AWARENESS TRAINING

BLOODBORNEPATHOGEN

PRESENTED BYTexas Family Medicine Preceptorship Program

UT Medical School at Houston - Environmental Health & Safety

HOW INFORMED ARE YOU?Name three bloodborne pathogens (BBP) that are transmitted through bodily fluids.

Name three ways you can be exposed to BBP.

How many people does tuberculosis affect worldwide?

True or False - it is okay to recap a needle?

What is a negative pressure room? What is it used for?

What cleaning agent should be used when cleaning up a blood spill?

What are standard precautions?

Can alcohol sanitizers be used to remove blood off hands?

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2

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5

6

78

What is a bloodborne pathogen?

TRAINING OUTLINE

What do UTHSC-H statistics say?

Preventive measures

Needlestick injury & exposure information

TB presentation & isolation

Your rights

Blood or other potentially infectious material (OPIM) spill clean up

The standard was originally issued in 1991, and was later revised for the prevention of contaminated sharps injuries, needlesticks

OSHA Bloodborne Pathogen Standard29 CFR 1910.1030 OSHA Bloodborne Pathogen Standard

• Education and selection of sharps injury reduction devices (e.g., self-sheathing needles)

In 2001 the revised standard, Needlestick Safety and Prevention Act included:

• Maintenance of a contaminated Sharps Injury Log

POWERPOINT PRESENTATION

Texas Department of State Health Service

• Reflect advanced technology that eliminate or reduce exposures

Exposure Control Plan:

• Document annually consideration for safer medical devices

BLOODBORNE PATHOGEN CONTROL

• Solicit input from employees at higher risk of occupational exposure.

B loodbornePATHOGENS (BBP)Pathogenic microorganisms present in human blood or other potentially infectious material (OPIM), and can infect and cause disease in humans. These pathogens include, but are not limited to, hepatitis B virus (HBV), hepatitis C virus, and human immunodeficiency virus (HIV).

B loodbornePATHOGENS (BBP)- HIV- HBV- HCV- T. pallidum- Herpes Virus- M. tuberculosis

- typically an aerosol hazard- Human T-Lymphotropic Virus Type l (HTLV-l)

B loodbornePATHOGENS (BBP)Body fluids that can harbor BBP:

- Blood- Semen and vaginal secretions- Saliva involved in dental procedures- Synovial fluid- Cerebrospinal fluid- Human tissue and cell cultures- All body fluids containing blood e.g. fluids: pleural, pericardial, amniotic

OCCUPATIONAL EXPOSURE*

FIRST SECOND THIRDMucous membrane contact- Splash in eyes, nose, or

mouth

Percutaneous inoculation- Misuse of sharps

(broken glass, needles, scalpels)

Exposure to broken/damaged skin- Risk increases if contact

involves a large area of broken/damaged skin or if contact is prolonged

2 3

* Risk increases with high titer levels in the source

1

How do you get exposed?

What should I do if I get exposed?

• Needlesticks or cuts from used needles or sharps• Contact of eyes, nose, mouth or broken skin with blood• Assaults – bites, cuts, knife wounds• Punctures• Splashes

REPORT ASAP, then:• Needlestick and cuts – wash with soap and water• Splashes – flush nose, mouse, or skin with water• Splashes in the eyes – irrigate with water, saline, or sterile wash

Engineeringcontrols

PersonalProtectiveEquipment

(PPE)

Administrativecontrols

Work placepractices

PREVENTIVE MEASURES

Leak-proof containers

• Use for storage & transportation of ALL bloodborne pathogen material

Sharps containers

• Fill no greater than ¾ full

Needleless devices

• Use retractable syringes, self-sheathing needles

Engineering controlsBiosafety cabinet (BSC)

Directional air flow

High efficiency particulate air (HEPA) filtration

Access control

Face protection

• Goggles or safety glasses with side shields

Clothing

• Lab coats, scrubs, disposable gowns (long pants only and no open toed shoes)• Replaced immediately when contaminated• Lab clothing restricted to work area

Gloves

• Replaced immediately if torn• Not worn outside the lab area!

Personal Protective Equipment

How toproperly remove gloves

Personal Protective Equipment (cont.)

