Bloodborne Pathogen Training2010 Advocate Condell EMS System Prepared by: Sharon Hopkins, RN, BSN, EMT-P
Objectives • Upon successful completion of this module the EMS provider will be able to: • Define the mission of OSHA • Describe what the OSHA Standard was designed for • Describe the training program for bloodborne pathogens • Define bloodborne pathogen • Provide an example of potential bloodborne pathogens • Define the term universal precaution
Objective cont’d • Define the term body substance isolation (BSI) • List an example of engineering control • List an example of a work place control • List PPE products available to use • Describe when PPE’s should be used • Recognize signs or labels that indicate the presence of a bloodborne pathogen hazard • Describe components of housekeeping and when they are performed
Objective cont’d • Describe necessary recordkeeping related to bloodborne pathogens • Define an exposure incident • Review the CMC EMS System Operating Guideline (SOG) policy for infection control and exposure • Describe the “Notification of Significant Exposure” form and how to complete • List routes of exposure to potential BBP
Objective cont’d • List transmission routes of bloodborne pathogens in the workplace • List factors affecting disease transmission • Describe the phases of the infectious process • Discuss definition, incubation period, transmission route, signs and symptoms, and PPE to use for a variety of infectious diseases • Successfully complete the post quiz with a score of 80% or better
What is OSHA? • A federal agency of the US Department of Labor • Created by Congress in 1971 under the Occupational Safety and Health Act • Mission: • To prevent work-related injuries, illnesses, and death
What is NIOSH? • National Institute for Occupational Safety and Health (NIOSH) created by the OSH Act • Functions as a research agency focusing on occupational health and safety
What is “The Standard”? • In 1990, OSHA issued a standard (Bloodborne Pathogen Standard) designed to prevent healthcare workers and others from being exposed to bloodborne pathogens such as hepatitis B and HIV
Who does the Standard cover? All employees who could "reasonably anticipate" • contact with blood • contact with other potentially infectious materials while performing their job duties
Compliance with the Standard • The Bloodborne Pathogen Standard specifies methods that are to be used to minimize the transmission of bloodborne pathogens in the work place. • These methods include: • Universal Precautions • Engineering and Work Practice Controls • Personal Protective Equipment (PPE) • Appropriate Housekeeping Measures
Training • Employees must be provided information • When first assigned a task with potential exposure • Repeated annually • During work hours • When new tasks or procedures are added • New exposure risk created must be addressed
Training Requirements • Make copy of standard accessible to all • Have a general discussion of bloodborne pathogen diseases and their transmission • Review your department’s exposure plan • Review how to obtain/view a copy of your department’s exposure plan 24/7 • Discuss how to recognize tasks and other activities that may involve exposure
Training Requirements cont’d • Discuss the use and limitations of methods for protecting or reducing exposure risk • Engineering practices • Work practice controls • PPE’s • Provide information on the Hepatitis B vaccine • Review how to handle a response to an emergency involving potential exposure
Training Requirements cont’d • Review the process when an exposure incident occurs • Review your department’s post exposure program and follow-up program • Discuss signs, labels, and color-coding used to indicate hazards • Provide an opportunity to ask questions and receive answers
Definition Bloodborne Pathogen • Microorganisms that: • are present in human blood • can infect and cause disease in people who are exposed to blood containing the pathogen • can be transmitted through contact with contaminated blood and body fluids
Examples Bloodborne Pathogens • Human Immunodeficiency Virus (HIV) • Hepatitis B (HBV) • Hepatitis C (HCV) • Non A, Non B Hepatitis • Syphilis • Malaria • Babesiosis • Brucellosis
Examples cont’d • Leptospirosis • Arboviral infections • Relapsing fever • Creutzfeld-Jakob disease • Human T-lymphotrophic Virus Type 1 • Viral hemorrhagic fever
Universal Precautions • The concept that all blood and potentially infectious materials must be treated as if they are known to contain HIV, HBV, or other bloodborne pathogens You can’t tell if material is or is not infectious so treat all materials as if they are infectious!
