Bloodborne Pathogens Training Course Information This bloodborne pathogens training program is required annually for UM-Flint employees who may reasonably anticipate contact with blood or other potentially infectious materials (OPIM) while on the job. Course Topics Bloodborne Pathogens Standard (copy available from EHS and
online) Bloodborne Pathogens Transmission
Exposure Control Plan Prevention (Universal Precautions) UM-Flint Hepatitis B Immunization Program Engineering Controls Sharps Disposal Personal Protective Clothing and Equipment (PPE) Spill Response BBP Waste Bloodborne Pathogens Standards and Regulations This program was designed to meet the requirements of: Occupational Safety and Health Administration (OSHA) Occupational Exposure to Bloodborne Pathogens 29 CFR 1910.1030 (1990).
Michigan Occupational Safety and Health Administration (MIOSHA) Bloodborne Infectious Diseases R 325.70001- R 325.70018 (1993). Needle stick Safety and Prevention Act (2000) Exposure Source Testing MI Act 368 of 1978 These standards apply to workers who are at risk of exposure to pathogenic microorganisms associated with human blood. Pathogenic Microorganisms Bloodborne Pathogens: are pathogenic microorganisms that are present in human blood or other potentially infectious materials (OPIM) and can cause disease. Pathogenic microorganisms include, but are not limited to: o HBV o HCV
o HIV o West Nile o Malaria o Syphilis o Brucellosis Other Potentially Infectious Materials (OPIMs) Blood products, semen, vaginal secretions Any body fluid contaminated with blood Any body fluid of unknown source Unfixed tissues or organs HIV or HBV containing cells or cultures Saliva in dental settings Blood, organs or other tissues from
experimental animals infected with BBP Introduction of human-derived materials (e.g. tumor cells) into animals. How are BBPs Transmitted? When infected blood or bodily fluid enters a break in the skin or a mucous membrane. Mucous Membranes are wet, thin tissue found in openings such as the mouth, eyes and nose. Breaks in the skin can allow BBPs to enter: Cuts Punctures Abrasions Rashes Acne
Hang Nails Bandage affected area and wear double gloves to prevent transmission through breaks in skin. Hepatitis B (Hep B) Infection of the liver may lead to: LIVER DISEASE LIVER CANCER DEATH 12,000 cases of HBV were identified annually (up to the year 1992). Numbers have decreased to approximately 800 cases annually since the introduction of
the immunization. HBV is extremely stable. It may survive 10 days outside of host! Hepatitis B (contd) Approximately 10% of infected individuals may become "carriers. They may suffer from infection at a later time and can be infectious to others for the rest of their lives while not having symptoms of HBV. Symptoms may occur 2-6 months after exposure and include:
Fever Vomiting Jaundice (yellowing) of eyes and/or skin Loss of appetite Dark-colored urine Aches in muscles and joints Hepatitis C (HCV) Viral liver infection transmitted via blood or OPIM.
