Infection Control and Bloodborne Pathogens

Presented by Riverland Community College

Objectives At the end of this training session,

participants will be able to:Describe what laws and safety regulations cover

Bloodborne PathogensList and describe the diseases that cause the greatest

concerns for providers and their symptomsDescribe how to prevent disease transmissionDescribe post-exposure treatments and follow-up that

may be providedDiscuss the difference between significant vs reportable

exposure

Things to Know if there is Risk of Exposure Counseling specific to exposure incident

is available Post-exposure treatments and follow-up

that may be provided.If you are exposed, confidential medical

evaluation is to be made immediately available to you.

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OSHA Bloodborne Pathogens Standard(29 CFR 1910.1030)

OSHA’s Bloodborne Pathogens standard prescribes safeguards to protect workers against the health hazards from exposure to blood and other potentially infectious materials, and to reduce their risk from this exposure.

Who Needs OSHA BBP Training? All employees who could be “reasonably

anticipated” as the result of performing their job duties to face contact with blood and other potentially infectious materials

“Good Samaritan” acts such as assisting a co-worker with a nosebleed would not be considered occupational exposure

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Employees Who May Be Exposed

Physicians, nurses and emergency room personnel Orderlies, housekeeping personnel, and laundry workers Dentists and other dental workers Laboratory and blood bank technologists and technicians Maintenance workers in healthcare facilities Staff of nursing homes and long-term care facilities Firefighters/Law enforcement personnel First Responders/EMTs/Paramedics Medical waste treatment employees Employees of funeral homes & mortuaries Home healthcare workers

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What are Bloodborne Pathogens?

Bloodborne Pathogens are disease-causing microorganisms that may be present in human blood. They may be transmitted with any exposure to blood or OPIM.

• Hepatitis Viruses• Hepatitis B (HBV)• HBV Immunization• Hepatitis C Virus• Human Immunodeficiency Virus (HIV)

Other Potentially Infectious Materials(OPIM)

Other Potentially Infectious Materials(OPIM)

Cerebrospinal FluidCerebrospinal Fluid

Saliva (in dental procedures)Saliva (in dental procedures)

BloodBlood

Pleural FluidPleural Fluid

Pericardial FluidPericardial Fluid

Peritoneal FluidPeritoneal Fluid

Semen and Vaginal Semen and Vaginal

SecretionsSecretions

Amniotic FluidAmniotic Fluid

Synovial FluidSynovial Fluid

Any fluid Any fluid Containing visible Containing visible

blood.blood.

How Exposures Occur

Most common: needlesticks Cuts from other contaminated sharps

(scalpels, broken glass, etc.) Contact of mucous membranes (for

example, the eye, nose, mouth) or broken (cut or abraded) skin with contaminated blood

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How Exposures Occur

Disease transmission is a two-way street. It is just as easy for you to infect a person with whom you come in contact as it is for that person to infect you.

A pathogen is a disease-producing organism that enters the body; basically, a germ.

The immune system relies heavily on the skin to keep the amount of pathogens that enter the body to a minimum.

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How Infections Occur

Chain of Infection Infectious Agent Reservoir Means of Exit Mode of Transmission Means of Entry Susceptible Host

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How Infections Occur

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Infectious Agent

Reservoir

Means ofExit

Mode ofTransmission

Means ofEntry

SusceptibleHost

Chain of Infection

How Infections Occur

Routes of Transmission:

Direct contactIndirect contactAirborne transmissionVector-borne transmission

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Direct Contact

Reservoir to port of entry. (Person to person)

Touching the body fluids from an infected person

KissingSexual ContactOral-FecalBlood or other bodily fluids comes in contact

with any port of entry.

Indirect Contact

Touching objects that have been in contact with the body fluid of an infected person○ Door knobs○ Countertops○ Eating utensils○ Steering wheel○ Waterborne

Airborne TransmissionBreathing in droplets that became

airborne when an infected person coughs or sneezes

Carried by current or ventilation systems

Airborne Transmission Large droplets that travel up to 3 feet.