Body Substance Isolation • Body Substance Isolation is an alternative infection control method in which all body fluids and substances are defined as infectious • Coverage of the Bloodborne Pathogen Standard extended to include all body substances
Controls in Place • The objective of engineering controls and work practice controls is the same: • to reduce or minimize employee exposure to bloodborne pathogens
Engineering & Work Practice Controls • Differences • One control isolates or removes the hazard from the workplace • Engineering control • One reduces the risk of exposure by altering how tasks are performed • Work practice control
OSHA Impact • OSHA gives precedence to engineering controls, where feasible, over work practice controls, as stated in a November 1999 compliance directive • Enforcement Procedures for the Occupational Exposure to Bloodborne Pathogens (OSHA CPL 2-2.44D): "Where engineering controls will reduce employee exposure either by removing, eliminating, or isolating the hazard, they must be used."
Implementing Controls • To guide selection of proper engineering and work practice controls to implement: • Determine tasks and procedures performed in the workplace where occupational exposure may occur • Determine which employees are at risk for occupational exposure while carrying out their normal duties
Engineering Controls • Examples: • labeled sharps disposal containers • self-sheathing needles • safer medical devices • sharps with engineered sharps injury protections and needleless systems • handwashing facilities • antiseptic hand cleanser • cleaning supplies and equipment
Work Practice Control • Examples: • Handwashing • Prohibiting recapping of needles by a two-handed technique • Handwashing • No eating, drinking, smoking in the ambulance • Handwashing • Disinfecting equipment and vehicle • Handwashing • Removing a soiled uniform • Handwashing
Handwashing • One of the simplest and most effective practices used to prevent the transmission of bloodborne pathogens • Prevents transfer of contamination from your hands to other areas of your body, to other persons, or to other surfaces you may contact later
Handwashing • As soon as possible following an occupational exposure to blood or other potentially infectious materials • After removal of gloves • Before and after every patient contact • After toileting • Before and after preparing food • Before and after eating or smoking • After coughing or sneezing into hands or blowing nose
Handwashing How-to • Take off rings • Turn on faucet • Wet hands • Apply soap • Scrub your hands - minimum 15 seconds • Rinse • Dry hands • Turn off faucet – use paper towel
Scrubbing Your Hands • Rub palms and backs of hands • Rub your fingers • Special attention to thumb and fingertips • Interlace fingers • Get into web spaces • Clean under and around fingernails • Rub your wrists • Go 2 - 3 inches up forearm
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 • Washing with soap and running water every time you remove your gloves is the recommended practice.
Did You Know? • Liquid soap is preferred • Bar soap can transfer microorganisms • Antimicrobial or plain soap? • Plain soap good enough for ordinary washing • Antimicrobial is preferred during patient care
Antiseptic Cleanser Precaution • Gels contain 60-65% ethanol • Same type of product found in beer and wine • Beer usually contains 3-6% alcohol • Wine generally contains 8-16% alcohol • Spirits contain over 40% alcohol • A teaspoon or 2 could make a toddler intoxicated or give them alcohol poisoning • Keep hand sanitizers out of children’s reach Source: Illinois Poison Center
Personal Hygiene Personal hygiene involves using good judgment when working in areas with the potential for exposure
Minimizing splashing, spraying, spattering and generation of droplets when attending to an injured person. • Refraining from eating, drinking, smoking, applying cosmetics or lip balms, or handling contact lenses where there is a reasonable likelihood of occupational exposure. • Keeping food or drink away from refrigerators, freezers, shelves cabinets or on countertops or bench tops where blood or other potentially infectious materials are present. • Refraining from mouth pipetting/suctioning of blood or other potentially infectious materials.
