bloodborne pathogens meadowlands hospital medical center

Bloodborne Pathogens

Meadowlands Hospital Medical Center

Learning Objectives

Describe the epidemiology, symptoms, and infection risks of select bloodborne pathogens.

Recognize potentially infectious material, tasks with occupational exposure, hazards, and exposure incidents.

Employ controls—including engineering controls, work practices, labeling, and personal protective equipment (PPE).

Summarize components of postexposure management.

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OSHA’s Bloodborne Pathogens Standard

Exposure determination

Exposure control plan Training Labels and signs

Standard precautions

Engineering and work-practice

controls

Disposal of sharps and regulated medical waste,

cleaning, laundry

PPE

Hepatitis B virus (HBV) vaccination

Postexposure evaluation and

follow-upRecord keeping

Requirements for HIV, HBV research

laboratories and production facilities

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Bloodborne Pathogens: What Are They?“Pathogenic microorganisms that are present in human blood and can cause disease in humans”

HIV

Hepatitis B, C, D

Syphilis

Creutzfeldt-Jakob disease

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Sources: Occupational Safety and Health Administration. Bloodborne pathogens [standard online]. 29 CFR § 1910.1030. 2012 Apr 3 [cited 2014 May 14]. https://www.osha.gov/pls/oshaweb/owadisp.show_document?p_id=10051&p_table=STANDARDS; University of the Sciences. Q&A on OSHA’s bloodborne pathogens standard [online]. [cited 2014 May 13]. http://www.usciences.edu/safety/infotrain/qablood.htm

HIV Infection: Stages

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Early stage

• Many but not all get symptoms

• May feel like "worst flu ever"

• 2–4 weeks after exposure

• Lasts a few days to several weeks

Clinical latency stage

• No or mild symptoms

• Often lasts a decade in the untreated

• Lasts longer in treated patients

Progression to AIDS

• Potential for opportunistic infections, related cancers

• Treatment may prevent progression to AIDS

2014 ECRI Institute

Sources: Centers for Disease Control and Prevention. About HIV/AIDS [online]. 2014 Feb 12 [cited 2014 May 13]. http://www.cdc.gov/hiv/basics/whatishiv.html; U.S. Department of Health and Human Services (U.S. HHS); HIV/AIDS 101: signs and symptoms [online]. 2013 Dec 19 [cited 2014 May 13]. http://aids.gov/hiv-aids-basics/hiv-aids-101/signs-and-symptoms; U.S. HHS. Stages of HIV infection [online]. 2013 Dec 19 [cited 2014 May 13]. http://aids.gov/hiv-aids-basics/just-diagnosed-with-hiv-aids/hiv-in-your-body/stages-of-hiv

HIV Infection: Signs and Symptoms

Early stage

• Fever• Swollen glands• Sore throat• Rash• Fatigue• Muscle, joint aches• Headache

Clinical latency stage

• No or mild symptoms

Progression to AIDS

• Rapid weight loss• Fever, night sweats• Extreme tiredness• Lymph gland swelling• Long-lasting diarrhea• Oral, anal, genital

sores• Pneumonia• Blotches on skin,

mucous membranes• Memory loss,

depression, etc.

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Sources: Centers for Disease Control and Prevention. About HIV/AIDS [online]. 2014 Feb 12 [cited 2014 May 13]. http://www.cdc.gov/hiv/basics/whatishiv.html; U.S. Department of Health and Human Services (U.S. HHS); HIV/AIDS 101: signs and symptoms [online]. 2013 Dec 19 [cited 2014 May 13]. http://aids.gov/hiv-aids-basics/hiv-aids-101/signs-and-symptoms; U.S. HHS. Stages of HIV infection [online]. 2013 Dec 19 [cited 2014 May 13]. http://aids.gov/hiv-aids-basics/just-diagnosed-with-hiv-aids/hiv-in-your-body/stages-of-hiv

HBV Infection: Stages, Signs, and Symptoms

Acute infection

• 70% of adults get symptoms

• Symptoms can appear 6 weeks to 6 months after exposure

• Symptoms usually last a few weeks but can last as long as 6 months

Chronic infection

• Most have no symptoms for decades

• Some have symptoms like those of acute infection

• 15%–25% get serious liver conditions• Some have no

symptoms even as liver becomes diseased

• Fever• Fatigue• Loss of appetite• Nausea• Vomiting• Abdominal pain• Dark urine• Clay-colored bowel

movements• Joint pain• Jaundice

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Source: Centers for Disease Control and Prevention. Hepatitis B FAQs for the public [online]. 2009 Jun 9 [cited 2014 May 13]. http://www.cdc.gov/hepatitis/b/bfaq.htm

