Bloodborne Pathogens and

Communicable Diseases

2012

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WHEN YOU START TO THINK THIS LECTURE IS

BORING, REMEMBER…

YOU CAN GET SICK AND DIE,

SO PAY ATTENTION!

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Training Objectives

• Educate CMT employees in bloodborne

pathogens seen by EMS workers in the field

• Discuss methods of protecting CMT employees

from bloodborne pathogens

• Provide information to allow the CMT employee

to make an educated decision about the HBV

vaccination

• Discuss the OSHA standard on bloodborne

pathogens

• Discuss CMT’s methods of compliance with the

OSHA Standard

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Definitions (From OSHA)

• Bloodborne Pathogen- microorganisms that are

present in human blood and can cause disease in

humans

• Exposure Incident- specific eye, mouth, mucous

membrane, non-intact skin or parenteral contact

with blood or OPIM that results from the

performance of a member’s duties

• Parenteral- piercing mucous membranes or the

skin barrier through such events as needle sticks,

human bites, cuts, and abrasions

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Definitions (Continued)

• Personal Protective Equipment (PPE)- specialized

clothing or equipment worn by a member for protection

against a hazard. General work clothes (uniforms,

jumpsuits, etc.) not intended to function as protection

against a hazard are not PPE.

• Universal Precautions- an approach to infection control

where all human blood and certain human body fluids are

treated as if known to be infectious

• Body Substance Isolation (BSI)- a form of infection

control based on the presumption that all body fluids are

infectious. BSI calls for always using appropriate barriers to

infection at an emergency scene, such as gloves, goggles,

face shields, gowns, and protective eyewear.

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Definitions (Con’t)

• Exposure Control Plan (ECP)- agency’s plan to

eliminate or minimize exposure

• Other Potentially Infectious Material (OPIM)-

• the following human body fluids: semen, vaginal

secretions, CSF, synovial fluid, pleural, pericardial,

peritoneal, amniotic, saliva (dental procedures), any

bodily fluids contaminated with blood, any fluid that

cannot be differentiated between fluid types.

• Any unfixed tissue or organ from a human (living or

dead)

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Definitions (Final)

• Contaminated Laundry- laundry which has been

soiled with blood or OPIM or may contain sharps

• Contaminated Sharps- any contaminated object

that can penetrate the skin including needles,

scalpels, broken glass, broken capillary tubes, and

exposed ends of dental wire

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OSHA Standard

• Exposure Control Plan – Identifies job/procedures with identified risks

– Schedule for implementing provisions

• All provisions have been implemented

– Procedure for investigation and follow-up

– Plan is accessible to all employees

– Annual review by EHSO

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OSHA Standard (Con’t)

• Initial training upon employment

• Annual re-training required

• Training in: – OSHA Standard

– Bloodborne Diseases and Transmission

– Exposure Control Plan

– Work Practices and PPE use

– HBV Vaccine

– Exposure recording and follow-up

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OSHA Standard (Con’t)

• Methods of compliance

– Universal Precautions

– Engineering and work practice controls

– Hand washing

– PPE/BSI

– Written cleaning schedule

– Sharps and regulated waste disposal

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OSHA Standard (Con’t)

• Record keeping

– OSHA mandates

• Types of records to be kept

• Duration of storage

• Disposal of records

• Hazard Communication

– Warning labels required (BioHazard) or

– Red Bio hazard bags instead of labels

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Bloodborne Pathogen Standard

• Effective March 6th, 1992

• Purpose – Limit the occupational exposure to blood and other

potentially infectious material (OPIM)

• Scope – Covers all members who could be “reasonably

anticipated” as a result of performing their duties to face

contact with blood and OPIM

– Everyone who works for CMT or rides as an observer or

student are “reasonably anticipated” to contact blood

and OPIM.

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BBP Standard (Con’t)

• Mandates of the standard – Exposure Control Plan (ECP) prevention

program

– Work place engineering to prevent exposure

– HBV vaccine provided by CMT

– Medical evaluation/follow up

– Training of employees

– Record keeping

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PPE and BSI

• Use as little or as much as you feel the

situation dictates

• During all patient care EXAMINATION

GLOVES WILL BE WORN!

• CMT provides all PPE. You do not pay

for any of it. CMT replaces it when it

becomes worn or soiled

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PPE/BSI (Con’t)

• CMT provides the following

– Non-sterile, non-latex exam gloves in

four sizes

– Pre-packaged PPE kits containing

• Golves

• Mask

– Hand sanitizer on all ambulances

– Soap at the bases

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A word on hand-sanitizer

before we continue...

- For immediate, short term use

- Not suitable as a substitute for hand washing

-You still need to wash your hands thoroughly as

soon as possible

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Sharps Disposal

• DO NOT RECAP SHARPS

• CMT uses several types of sharps for

BLS and ALS purposes – IV Angiocaths

– Glucose testing lancets

– Epi-Pens

• CMT provides sharps containers on

all ambulances… Use them! – $70,000.00 per improperly disposed sharp

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Two Major Definitions

• Infectious

– An illness that is caused by the body's

rejection of a virus, fungi, or parasite

• Communicable

– Able to spread from one person to another

A disease can be infectious and

not communicable at the same time

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Infectious Material

• Primary Risks

– Blood

– Semen

– Vaginal Secretions

• Secondary Risks

– Synovial (joint)

fluid

– Cardiac fluid

(other than blood))

– Abdominal and

stomach fluid

– Pulmonary fluids

– Spinal fluid

– Amniotic fluid

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Other Potentially Infectious

Material (OPIM)

• Tears

• Sweat

• Saliva

• Urine

• Stool

• Vomit

• Nasal secretions

• Sputum

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Modes of Transmission

• Direct contact – straight from person to person, exchange of blood or body fluids

ex: blood splash into the eyes

• Indirect contact – person to object; infection can spread by touching surfaces that have been contaminated with the bacteria or virus

ex: Loading stretcher into ambulance and not removing contaminated gloves before touching steering wheel of ambulance

touching a contaminated needle

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Direct Contact

• Bloodborne

• Airborne

• Occult

– Occult means “hidden”

– “Occult blood” is blood hidden inside

some other material

• Idiopathic

– Fancy medical word meaning “We

don’t have a clue!”

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Indirect Transmission

• Vehicle-borne

– The transfer of an infectious agent to a

host via contaminated items such as

water, food, milk, or biological

products, such as blood, tissues, and

organs.

• Vector-borne

– The transfer of infectious

microorganisms from an infected host

via an insect or arthropod.

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Methods to Reduce Exposure

• Engineering Controls

– Devices that may be used to eliminate,

minimize, or reduce occupational

exposure to bloodborne pathogens.

• Work Practice Controls

– Practices and procedures that reduce or

eliminate the chance of occupational

exposure to bloodborne pathogens.

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Examples

• Engineering Controls

– Sharps containers

– Self capping needles

– PPE

• Work Practice Controls

– Decontaminating work area

– Frequent hand washing

– Consis