Bloodborne Pathogens

1. Bloodborne Pathogens 2013 Annual CE Condell Medical Center EMS System Site Code: 107200E-1213 Prepared by: Sharon Hopkins, RN, BSN, EMT-P

2. Objectives • Upon successful completion of this module, the EMS provider will be able to: • 1. Describe employer responsibilities to employees • 2. Define the involvement of federal agencies related to bloodborne pathogens. • 3. Define bloodborne pathogen (BBP). • 4. Provide an example of potential bloodborne pathogens. • 5. Define the term standard precautions.

3. Objectives cont’d • 6. Define personal protective equipment (PPE) available for use. • 7. Define & list examples of engineering controls. • 8. Define & list examples of work place controls. • 9. discuss hand washing versus use of antiseptic hand products • 10. Recognize signs or labels used to indicate the presence of a bloodborne pathogen hazard.

4. Objectives cont’d • 11.List transmission routes of bloodborne pathogens in the workplace. • 12. Describe the phases of the infectious process. • 13. List factors affecting disease transmission • 14.Describe characteristics of the immune system. • 15.Discuss definition, incubation period, transmission route, signs and symptoms, and PPE to use for a variety of infectious diseases.

5. Objectives cont’d • 16.Describe components of housekeeping and when they are performed • 17.Describe necessary recordkeeping related to bloodborne pathogens. • 18.Review the CMC EMS System Operating Guideline (SOG) policy for infection control and exposure. • 19.Describe the “Notification of Significant Exposure” form and how to complete and forward the form. • 20.Successfully complete the post quiz with a score of 80% or better.

6. Why Take A BBP Program? • Increase your awareness of hazards • Increase your knowledge base • Understand steps to take for prevention of contracting or spreading illness • Understand your role in the healthcare environment • Know how to make your environment as safe as possible for all

7. Employer Responsibilities • Identify hazards in the workplace • Identify and provide appropriate PPE • Train employee in use & care of PPE’s • Maintain PPE’s and replace worn or damaged PPE’s • Periodically review, revise, update PPE program

8. Federal Agency Involvement • CDC • Monitors national disease data • Disseminates information to all health care providers • NIOSH works with OSHA • Sets standards & guidelines for workplace and worker controls to prevent infectious diseases in workplace

9. Infectious Agent • This is a hazardous material • Has the capability of affecting a large number of persons • Epidemiologists study infectious diseases • Information gathered through clinically based studies and statistical techniques • Results of information gathered guides our responses

10. Normal Flora • Microorganisms that live in and on our bodies without causing disease • Part of host defenses • Help keep us free of disease • Normal flora creates an environment not conducive to disease-producing microorganisms (pathogens) • Opportunistic pathogen • Usually non-harmful pathogens that cause disease in unusual situations (i.e.: weakened immune systems)

11. Reporting Contagious Diseases • All states have provisions to report information • Over 60 disease reported at a National level • State-reportable diseases vary • Reportable time frame variable by disease • HIPAA has provisions in place to avoid violation of privacy and confidentiality issues but still allow appropriate reporting to occur • EMS does not report diseases, hospitals gather the information and submit reports

12. Defining a Bloodborne Pathogen • Disease transmitted by contact with blood or body fluids of an infected person • Risk of exposure increases in presence of open wounds, active bleeding, or increased secretions

13. Examples BBP • HIV/AIDS • Hepatitis B (HBV) • Hepatitis C (HCV) • Hepatitis D (HDV) • Syphilis • Malaria

14. Other Potentially Infectious Agents • Cerebrospinal fluid • Synovial fluid • Pleural fluid • Amniotic fluid • Pericardial fluid • Peritoneal fluid • Semen • Vaginal secretions • Any body fluid contaminated with blood or saliva in dental procedures • Body fluids in emergency situations that cannot be recognized

15. Safe Practice Everyone’s got something that you don’t want Take precautions with every potential exposure – seen and unseen

16. Standard Precautions • Routinely use appropriate PPE to prevent exposure to any contact of blood or other body fluids • Need to protect skin and mucous membranes • Wash hands frequently • Hand sanitizer acceptable in absence of soap & water especially in absence of gross material • Take precautions to avoid needle sticks