Symptoms similar to those caused by HBV No vaccine is available. 80% of individuals have no symptoms & may be lifelong carriers. Very difficult for bodys immune system to recover from HCV infection Leading indication for liver transplants in the U.S. Human Immunodeficiency Virus (HIV) Virus causes Acquired Immunodeficiency Syndrome (AIDS) May be passed via infected blood or OPIMs which contact
broken skin or mucous membranes Some individuals develop flu-like symptoms within 7-21 days after exposure. Some infected individuals develop AIDS as a result of their HIV infection. Studies suggest the best independent predictors of primary HIV infection are rash and fever following an HIV exposure. HIV will not survive long outside host (~90-99% reduction within several hours). What are Bloodborne Pathogens Methods to Reduce BBP Exposures :
Universal Precautions or Standard Precautions Exposure Control plan (ECP) Hepatitis B Vaccination Engineering Controls Workplace Controls Safe Work Practices
Personal Protective Equipment (PPE) Proper Hand-washing Technique Reporting exposures immediately and seeking medical treatment as soon as possible. Universal or Standard Precautions ALL human blood and OPIM are treated as if infectious. Exposure Control Plan (ECP) The ECP must be made available to all employees who are at risk. ECP must be readily available to
employees. Employees should be familiar with the ECP and know where it is located. ECP should be reviewed/revised ANNUALLY with input from employees. Reporting an Exposure Incident Is it work related? Date & time of exposure Where & how the exposure occurred Procedure being performed The type & brand of device involved How & when in handling the device the exposure occurred Details of the exposure (e.g. the type & amount of fluid)
Information about the exposure source if known Vaccination status of the exposed person Additional details can be provided in writing or e-mail to EHS and Work Connections Hepatitis B Vaccination Available to Category A employees at no cost Series of 3 injections: 1st Dose- given at anytime 2nd Dose-1 month after 1st Dose 3rd Dose- 5 months after 2nd Dose Provides protective levels of antibody in 97% of healthy individuals You dont get HBV from the vaccine No booster shot required (lifelong immunity)
According to the FDA, the current shot is one of the safest available Side effects may include: soreness, redness and swelling at injection site For further information, EHS encourages you to contact your primary care physician/practitioner Hepatitis B (contd) Vaccination need not be offered if Individuals already received the complete series Antibody testing shows immunity Contraindicated for medical reasons The vaccine is NOT mandatory. Employer must offer the vaccine, however, you do not have to accept the vaccine.
You may decline the vaccination series, in which you will be asked to sign a declination form. To receive the Hepatitis B Vaccine, please contact: UM-Flint EHS @ (810)766-6763 Hepatitis B Vaccination Forms No Vaccines for HCV or HIV No vaccine against HCV and no treatment after exposure that will prevent infection. No vaccine against HIV. For HIV: recommendations from the CDC, suggest a 4-week course of antiretroviral drugs depending upon the risk of transmission (exposures involving a larger
volume of blood with larger amount of HIV). This should begin within hours after exposure. Engineering Controls Are used to isolate or remove the potential hazard from the workplace. Controls are used in combination with safe work practice controls.
Sharps disposal containers Hand washing facilities &waterless soap dispensers Biohazard bags/waste containers Spill/clean-up kits Use tongs for picking up hazardous object Sharps disposal containers Hand washing facilities Biological Safety Cabinets
Autoclave Facilities Mechanical means to remove broken sharps items Sharps Departments or units generating sharps waste are responsible for proper disposal. Puncture resistant plastic container Located in area where sharps
are used Sharp containers- Fill only to indicator line or full. Call EHS (810)766-6763 for removal. Do NOT OVERFILL sharps container. Overfilled sharps Sharps (contd) Examples: Needles Scalpels Razor blades Lancets Contaminated glass Pasteur pipettes
Glass capillary tubes Contaminated broken glass Contaminated microscope slides and cover slips Exposed ends of dental wires Workplace Controls Wash hands after contacting bodily fluids or contaminated surfaces Keep fingernails short Scrub nail area Clean surfaces regularly Keep disinfectant solution and waterless hand
disinfectant nearby. Keep PPE in stock and readily available. Safe Work Practices Remove Personal Protective Equipment (PPE) before leaving the work area Follow proper protocol for cleaning blood/bodily fluid spills Remove clothing soiled with blood or OPIM soiled immediately Wash hands immediately after removing gloves or other protective clothing.