Source: Globus

Medical surveillance

• TB skin test (PPD)

Immunizations

• Hepatitis B series

Training

Management of staff (SOP compliance)

Background checks, security clearance

Administrative Controls

Universal / Standard precautions• Treat all human blood

and body fluids as if known to be infectious for HIV, HBV, or other potentially infectious material (OPIM)

GOOD WORKPLACE PRACTICES

NEVER recap needles!

Follow SOPs

Survey work area• Note locations of all necessary equipment, waste

containers, disinfectants, and soaps

Establish & maintain clean & dirty zones

DO NOT eat, drink, or apply cosmetics in the work area

GOOD WORKPLACE PRACTICES

Decontaminate work surfaces• At start and end of procedures• Immediately after spill• Before removal of equipment

Dispose of waste properly

Label containers – hazard communication• Chemical & biological working stocks

Wash hands frequently, always between patients & always before leaving work area!

GOOD WORKPLACE PRACTICES (cont.)

• Get the hepatitis B vaccine• Review the employer’s Exposure Control Plan• Dispose of sharps PROMPTLY into an appropriate container• Use sharps devices with safety features• Clean work surfaces• Use personal protective equipment (such as gloves and face shields)

GOOD WORKPLACE PRACTICES (cont.)

How can you protect yourself overall?

BLEACH

ALCOHOL

CIDEX

Cleaning agents/disinfectants you will encounterStart from perimeter and work your way in

ROUTINE DECONTAMINATION

On average only 40% of healthcare

workers regularly

wash their hands

Hand Hygiene Hospital acquired infections result in transmission of:

• MRSA – Methicillin resistant S. aureus• 1.2 million infections; 48,000 patient deaths yearly

• VRE – Vancomycin resistant Enterococci• $4.5 billion yearly cost for treatment

Methods of contamination:

• Moving patients• Taking blood pressure• Touching bedrails

Source: Hand Hygiene Resource Center http://www.handhygiene.org/

The Inanimate Environment Can Facilitate Transmission

Contaminated surfaces increase cross-contamination

X RepresentsVRE culture positive sites

Source - Abstract: The Risk of Hand and Glove Contamination after Contact with a VRE (+) Patient Environment.

Hayden M, ICAAC, 2001, Chicago, IL.

Proper hand washing is

VITAL to infection prevention!

You may not realize you have germs on

your hands!

Hand Hygiene (cont.) Wash your hands, even if gloves have been worn…

• Before patient contact, including between different patients

• AFTER contact with anything contaminated

• During patient care• Before and after invasive procedure• Before and after contact with wound• Between procedures on different body parts

of the same patient• Between glove changes• Immediately if skin is contaminated or if an

injury occurs

Proper Hand WashingWet hands with warm (not hot) water

Apply soap on hands• Liquid soap is better (germs can live on wet soap bars)

Rub hands together for at least 15 seconds• Wash longer if there is visible dirt on hands• Cover all surfaces of hands and fingers – including

between fingernails, backs of hands, thumbs, and under fingernails

Rinse hands thoroughly with warm water

Dry hands thoroughly• If using blow dryer, push

button with elbow• If available, use towel to

turn off water

WHAT SONG IS ABOUT 15 SECONDS LONG?

Source: Hand Hygiene Resource Center http://www.handhygiene.org/

“Happy Birthday” Song

-or-

“ABC” Song

WHERE WE

MISS

Hand Hygiene (cont.)

Alcohol sanitizers

• 62% ethyl alcohol• Accepted as effective under certain

conditions• Should not be used when there is

visible dirt or grime

Hand Hygiene (cont.)

