BLOODBORNE

PATHOGENS

NWSSB, Det. Corona

Annual Sustainment Training

Instructor: Richard Owens

October 3, 2008

Regulatory Text• 29 CFR 1910.1030 is available in the

NAVOSH Department• It requires employers to:

– Classify the potential exposure for each employee

– Develop an exposure control plan

– Develop a post exposure control plan

– Train employees on bloodborne pathogens hazards

– Provide protective equipment and mandate its use

– Keep accurate records

What is a Pathogen?• A pathogen is defined as an

organism, either bacteria or virus, that causes a disease. Pathogens that we need to be aware of include, but are not limited to, Hepatitis B, Hepatitis C, and HIV (Human immunodeficiency virus).

Bloodborne Diseases• Hepatitis B (HBV)

• Hepatitis C (HCV)

• Human Immunodeficiency Virus (HIV)

• Acquired Immunodeficiency Syndrome (AIDS)

Bloodborne Diseases• Law Enforcement personnel are at risk for occupational

exposure to bloodborne pathogens, including hepatitis B virus (HBV), hepatitis C virus (HCV), and human immunodeficiency virus (HIV). Exposures occur through needlesticks or cuts from other sharp instruments contaminated with an infected suspect’s blood or through contact of the eye, nose, mouth, or skin with a suspect's blood. Important factors that influence the overall risk for occupational exposures to bloodborne pathogens include the number of infected individuals in the local population and the type and number of blood contacts. Most exposures do not result in infection.

What Is Hepatitis?• The word "hepatitis" means inflammation of

the liver. Toxins, certain drugs, some diseases, heavy alcohol use, bacterial and viral infections can all cause hepatitis. Hepatitis is also the name of a family of viral infections that affect the liver. The most common types in the United States are hepatitis A, hepatitis B, and hepatitis C. We will discuss hepatitis B and C.

Hepatitis B (HBV)• Symptoms of this disease include, but are not limited to

headache, nausea, vomiting, abdominal pain, jaundice (the skin turns yellow), weakness and fatigue. Bowel movements may be gray in color. The urine may be dark and look like tea.

• Sometimes though, hepatitis is a mild illness. If you have a mild case of hepatitis, you may not even realize that you have it. It may not cause symptoms or may only cause symptoms similar to the stomach flu. You might think you have the flu, and not know you have hepatitis.

• The incubation period for Hepatitis B is between 4 and 20 weeks.

Hepatitis B Vaccination• Hepatitis B vaccination is recommended for all infants, older

children and adolescents who were not vaccinated previously, and adults at risk for HBV infection.

• Noninfectious, yeast based vaccine• Three injections in the arm• More than 90% of those vaccinated will develop immunity to the

hepatitis B virus. Booster shots may be required at some point in the future.

• Workers who decline vaccination must complete a declination form. At any time after a worker initially declines to receive the vaccine, he or she may opt to take it.

Hepatitis B Vaccination – FAQ’s• Who should take the vaccine?

– The vaccine is offered to employees who have contact with blood and other infectious material

• How much does it cost?– Free!!! All you need to do is consent to take it.

• What is the vaccine?– A series of 3 shots, usually offered over a 6 month period. You must take all 3 of

these shots to help your body develop the immunity necessary to protect you.• Are all people who take the vaccine protected from HBV?

– No. Some people may not get protection, so there is no 100% guarantee you will get immunity. The chances, however, are very high, around 85-95%.

• Are there special considerations concerning the vaccine?– Yes. People who are sensitive to yeast or components of the vaccine should not take

the vaccine (most people can take it).• Do I need to decide on whether or not to take the vaccine?

– Yes. You must make a decision to take the vaccine or not, and sign the correct form (consent form or denial form

• How long will it last?– It is not clear how long the vaccine is effective. However, all indications are

protection lasts at least seven years.

Hepatitis B Vaccination – Notes

• Taking the vaccine may need to be delayed if you have a bad infection (cold, flu, etc.) Before making a decision as to whether you can or cannot take the vaccine you should discuss it with your family physician.

