CHICOPEE PUBLIC SCHOOLS

1. CHICOPEE PUBLIC SCHOOLS STANDARD PRECAUTIONS BLOOD BORNE PATHOGENS TRAINING MODULE Developed by: Karen Turmel, Nursing Supervisor 7/2011

2. THIS PROGRAM MEETS THE FOLLOWING GUIDELINES: • OSHA Standards on Bloodborne Pathogens (29 CFR 1910.1030) • Public sector workplaces in Massachusetts are not covered by OSHA standards, but…. • Massachusetts Division of Occupational Safety dictates that public sector employers comply with the same requirements

3. At the end of this lesson, you will be able to: • List the four most common bloodborne pathogens (BBPS) • Identify and take appropriate actions to reduce the risk of exposure to BBPS • Describe how to respond if an injury occurs at your site

4. Definition of BBP • Bloodborne pathogens are microorganisms in the blood and/or body fluids that can cause disease in humans, including, but not limited to, Hepatitis B, C, D, and human immunodeficiency virus (HIV)

5. At risk occupations: High Risk • Health service personnel • Coaches and athletic trainers • PE teachers • Special Ed teachers • Special Ed paraprofessionals • Special Ed bus drivers

6. Low Risk • Custodians • Secretaries • Regular education teachers • Paraprofessionals • Bus drivers

7. Your role and responsibilities: • Minimize the risk of BBP exposure for students, co-workers, and yourself. • Take proper precautions at all times. • If an incident should occur, respond quickly and correctly.

8. Four most common BBPS • Hepatitis B (HBV) • Inflammation of the liver that can lead to cirrhosis, cancer or death. • Can be indirectly transmitted on objects. May be transmitted through direct contact with infected blood or body fluids. • Most people recover but some become carriers who have no symptoms of disease themselves but are able to spread the disease for many years. • There is a vaccine for HBV

9. HBV • The HBV virus can be transmitted indirectly if you touch a contaminated surface and then touch your nose, mouth, eyes, or broken skin. • It is many more times contagious than HIV • HBV can survive on dried surfaces at room temperatures for up to a week

10. Hepatitis C • It can also be spread through sexual activity between an infected and uninfected person. • There is presently no vaccine against this virus • A person may have the virus for years without any symptoms

11. Hepatitis C (HCV) • More common than HBV • Not as infectious as HBV • Leads to chronic liver disease • Is spread mostly through the use of shared needles as in intravenous drug use or tatoos.

12. Hepatitis D (HDV) • Hepatitis D appears only in conjunction with HBV. • It leads to the more serious cirrhosis, cancer and more commonly death.

13. Human Immunodeficiency Virus (HIV) • Attacks the immune system • Carried by human blood and/or body fluids • Spread by contact with infected blood or body fluids • Leads to Acquired Immunodeficiency Syndrome (AIDS)

14. HIV • Although medical advances have led to prolonged survival time, AIDS is always fatal • A person may have the virus for many years with no apparent symptoms • At this time there is no vaccine available

15. Transmitting BBPS • BBPS are most commonly spread through high-risk activities like unprotected sex and sharing drug needles. • At school sites your risk of exposure is low.

16. Potential risks • Include blood or body fluids that: • Spray, splash onto mouth, nose or eye mucous membranes. • Have contact with broken areas of skin; even tiny breaks you cannot see. • Accidental injury with a sharp object like a needle, broken glass, or anything else that can pierce your skin

17. Even if you are exposed to a BBP, you may not become sick. Your risk of becoming sick is based on the amount of pathogen in the blood that entered your body, the length of time of exposure, and your body’s ability of fight the pathogen. • There are treatments that can decrease your risk of sickness even after exposure

18. Five Standard Precautions • Wash hands and work surfaces frequently with soap and water • If hands are not visible contaminated, an alcohol based hand sanitizer is appropriate • Use gloves and other personal protective equipment when you anticipate exposure to blood and/or other body fluids • Gloves do not take the place of good hand hygiene although they are an important way to reduce the spread of disease • Wash hand immediately following glove removal using proper technique

19. Handwashing This is known to be the SINGLEmost important thing we can do to prevent the spread of disease

20. Procedure • Wet hands thoroughly under warm water • Dispense non-abrasive soap into wet hands • Vigorously rub hands together for twenty seconds (about the time it takes to sing Happy Birthday twice) • Be sure to scrub all surfaces…top, bottom, under fingernails, between fingers, and about an inch up on wrists. IT IS THE FRICTION OF LATHERING THAT KILLS GERMS.