17. Personal Protective Equipment - PPE • The type of protective equipment appropriate for your job or research varies with the task and the degree of exposure you anticipate

18. PPE’s • Eye and face protection • Hand protection (i.e.: gloves) • Protective clothing (i.e.: gowns) • Employee needs to be informed: • When and what PPE to use • How to put PPE on, adjust it, wear it, and take it off • Limitations of PPE • Maintenance, care, useful life, and disposal of PPE

19. Using PPE’s • Why do you think hand washing is promoted so much? • Most pathogens are transferred via our contaminated hands • When wearing gloves, are you aware of when they come into contact with potential pathogens? • Are you aware of what you do with your gloved hands and how many times you touch and potentially cross contaminate?

20. Engineering Controls • Controls that isolates or removes bloodborne pathogen hazards from the workplace to minimize exposure • Sharps disposal containers • Needleless systems • Self-sheathing needles • Devices only good if & when they are used

21. Work Practices • Practices that remove the likelihood of exposure by altering how a task is performed • Handwashing • Recapping a needle with the one-handed technique • No eating or drinking in ambulance • Disinfecting equipment and vehicle • Changing from soiled clothing • Keeping work area clean and decontaminated

22. How Good Are You? • Frequently missed areas when hand washing performed

23. Antiseptic Hand Cleaner • Antiseptic hand cleaners may be used as an appropriate hand washing practice IF: • Your gloves remained intact • You have had no occupational exposure to blood or other potentially infectious materials • Material can be left to air dry on your skin • Choose product with at least 60% alcohol

24. Hazardous Material Labels • Fluorescent orange or orange red label with contrasting letter and symbols (universal symbol) • Must be used to identify presence of blood or other potentially infectious material • Red bags may be substituted for labels

25. Factors Affecting Transmission • Correct mode of entry available for that pathogen • Virulence – strength or ability to infect or overcome body’s defenses • Number of organisms – minimal dose necessary to cause infection • Resistance of host – ability to fight off pathogen

26. Modes of Transmission • Bloodborne • Airborne • Sexual* • Indirect • Opportunistic* • Fecal-oral • *Sexual route and opportunistic not of concern to on-the-job EMS provider

27. Bloodborne Exposure • Direct or indirect contact with blood or infected body fluids • Needle stick • Splash on broken skin • Splash on mucous membranes • Eyes, nose, mouth

28. Airborne Exposure • Particles remain suspended in air a long time and float over a distance • At risk when less than 6 feet from source • Transmitted via sneezing, coughing, talking, shedding of skin • Patient to wear a surgical mask to minimize spread of disease • TB, polio, pneumonia, influenza, chicken pox • Healthcare worker to wear N95 to prevent exposure to particles

29. Droplet Exposure • Droplet of moisture expelled from upper respiratory tract and then inhaled into respiratory system or contact with mucous membranes • Droplets too heavy to remain airborne for long • Transmitted via sneezing, coughing, talking • Most at risk within 3 feet of source • Common cold, influenza, H1N1, meningitis, rubeola (measles), whooping cough

30. Indirect Exposure • Contact with a contaminated object or surface and then material is transferred to your mouth, eyes, nose or open skin • HBV can survive about 7 days dried on a surface • HIV does not live outside the body long

31. Fecal-Oral Exposure • Ingestion of contaminated food or water • Contaminated hands transfer microorganisms to all surfaces and objects touched • Recipient touches contaminated surface and then brings contaminated hands to face or ingests contaminated product • HAV, food poisoning

32. Phases of The Infectious Process • Latent period • Host infected but not infectious; cannot transmit the agent • Communicable period • May have some signs and can transmit to another host • Incubation period • Time between exposure and presentation; can range from days to months to years

33. Phases Cont’d • Seroconversion • The point in time when antibodies are developed and a previously negative lab test is now positive • Window phase • Time between exposure to disease and seroconversion • Disease period • Time form onset of signs and symptoms until resolution or death

34. Factors Affecting Disease Transmission • Mode of entry • Point of entry available (i.e.: non-intact skin, mucous membrane) • Virulence • Strength of organism (ability to infect) • Dose • Number of organisms • Host resistance • Is host healthy or not?

