1 preventing exposures to blood borne pathogens updated 10/06 all staff
TRANSCRIPT
1
Preventing Exposures to Preventing Exposures to Blood Borne PathogensBlood Borne Pathogens
Updated 10/06
All Staff
2
What is exposure control?What is exposure control?
Exposure control is an approach to eliminate employee contact to a potential health hazard.
3
Elements of an exposure Elements of an exposure control plancontrol plan
• Exposure determination• Methods of compliance:
– universal precautions – work practices – engineering controls– use of personal protective equipment
4
Elements of an exposure Elements of an exposure control plancontrol plan
• Hepatitis B vaccination program • Procedure for evaluation of exposure incidents • Post-exposure evaluation and follow-up• Inclusion of evaluation of safer engineering
devices
5
Where is your exposure Where is your exposure control plan located?control plan located?
• A copy of your exposure control plan should be maintained by your
employer.• It should be reviewed and updated
annually.• You should have access to the plan
for review.
6
Why is an exposure control Why is an exposure control plan important ?plan important ?
Identifies employees at risk for exposure to bloodborne pathogens
Provides for the education of employees regarding the bloodborne pathogen risk and how to avoid this risk
Provides a mechanism to educate employees about the uses and limitations of engineering controls, work practices and personal protective equipment
Provides a plan for post-exposure follow-up
7
What is an occupational What is an occupational exposure?exposure?
An “occupational exposure is a reasonably anticipated skin, eye, mucous membrane, non-intact skin or parenteral contact with blood and other potentially infectious materials that may result from the performance of an employee’s duties.”
OSHA
8
How can exposures be How can exposures be prevented?prevented?
1) Your employer should identify job categories at risk for exposure.
2) Consistent use of universal precautions for all clients.
3) Use of personal protective equipment.
4) Use of engineering controls .
5) Use of safe work practices.
9
Prevention is the key!Prevention is the key!
10
How are bloodborne pathogens How are bloodborne pathogens transmitted?transmitted?
Hepatitis B and C and HIV are transmitted in a Hepatitis B and C and HIV are transmitted in a
healthcarehealthcare setting: setting:
by needle stick injuries contact with blood or body fluids through
cuts, scrapes and breaks in the skin splashes to the eye, nose and mouth area
11
What are the symptoms of What are the symptoms of Hepatitis B and C?Hepatitis B and C?
Hepatitis attacks the liver and may cause serious liver disease.
Sometimes jaundice occurs with these infections.
Hepatitis can feel like a flu-like illness for months.
12
Do people with hepatitis Do people with hepatitis always have symptoms?always have symptoms?
Some people never have symptoms. Others are considered in a chronic carrier
state - no symptoms but can pass the disease to others
HBV can lead to cirrhosis, liver cancer and death.
Hepatitis C may lead to cirrhosis of the liver.
13
How many cases of How many cases of Hepatitis B occur each year?Hepatitis B occur each year?
Approximately 140,000 - 320,000 cases occur each year.
20,000 people go on to be chronic carriers 850 people will develop chronic liver
problems 140-320 people will die from active
Hepatitis B each year
14
How many cases of How many cases of Hepatitis C occur each year?Hepatitis C occur each year?
35, 000 - 180,000 Americans become infected with HCV per year
HCV is associated with 8,000 - 10,000 deaths each year (chronic liver disease
> 85% of people who become infected with HCV will go on to develop chronic infection
15
HIVHIV
The number of people with HIV and AIDS continues to increase.
Total number of people living with HIV/AIDS is 40 million as of 2003
Approximately 5 million people were newly infected with HIV in 2003
16
What are the symptoms of What are the symptoms of HIV?HIV?
HIV attacks the body’s immune system Many people are infected but do not know
they have been infected. Early symptoms of AIDS may include
fever, loss of appetite, weight loss, chronic fatigue and skin rashes.