21. Rinse hands • Dry hands thoroughly. Wet skin can become chapped and chapped skin has many openings where germs can enter the body. Generously use hand cream to prevent chapping. • Use a dry towel to turn off the water. The same dry towel can be used to open the restroom door. • Dispose of the dry towel properly

22. Hand Sanitizers • Do not require water • Are an excellent alternative to handwashing when soap and water are not available and hands are not visibly soiled • Apply about ½ teaspoon to palm of hand • Vigorously rub hands together covering all surfaces as in hand washing until hands are dry. Again it is the friction of drying alcohol that kills germs • Wash hands with soap and large amounts of water as soon as you can

23. Prevention • Standard Precautions • A method of infection control in which all blood or bodily fluids a person comes in contact with is assumed to be infected. • People with BBPS may not know they are infected • You may be a carrier and not know it; using preventative measures protect your students and staff

24. Protect Yourself • Use infection control measures • Use standard precautions • Use good hand washing techniques • Use personal protective equipment • Follow the district’s procedures/guidelines

25. Protect Yourself • Report an exposure to your supervisor immediately after washing or flushing the exposed area. • There are treatments that can lessen the risk of developing a bloodborne disease but the treatment is time sensitive.

26. Personal Protective Equipment(PPE) • Safety devices or safeguards worn by workers to protect against environmental hazards • Designed to reduce the risk of disease transmission • Always wear gloves when you anticipate touching blood, bodily fluids, or contaminated surfaces

27. Other PPE • Resuscitation device: • Always use when administering mouth to mouth resuscitation • Smock or apron • Always use when cleaning up large amounts of blood or other bodily fluids • Eyewear • Face shield

28. Gloves • Single- use disposable gloves when administering first aid or when cleaning up blood or body fluid spills • Cover any cuts with bandages before putting on gloves • Always wash your hands before and after using gloves • When removing gloves, be sure that your bare skin does not come into contact with the exterior of the glove (peel inside out)

29. Sharps • Protect yourself and others from sharp objects. • If you have a needle or anything with a sharp point, dispose of it in the sharps container in the Nurse’s office

30. Avoid contact with sharp objects • Notify school nurse or custodian if any are found • Dispose of hazardous material safely using engineering controls such as a puncture proof, fluid impervious needle box for sharp objects, tongs or dustpan and broom for picking up broken glass

31. Sharps Be alert for sharp objects, like broken glass or needles when emptying trash containers • Never smash down trash with your hands or feet • Always carry trash away from your body • Never pick up broken glass with your hands. Use tongs or a dustpan and brush

32. Sharps • Any object that can penetrate the skin including, but not limited to needles, box cutters, and broken glass • Use a brush and dustpan or tongs to pick up broken glass/sharp objects • Never use your hands • Place them in a closable, leak proof, puncture resistant container with a biohazard label • Never reach into a trash container or push trash down with your hands or feet • Use properly labeled sharps container for needles • Never recap, bend, break, or shear needles • Wear gloves • Replace sharps container when full~never overfill. • Sharps containers are located in your Nurse’s offices.

33. Hazardous Waste Hazardous waste is defined in MA CFR as “blood that could be returned to a liquid state.” A soiled bandage that is not dripping blood or body fluid is not considered hazardous waste and can be disposed of in regular trash. • Used needles should be immediately placed in a sharps container • Do not eat or drink in areas that maybe contaminated

34. Work Surfaces • Make sure work surfaces, particularly any public counters, are kept clean • Use a disinfectant that kills germs • Make this part of your daily routine • When needed contact your custodian to do a thorough cleaning

35. Cleaning up spills To determine if a cleaning solution is EPA Registered: READ THE LABEL!! • Follow the directions on the blood spill kit. • Cleaning spills • Wear gloves! • Carefully cover the spill with paper towels or cloths • Carefully pour an approved cleansing solution on the spill • Leave on for 10 minutes so as to kill any BBP • Place contaminated items in a leak proof bag • Place securely fastened bag in a plastic lined trash container and dispose of properly. • Remove gloves using proper method ~ never let bare skin touch contaminated gloves. • Remember to decontaminate any mops, sponges, pails, etc. that were used in the clean up process. • Never hesitate to dispose of cleaning materials

36. Contaminated sports equipment • Use an EPA ~ registered tuberculocidal disinfectant solution to clean and decontaminate sports items and equipment that has come in contact with blood and other potentially infectious materials. • Follow the clean up guidelines. • Remember to protect yourself from contamination! • If you have any questions please contact your custodian and/or School Nurse.

