blood/body fluids.

10. Training in the OSHA BBP Standard is only required for new employees.

Resources Centers for Disease Control and Prevention

– HIV/AIDS (http://www.cdc.gov/hiv/) – Viral Hepatitis (http://www.cdc.gov/hepatitis/index.htm)

Occupational Safety and Health Administration– www.osha.gov/SLTC/bloodbornepathogens/index.html

Virginia Department of Environmental Quality– Hazardous waste disposal

(http://www.deq.virginia.gov/Programs/LandProtectionRevitalization/SolidHazardousWasteRegulatoryPrograms/HazardousWaste.aspx)

Virginia Department of Health– Contact your local health department (www.vdh.virginia.gov/lhd/)– Healthcare-Associated Infections Program (

www.vdh.virginia.gov/epidemiology/surveillance/hai)– Division of Immunization (www.vdh.virginia.gov/epidemiology/Immunization/)

Virginia Department of Labor and Industry– Virginia Occupational Safety and Health Compliance Program (

www.doli.virginia.gov/vosh_enforcement/vosh_enforcement_intro.html)