Occupational Exposures toBloodborne Pathogens

29 CFR 1910.1030 Training

Morgan County

Emergency AmbulanceService

The MCEAS invites you to participate in this Bloodborne Pathogen Training and wants to thank Northeastern University for their slide presentation.

Please complete the slides, taking notes as needed. After completing the presentation, click on “Take Exam”. You will be directed to a seventeen question exam. After taking the exam, type your name and the date as you want printed on your certificate. Click “Submit Form”. Print your Certificate and present a copy to your “Training Coordinator”.

Occupational Exposures toBloodborne Pathogens

29 CFR 1910.1030

• Covers all workers occupationally exposed to blood or other potentially infectious materials

Needlestick Safety andPrevention Act

• Update the Exposure Control Plan (ECP) to reflect the changes in technology that eliminate or reduce exposure

• Annually document the consideration and use of safer medical devices that are appropriate, commercially available and effective

• Establish and maintain a sharps injury log for recording percutaneous injuries from contaminated sharps

• Establish a program for identifying, evaluating and selecting safety devices and work practices in the ECP.

It amended the Bloodborne Pathogen Standard in 2001 to require the employer to do the following:

Blood and Other Potentially Infectious Materials Covered Under the OSHA

Standard Include

Blood• Human blood• Blood products• Blood components

Other Potentially Infectious Materials

• Human body fluids• Unfixed human tissue

or organs• HIV or HBV

containing cells, tissue cultures or experimental animals

Body Fluids not Expected to beInfectious Unless Visibly

Contaminated with Blood

• Urine• Feces• Vomit• Tears• Sweat• Sputum• Nasal Secretions

Occupational Exposure toBloodborne Pathogens

• Traditional Concerns:– Chemicals– Radiation– Infectious waste and sharps

• New Concerns:– Hepatitis B virus– Human immunodeficiency virus

Hepatitis B Virus (HBV)

• HEPATITIS: Inflammation of the liver caused by drugs, toxins, autoimmune disease, or infectious agents.– Potentially life threatening bloodborne pathogen– Potential for carriers to pass disease to others– Effects can be both acute and chronic– Carriers face higher risk of liver ailments which can be

fatal, including cirrhosis of the liver and primary liver cancer

– CDC estimates between 140,000 and 320,000 become infected every year in the US

HBV Outcomes

1. Self Limited Acute Hepatitis B• Body produces antibodies• Coincides with destruction of liver cells with HBV• Lifetime immunity against reinfection• Some risk of extreme symptoms such as jaundice

which may cause hospitalization

2. Chronic HBV Infection• Can not clear virus from liver cells• Severe long term consequences such as cirrhosis

Hepatitis B Vaccination

• A 3-shot vaccination series is available for the hepatitis B virus. It is highly effective.

• Employees with potential occupational exposure to bloodborne pathogens are entitled to the vaccination at no cost.

• If you have previously declined the vaccination but would like to receive it, please contact your Designated Control Officer

Symptoms of HBV

• Yellow Eyes and Skin (Jaundice)• Abominable Pain• Fever and Vomiting• Dark Urine• Fatigue

Human Immunodeficiency Virus(HIV)

• RETRO VIRUS: must use host cell to reproduce

• HIV gradually depletes the number of cells which are essential for host immune function. This depletion of immune cells renders the infected individual increasingly susceptible to opportunistic infections.

• Auto immunodeficiency Syndrome (AIDS)

• HIV is not easily contacted. Risk increases with contact with infected blood or blood products. Well known routes of exposure: unsafe sex, needle sharing, blood transfusions.

Symptoms of AIDS

• Fever• Swollen Glands• Diarrhea• Extreme Weight Loss• Skin Lesions• Mental Disorientation

Who is at RiskThe Centers for Disease Control

Reported the Following:

• 816,149 people in the US are living with HIV/AIDS through December 2001

• 42 million people are estimated to be living with HIV / AIDS worldwide in 2002

• 5 million new HIV infections occurred in 2002 worldwide

• AIDS caused the death of 3.1 million people worldwide in 2002

HIV Treatment Advances

• Antiviral drugs called protease inhibitors have been developed to slow the replication of the virus but are not a cure

• Protocols have been developed to deal with high risk exposures to reduce likelihood of becoming HIV infected

Occupations at Risk

• Physicians• Paramedics / EMT’s• Athletic Trainers• Morticians• Nurses• Laundry Workers• Clinical Workers• Fire Fighters• Correctional Officers

• Phlebotomists• Dentists• Housekeeping• Coaches• Medical Examiners• Laboratory Workers• Police• Rescue• Maintenance Workers

What to do to Protect Workers

• Universal precautions• Written Exposure Control Plan• Identify job classifications at

risk• Train employees• Hepatitis B vaccination• Engineering controls• Work practice controls• Personal protective equipment• Housekeeping• Labeling• Exposure incident response• Record keeping