37. When an injury/exposure occurs: • Assess the severity of the situation calmly and quickly • Approach the situation safely • Reassure the victim in order to keep them calm • Avoid being exposed to blood or bodily fluids yourself • Use PPE • Notify the School Nurse immediately for assistance • Administer first aid immediately • For an exposure immediately, wash the exposed are with soap and water, flush with water for at least 15 minutes • If eyes, nose, or mouth exposed flush with running water for at least 15 minutes • Report to your School Nurse for medical care • Call School Nurse to come to injured person(s)

38. Report the incident to your School Nurse and Supervisor so he/she can assist you with complying with protocol and seek additional medical care if necessary • Referral to your primary care physician and/or the Work Connection at Holyoke Hospital may be necessary • After treatment complete an Incident Report and submit it to your building principal • A report is required anytime an incident occurs in which there is potential exposure to a BBP.

39. First Aid • For minor cuts and scrapes encourage the victim to self administer first aid if age appropriate. • For more serious injuries, put on gloves before you administer first aid. • Never hesitate to bring victim or yourself to the School Nurse for evaluation and treatment.

40. Summary In this program you have read about: • Bloodborne pathogens (BBP) • The four most common BBPs • Standard precautions for reducing the risk of exposure • What to do when an injury/exposure occurs Normal teaching and learning activities do not place anyone at risk for bloodborne infections, but accidents and injuries at school can produce situations where students and/or staff might be exposed to another person’ s blood or body fluids. BE PREPARED!!! BE SAFE!!!

41. Please take a moment to complete the BBP post test and evaluation. Please return the test and evaluation to your School Nurse and feel free to discuss any concerns or questions you may have regarding this program. Your School Nurse will submit proof of completion to Curriculum Director so you can receive credit for completing this program. Thank you for taking the time to complete this self~learning module!

42. Bloodborne pathogens post test • Which disease is not bloodborne? • Hepatitis A • Hepatitis B • Hepatitis C • HIV • Bloodborne pathogens may enter your bloodstream through: • Skin abrasions • Open cuts • Accidental needle sticks • All of the above • Observing “standard precautions” means treating all blood and body fluids as if they are known to be infectious. • True • False

43. Post test continued….. 4. Wearing gloves is one of the most important personal protective measures for preventing an exposure to BBP. 1. True 2. False 5. If you wear gloves when cleaning up blood or body fluids, it is not necessary to wash your hands afterwards. 1. True 2. False 6. PPE includes which of the following? 1. Gloves 2. Goggles 3. Aprons 4. All of the above 7. It is not necessary to wash your hands if you use a hand sanitizer. 1. True 2. False

44. Post test continued…… 8. When cleaning up a BBP spill, which of the following should you NOT do? 1. Use disposable gloves 2. Dispose of waste in an unlined waste container 3. Wash hands thoroughly with warm water and soap 4. Contact your school nurse and custodian 9. An incident report must completed even if you have only been exposed to a small amount of blood or body fluids. 1. True 2. False 10. When taking care of an injured person you should always assume that they may have be infectious and use PPE. 1. True 2. False

45. Post test continues….. What would you do?? 11. A high student, Mary, is in your class and you notice she has a bloody nose. What would you do first? 1. Send Mary to the School Nurse 2. Call Mary’s parents 3. Hand Mary some tissues and ask her to hold pressure on her nose 12. As a hall monitor you notice that Johnny has vomited in the hallway as he is on his way to the nurse. Would you? 1. Stop Johnny and have him clean up after himself 2. Be a nice person, grab some paper towels and clean up the vomit yourself 3. Call the custodian to have the vomit cleaned up right away and direct other students away from the area

46. BBP answer sheet Name: __________________ Date: ____________ School: __________________ Please circle the correct answers. • 1 2 3 4 • 1 2 3 4 • 1 2 • 1 2 • 1 2 • 1 2 3 4 • 1 2 • 1 2 3 4 • 1 2 • 1 2 • 1 2 3 • 1 2 3