Bloodborne PathogensIn the School Setting

Julie A. Strunk, RN BSN

Why do we need to do this each year?

OSHA requires annual training for OSHA requires annual training for employees who are at occupational risk employees who are at occupational risk of exposure to bloodborne pathogensof exposure to bloodborne pathogens

The purpose of the regulation is to protect The purpose of the regulation is to protect employees against exposure to employees against exposure to bloodborne pathogens which could lead bloodborne pathogens which could lead to disease or deathto disease or death

Bloodborne Pathogens Definition

Bloodborne Pathogens are Bloodborne Pathogens are microorganisms microorganisms (such as (such as viruses)viruses) transmitted transmitted through blood, or other through blood, or other potentially infectious potentially infectious material such as certain material such as certain bodily fluids bodily fluids (semen, (semen, breast milk, etc.)breast milk, etc.) or or tissues.tissues.

Bloodborne Pathogens

Body fluids, especially those Body fluids, especially those visibly contaminated with blood, visibly contaminated with blood, are capable of causing disease.are capable of causing disease.

Pathogens can enter your body Pathogens can enter your body through a cut or break in the through a cut or break in the skin, through your eyes or skin, through your eyes or mucus membranes.mucus membranes.

Can also be transmitted Can also be transmitted sexuallysexually

Main diseases of concern are Main diseases of concern are Hepatitis B and C viruses and Hepatitis B and C viruses and HIV (AIDS virus)HIV (AIDS virus)

HIV attacks your body’s HIV attacks your body’s ability to protect itself ability to protect itself against diseaseagainst disease

Initially there are no Initially there are no visible signs of having visible signs of having the virusthe virus

Most people with HIV Most people with HIV develop AIDSdevelop AIDS

There is no vaccination There is no vaccination for HIVfor HIV

HIVHuman Immunodeficiency Virus

HIV

The HIV Virus can live outside of the body The HIV Virus can live outside of the body for only a few hoursfor only a few hours

10-50 virus particles per ml of blood10-50 virus particles per ml of blood There are 4 modes of transfer:There are 4 modes of transfer:

BloodBlood SemenSemen Vaginal secretionsVaginal secretions Breast milkBreast milk

Hepatitis: Inflammation of the Liver

Types of Viral HepatitisTypes of Viral Hepatitis

Hepatitis A (HAV)Hepatitis A (HAV) fecal / oral fecal / oralHepatitis B (HBV)Hepatitis B (HBV) bloodborne bloodborneHepatitis C (HCV)Hepatitis C (HCV) bloodborne bloodborne

Hepatitis B and C

Up to 100 times easier to Up to 100 times easier to catch than HIVcatch than HIV

Unlike HIV, the Hepatitis Unlike HIV, the Hepatitis virus can live outside of the virus can live outside of the body for several daysbody for several days

1,000,000 – 1,000,000,0001,000,000 – 1,000,000,000 virus particles per ml of virus particles per ml of bloodblood

Concentration of Hepatitis B Virus in Various Body Fluids

Low/Not Low/Not

___High___High ModerateModerate Detectable_ Detectable_

Blood Blood Semen Urine Semen Urine

SerumSerum Vaginal Fluid Vaginal Fluid Feces Feces

Wound exudatesWound exudates Saliva Saliva Tears Tears

Breast milkBreast milk

HIV vs. Hepatitis B

HIV Hepatitis BTransmitted through blood, semen, vaginal secretions and breast milk

Transmitted through blood, semen and vaginal secretions

10-50 Virus particles per ml of blood

1,000,000-1,000,000,000 Virus particles per ml of blood

Virus lives outside of the body only a few hours

Virus lives outside of the body for up to 7 days

Up to 100 times easier to catch than HIV

No vaccination available Vaccinations available

Reasons Not To Receive the Hepatitis B Vaccine

Previous infection with HBVPrevious infection with HBV Yeast sensitivityYeast sensitivity Thimerosal sensitivityThimerosal sensitivity PregnancyPregnancy Immunosuppressive therapyImmunosuppressive therapy

Hepatitis C 3-4 million carriers, most 3-4 million carriers, most

common bloodborne infection in common bloodborne infection in USUS

Disease can incubate for Disease can incubate for decades and most people have decades and most people have no symptomsno symptoms

By 2010 may affect more By 2010 may affect more Americans each year than AIDSAmericans each year than AIDS

HCV is not related to the viruses HCV is not related to the viruses that cause Hepatitis A or B that cause Hepatitis A or B

No Vaccine or effective post-No Vaccine or effective post-exposure prophylaxis exposure prophylaxis

85% develop chronic infection85% develop chronic infection Leading indication for liver Leading indication for liver

transplantstransplants

Sources of Infection for persons with Hepatitis C

Hepatitis C

The “OTHER” sources of infectionThe “OTHER” sources of infection Contact with infectious body fluids to Contact with infectious body fluids to

broken skinbroken skin Contact with infectious body fluids to Contact with infectious body fluids to

mucous membranesmucous membranes Puncture wounds with used needlesPuncture wounds with used needles

Symptoms of Hepatitis B or C

Flu-like symptomsFlu-like symptoms Fatigue Fatigue JaundiceJaundice Severe pain in jointsSevere pain in joints Lung diseaseLung disease Inflammation of the liverInflammation of the liver Inflammation on and ulcers of the colonInflammation on and ulcers of the colon May be asymptomatic (no symptoms)May be asymptomatic (no symptoms)

There is no cure for

Hepatitis B or CThere is a vaccine for

Hepatitis B

How are Bloodborne Pathogens Spread on the Job?