HCV Infection: Stages, Signs, and Symptoms

Acute infection

• 20%–30% of people get symptoms

• Symptoms can appear 2 weeks to 6 months after exposure

Chronic infection

• Most have no symptoms

• In many cases, no symptoms until liver problems have developed

• Can lead to liver damage, liver failure, liver cancer, even death

• Fever• Fatigue• Loss of appetite• Nausea• Vomiting• Abdominal pain• Dark urine• Clay-colored bowel

movements• Joint pain• Jaundice

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Source: Centers for Disease Control and Prevention. Hepatitis C FAQs for the public [online]. 2014 Feb 10 [cited 2014 May 13]. http://www.cdc.gov/hepatitis/c/cfaq.htm

How Common Are Bloodborne Pathogens in the United States?

1.1

milli

on

800,

000

to .

. .

1.4

milli

on

3.2

milli

on

* Age 13 or older

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Sources: Centers for Disease Control and Prevention (CDC). HIV in the United States: at a glance [online]. 2013 Dec 3 [cited 2014 May 13]. http://www.cdc.gov/hiv/statistics/basics/ataglance.html; CDC. Hepatitis B FAQs for the public [online]. 2009 Jun 9 [cited 2014 May 13]. http://www.cdc.gov/hepatitis/b/bfaq.htm; CDC. Hepatitis C FAQs for the public [online]. 2014 Feb 10 [cited 2014 May 13]. http://www.cdc.gov/hepatitis/c/cfaq.htm

Standard Precautions: Approach All Blood and OPIM As If They Were Infectious

16% of people with HIV infection are unaware of their infection.

19% of people with HIV infection are age 55 or older.

Chronic HCV infection is most prevalent among baby boomers.194

5

1965

OPIM = other potentially infectious material

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Sources: Centers for Disease Control and Prevention (CDC). HIV in the United States: at a glance [online]. 2013 Dec 3 [cited 2014 May 13]. http://www.cdc.gov/hiv/statistics/basics/ataglance.html; CDC. HIV among older Americans [online]. 2013 Dec 20 [cited 2014 May 13]. http://www.cdc.gov/hiv/risk/age/olderamericans/index.html; CDC. Hepatitis C FAQs for the public [online]. 2014 Feb 10 [cited 2014 May 13]. http://www.cdc.gov/hepatitis/c/cfaq.htm.

Who May Have Occupational Risk?

Anyone who works in healthcare and has potential for exposure to infectious materials Infectious body substances Contaminated medical supplies and equipment Contaminated surfaces

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Source: Kuhar DT, Henderson DK, Struble KA, et al. Updated US Public Health Service guidelines for the management of occupational exposures to human immunodeficiency virus and recommendations for postexposure prophylaxis. Infect Control Hosp Epidemiol 2013 Sep;34(9):875-92. Also available at http://www.jstor.org/stable/10.1086/672271

Blood and OPIMPotentially infectious

BloodBody fluids with visible bloodAll body fluids in situations in which it is difficult or impossible to differentiate between body fluids

Semen*Vaginal secretions*Cerebrospinal fluidSynovial fluidPleural fluidPeritoneal fluidPericardial fluidAmniotic fluidSaliva (dental procedures)

Unfixed human tissue or organ (except skin)HIV-containing cell, tissue, or organ culturesHIV- or HBV-containing culture media or other solutionsBlood, organs, other tissues from experimental animals infected with HIV or HBV

* Potentially infectious but not implicated in occupational transmission

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Source: Occupational Safety and Health Administration. Bloodborne pathogens [standard online]. 29 CFR § 1910.1030. 2012 Apr 3 [cited 2014 May 14]. https://www.osha.gov/pls/oshaweb/owadisp.show_document?p_id=10051&p_table=STANDARDS

What Incidents Should Be Evaluated?