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
PPE - Gloves • Should be made of latex, nitrile, rubber, or other water impervious materials • If particularly thin or flimsy, double gloving can provide an additional layer of protection • If you have cuts or sores on your hands, cover these with a bandage or similar protection as an additional precaution before donning your gloves
Gloves • Always inspect your gloves thoroughly before putting them on • Never use gloves that are damaged, such as torn or punctured • Remove contaminated gloves carefully, avoiding touching the outside of the gloves with bare skin • Dispose of contaminated gloves in a proper container
Removing Gloves • Grab one glove cuff and pull off glove • Capture removed glove in other palm • Pull off remaining glove by grabbing inside of cuff • Pull glove off and over first removed glove • Dispose of gloves
PPE – Eye Protection • Bloodborne pathogens can be transmitted through the mucous membranes of the eyes. • Use eye protection whenever there is a risk of splashing or vaporization of contaminated fluid • Airway control (ie: intubation, suctioning) • Cleaning up spills • Cleaning equipment
Mask and Face Shields • Masks and face shields provide additional protection for potential eye, nose, or mouth contamination • Used during tasks that may generate blood or other potentially infectious materials via: • Splashes • Spray • Spatter • Droplets
Protective Clothing • Appropriate protective clothing such as, but not limited to, gowns, aprons, lab coats, clinic jackets, or similar outer garments shall be worn in occupational exposure situations • Type and characteristics will depend upon the task and degree of exposure anticipated.
General Guidelines for Personal Protective Equipment Use • Persons should be trained to use the equipment properly. • The equipment should be appropriate for the task and should fit properly, especially gloves. • Equipment should be free from physical flaws that could compromise safety. • Persons must use appropriate protective equipment each time they perform a task involving potentially infectious materials.
Employer Responsibilities • Issue PPE or make it readily accessible in the work area • Maintain, replace or dispose of any PPE at no cost to employees • Employer can provide the engineering controls • The employee needs to exercise the work practice controls for the process to be effective
Signs, Labels & Color Coding • Signs and labels in the workplace communicate bloodborne pathogen hazards to employees. • Warning label must include the universal biohazard symbol and the term "biohazard" in a color that contrasts with the fluorescent orange, orange-red background
Using Warning Labels • Warning labels must be affixed to containers of regulated waste, refrigerators and freezers containing blood or other potentially infectious material, and other containers used to store, transport, or ship blood or other potentially infectious materials. • Red bags or red containers can be substituted for labels.
Warning Labels • Contaminated equipment which is to be serviced or shipped must also have a warning label and a statement regarding which portions of the equipment remain contaminated.
Research Laboratories • HIV and HBV Research Laboratory and Production Facilities must have biohazard signs posted at the entrance. • Signs must also include: • Name of the infectious agent • Special requirements for entering the area • Name, telephone number of the laboratory director or other responsible person
Cleaning and Decontamination Duties • Review product labeling for any special directions/precautions • Wear appropriate PPE for task being performed • Remove all blood and debris from surface to be cleaned • Products can’t clean the surface if they can’t be in contact with the surface • Allow disinfectant to air dry • Leave surface wet 30 seconds for HIV disinfection • Leave surface wet 10 minutes for HBV disinfection
Clean Up Involving Blood or Body Fluids • Wear appropriate Personal Protective Equipment (PPE). • Carefully cover the spill with absorbent material, such as paper towels, to prevent splashing. • Decontaminate the area of the spill using an appropriate disinfectant, such as a solution of one part bleach to ten parts water. When pouring disinfectant over the area always pour gently and work from the edge of the spill towards the center to prevent the contamination from spreading out.
Clean Up of Spills cont’d • Wait 10 minutes to ensure adequate decontamination, and then carefully wipe up the spilled material. • Be very alert for broken glass or sharps in or around the spill. • Disinfect all mops and cleaning tools after the job is done. • Dispose of all contaminated materials appropriately. • Wash your hands thoroughly with soap and water immediately after the clean up is complete.