Lovington Municipal Schools Standard Precautions against Bloodborne Pathogens

1. Lovington Municipal SchoolsStandard Precautions against Bloodborne Pathogens THE OCCUPATIONAL SAFETY AND HEALTH ADMINISTRATION STANDARD

2. Bloodborne Pathogens for School Employees The Occupational Safety and Health Act 1910.1030 mandates training for employees regarding the Bloodborne Pathogens Standard in order to reduce the occupational transmission of infections caused by microorganisms sometimes found in human blood and in other potentially infectious materials. The training is mandated upon being hired and annually. These pathogens include, but are not limited to, human Immunodeficiency Syndrome (HIV), Hepatitis B (HVB) and Hepatitis C (HVC).

3. Specific Bloodborne Pathogens Hepatitis B (HBV) • Stable Virus can survive outside of the body after blood dries. • It affects the liver of those infected. • It is spread through blood contact, vaginal fluid, semen, and blood tinged fluids. Also can be passed from a mother to her baby at birth. • Some individuals become chronic carriers while most recover completely. • One hundred times more infectious then Human Immunodeficiency Syndrome (HIV)

4. Mode of Transmission of HBV • Primarily transmitted through “Blood to Blood contact” by accidental needle sticks or other contaminated sharp object injuries, sexual contact, mucous membrane, and through open cuts. • Not transmitted by casual contact.

5. Signs and Symptoms of HBV • Jaundice – yellow color to the skin and whites of the eyes. • Fatigue • Fever • Headaches • Abdominal pain • Loss of appetite • Nausea and vomiting • Dark urine Symptoms may not become noticeable for one to nine months after exposure.

6. Course of HBV Infection • Incubation period averages twelve weeks. • Most cases of HBV resolves without complications and infected individuals do not become infectious carriers. • Five percent of infected adults become carriers of the HBV virus and are able to infect others. They may or may not show physical signs or symptoms. • Chronic liver disease may occur in six to seven percent of those infected with HBV.

7. HBVPrevention • A vaccine does exist to prevent HBV infection. • Employers are required to offer HBV vaccination to employees covered under the Bloodborne Pathogen Standards. • Follow universal precautions. • HBV is declining because of vaccine use.

8. HBV Vaccine History of the Vaccine • The current form of the hepatitis B vaccine has been used in the United States since 1986. To make the vaccine researchers copy the genetic sequence of a protein contained in the virus into a yeast cell which is then cultured, purified, and prepared into a vaccine. These recombinant vaccines are safe, induce an immune response, and are incapable of infecting recipients with the hepatitis B virus. • Prior to 1991 the vaccine was recommended only for people who were identified to be at a high risk for acquiring the infection. • In 1991 the recommendation was extended to include all infants as well. This new recommendation was made for several reasons, including: Approximately 30% of people who get hepatitis B do not have any identified risk factors, so people at high risk often were not immunized. When infants and children are infected with hepatitis B the odds that they will develop chronic liver disease or cancer are at least three times higher than those infected as adults. Therefore, preventing infection in infants and children is very important. 

9. Hepatitis B Vaccine The series of immunizations with recombinant hepatitis B vaccines are 95% effective at inducing sero-immunity. Because the vaccine has only been in use 20 years, that is how long immunity is known to last. Immunity is probably lifelong. • Known Side Effects The majority of people who receive the hepatitis B vaccine (65%) do not experience any reactions to it. About 3% of those immunized will develop pain and tenderness where the shot was given. Low-grade fever occurs in about 1 to 6% of vaccine recipients. Serious reactions are extremely rare. In far less than 1 out of 10,000 shots given, or about .001%, serious allergic reactions including anaphylaxis (a rapid life-threatening allergic response affecting more than one part of the body; it can also be a systemic, whole-body response that causes the airway to swell, close off, and prevent the intake of oxygen) may occur.

10. HBV Post-Exposure Prophylaxis and Follow-ups • No definite cure for HBV infections. • Post-exposure prophylaxis should begin within twenty-four hours, but no later then seven days after the time of exposure. • Treatment requires a health care provider. • OSHA requires that all treatments meet the CDC’s most recent guidelines. • Exposed person should receive HBV vaccine. • HBV infection treatment may require a liver transplant for more severe cases.

11. Specific Bloodborne Pathogens Continued Hepatitis C (HCV) • