Blood Borne Pathogens

1. Blood Borne Pathogens Patty Maloney, MSN/Ed.

2. Bloodborne Pathogens • Disease causing microorganisms (viruses, bacteria, or parasites) carried in human blood. • Common bloodborne pathogens include: Hepatitis A Hepatitis B HIV • Pathogens may be transmitted through unprotected contact with human blood or body fluids.

3. Airborne Pathogens Airborne pathogens are disease-causing agents that spread infection through droplets or dust. Eg. Coughing, sneezing.

4. Chain of Transmission Certain elements must exist for a pathogen to cause illness or disease: • Source-infected person or animal • Route of Transmission-contact, air etc. • Portal of entry-cut, nose etc. • Susceptible host

5. OSHA • US Department of Labor’s Occupational Safety and Health Administration (OSHA) • Regulations issued to protect employees of certain jobs from bloodborne pathogens. • Regulations are known as OSHA Bloodborne Pathogen Standards. • Employee safety is insured by training, education, safety measures and exposure control.

6. OSHA Regulations • OSHA Bloodborne Pathogen Standard was first issued in 1991 to protect employees from occupational exposure to bloodborne pathogens.

7. OSHA Regulations Regulations require employers to use a combination of engineering and work practice controls such as protective clothing and equipment, safety precautions in the workplace.

8. Engineering Controls • Controls designed at developing products to create a safer working environment. • Ex. Needleless systems, sharps containers, eye stations.

9. OSHA Training • Goal of training is to educate employees regarding bloodborne pathogen issues and how to minimize or eliminate the exposure to bloodborne pathogens by using a combination of universal precautions, work practice controls, engineering controls, and personal protective equipment. • Training is initiated upon hire and must be done within the first year of employment. Standards must be updated yearly and when new standards are implemented.

10. Osha expectations • Objective is to minimize or eliminate the hazard posed by the exposure. • Prevent infection by immunization when possible. • Knowledge of symptoms of infection. • Counseling after exposure incident. • Postexposure treatments and follow-up.

11. Who needs osha training • Anyone who has the potential for exposure to blood or other potentially infectious materials (OPIMs). • Ex. Physicians, nurses, physician’s assistants, nurse practioners, other healthcare employees.

12. Contaminated Sharps Any contaminated object that can penetrate skin, including but not limited to needles,scapels, broken capillary tubes, exposed ends of dental wires.

13. Contaminated Sharps Contaminated needles or sharps must NOT be bent, recapped, or removed unless no alternative is feasable. Reusable sharps must be placed in clearly labeled, puncture-resistant, leak-proof containers immediately or as soon as possible after use. Reusable sharps must be decontaminated before reuse.

14. Sharps Containers The Federal Food and Drug Administration (FDA) regulates sharps disposal containers as Class II Medical devices. OSHA’s Bloodborne Pathogens Standard establishes minimum design performance elements for sharps disposal containers. A sharps container must have a warning label affixed to it.

15. Sharps Containers A sharps container must meet certain criteria to meet the Standard: • Must be closable • Puncture resistant • Leak proof on sides and bottom • Labeled or color coded

16. Sharps Containers Duct tape may be used to secure a lid but may not be used to serve as a lid. Sharps containers must be maintained in an upright position and not be overfilled. Whatever goes into a sharps container stays in the sharps container, do not attempt to remove it.

17. Transmission of pathogens • Transmission occurs when blood or other potentially infected materials come in contact with mucous membranes or nonintact skin.

18. Transmission of pathogens • May also be transmitted by blood splashes, handling contaminated items and injection by a contaminated needle.

19. Respiratory Hygiene Respiratory hygiene/Cough etiquette helps to minimize the transmission of aerosol-transmissible pathogens, these include: • Covering mouth/nose during coughing and sneezing using tissues or masks to contain secretions. • Disposing of tissues/masks contaminated with secretions properly. • Hand hygiene • Ensuring spatial-separation of at least 3’ from others when coughing.

20. Standard Precautions An aggressive standardized approach to infection control. These infection control practices apply to all patients and animals in the research setting regardless of suspected or confirmed infection status. Treats all bodily substances as if they contain pathogens.

21. Standard Precautions Standard precautions are a combination of Universal precautions and body substance isolation. Standard Precautions recommend: • Hand hygiene • Respiratory hygiene, cough etiquette, safe injection practices, use of gown, glove, mask, eye protection,

22. Hand Hygiene A general term that applies to any one of the following: • Handwashing with plain soap and water • Antiseptic hand wash • Antiseptic hand rub • Surgical hand antiseptics

23. Substances requiring standard precautions • Blood • Saliva • Mucous • Sweat • Seman • Vaginal secretions • Cerebrospinal fluid • Synovial fluid • Pleural fluid • Any body fluid with visible blood

24. Transmission-based precautions Recommended to provide additional precautions beyond standard precautions to interrupt the transmission of pathogens. All healthcare personnel must adhere strictly to the isolation precautions that are ordered for patients in the healthcare facility. The following precautions should be used in addition to standard precautions.