• You cannot get AIDS from the shot

Hepatitis C (HCV)• HCV is a liver disease. HCV infection sometimes results in an

acute illness, but most often becomes a chronic condition that can lead to cirrhosis of the liver and liver cancer. Symptoms of Hepatitis C are almost the same as Hepatitis B.

• They may include headache, nausea, vomiting, abdominal pain, jaundice (the skin turns yellow), weakness and fatigue. Bowel movements may be gray in color. The urine may be dark and look like tea.

• There is currently no vaccine for Hepatitis C.• For hepatitis C, it’s estimated that the incubation period is 2 to 26

weeks. 75% to 85% of those who are infected with hepatitis C do not recover completely and are more likely to continue to have a long-term infection.

• Hepatitis is increasingly common among people with AIDS and thus presents a new challenge for the health care and social service providers who assist them.

Human Immunodeficiency Virus (HIV)

• HIV stands for human immunodeficiency virus. This is the virus that causes AIDS. HIV is different from most other viruses because it attacks the immune system. The immune system gives our bodies the ability to fight infections. HIV finds and destroys a type of white blood cell (T cells or CD4 cells) that the immune system must have to fight disease. HIV is not as infectious as hepatitis B virus because there are not as many virus particles present in body fluids. Also the HIV virus is more fragile than the HBV virus and can be easily destroyed on environmental surfaces.

Acquired Immunodeficiency Syndrome (AIDS)

• AIDS stands for acquired immunodeficiency syndrome. AIDS is the final stage of HIV infection. It can take years for a person infected with HIV, even without treatment, to reach this stage. Having AIDS means that the virus has weakened the immune system to the point at which the body has a difficult time fighting infection. When someone has one or more specific infections, certain cancers, or a very low number of T cells, he or she is considered to have AIDS.

Symptoms of HIV/AIDS

• The only way to know whether you are infected is to be tested for HIV. You cannot rely on symptoms alone because many people who are infected with HIV do not have symptoms for many years. Someone can look and feel healthy but can still be infected. In fact, one quarter of the HIV-infected persons in the United States do not know that they are infected.

Symptoms Associated with HIV/AIDS

• Swollen lymph glands – yeast infections• Recurrent fever – other opportunistic• Night sweats • Infections, such as

– rapid weight loss– Kaposi Sarcoma – Herpes Virus 8. Usually shows up in the

skin or on the mouth, nose, or eye.– constant fatigue– Pneumocystis- Tiny fungus that live in the lungs.– diarrhea and decreased appetite – Pneumonia

• Currently there is no vaccine for HIV/AIDS

Methods of Transmission• Transmission may be direct or indirect• DIRECT – immediate contact with a pathogen (blood)

• INDIRECT - touching an item infected with the pathogen then touching a vulnerable area on self (mouth, nose, eyes, cut in skin)

• Your skin is a natural protective barrier against blood-borne pathogens. Pathogens enter the body through open cuts, abrasions, dermatitis & mucus membranes in the mouth, eyes, and nose.

• Bloodborne pathogens can be transmitted in the following body fluids:– Semen, Vaginal secretions, Cerebrospinal fluid, Synovial fluid, Pleural

fluid, Peritoneal fluid, Amniotic fluid, Saliva

• Dry Pathogens can live up to a week on an object

How HIV Is and Is Not Transmitted

HIV is transmitted in 3 main ways: • Having sex (anal, vaginal, or oral) with someone infected with

HIV • Sharing needles and syringes with someone infected with HIV • Being exposed (fetus or infant) to HIV before or during birth

or through breast feeding

HIV is a fragile virus. It cannot live for very long outside the body. As a result, the virus is not transmitted through day-to-day activities such as shaking hands, hugging, or a casual kiss. You cannot become infected from a toilet seat, drinking fountain, doorknob, dishes, drinking glasses, food, or pets. You also cannot get HIV from mosquitoes. HIV is primarily found in the blood, semen, or vaginal fluid of an infected person.