Coughing SneezingTalking

Lands on dust or surfacesInfluenzaMeninigitisColdsRSV

Vector-Borne

Bite from an infected animal or insectBlood transfusionsOrgan transplant

What are the Infection Concerns? Both patients and healthcare workers

are at an increased risk of infectionPatients

○ weakened immune systems○ injury

Healthcare Personnel○ daily duties

Consequences of infection

How Infections Occur

Most infectious diseases are caused by one of five types of pathogens. The most common are viruses and bacteria.VirusesBacteriaFungiProtozoaParasites

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How Infections Occur

Viruses○ Hepatitis, Chicken Pox, HIV, etc.

Bacteria○ Meningitis, Tuberculosis, food poisoning

Fungi○ Athlete’s foot, ringworm

Protozoa○ Malaria, dysentery

Parasites○ Abdominal pain, anemia, etc.

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Viruses Will use genetic make-up of host cell to

replicated self.Hepatitis, Chicken Pox, HIV, Herpes, etc.

Latent type of infectionCell reproduces both own and viruses

genetic structure. (Herpes) Persistent Infection

Hepatitis B

Bacteria

○ Meningitis, Tuberculosis, food poisoning

○ One-celled organismsDivide and multiplyProduce enzymes and toxins

○ Damage surrounding tissue○ Impair the body’s ability to defend itself

Transmission depends upon:Transmission depends upon:

The virulence of the pathogen.HBV vs. HIV

The length of the exposureMore time equals greater

risk The route of entry

Blood to bloodMucosal tissue

Your general healthHealthy & well-rested

minimizes risk Your immunity

Maintain your immunizations

The Body’s Means of Fighting off Organisms

Vaccinations/ImmunizationsHealthy lifestyleStrong resistance High risk individuals

○ HIV +○ Chronic health issues○ Surgery

The HIV virus can survive outside the host body for up to seven days in dried blood

True False

Diseases that Cause Concern Human Immunodeficiency Virus (HIV)

immune system

Hepatitis B Virus (HBV)liver

Other Pathogens

Human Immunodeficiency Virus (HIV) Blood and other body fluids AIDS

no cure/no vaccineAuto-immune system suppressedVulnerable to opportunistic diseases

Environmental disinfectioneasy to kill

Human Immunodeficiency Virus Symptoms Certain symptoms &

conditions may be associated with HIV/AIDS

Fever Weight loss Swollen lymph nodes

White patches in mouth (thrush)

Certain cancers eg. Kaposi’s sarcoma, certain lymphomas

Infections eg. pneumocystis pneumonia, TB, etc.

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Hepatitis Viral Disease

Inflammation of the liver

Turn of the century identified as 2 typesEnteric (food and water)Parenteral (blood and/or other bodily fluids)

Currently-A, B, C, D, E , F & G

Hepatitis A (formerly called Infectious hepatitis)

Foodborne illness Vaccine preventable More common in countries with underdeveloped

sanitation systems Does not develop into chronic hepatitis or cirrhosis Can lead to acute liver failure and death In the News: 2009 outbreak in Illinois McDonalds

The Hepatitis B virus can survive outside the host body for days in dried blood.

True False

Hepatitis B Virus (HBV) (formerly called Serum hepatitis)

Parenteral Infection: blood and body fluidssaliva

Highly infectiousdiluted blood 1:100,000,000viable in dried bloodincrease in sexually transmitted cases

Immunization3 shots

Hepatitis B Virus Symptoms

Lethargy Loss of appetite Fever Vomiting

Yellow skin & eyes (jaundice)

Dark-colored urine.

Light colored stool

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DID YOU KNOW???

It is estimated that 4.9% of all Americans have been infected with HBV

Hepatitis C (HCV)

Most common chronic bloodborne infection in the US.Transmitted through large or repeated direct

exposures to blood such as: long term kidney dialysis, tattoos, sexual contact, parenteral infection

In many cases, there are no symptoms until cirrhosis has developed.