WASH BEFORE WASH AFTEREating

Caring for someone who is sick

Using Toilet

Blowing nose, coughing, or sneezing

Caring for someone who is sick

Most Cited Sources of Needlestick

IMPROPERLIGHTING

IMPROPER HANDLING

NOT FAMILIAR

WITHDEVICE

IMPROPER SHARPS DISPOSAL

UNCOOPERATIVE PATIENTS

Overfilled sharps

containers

Passing to other

personnel

Impropersuture

technique

EXPOSURE

NEEDLESTICKPOSSIBLE

APPLY ROUTINE FIRST AID IMMEDIATELYClean site of injury with soap & flush with water for at least 15

minutesFlush mucous membranes with water or saline for at least 15 minutes

NOTIFY SUPERVISOR / PRECEPTORComplete First Report of Injury

• Used to process insurance claims & helps identify trends

SEEK MEDICAL ATTENTIONStudent Health Services Clinic – look in your student handbook

• Baseline Labs

• HIV antibody (with consent)• RPR (Syphilis)• Hepatitis B surface antibody• HCV antibody

• If source is known to be Hepatitis C+, also obtain liver function & HCV RNA tests

• CBC with differential and platelets, chemistry profile, urine pregnancy test if source is known HIV+ and if exposed personnel chooses to utilize post-exposure prophylaxis

Medical Surveillance for injury• Hepatitis B Vaccination

• Tuberculosis skin test, Quantiferon test

Percutaneous injury transmission rates with blood or blood products

• Hepatitis B 2 – 40%

• Hepatitis C 3 – 10%

• HIV 0.2 – 0.5%

CDC Exposure Risk

Cough

Chest Pain

Coughing up blood

Weakness

Fever and/or night sweats

Weight loss

TB Presentation & Isolation

WHO TUBERCULOSIS DATA

TEXAS TUBERCULOSIS DATA

TB Presentation & Isolation (cont.)Routinely ask all patients: • History of TB disease?• Symptoms suggestive of TB?

Patients with history or symptoms of undiagnosed TB: • Refer promptly for medical evaluation of

possible active infection• Wear surgical mask• Provide urgent care in TB isolation areas

(i.e., negative pressure rooms)

TB ReportingIn Texas:

512.533.3000

TB Presentation and Isolation (cont.)

REMINDERBloodborne Pathogens can be transmitted via the following routes:

• Airborne

• Droplet

• Contact

How to protect yourself & the patient

REMEMBER

Place mask on patient

Use an N-95 respirator when caring for the patient (get fitted)• Routine duties• Sputum-inducing procedure

Enforce cough etiquette

In the event of a possible exposure to bloodborne pathogens, the person is entitled to:

• Confidential medical evaluation and follow-up

• Documentation of routes of exposure

• Identification, documentation, testing, and results of the source individual

• Counseling

• Evaluation of reported illness

• Source patient blood draw

YOUR RIGHTS

Blood (or OPIM) Spill Clean UpClean all blood (or OPIM) spills with a 10% bleach solution or another EPA-approved disinfectant

Apply the approved disinfectant to perimeter of spill

Allow at least 15 minutes of disinfectant contact time• Slowly proceed inwards

Dispose all materials used to clean up spill (e.g. towels, gloves) in a biohazard bag

Biological Waste DisposalPlace red biohazard bags inside hard-walled, leak-proof secondary containment

• Do not over fill!

Place sharps in an appropriate hard-walled, leak-proof sharps container

• Do not recap needles!• Do not over fill (no more than ¾

full)!• Let clinic administrator or

manager know if it needs to be replaced

What is Biological Waste & What is Trash?

Bloody Gloves

Used Needles

Disposable Gowns (Unsoiled)

UA Dipstick

Unsoiled Exam Gloves

Identify which receptacle these (below) belong in

What is Biological Waste & What is Trash?

Unsoiled Exam Gloves

Disposable Gowns (Unsoiled)

Bloody GlovesUsed Needles

UA Dipstick

INFORMATION RESOURCESAvailable resources about bloodborne pathogens

• Contact your Occupational or Employee Health Clinic or report to the Institutional Emergency Department IMMEDIATELY

• Biological Safety Manual (in every lab & website)

• OSHA Bloodborne Pathogen Standard

• Center for Disease Control

• Texas Department of State Health Services

REMEMBER!You are responsible for knowing and practicing all the BBP training and safety precautions outlined in this presentation while participating in your Family Medicine preceptorship.

Make sure you have your preceptors number and tell someone immediately when you are exposed to any bloodborne pathogens.

QUESTIONS?Refer to your Student Handbook

Please remember:Contact your preceptor immediately following any exposures

Go to the nearest Occupational or Employee Health Clinic or go to the Emergency Department for treatment

THANK YOU FOR LEARNING