Exposure Control PlanIncludes:

Exposure Determination Engineering Controls Required Work Practices Personal Protective Equipment Housekeeping Waste Disposal Laundry Communication of Hazards to Personnel Medical Surveillance Recordkeeping

Tasks Associated with Exposure

Rendering CPR/1st Aid

Contact with an offender with open wounds

Tasks Associated with Exposure

Evidence Collection and Crime Scene Processing

Officer/Suspect injuries occurred during arrest procedures

Tasks Associated with Exposure

Cleaning up cuts, scrapes, bloody noses

Handling or cleaning up contaminated surfaces

Being cut by contaminated sharps

Any task where there may be contact with blood, semen, vaginal secretions, or other body fluids that may contain blood

Emergencies In an emergency situation, always use

Universal/Standard Precautions In an emergency have someone dial 9-911 and report

the incident. Render what first aid and CPR necessary and

possible using proper PPE until the emergency responders arrive to take over.

Treat all blood or potentially infectious body fluids as if they are contaminated.

Minimize your exposure by wearing:– Gloves– Splash goggles– Pocket mouth-to-mouth resuscitation masks– Other barrier devices

Exposure Incident Procedures Notify the Safety Office. After the exposed individual

cleans up he or she shall then be taken to the Branch Medical Clinic. A follow-up report shall be submitted to the servicing medical authority and should include the following:– An explanation of the circumstances that lead to the exposure

incident.– Identification of the source individual where the law permits.

The source individual’s blood shall be tested after consent, if consent is necessary, in order to determine infectivity. If such information is already known, then such testing is not required.

– The exposed individual shall have the results of the source individual’s testing made available to him/her, and be counseled on the confidentiality of this information.

Exposure Action Plan

Following an exposure, these steps should be taken:1) Wash the area with soap and water or flush

mucous membranes immediately.

2) Report incident to supervisor immediately.

3) If regulated waste is generated (i.e. - bloody towels), it must be bagged, labeled and disposed of according to local Infection Control procedures.

If you are Exposed: Wash the exposed area thoroughly with soap and

running water. Use non-abrasive soap or liquid hand sanitizer for 20

seconds (or sing the ABC’s) Flush mouth, nose, eyes for 15 minutes if blood is

splashed in mucous membranes Report the exposure to your supervisor Fill out an incident report form immediately If unknown source - request blood testing and

Hepatitis B vaccination if you do not already have it

Post Exposure Information The health care professional shall document the exposure route

and circumstance. The results of the source individual’s blood testing and all other medical records appropriate to treatment of exposed individual, including vaccination status, shall be recorded. The exposed individual shall be provided with a copy of the health care professional’s written opinion within 15 days after completing the evaluation. The written opinion is limited to the results and any medical conditions resulting that may require further evaluation or treatment. all other findings are confidential.

The exposed individual may request his/her medical records at any time for at least the duration of Navy employment plus 50 years.

Reducing Risks1. Engineering Controls

– Equipment and maintenance

2. Work Practice Controls

– Proper hand washing (done frequently)

– (If water not available, use antiseptic wipe)

– Proper Hygiene

– Keep possible exposure areas free from food items

3. Proper use of Personal Protective Equipment (PPE)

– Gloves are to be used when handling any body fluid

– Careful removal of gloves (not touching outside area)

– Using appropriate equipment in all situations

Engineering Controls

Devices that may be used to store regulated waste in order to eliminate, minimize, or reduce occupational exposure to bloodborne pathogens.

What Is Regulated Waste?

• Any liquid or semi-liquid blood or other potentially infectious materials.

• Contaminated 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 or other potentially infectious materials.

Signs and Colors• The standard requires

that fluorescent orange or orange-red warning labels be attached to containers of regulated waste or red bags may be used.

Work Practice Controls• Practices and procedures which reduce or

eliminate the chance of occupational exposure to bloodborne pathogens such as:– Universal Precautions– Hand Washing– Personal Hygiene– Food Control

Work Practice ControlsHand Washing

• Hand washing is one of the most important (and easiest) practices used to prevent transmission of bloodborne pathogens.

• Use soap and water. Do not use harsh, abrasive soaps and wash for at least 20 seconds (Sing the ABC’s)

• Use paper towels to turn off the water and to also open the bathroom door

• If soap and water are not available, use a waterless hand washing solution.