Routes of Exposure

Worker

Path

Source

Needle sticks & sharps

Mucous membranes, skin, eyes, mouth

Non-intact skin

Most common for health care workers

Spills, splashes, sprays, infectious materials

Cuts provide direct transfer

Transmission of BloodbornePathogens

• Contact with broken skin can include:– Rashes– Hang nails– Cuts– Punctures– Abrasions– Acne

– Cold sores

• Contact with mucous membranes include:– Eyes, nose, & mouth

• Other modes of transmission include:– Sexual contact– Amniotic fluid, blood during

birthing and occasionally breast milk (mother/child)

Universal Precautions

• Personal Protective Equipment

• Hand Washing• Sharps Containers• Infectious Waste• Disinfectants• Reporting Incidents

Means you treat all blood and other potentially infectious material (OPIM) as though they are infectious. Work practices or equipment to help you with universal precautions include:

Wash Your Hands

• Hand washing after using toilet: – Women 74%

– Men 61%

• New York City- 60% • Chicago- 78% • New Orleans- 69% • Atlanta Braves Game

– Women 89%

– Men 46%

Percentage of people observed washing their hands in public restrooms:

Pass the popcorn!!

Engineering Controls

• Hand washing and eyewash facilities

• Autoclaves for decontaminating waste

• Sharps disposal containers• Biological safety cabinets• Centrifuges with aerosol

covers• Secondary containers• Safer medical devices (needle

safe / needles-less)

Serve to reduce employee exposure in the workplace by either isolating the worker from the exposure or removing the hazard

Needle Safe Devices

Work Practice Controls

• Wash your hands frequently• Do not bend or recap needles if possible• Place sharps in appropriate containers ASAP• Do not eat, drink, or apply cosmetics in work

areas• Do not mouth pipette• Minimize splashing, spraying, splattering, and

generation of droplets during procedures

Personal ProtectiveEquipment

• When manipulating quantities of blood large enough to generate a splash

• Cleaning up a spill of blood• Administering first aid where

the victim is actively bleeding

• Inspect to insure they are not defective

• Replace when contaminated or as soon as feasible

• Do not reuse disposables• Remove gloves when you

leave the work area• Wash your hands after you

remove your gloves

Wear Eye Protection: When Using Gloves:

Regulated Waste Disposal

• IF they are:– Pourable– Drippable– Compressible

Contaminated Items that:

Would release blood or other potentially infectious materials

Tags, Labels & Bags

• Tags and Labels shall be fluorescent orange or red-orange with lettering and the Biohazard symbol in a contrasting color.

• Bags must have this label on them or they must be red in color and leak proof.

What to do if an ExposureIncident Occurs

• Flush the affected area with water immediately

• Report incident to your supervisor• Go to Appalachian Regional

Hospital– Fill out an Exposure Incident Report

& Accident Form

Exposure Follow-up

• You will undergo a medical evaluation• There will be an accident / incident

investigation• Additional medical follow-up as necessary

CONFIDENTIALITY IS IMPORTANT

Record keeping

• The duration of the employment • PLUS 30 years

• Records must be kept CONFIDENTIAL!

The employer shall maintain records for:

Spill Clean-up

• Use PPE – at minimum gloves and eye protection must be worn

• Use appropriate disinfectants• Use mechanical means (tongs, dustpans, etc.) to pick up

sharp objects• Dispose of waste properly

Your department or research group should

be geared up to handle small spills.

Participation of StudentAthletes with HBV or HIV

• Decisions based on clinical signs

• Competitive training not a problem for asymptomatic carriers

• Combative sports not recommended because of higher transmission risk

HBV Infection HIV Infection

• Decision based on health status

• Exercise and training not harmful to infected individuals

• Concerns of transmission from wounds or mucous membranes

NCAA SPORTS MEDICINEHANDBOOK

• Stop practice or game ASAP• Player should leave the field of play and

receive treatment• Athlete should not return until approved by

medical personnel• Saturated uniforms must be replaced

Wound with oozing or bleeding

NCAA Guideline 2HUniversal Precautions

• Wear gloves and protective eye wear

• Wash contaminated hands immediately

• Clean contaminated surfaces

• Use proper needle handling procedures

• Use resuscitation mouthpieces and bags

• Avoid patient contact when you have dermatitis

• Bag and wash soiled linen

• Follow universal guidelines in the athletic environment

Good Web Resources Relatedto Bloodborne Pathogens

• NCAA - www.ncaa.org • EH&S - www.ehs.neu.edu• OSHA - www.osha.gov• CDC - www.cdc.gov• NIH - www.nih.gov

Bloodborne Pathogens Exam

• Take Exam