Evaluation

Injury that pierces the skin (e.g.,

needlestick, cut with a sharp object)

Contact between potentially infectious

body fluid and mucous membrane or nonintact skin

Direct contact with concentrated virus in a research laboratory

Human bite

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Source: Centers for Disease Control and Prevention. Updated U.S. Public Health Service guidelines for the management of occupational exposures to HBV, HCV, and HIV and recommendations for postexposure prophylaxis. MMWR Recomm Rep 2001 Jun 29;50(RR-11):1-52. Also available at http://www.cdc.gov/mmwr/PDF/rr/rr5011.pdf

Sharps: Not Just NeedlesA contaminated sharp is “any contaminated object that can penetrate the skin.”

“Contaminated” means “the presence or the reasonably anticipated presence of blood or other potentially infectious materials on an item or surface.”

These are only examples.

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How Common Are Injuries?

Each year, almost one in five healthcare workers experiences a needlestick injury.

Only 54% of injuries are reported.

Your health and safety are important!

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2014 ECRI Institute

Sources: Premier Safety Institute. Prevent needlestick injuries [online]. 2011 [cited 2014 May 14]. https://www.premierinc.com/quality-safety/tools-services/safety/topics/needlestick/downloads/SharpsBRO_SEPT-2011-HR.pdf; Schillie S, Murphy TV, Sawyer M, et al. CDC guidance for evaluating health-care personnel for hepatitis B virus protection and for administering postexposure management. MMWR Recomm Rep 2013 Dec 20;62(RR-10):1-19. Also available at http://www.cdc.gov/mmwr/preview/mmwrhtml/rr6210a1.htm

Likelihood of Getting Infected from Percutaneous Exposure to Infected Blood

1 in 333 1 in 4

1 in 56

1 in 100 - 1 in 17

HIV HBV (if unvaccinated)

HCV

HBeAg+

HBeAg-

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Source: Centers for Disease Control and Prevention. Updated U.S. Public Health Service guidelines for the management of occupational exposures to HBV, HCV, and HIV and recommendations for postexposure prophylaxis. MMWR Recomm Rep 2001 Jun 29;50(RR-11):1-52. Also available at http://www.cdc.gov/mmwr/PDF/rr/rr5011.pdf

Documented Cases of HIV Transmission to Healthcare PersonnelCDC investigates voluntarily reported cases of HIV transmission to healthcare personnel. Cases may be underreported.

CDC analyzes cases in those with no nonoccupational risk factors, but over 90% of HIV-infected healthcare personnel have nonoccupational risk factors.

From 1981 to 2010, CDC identified only 57 cases of documented HIV seroconversion after occupational exposure.

Another 143 cases were identified as “possible” cases of transmission.

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Source: Centers for Disease Control and Prevention. Surveillance of occupationally acquired HIV/AIDS in healthcare personnel, as of December 2010 [online]. 2011 May 23 [cited 2014 May 15]. http://www.cdc.gov/HAI/organisms/hiv/Surveillance-Occupationally-Acquired-HIV-AIDS.html

Get Involved

engineering and work-practice controls.

• identification, • evaluation, and• selection of

for input regarding . . .

• responsible for direct patient care

• who are potentially exposed to injuries from contaminated sharps . . .

nonmanagerial employees . . .

OSHA requires employers to ask . . .

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Our Exposure Control Plan

Our exposure control plan . . .

Our plan is located on our intranet in the Policy and Procedure Manual.

Describes how we implementEngineering controlsWork-practice controlsPPEHousekeepingSharps disposal

HBV vaccinationBiohazard labelsTraining

Is required by OSHA’s bloodborne pathogens standard

Describes how exposure incidents will be evaluated

Outlines what records we keep regarding your occupational exposure

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HBV Vaccination: Efficacy and Dosing

Costs you nothing See employee health nurse

Can prevent HBV infection and serious consequences

Offers long-term protection, possibly lifelong

Usual dosing schedule

2nd1st

3rd4 weeks after 1st dose

5 months after 2nd dose

Blood testing for immunity 1–2 months after last dose

More vaccine doses and testing are indicated if not immune

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Source: Centers for Disease Control and Prevention. Hepatitis B vaccine: what you need to know [online]. 2012 Feb 2 [cited 2014 May 16]. http://www.cdc.gov/vaccines/hcp/vis/vis-statements/hep-b.pdf

HBV Vaccination: Safety

HBV vaccine cannot cause HBV infection.