No vaccination available Can last in dried blood up to 3 weeks

Hepatitis C Symptoms

Lethargy Loss of appetite Abdominal pain Nausea

Vomiting Yellow skin &

eyes (jaundice) Urine that is dark

in color

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Hepatitis D & E

Hepatitis D (Delta Virus)Rare in most developed countries, and is

mostly associated with intravenous drug use. Propagates only in the presence of the

HBV virus. Hepatitis E

Fecal-oral transmission routeSeen more developing countries

○ occur after heavy rainfalls because of their disruption of water supplies

Hepatitis F & G

Hepatitis FDebate continues on its presence

Hepatitis GSymptoms are non-existentFound in co-infections with other viruses,

such as HCV and HIV

Reportable IncidentsReportable Incidents

Incidents that involve Incidents that involve the failure of barrier the failure of barrier protection (glove protection (glove failure), blood or OPIM failure), blood or OPIM contact with intact skin contact with intact skin or conditions preventing or conditions preventing the use of PPEthe use of PPE

Reportable Reportable Incident that must Incident that must be reported to your be reported to your supervisor before supervisor before the end of your the end of your shiftshift..

Significant ExposuresSignificant Exposures

Follow your Follow your organization’s organization’s Exposure Exposure Reporting Reporting Policy.Policy.

• NeedlesticksNeedlesticks

• Blood/OPIM contact Blood/OPIM contact with non-intact with non-intact

skinskin

• Blood/OPIM contact Blood/OPIM contact with mucosal with mucosal

tissuetissue

OSHA Office of Training and Education 42

What to do if an exposure occurs?

Wash exposed area with soap and water

Flush splashes to nose, mouth, or skin with water

Irrigate eyes with water or saline Report the exposure Direct the worker to a healthcare

professional

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Post-Exposure Follow-Up

Employer will:document routes of exposure and how exposure

occurredrecord injuries from contaminated sharps in a

sharps injury log, if requiredobtain consent from the source individual and

the exposed employee and test blood as soon as possible after the exposure incident

provide risk counseling and offer post-exposure protective treatment for disease when medically indicated in accordance with current U.S. Public Health Service guidelines

The Ryan White ActThe Ryan White Act

Requires Health Care Providers (hospitals, nursing homes, primary care facilities) to notify ALL personnel who may have been exposed to infectious/communicable diseases.

Labels and Signs

Labeling Regulated WasteLabeling Regulated Waste Refers to the following categories of waste

that require special handling at a minimum:Liquid or semi-liquid blood or OPIMItems contaminated with blood or OPIM & would

release these substances in a liquid if compressedCaked with dried blood or OPIMContaminated sharpsPathological & microbiological wastes containing

blood or OPIM

When Labeling Regulated Waste is NecessaryWhen Labeling Regulated Waste is Necessary On containers of regulated waste or on

refrigerators or freezers that are used for storage

Equipment being sent to another facility for servicing or decontamination

Must be labeled with biohazard labelEven if your facility considers all of its waste to be

regulated, it still must bear the label

Biohazard LabelsBiohazard Labels Biohazard labels may be attached to bags

containing potentially infectious materials Labels must be fluorescent orange or

orange-red with letters or symbols in contracting color or color-coded for your facility

Attached to any container that is used to store or transport potentially infectious materials

Contaminated SharpsContaminated Sharps OSHA Definition—any contaminated

object that can penetrate the skin, including, but not limited to, needles, scalpels, broken capillary tubes, and exposed ends of dental wires.