35. Stopping a Potential Infection • Break the cycle at one of 4 points: Infectious agent Means of transmission Host Routes of exposure

36. The Immune System • Protects body from foreign invaders • Needs to differentiate self from nonself • Can recognize antigens of most bacteria and viruses as foreign material • Series of actions put into motion to eliminate the foreign material or antigen • The inflammatory response initiates defense mechanisms for release of special chemicals, processes and formation of antibodies all to fight disease

37. Infectious Disease Discussion • The following slides discuss a few select diseases that may be problematic for the healthcare worker or at least something to be aware of • Reminder: assume all persons have something contagious that you don’t want

38. Review Selected Infectious Diseases Definition Incubation Period Transmission Mode Signs & Symptoms Recommended PPE’s Special Considerations

39. HIV • A fragile virus that attacks the immune system • Eventually leads to AIDS – a collection of signs and symptoms • Incubation is variable and can be in years • Transmission • Sexual contact • Contact with contaminated blood • Mother to newborn

40. HIV cont’d • Signs & symptoms • Fatigue, fever, sore throat, lymphadenopathy, splenomegaly, rash, diarrhea, secondary infections, weight loss, dementia, psychosis • No vaccine • PPE – gloves, goggles, mask, gown as needed to avoid blood contamination • HIV rarely presents life threatening • Is more often a psychosocial challenge

41. Hepatitis B (HBV) • Viral infection; can develop into chronic state; affects the liver • Incubation 4 - 25 weeks • Transmitted by direct contact with blood or body fluids • Complaints start as flu-like symptoms • Dark urine, light colored stools, fatigue, fever, jaundice • PPE’s – gloves, goggles, mask, avoidance of needlesticks

42. Hepatitis B Virility • The CDC states that Hepatitis B Virus can survive for at least one week in dried blood on environmental surfaces or on contaminated instruments.

43. Hepatitis B Vaccine • Highly effective means of protection from the virus • Must be offered within 10 days of assignment to task with exposure risk involved • If employee declines, must sign declination form • Kept on file • Employee may, at any time, request the hepatitis B vaccine after initial declination • 3 injection series • Given IM in deltoid • Once started, 2nd dose is in 1 month; 3rd dose 6 months from 1st dose

44. Hepatitis C (HCV) • Viral infection causing inflammation of liver • Can lead to cirrhosis and cancer • Leading reason for liver transplants in the USA • Incubation 2-25 weeks • Transmission – contact with contaminated blood • Contagious throughout course of infection

45. HCV cont’d • Symptom onset slow (up to 20 years for chronic infection) • Loss of appetite • Vague abdominal discomfort • Nausea and/or vomiting • Jaundice less common than with HBV • No vaccine is available • PPE’s – gloves, mask, goggles, avoidance of needle sticks

46. Tuberculosis (TB) • Bacterial infection most commonly affecting the lungs • TB infection • Person has the bacteria but is not ill; cannot spread disease • TB disease • Person ill, can spread TB • Incubation 4 -12 weeks • Transmission via airborne droplet • Prolonged exposure increases risk

47. TB cont’d • Signs and symptoms • Fever • Chills • Weakness. fatigue • Night sweats • Weight loss • Dyspnea • Productive cough • Chronic cough

48. TB cont’d • PPE’s • Respiratory isolation • Tight fitting surgical mask on patient • N95 mask for providers • Obtain periodic skin testing • If positive, need chest x-ray • Provide adequate ventilation while caring for and transporting the patient with suspected or positive diagnosis

49. Chickenpox (Varicella) • Viral infection • Transmitted via direct and indirect contact and airborne droplets • Incubation 10 - 21 days • Signs and symptoms • Sudden onset low-grade fever • Mild feeling of not being well (malaise) • Rash

50. Chickenpox cont’d • Contagious about 2 days prior to rash and until all vesicles have scabbed over • Skin eruptions continue over 3 – 4 days • PPE’s – gloves; surgical mask on patient, mask on healthcare provider • Vaccination added to childhood immunization schedule