Infection Control, DA103 Bloodborne Pathogens Standard 1991
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- Slide 1
- Infection Control, DA103 Bloodborne Pathogens Standard
1991
- Slide 2
- Key Federal Agencies Involved OSHAregulates and passes laws to
protect employees Occupational Safety and Health Administration
CDCrecommends guidelines for infection control Centers for Disease
Control FDAregulates medical and dental device manufacturers Food
and Drug Administration EPAregulates actions and materials that
affect the environment Environmental Protection Agency
- Slide 3
- The beginnings Early 1980s Infection control focused on
protecting patient from hospital- acquired infections Little or no
emphasis on healthcare workers AIDS epidemic Led to awareness of
transmission of Bloodborne Pathogens HBV was actually higher
occupational risk to healthcare workers CDCs Guideline for
Infection Control in Hospital Personnel 1983 First protocols
designed to protect healthcare workers
- Slide 4
- Later Mid-1980s Various healthcare worker groups petitioned
OSHA to take action by creating formal laws to Reduce risk to
employees from exposure to various infectious agents Protect
employees from occupational exposure to HBV Environmental
Protection Agency (EPA) (1989) Rules about tracking and managing
medical wastes
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- Finally! 1991 OSHA published Occupational Exposure to
Bloodborne Pathogens Standard To eliminate or minimize occupational
exposure to HBV, HIV, and other bloodborne pathogens effective in
March 1992 1998 CDC revised Guidelines for infection control in
healthcare personnel to include methods to reduce transmission of
infections from patient to healthcare personnel and from personnel
to patients. Advancements in Healthcare Technology Food and Drug
Administration (FDA) regulates medical and dental devices 2001 OSHA
published Needlestick Safety and Prevention Act
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- Who is affected by OSHAs Bloodborne Pathogens Standard? Any
type of facility in which employees might be exposed to blood and
other body fluids Dental and medical offices Hospitals, emergency
medical services, nursing homes Funeral homes Some states also have
their own specific OSHA regulations Must be at least as strict as
the Federal regulations
- Slide 7
- Examples of Bloodborne Pathogens Known to be in blood: HBV
(Hepatitis B) HCV (Hepatitis C) Other Non-A, Non-B Hepatitis
(Hepatitis E) HIV (Human Immunodeficiency Virus) Other potentially
infectious material (OPIM) Saliva and other body fluids which might
contain blood
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- Major Provisions Exposure Control Plan (ECP) Engineering and
Work Practice Controls - Personal Protective Equipment (PPE)
Vaccination, Post-Exposure Follow-up Labeling and Training
Recordkeeping
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- Exposure Control Plan written action plan to minimize potential
occupational exposures to infectious microorganisms specific to the
individual place of employment Includes Exposure determination
Details infection control procedures Administrative steps
Implementation date Recordkeeping (employee training and medical)
Training
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- Exposure Determination made without regard to use of PPE 1.
List of job classifications where all employees have exposure
potential. Category I Dentist, dental hygienist, dental assistant
HIGH RISK 2. List of job classifications where some employees have
exposure. Category II Office staff who may help out in clinical
area INTERMEDIATE RISK 3. List of job classifications which have NO
exposure. NO RISK (financial secretary, insurance secretary)
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- Compliance includes Universal Precautions work practices which
require everyone to assume that all blood and body substances are
potential sources of infection, independent of perceived risk.