25. Contact Precautions Contact precautions are used to protect from infections spread by skin-to-skin contact or contact with other surfaces such as linen, doorknobs, counters. Eg staphylococcus aureus

26. Droplet Precautions Droplet precautions are used for infections caused by large droplets by coughing, talking, or sneezing such as influenza.

27. Airborne Precautions Airborne precautions are used for infections that spread small particles in the air such as chickenpox, and tuberculosis.

28. Reporting • If exposure to blood or OPIM occurs, the incident must be documented. • Information should include: name, job, classification, location of incident, engineering controls in use at time of incident, procedure being done, protective equipment, training.

29. Hepatitis • Hepatitis means inflammation of the liver caused by drugs, poisons, toxins or bloodborne pathogens. • Viral hepatitis is the leading cause of liver cancer and liver transplants in the United States.

30. Hepatitis B • Can affect anyone. • It is estimated that 1 to 1.4 million persons in the U.S. are chronically infected with HBV. • There has been a decline since the implementation of the Hepatitis B vaccine. • Persons at higher risk for HBV are infants of mothers with HBV, those who engage in risky behaviors, or preexisting health condition, and healthcare workers.

31. Clinical Features • Symptoms generally last from 4 to 6 weeks. • Jaundice (yellowing of eyes and skin). • Fatigue • Abdominal pain • Loss of appetite • Intermittent nausea • Vomiting • Fever • Joint pain • Gray colored stools

32. Hepatitis B • Incubation period from time of exposure averages 12 weeks with a range of 4 weeks to 6months. • No cure, vaccination is the best protection • Approximately 90% of HBV cases resolve without further complication, about 6% to 10% will progress to chronic HBV.

33. Hepatitis B

34. HBV Vaccine • Immunization is required for all health care workers at no cost to the employee. • Series of 3 injections: • first injection • second injection one month later • third injection 5 months after the second one.

35. Hepatitis C • Most common chronic bloodborne infection in the US. • Transmitted primarily through large or repeated direct percutaneousexposures to blood. • No vaccine for Hepatitis C. • Prevention is directed toward the use of engineering and work practice controls, personal protective equipment,

36. Clinical Features • 70% to 75% of patients with hepatitis C are asymptomatic. • Symptoms may include: • Jaundice • Fatique • Abdominal pain • Loss of appetite • Intermittent nausea • vomiting

37. Clinical Features • Incubation period averages 7 weeks, range is 3 weeks to 20 weeks. • Chronic infection is common, affecting more than 85% of people infected. • Chronic liver disease may occur in 70% of those infected with HCV. • 8,000 to 10,000 deaths occur each year as a result of HCV-associated liver disease.

38. Human Immunodeficiency Virus Acquired immunodeficiency syndrome (AIDS) is a condition in which the body is unable to fight off infection or destroy mutated cells. The body is vulnerable to opportunistic infections and cancer.

39. Routes of transmission Persons at higher risk include: • Infants of mothers with HIV • Those who engage in risky behaviors such as drug abuse, unprotected sexual encounters • pre-existing health conditions • Exposure to HIV

40. Clinical Presentation • Night sweats • Weight loss • Fever fatigue • Gland pain • Swelling • Muscle pain • Joint pain

41. Post Exposure • Testing done ASAP and periodically for at least 6 months. • Antibodies usually become detectable within 3 months of infection. • 99.7% of exposures do NOT lead to infection. • If treatment with antiviral medications plus a protease inhibitor is recommended, treatment should begin within hours of the exposure/.

42. Airborne Pathogens Diseases that can be transmitted by droplet or airborne routes. Airborne transmission occurs when droplet particles from an infected person enter a susceptible host.

43. Influenza Influenza or flu is an illness that is easily spread from person to person. Primarily effects the respiratory system. Epidemics occur in late fall to early spring. Rates of flu are usually higher in children and adults older than 65 years of age.

44. Influenza Several strains of the influenza may exAirborne pathogens are transmitted through droplets or dust. Large droplets can travel short distances and cause direct transmission. Small droplets can turn into an aerosol and can float in the air for long distances. Sneezing can transmit disease through direct contact and airborne routes.

45. Influenza Incubation period is approximately 1 to 3 days. Only considered immune if vaccinated. Centers for Disease Control and Prevention (CDC) states that it is effective between 70% and 90%. Effectiveness also depends on age, disease, and immune status. No vaccine is 100% effective. Implement preventive strategies.

46. Clinical Presentation Primary Symptoms: • Fever • Malaise • Muscle aches • Body aches • Sore throat • Runny nose • cough Other possible symptoms: • Diarrhea • Eye infections • Pneumonia • Respiratory distress

47. This is how you feel

48. Postexposure Treatment • Prescription antiviral medications may be indicated, must be administered within 48hrs to be effective. • Proper Handwashing. • Standard droplet precautions for suspected and confirmed cases.

49. FYI Viral cultures are collected yearly, these cultures provide information about influenza strains and subtypes. This information is used to guide formulation of vaccines for the next flu season.

50. Swine Flu • In 2009, a new strain of influenza began to spread. Also known as (H1N1). • Origin of strain was found to be from the pig, (swine). • Reached pandemic proportions in the US. • Currently under control due to preventative precautions.