BBP Exposures IMMEDIATELY notify Supervisor & EHS. Go to UM Medical Provider for post-exposure follow-up ASAP Eyes: Flush with water Skin: Wash thoroughly with soap & water for 15 min. Protective Work Clothing & Equipment (PPE) PPE is to be provided at no cost to the employee. Examples: GLOVES, goggles, apron, booties
Assure appropriate PPE is readily accessible and fits properly Supervisor will monitor and ensure employee uses PPE. Provide for cleaning, laundering, or disposal of PPE. Protective Work Clothing and Equipment (PPE) Hand Protection: Ensure equipment is available Non-latex products must be available for individuals with latex allergies Disposable gloves should be replaced if peeling, cracked, discolored, punctured, torn or deteriorated
Gloves all sizes must be available Do not re-use disposable gloves Remove gloves BEFORE leaving the work area Always wash hands after removing gloves Blood/Body Fluid Spills Spills must be cleaned as soon as possible. Wear gloves, gowns or lab coats & eye protection during clean up. A solution of 1:10 bleach to water or an EPA-approved disinfectant should be used. If broken glass is involved, carefully remove using a mechanical device such as tongs or
forceps. Broken glass is placed in the sharps container. Never pick up broken glass by hand! Spill Clean-up Procedure http://www.youtube.com/watch?v=gnOtvAztKoQ Disinfectant Procedure Information Take the necessary precautions when handling disinfectants - some may be caustic and hazardous Prepare all disinfectants daily. Some prepared diluted mixtures, like bleach and water, are not stable and lose efficacy as a disinfectant over time
Spray on and allow to air dry If area is heavily soiled, clean with detergent and water first Impervious (waterproof) surfaces are cleaned differently than porous/fabric surfaces. Do not use commercially pre-saturated wipes to sanitize surfaces as their efficacy has not been tested The contamination of the wipe during use may not be sufficiently controlled by the bleach solution in the wipe Hand-washing First line of defense against infectious disease
Hands and other skin surfaces must be washed immediately, and thoroughly, after handling potentially infectious materials Wash hands and lather, rubbing front and back for at least 20 seconds with soap Rinse under running warm water from wrists to fingertips Dry with paper towel and turn faucet off with paper towel http://www.youtube.com/watch?v=vYwypSLiaTUD Employee Responsibilities Know and understand your departments ECP What PPE to use? When? What to do when uncertain about an OPIM, BBP or not?
Who in your department is authorized to clean up blood? Category A or B? What are you? ALWAYS follow SAFE work practices maintain a clean & sanitary environment. Wash hands. Get HBV Vaccine . . . or sign declination form. Discuss other vaccinations that are available with your health care provider. Report all exposure incidents immediately Participate in your departments annual ECP review. Other Communicable Diseases West Nile
Meningitis Norovirus H1N1 Tuberculosis (TB) West Nile Derived from being bitten by an infected mosquito The most serious form of WNV is Fatal Encephalitis: inflammation of the brain Incubation period is 2-15 days Symptoms include: High fever Neck stiffness Disorientation Coma
Tremors Convulsions Muscle weakness Paralysis According to the CDC, 1 in 150 people get infected, however, 4 out of 5 people infected with the virus express asymptomatic infections. This means that they do not show any signs of sickness. West Nile According to the CDC, 1 in 150 people get infected, however, 4 out of 5 people infected with the virus express asymptomatic infections. This means that they do not show any signs of sickness.