17
Prevention ApproachesPrevention Approaches
18
Contact task categories Contact task categories
Category I - Routine contact with blood and body fluids
Category II - Occasional contact with blood and body fluids
Category III - No contact with blood and body fluids
19
Written Policies which:Written Policies which:
prohibit recapping, breaking or shearing needles specify safe practices when handling reusable
sharps require use of mechanical means to clean up
broken glassware disposal of contaminated sharps
20
Standard PrecautionsStandard Precautions
All blood and body fluids are treated as if known to be infectious for HIV, HBV and HCV
Consistently used with all clients
21
Engineering ControlsEngineering Controlscontrols that either remove the hazard or
isolate the worker from the hazard
Examples of controls are sharps disposal containers, self-sheathing needles, or biosafety cabinets.
Employees must be instructed in the use of engineering controls.
There must be regular inspection and replacement of engineering controls.
22
Safe Work PracticesSafe Work Practices These practices prevent exposures.These practices prevent exposures.
HANDWASHING facilities should be close to the work area.
Handling of contaminated equipment and processing of specimens.
Identification of high risk areas by use of biohazard labeling.
23
Safe Work PracticesSafe Work Practices
no eating, drinking, smoking, applying lip balm or cosmetics, or handling of contact lenses in the work areas where there is a risk of exposure.
handwashing alternatives when running water is not available
universal precautions when handling all specimens all contaminated equipment must be
decontaminated prior to servicing
24
Personal Protective BarriersPersonal Protective Barriers
Must be provided at no cost to the employee nor can cost be past on to clients.
Include barriers such as fluid-resistant gloves, gowns, face shields, and masks.
Employees must be trained in the proper use and selection of PPE.
Must be easily accessible
25
Hepatitis B immunizationHepatitis B immunization Educate employee on risk of BBP Free to employee Voluntary If employee declines, a declination form
must be signed. Offer within 10 days of beginning
employment Three injections over 6 months Verify sero-conversion 30 days post
immunization
26
Hepatitis B immunizationHepatitis B immunization Non-converters
Re-immunize with the complete series Retest 30 days post completion of the second
series. If employee does not demonstrate immunity, consider as “non responder” and not immune to Hepatitis B.
If exposed to active HBV, administer Hepatitis B Immune globulin
27
Contaminated MaterialsContaminated Materials
procedures must be followed to decontaminate the environment,equipment, laundry and work surfaces
procedure for collecting, transporting and disposal of waste
schedule for cleaning and decontamination of worksite based on location, type of surface, soil and tasks involved
28
Handling Contaminated Handling Contaminated MaterialMaterial
universal precautions label with biohazard labeling or use red
bags for disposal requirements for disposal include:
close-able, labeled containers, constructed to prevent leakage during handling, storage, or transporting.
29
Compliance MonitoringCompliance Monitoring
Employers are required to ensure that employees are following the practices.
Employee health/infection control programs Management monitoring Investigation of exposure circumstances
30
Post exposure follow-upPost exposure follow-up
31
Post exposure follow-upPost exposure follow-up
Determination as to who will be the provider Compliance with Maryland state laws and
OSHA regulations Written informed consent of employee and
source prior to HIV testing Evaluation of incident to prevent
re-occurrence
32
Post Exposure Follow-upPost Exposure Follow-up
After signed informed consent of After signed informed consent of employee and source:employee and source:
employee baseline testing to include: Hepatitis B surface antibody Hepatitis C antibody HIV
source testing to include: Hepatitis B antigen Hepatitis C antibody HIV
33
What should be sent What should be sent with the employee?with the employee?
Copy of the OSHA BBP regulations Description of duties and responsibilities as
related to the exposure Documentation of routes of exposure and
circumstances under which the incident occurred
34
What should be sent What should be sent with the employee?with the employee?
source and employee’s blood work (should be confidential and sent directly to the outside provider)
relevant employee records regarding immunization
35
Elements of healthcare Elements of healthcare professionals evaluationprofessionals evaluation
Healthcare professional’s opinion stating the employee was counseled and advised will be sent to the employer
Employee should anticipate a written opinion of the visit within 15 days. Opinion should contained detailed information.
36
Related issuesRelated issues
Communicable disease Communicable disease reporting and notificationreporting and notification
37
COMAR regulations require reporting of clients with communicable diseases
A call to your local health department will meet the requirements and provide an opportunity for additional information sharing e.g., staff followup;
EMS notification in circumstances were identification of a communicable disease is communicated to the office
38