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Blood Borne Pathogens OSHA 1910.130

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    1. Blood Borne Pathogens OSHA 1910.130 Jeffrey S. Davin, M.D. October 28, 2008

    3. What are Blood Borne Pathogens ? HIV - The virus that causes AIDS. Hepatitis B - Liver Infection Hepatitis C - Liver Infection

    4. Less common BBPs Syphilis Malaria

    5. Who are affected by BBPs Health Care Workers Housekeepers Janitors Police/Firemen/EMS Hazardous Waste Workers Teachers/Students Athletes

    6. Significance of BBPs Risk of transmission from skin penetrating trauma with HIV infected blood is 0.3% or 3 in 1000 (1 in 333). Risk from mucous membrane exposure (mouth, nose, eyes) is 0.09% or 9 in 10,000. Risk from non-intact skin exposure is estimated to be less than mucous membrane exposure.

    7. Significance of BBPs Average risk of skin penetrating trauma with Hepatitis C infected blood is 1.8% or 1.8 in 100 (range 0-7%). Risk of skin penetrating trauma with Hepatitis B infected blood is up to 30% or up to 1 in 3 depending on source.

    8. OSHA 1910.130 Blood Borne Pathogens Applies to all employees who reasonably anticipate skin, eye, mouth, or mucous membrane or parenteral contact with blood or other potentially infectious material as a result from the performance of their duties. 1992

    9. OSHA BBP Regulation Exposure Control Plan Key Elements Exposure determination Eliminate or minimize exposure Prevention methods Vaccination procedures (Hepatitis B only) Post-exposure evaluations Training Record Keeping

    10. Hepatitis B Vaccination Must be offered to employees Series of 3 injections Immunity can be checked Significant lack of seroconversion - additional boosters needed in 10-15% Now given during infancy/childhood

    11. Vaccine Non-responders 3 shots dont work

    13. Vaccine Non-responders 3 shots dont work May still be immune May convert with booster injections Recommend repeat series If non-responder, exposure to Hepatitis B requires treatment with HBIG as soon as possible (7 days max)

    14. No Vaccine For Hepatitis C No Vaccine For HIV

    15. Hepatitis C Exposure Monitor for development of Hepatitis C Monitor symptoms Monitor blood tests Treatment available with Interferon

    16. Exposure to HIV Prophylactic treatment available Should be started within 1-2 hours of exposure 2 or 3 drugs for 4 weeks Varying degrees of toxicity/side effects from treatment Effectiveness is theoretical

    17. Post- Exposure Evaluations

    18. Exposure Determination What is Significant? Was the exposure unprotected? Was the skin barrier penetrated? Was there mucus membrane exposure? Volume of material.

    19. Potentially Infectious Materials Proven to spread HIV Blood Semen Vaginal secretions Breast milk Saliva in dental procedures

    20. Potentially Infectious Materials Known to contain HIV Cerebrospinal fluid Synovial fluid Pleural fluid Pericardial fluid Peritoneal fluid Amniotic fluid Unfixed tissues or organs

    21. NOT INFECTIOUS as a Blood Borne Pathogen Tears Sweat Routine Saliva Urine Stool Unless Visible Blood Is Present

    22. Modes of Transmission Percutaneous (sharps instruments) Broken or non-intact skin Mucous membranes (eyes, nose, mouth) Sexual Transplacental (Mother to Fetus)

    23. Exposure Determination First determine if unprotected exposure has actually occurred. If yes. Determine Source status for HIV, Hepatitis B and C Determine status of Exposed as a baseline for HIV, Hepatitis B and C Determine Exposed immune status for Hepatitis B

    24. Testing the Source of Exposure HIV antibody Hepatitis B surface antigen Hepatitis C antibody Need consent to be tested, especially for HIV May need legal help to obtain tests Timing and follow-up issues

    25. Testing the Exposed This is Baseline Testing Same tests as Source Test Hepatitis B antibody level if vaccinated

    26. Source Known HIV Positive Start drugs within 2 hours of exposure Consider up to 36 hours after exposure If source status is unknown, consider treatment until results are available If source is totally unknown treat case by case

    27. Information to be Provided to the Healthcare Professional A copy of this regulation A description of the exposed employees duties as the relate to the exposure incident Route of exposure Results of the source individuals blood testing All relevant records of the employee such as Hepatitis B vaccination records

    29. Current Recommendation to Employers for Exposure follow-up Initial evaluation and blood work should be done at the Emergency room Follow-up to review lab results, assess risk status and to establish need for additional testing at a Bethesda Care Center

    30. Blood Borne Pathogens Use Universal Precautions at all times Treat ALL Blood/Body Fluids as Infected