Work Practice ControlsPersonal Hygiene

• If you are working in an area where there is reasonable likelihood of exposure, you are never to:– Eat– Drink– Smoke– Apply cosmetics– Handle contact lenses

Work Practice ControlsFood Control

• Do not keep food or drink in refrigerators, freezers, shelves, cabinets, or on counter tops where blood or potentially infectious materials are present.

• Do not eat or drink where you are likely to be exposed to blood and bodily fluids.

Personal Protective Equipment (PPE)

• Gloves, gowns, laboratory coats, face shields or masks, and eye protection.

• PPE is considered appropriate if it does not permit blood or other potentially infectious materials to pass through or reach employees’ work clothes, street clothes, undergarments, skin, eyes, mouth, or other mucous membranes under normal conditions of use and for the duration of time which the protective equipment will be used

Personal Protective Equipment (PPE) - Rules

• Replace PPE that is torn or punctured.

• Remove PPE before leaving the work area.

• Properly disinfect or dispose of used PPE.

• Wash hands immediately after removing PPE

Personal Protective Equipment (PPE) - Rules

• Universal/Standard Precautions - Treat all blood or potentially infectious body fluids as if they are contaminated.

• Always wear personal protective equipment (PPE) in exposure situations.

• Individual departments will specify the type of protective barrier(s) to be used during any specific procedure, according to the type of exposure anticipated

• Departments will be responsible for providing PPE to their employees at no expense to the employee, except in certain situations.

Personal Protective Equipment (PPE) - Gloves

• Gloves should be made of latex, nitril, rubber, or other water impervious materials. (if you have a latex allergy, you must wear a different glove)

• Inspect gloves before use and change between personal contact

• Use sterile gloves for procedures involving contact with mucous membranes and for other personal care.

• Double gloving can provide an additional layer of protection.• If you have cuts or sores on your hands, you should cover

these with a bandage or similar protection as an additional precaution before donning your gloves.

• Do not touch the outside of used gloves

Personal Protective Equipment (PPE) Goggles, Face Shields, and Aprons

• Use goggles if there is a risk of splashing or vaporization of contaminated fluids

• Face shields provide additional face protection for the nose and mouth.

• Lab coats protect your clothing, and should never be worn home

Decontamination and Sterilization

• All surfaces, tools, equipment and other objects that come in contact with blood or potentially infectious materials must be decontaminated and sterilized as soon as possible.

BE SAFE, ASSUME ALL BODY FLUIDS ARE CONTAMINATED

Contaminated Clothing

• Remove clothing that is contaminated with blood, body fluid or body tissue as soon as possible

• Use Universal Precautions when handling contaminated clothing (Treat as if it is contaminated)

• Place clothing in approved & labeled bags or containers – do not launder at home

Body Fluid Spill Clean-up• SPILL CONTAINMENT

– Sprinkle necessary absorbent material on spill.

• SPILL CLEAN UP– Use disposable gloves– Use provided scoop to pick up absorbent material, and place

in containment bag.

• DECONTAMINATION OF AREA– Use germicidal cleaning cloth to wipe over entire spill area.

• DISPOSAL OF CONTAMINATED WASTE– Dispose of used germicidal cloth and any other contaminated

materials (including gloves) into red containment bag. Call proper agency for waste pick up.

– Double bag it

Sterilization• Following an exposure, these steps should

be taken:

– Use 1:10 dilution of bleach to clean

contaminated surfaces.

– Dispose gloves and paper towels in biohazard

bags.

– Place sharps in sharps container

Cleaning• Surface Areas

– Use protective gloves

– Remove all visible signs of pathogen (blood, vomit, etc.)

– Scrub area with soap and water

– Spray area with disinfectant spray

– Allow area to air dry completely

Sharps Disposal

• Individuals handling any sharps contaminated with body fluids, other than their own, should wear disposable gloves.

• All sharps are to be discarded in sharps disposal containers and the gloves disposed of in an infectious waste bag.

• The sharps disposal container is to be discarded when the container is three fourths full.

ConclusionDuring this Period of Instruction We Discussed:

– What is a Pathogen– Bloodborne Diseases– Methods of Transmission– Exposure Control Plans– Emergencies– What to do if Exposed– Methods to Reduce Exposure– Personal Protective Equipment– Decontamination and Sterilization

AnyQuestions?