Contaminated SharpsContaminated Sharps Reusable sharps

Must be placed in a clearly labeled puncture-resistant, leakproof container asap after use

Acceptable sharps containersClosablePuncture resistantLeakproof on sides & bottomLabeled or color-coded in accordance with the

Standard

Sharps ContainersSharps Containers Must be easily accessible to personnel and

located as close to immediate area as possible. Sharps containers mounted onto walls should be

52” to 56”from the floor. Maintained in an upright position Reusable containers (those used to transport

contaminated sharps for cleaning) shall not be opened, emptied, or cleaned manually which would expose employees to risk of injury

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Sharps Injury Log

Employers must maintain a sharps injury log for the recording of injuries from contaminated sharps

The log must be maintained in a way that ensures employee privacy and must contain, at a minimum:Type and brand of device involved in the incidentLocation of the incidentDescription of the incident

Disinfection

“You can clean without disinfecting or sterilizing...

...but you cannot disinfect or sterilize without cleaning.”

Disinfection is a Process

Step 1 - CleaningIf foreign material/soil is visible (i.e., body

fluids), remove by cleaning prior to disinfection

Soil can keep the disinfection process from working

Step 2 - DisinfectingDisinfection is a process that eliminates

many or all microorganisms except spores

Universal Precautions

Treat all human blood & certain body fluids as if they are known to contain HIV, HBV, HCV or other bloodborne pathogens regardless of the perceived risk of the source.

Personal Protective Equipment Gloves

blood or body fluidsmucous membranesskin with open cuts or sorescontaminated items or surfaces

Gown or Apron Mask Don’t Forget Eye Protection!

Preventing Disease Transmission Wash hands!

if visibly soiledbefore and after restroombefore and after eatingafter taking off gloves

Hand Washing Recommendations Hand Hygiene Indications

Visibly soiled hands - traditional wash

Hand Hygiene TechniqueTraditional Handwash

○ Wet hands first○ 3 - 5 mL of product○ Wash for at least 15 seconds○ Rinse○ Dry - use towel to turn off faucet

Tips for a Traditional Wash Proper Handwashing:

Wet hands BEFORE adding soapDime-sized amount of soap is plentyUse warm, not HOT waterRinse thoroughlyDry thoroughly

New Guideline Recommendations

Hand Hygiene Indications If hands are not soiled, use alcohol:

○ Before and after gloving○ Before and after patient contact

intact skinnon-intact skin, wound dressings (no visible soil)between contaminated and clean body sites

Considerations

Use caution when handling items that may contain sharps

Do not eat, drink, apply cosmetics or handle contact lenses in areas where exposure is likely to occur

Place soiled linen in an impermeable bag

Clean, disinfect or sterilize contaminated equipment between uses

Blood Spills

Spills of blood or body fluids should be cleaned up promptlyUse an appropriate disinfectant (HIV and

HBV effective)OSHA considers tuberculocidal agents

(bleach, phenol) HIV and HBV effectiveOSHA now considers quats EPA registered

as effective against HIV and HBV effective

Prions (vCJD)Prions (vCJD)

Bacterial sporesBacterial spores Not HighNot High

SterilizationSterilization ((BacillusBacillus, , ClostridiumClostridium spp.) spp.) NumbersNumbers

MycobacteriumMycobacterium IntermediateIntermediate High-LevelHigh-Level ((M. tuberculosisM. tuberculosis)) DisinfectionDisinfection DisinfectionDisinfection

Nonlipid orNonlipid or small virusessmall viruses CheckCheck (Poliovirus, HAV)(Poliovirus, HAV) LabelLabel

FungiFungi (Candida sp.)(Candida sp.)