By a sharp object that is By a sharp object that is contaminated by the virus contaminated by the virus when it cuts or punctures the when it cuts or punctures the skinskin

When a contaminated object When a contaminated object touches inflamed skin, acne, touches inflamed skin, acne, skin abrasionsskin abrasions

When a contaminated surface When a contaminated surface is touched, then eyes, nose, is touched, then eyes, nose, mouth, open wounds or mouth, open wounds or inflamed skin is touchedinflamed skin is touched

How to Reduce Your Risk

UNIVERSAL PRECAUTIONSUNIVERSAL PRECAUTIONSSTANDARD PRECAUTIONSSTANDARD PRECAUTIONS

"Universal precautions," as defined by CDC, are a set "Universal precautions," as defined by CDC, are a set of precautions designed to prevent transmission of of precautions designed to prevent transmission of human immunodeficiency virus (HIV), hepatitis B human immunodeficiency virus (HIV), hepatitis B virus (HBV), and other bloodborne pathogens when virus (HBV), and other bloodborne pathogens when providing first aid or health care. Under universal providing first aid or health care. Under universal precautions, blood and certain body fluids of all precautions, blood and certain body fluids of all patients are considered potentially infectious for HIV, patients are considered potentially infectious for HIV, HBV and other bloodborne pathogens.HBV and other bloodborne pathogens.

If It’s Warm, Wet, and Not Yours, DON’T Touch It!

How to Reduce Your Risk

Needles and other sharps Needles and other sharps must be discarded in rigid, must be discarded in rigid, leak-proof, puncture leak-proof, puncture resistance containersresistance containers

When emptying trash When emptying trash containers, do not use containers, do not use your hands to compress your hands to compress the trash in the bagthe trash in the bag

Lift and carry the trash bag Lift and carry the trash bag away from your bodyaway from your body

                                             

               

How to Reduce Your Risk

Do not eat, drink, Do not eat, drink, smoke, apply smoke, apply cosmetics or cosmetics or handle contact handle contact lenses in areas lenses in areas where there is the where there is the possibility of possibility of exposure to BBPexposure to BBP

How to Reduce Your Risk

Personal Protective Equipment (PPE)Personal Protective Equipment (PPE)• GlovesGloves• MasksMasks• Eye protectionEye protection• CPR microshieldsCPR microshields

Clean-upProcedures

Cleaning Up Body Fluid Spills

Please call the office or custodial staff Please call the office or custodial staff for a body fluid spill. Keep students for a body fluid spill. Keep students away from the contaminated area away from the contaminated area until cleaned.until cleaned.

GlovesGlove removal and disposal techniqueGlove removal and disposal technique

Grip one glove near the cuff and peel it down until Grip one glove near the cuff and peel it down until it comes off inside out. Ball it up in the palm of it comes off inside out. Ball it up in the palm of your gloved hand.your gloved hand.

Place two fingers of your bare hand inside the cuff Place two fingers of your bare hand inside the cuff of the remaining glove and peel glove down so of the remaining glove and peel glove down so that it also comes off inside out with the first glove that it also comes off inside out with the first glove tucked inside. Never touch the outside of the tucked inside. Never touch the outside of the glove with your bare hands.glove with your bare hands.

Properly dispose of the gloves. Properly dispose of the gloves. Wash hands immediately.Wash hands immediately.

Hand washing

THE SINGLE MOST EFFECTIVE WAY THE SINGLE MOST EFFECTIVE WAY TO PREVENT THE TRANSFER OF TO PREVENT THE TRANSFER OF GERMS is to GERMS is to WASH YOUR HANDSWASH YOUR HANDS using soap and running water.using soap and running water.

Scrub for at least 30 Scrub for at least 30 seconds, rinse well, seconds, rinse well, dry with a paper towel.dry with a paper towel.

What Should I Do If I Have Accidental Contact With Body Fluids?

Wash area thoroughly with soap and Wash area thoroughly with soap and warm waterwarm water

Contact School Nurse or Supervisor Contact School Nurse or Supervisor of Health Services of Health Services Right Away!Right Away!

Report to your supervisorReport to your supervisor

Remember!

Risk of exposure to BBP in the school Risk of exposure to BBP in the school setting is lowsetting is low

Risk of HBV transmission in schools is Risk of HBV transmission in schools is rarerare

There have been no cases of HIV There have been no cases of HIV transmission in schooltransmission in school

We’re All TeachersWe’re All Teachers

Kids learn from watching us!Kids learn from watching us!