Most people have no problems.

Mild ProblemsInjection site soreness Up to 1 in 4 people

Fever Up to 1 in 15 people

Severe ProblemsSevere allergic reaction

1 in 1.1 million doses

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Source: Centers for Disease Control and Prevention. Hepatitis B vaccine: what you need to know [online]. 2012 Feb 2 [cited 2014 May 16]. http://www.cdc.gov/vaccines/hcp/vis/vis-statements/hep-b.pdf

Elimination and Substitution

Elimination or substitution may be used only when clinically appropriate.

Examples are: Oral rather than intravenous administration Use of a needleless device (e.g., needleless IV system)

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Engineering Controls: Sharps with Engineered Sharps Injury Protections Intended to reduce the risk of a sharps injuryMust be used appropriately to reduce injury riskWe have the Vanish pint needle system (the needle retracts

directly from the skin)

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Engineering Controls: How We Select Protective DevicesBy seeking input from

direct care staff Determine availability of

devices for applications that pose exposure risk

Review available devices at least annually, including changes in technology

Some factors to consider • User’s hands always behind needle• Integration of safety features• Ease of use• Use by right- and left-handed staff• Obvious engagement of safety feature• Locking of safety feature after activation• Safety feature activation before removal from

patient• One-handed activation• Permanent protection after activation• Standardization issues

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Sources: Occupational Safety and Health Administration (OSHA). Bloodborne pathogens [standard online]. 29 CFR § 1910.1030. 2012 Apr 3 [cited 2014 May 14]. https://www.osha.gov/pls/oshaweb/owadisp.show_document?p_id=10051&p_table=STANDARDS; ECRI Institute. Needlestick-prevention devices. Disposable syringes and injection needles. Health Devices 2007 Aug;36(8):241-73; ECRI Institute. Sharps safety and needlestick prevention. 2nd ed. Plymouth Meeting (PA): ECRI Institute; 2003; Premier Safety Institute. Prevent needlestick injuries [online]. 2011 [cited 2014 May 14]. https://www.premierinc.com/quality-safety/tools-services/safety/topics/needlestick/downloads/SharpsBRO_SEPT-2011-HR.pdf

Engineering Controls: Use of Sharps Disposal ContainersDiscard sharps

immediately or as soon as feasible.

Place reusable sharps in appropriate containers until reprocessed. If reprocessing, don’t reach

by hand into the container.

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Engineering Controls: Replacement of Sharps Disposal ContainersDon’t overfill.Replace routinely.

When moving containers of used sharps: Close immediately before

removal.

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Containers for Disposal of Other Regulated WasteUse appropriate containers.Close before removal. If outside of container is contaminated, place in second

container.

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Some Other Times to Clean and Disinfect

Replace equipment or surface coverings: As soon as feasible if

overtly contaminated At end of shift if they may

have become contaminated during the shift

Disinfect . . .

• Contaminated work surfaces

After procedures

• Overtly contaminated surfaces

• Blood or OPIM spills

Immediately or as soon as feasible

• Surfaces that may have become decontaminated since last cleaning

At end of shift

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Contaminated Laundry

Minimize agitation when handling. If wet and reasonably likely to soak or leak through the bag or

container, place in bag or container that prevents soak-through and leakage.

Wear gloves and other appropriate PPE.

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Administrative Controls: Work Practices

Ask for help if patient is uncooperative.

Ensure stable surface and available sharps container.

Limit butterfly use use safety ones if necessary.

Don’t pass by hand set sharp down and pick it up.

Use neutral zone for minor non-OR surgeries.

Avoid recapping use one-hand technique if required.

Dispose of sharps immediately after use.

Clean broken glass using brush and dustpan.

Inform other personnel if patient is uncooperative.

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Source: Premier Safety Institute. Safer work practices to prevent sharps injuries [online]. [cited 2013 Dec 5]. https://www.premierinc.com/needlestick/downloads/16_workpractices.doc

Administrative Controls: Signs and Labels

Things that contain blood or OPIM are labeled with this symbol.

There are exceptions. For example, the following may also contain blood or OPIM: Red bags, red containers Containers of blood or blood products

released for clinical use Individual containers placed in a labeled

container for storage, transport, disposal

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PPE: Types and Locations

PPE is available at no cost to you. Located on each unit isolation carts

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PPE for Standard Precautions

Also wear PPE as indicated by transmission-based precautions.