Vegetative bacteriaVegetative bacteria Low-LevelLow-Level (S. aureus, MRSA, VRE)(S. aureus, MRSA, VRE) DisinfectionDisinfection

Lipid or medium-Lipid or medium- sized virusessized viruses (Herpes simplex, HBV, HIV)(Herpes simplex, HBV, HIV)

Descending Order of Resistance

Choosing a Disinfectant for Blood Spills

Sodium Hypochlorite (bleach)

Phenolic HBV Effective

Quaternary Ammonium Compound

Sodium Hypochlorite

Proshistory of disinfectioneconomical

Conssurface compatibilitystabilitysafetycleaning ability

Phenol

Prosbroad kill range, including TBcleaning abilityresistance to hard water and organic soil

Conssurface compatibilitytoxicity

HBV Effective Quaternary Ammonium Compounds Pros

cleaning abilitybroad spectrum of killresistance to hard water and organic soilsurface compatibilitysafety

Consnot tuberculocidal, unless combined with

another chemical

Final Points to Remember Basic Steps to Prevent Infection

use appropriate cleaning and disinfectant procedures

wash your hands thoroughlypractice good skin careuse personal protective equipmentHBV Vaccinationknow the exposure control plan

Tuberculosis

Tuberculosis Infectious disease cause

by the bacterium, Mycobacterium tuberculosis.

Spread by airborne droplets, “droplet nuclei,” which may be generated when a person with TB disease coughs, sneezes, speaks or sings.

Occurrence

Nearly one-third of the world’s population is infected with TB, which kills almost 3 million people per year.

Why Is TB Increasing?

Multiple contributing factors: Homelessness Intravenous drug use Overcrowding in institutional settings HIV infection Drug-resistant strains of TB Reduced TB control and treatment

resources Immigration from high TB prevalence areas

Where Is TB Found in the Workplace? Healthcare Facilities Correctional

Institutions Homeless Shelters Long-term Care

Facilities for the Elderly

Drug Treatment Centers

What Does it Mean to You?What Does it Mean to You? Your employer must provide training in

recognizing high-risk patients and procedures.

Employers must provide fit-tested and N95 masks for all employees.

Employees must receive free skin test (Mantoux test) upon hiring and at least annually thereafter.

Employer must provide evaluation and management of symptomatic employees with history of positive skin tests.

Employer must maintain complete records of all training, skin tests and exposures.

What Does it Mean to What Does it Mean to You?You?

Tuberculosis signs and symptomsTuberculosis signs and symptoms Persistent productive cough (lasting 2

weeks or more) Weight loss Loss of appetite Night sweats and/or fever General weakness or lethargy Hemoptysis (coughing up blood)

Tuberculosis ScreeningTuberculosis Screening Healthcare Workers have increased risk

of TB Frequency of Screening is dependent on

the number of active cases within facility

TB Skin Test (Mantoux)TB Skin Test (Mantoux) Injection of purified protein derivative

(PPD) under skin Injection is then checked for reaction in

48 to 72 hours

TB and Respiratory Protection The primary means to control occupational

diseases caused by breathing contaminated air is through the use of feasible engineering controls such as enclosures, confinement of operations, ventilation or substitution of less toxic materials.

When these controls are not feasible, or while they are being instituted, appropriate respirators shall be used.

When to Wear the Respirator(N95 masks) When to Wear the Respirator(N95 masks)

When entering a TB isolation area During contact with a patient with

suspected or confirmed active TB During high risk procedures on high risk

patient groups

A respirator may be re-used by the same A respirator may be re-used by the same person until it becomes wet or damaged.person until it becomes wet or damaged.

Respirator LimitationsRespirator Limitations Do not wear a respirator unless cleared Do not put respirator on patient N95 masks or H.E.P.A. respirators do not protect from hazardous chemicals

Do not wear in oxygen deficient atmosphere

Do not share respirators

Accident Prevention Signs and Tags

In accordance with 1910.145 (f)(8), a warning shall be posted outside the respiratory isolation or treatment room or a message referring one to the nursing station for instruction may be posted.

1910.145 (f)(4) requires that a signal word or biological hazard symbol may be presented as well as a major message.

Accident Prevention Signs and Tags (Continued)

Employers are also required to use biological hazard tags on air transport components which identify TB hazards to employees associated with working on air systems that transport contaminated air.

QuestionsQuestions??

References

OSHA Office of Training & Education American Academy of Orthopedic

Surgeons, Bloodborne Pathogens Fourth Edition