Engineering Controls devices that remove the exposure hazard from
the workplace. Work Practice Controls altering the manner in which
a task is performed to reduce risk of exposure to bloodborne
pathogens
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- Universal Precautions Not possible to identify individuals who
are infectious Same precautions used for all patients
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- Engineering Controls Sharps containers Readily accessible kept
in or near work area Puncture resistant / leak-proof Labeled or
color coded biohazardous waste Ability to close Replaced as soon as
full no pushing down to make more room What items go into a sharps
container? Burs, scalpels, matrix bands, wires Other examples of
engineering controls are Eyewash Stations Ultrasonic Cleaner Needle
Recapping Device
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- Work Practice Controls Hand washing One handed scoop (needle
recapping) No eating, drinking or smoking in clinical area Minimize
spatter: Using suction Dental Dams Proper waste disposal methods
Bloody gauze, tissue specimens, extracted teeth Specimens in a leak
proof container (biopsy tissue) Decontaminate equipment before
shipping or servicing; if not possible, label item as a biohazard
Use of PPE
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- Compliance also involves: House keeping: Written schedule for
cleaning and disinfections Contaminated surfaces and equipment must
be cleaned at once Use protective barriers whenever possible
Regulated containers of disposable infectious hazardous waste Must
be closeable and leak proof Must be labeled and color coded (red,
biohazard) Must be placed in a secondary container (must also be
labeled) Dispose according to state regulations Medical or
hazardous waste hauler, must be a hired, contracted company
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- Additional Compliance Methods: Laundry: Employee does NOT take
laundry home This is the employers responsibility Handling should
be kept to a minimum Transport in labeled or color coded bags Can
be washed on site (using PPE) or by a professional service
- Slide 17
- Vaccinations and Post-exposure Follow-up Hepatitis B
vaccination: Recommended for all healthcare workers 3 injections: 1
st, 2 nd one month after, 3 rd five months after first injection
Note: some people do not respond to first series and must have a
second series of injections; if those dont take, they probably have
a natural immunity Employer must offer vaccination series within 10
days of employment; must pay for the series Employee can refuse to
have the series, but may be asked to sign a declination waiver
Employee can change mind and have vaccination series at a later
time If CDC determines that a booster injection is recommended (in
the future) the employer must also make that available to the
employee
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- Why HBV? Virus transmitted in blood Healthcare workers are at
high risk to exposure In 2005, about 51,000 people became infected
with HBV People who are infected with HBV can spread it to others,
even if they dont appear sick. About 5-10% become carriers Acute
(short-term) illness. Flu-like symptoms OR no symptoms Seem to
recover but actually develop Chronic (long-term) infection. liver
damage (cirrhosis) liver cancer death Each year about 3,000 to
5,000 people die from cirrhosis or liver cancer caused by HBV.
- Slide 19
- Post-Exposure Follow-up After you complete this lecture, please
read the article entitled: Steps to Follow After a Stick Incident
and answer the questions for credit
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- Sharps Injuries All sharps injuries must be recorded in a
Sharps Injuries Log Used to help employer and staff determine
situations where sharps injuries might occur AND to make
engineering and work practice control changes to prevent injuries
Sharps injuries can be greatly reduced with a no-recapping policy
for needles Needle re-capping is allowed in dental offices but we
must use proper precautions, such as recapping devices
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- Labeling and Training Labels: Biohazard: symbol and words must
be visible Fluorescent orange or orange red in color Red bags or
containers substitute for labels Labels must be placed on:
Regulated waste (gauze, teeth, tissue, etc) Refrigerators or
freezers with OPIM or blood inside Transport or storage containers
Contaminated equipment
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- Information and Training: Includes all employees with possible
occupational exposure (full time, part time, temps, and students)
New employees must train within 10 days of start date Entire staff
annually (at least) Additional training when tasks modified or new
ones added Questions and answer period should be included Review
all of the Bloodborne Pathogens Standard Document training, and
keep it for 3 years Date, trainer, who attended and subjects
covered
- Slide 23
- Record-keeping Medical Records: Kept on each occupational
exposed : Vaccination status and dates Any post-exposure
documentation Must be kept separate and confidential Maintain for
30 years after employment ends Training Records Documentation of
dates, trainer, who attended, subject matter Maintain for 3
years
- Slide 24
- Employee Responsibility: Cooperate and follow office policies
Training Universal Precautions Use PPE Use safe work practices and
engineering controls Report unsafe situations to employer Keep work
area neat and clean Know your job classifications and risks Get
immunized against HBV, if you are able to