• The task and degree of exposure warrant.

• Gross contamination can be reasonably anticipated.

• Splashes, spray, spatter, or droplets of blood or OPIM may be generated AND

• eye, nose, or mouth contamination can be reasonably anticipated.

• Hand contact with blood, OPIM, mucous membranes, or nonintact skin can be reasonably anticipated.

• You’re performing vascular access procedures.• You’re touching contaminated items or surfaces.Gloves Masks

and eye protection

Protective body

clothingHead and/or

foot protection

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PPE: DonningSee the complete sequence with detailed steps on the Centers for Disease Control and Prevention’s (CDC) website.

1. Gown

2. Mask or respirator

3. Goggles or face shield

4. Gloves

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Source: Centers for Disease Control and Prevention. Sequence for donning and removing personal protective equipment [poster online]. [cited 2014 May 23]. http://www.cdc.gov/HAI/pdfs/ppe/ppeposter1322.pdf

http://www.cdc.gov/HAI/pdfs/ppe/ppeposter1322.pdf

PPE: Safe Glove Use

Replace disposable gloves: As soon as practical if contaminated As soon as feasible if their ability to serve as a barrier is compromised

(e.g., they are torn or punctured)Don’t reuse disposable gloves.

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PPE: RemovalSee the complete sequence with detailed steps on CDC’s website.

3. Gown

4. Mask or respirator

2. Goggles or face shield

1. Gloves

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Source: Centers for Disease Control and Prevention. Sequence for donning and removing personal protective equipment [poster online]. [cited 2014 May 23]. http://www.cdc.gov/HAI/pdfs/ppe/ppeposter1322.pdf

http://www.cdc.gov/HAI/pdfs/ppe/ppeposter1322.pdf

PPE: Removal

Remove before leaving patient room/ or work area.Place in designated area or container.Perform hand hygiene immediately or as soon as feasible after

removal.

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Limitations of Controls

What can you do?Understand the risks.Vaccinate against HBV.Use standard precautions.Use controls properly.Report hazards and incidents

promptly.Give feedback.

Engineering controls, work-practice controls, labeling, and PPE can help reduce the risk of exposure to bloodborne pathogens.

But they do not eliminate the risk.

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What to Do in an Event Involving Blood or OPIM ExposureWash wounds, exposed

skin with soap and water.Flush mucous membranes.Immediately notify your

supervisor and go to the ED (and fill out employee incident report)

Postexposure prophylaxis for HIV, if indicated, should be started “as soon as possible, preferably within hours of exposure.”

Report right away!

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Sources: Centers for Disease Control and Prevention. Updated U.S. Public Health Service guidelines for the management of occupational exposures to HBV, HCV, and HIV and recommendations for postexposure prophylaxis. MMWR Recomm Rep 2001 Jun 29;50(RR-11):1-52. Also available at http://www.cdc.gov/mmwr/PDF/rr/rr5011.pdf; Kuhar DT, Henderson DK, Struble KA, et al. Updated US Public Health Service guidelines for the management of occupational exposures to human immunodeficiency virus and recommendations for postexposure prophylaxis. Infect Control Hosp Epidemiol 2013 Sep;34(9):875-92. Also available at http://www.jstor.org/stable/10.1086/672271

Report an Exposure Incident

Postexposure evaluation and follow-up will be done.

•at no cost to you•available at a reasonable time and place•performed by or under the supervision of

a licensed healthcare professionalAll medical evaluations,

procedures, and postexposure

prophylaxis will be

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Postexposure Evaluation: What It Involves

Documentation of exposure route, circumstances

Identification of source person (unless infeasible or prohibited by law)• Testing of source’s blood (if

consent obtained or if permitted by law)

Testing of your blood (with your consent) for HBV and

HIV serologic status

Postexposure prophylaxis for HIV and/or HBV (if

indicated and accepted)Counseling Evaluation of reported

illnesses

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Postexposure Evaluation: Documentation

Depending on the circumstances, information about the exposure incident and resulting illnesses may be recorded in our

OSHA 300 log

and

Sharps injury log

Information about postexposure examinations, medical testing, and follow-up procedures will be placed in your

Employee medical record

All have measures to protect your confidentiality.

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bloodborne pathogens meadowlands hospital medical center

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