There are 3 possible outcomes from being infected with WNV: Asymptomatic: you do not show any signs of infection (most people fall into this category) Develop West Nile Fever: experience symptoms (expressed in 20% of infected individuals) Severe West Nile Disease, West Nile Meningitis, West Nile Encephalitis: experience severe symptoms and possibly die (expressed in 1% of infected Meningitis Inflammation of the membrane (meninges) that covers the brain and spinal cord Caused by either: Viral Meningitis(Aseptic)
Bacterial Meningitis Viral Meningitis Caused by Enteroviruses Less severe and is healed without any specific treatment Symptoms include: High fever Severe Headache Stiff neck Sensitivity to bright light Sleepiness or trouble waking up Nausea, vomiting Lack of appetite Symptoms last between 7-10days with full recovery
No specific treatment Bacterial Meningitis Highly severe and some forms are contagious 2 strains of the leading cause of Bacterial Meningitis are Streptococcus pneumoniae and Neisseria meningitis Symptoms include:
High fever Headache Stiff neck Discomfort looking into bright lights
Nausea Vomiting Confusion Sleepiness Brain damage Hearing loss Learning disability Disability Bacterial Meningitis (contd) Transmitted via respiratory and throat secretions Modes of transmission include: Coughing Kissing Sneezing
Not as contagious as the flu, therefore, you cannot become infected through casual contact Example: You will not become infected if you breathe in the same air that someone with meningitis breathed Incubation period ranges from several hours to 2 days There are vaccines against some forms of meningitis. According to the CDC, the current vaccines available are safe and effective Norovirus A type of Gastroenteritis: inflammation of the stomach and small and large intestines Caused by a host of viruses that produces the outcome of vomiting and diarrhea
According to the CDC, it is the leading cause of foodborne-disease outbreaks in the United States Common name: Stomach Flu, but not caused by Influenza Norovirus Symptoms: Watery diarrhea Vomiting Headache Fever Abdominal cramps Symptoms begin 1 to 2 days after infection and lasts for 1 to 10 days depending on the strain of
virus. Transmitted through contaminated food and beverages via the oral-fecal pathway H1N1 (Variant Influenza Virus) Respiratory disease normally affecting pigs, caused by a specific strain that affects human beings Spread through the direct contact of infected pig or infected person According to the CDC,
human to human transmission is not as easily spread Symptoms are similar to those of the human flu Tuberculosis (TB) It is an airborne disease caused by bacterium, Mycobacterium tuberculosis, which attacks the lungs. It can also attack the kidneys, spine and brain. If untreated it can be fatal. There are 2 forms of TB: Latent TB: when the bacteria lives in the hosts body without making the person sick. They test positive for the TB skin test, however, they are not
infectious Active TB: when the bacteria is active in the hosts body and makes the person sick and is infectious. People can become infected if some one with active TB sings, speaks, coughs or sneezes in the nearby area. Tuberculosis (TB) If infectious, there is a treatment. TB disease can be treated by taking several drugs for 6 to 9 months. There are 10 drugs currently approved by the U.S. Food and Drug Administration (FDA) for treating TB. Of the
approved drugs, the first-line anti-TB agents that form the core of treatment regimens include: isoniazid (INH) rifampin (RIF) ethambutol (EMB) pyrazinamide (PZA) Regimens for treating TB disease have an initial phase of 2 months, followed by a choice of several options for the continuation phase of either 4 or 7
months (total of 6 to 9 months for treatment). Treatment regimen must be fully completed to fully cured. If not taken as prescribed and correctly, infected persons TB bacteria will become resistant to medication and would require a stronger and expensive medication. Questions ECDC Soiled Clothing Remove clothing immediately Place in a labeled plastic bag (To Be Washed) and separate from normal laundry and use proper laundering techniques. (Make sure water is hot, 82oC, and is on the hot cycle for at least 10 mins)
Childs clothing should be placed in a labeled plastic bag (Soiled) and should be sent home with parents DPS/Medical Staff Soiled Clothing Remove clothing immediately Place in a labeled plastic bag (Biohazard) Have clothing be sent to proper laundering facilities that will decontaminate the uniform Spill Clean-up Procedure Put on personal protective equipment
Remove sharp objects carefully with forceps/tongs Circle spill with disinfectant. Use bleach (1:10 dilution), Lysol, Virex, or EPA registered tuberculocidal disinfectant Cover and saturate
with disinfectant. Let stand 15 - 20 minutes. Clean and Dispose of Paper Towel Re-spray area with disinfectant Re-wipe with paper towel Decontaminate materials used to clean spill Bibliography
Practitioners must have an understanding of the blocks and challenges in safeguarding work and apply strategies to manage these, including situations of hostility and disguised compliance and to challenge their own and others' practice both at individual and agency level.
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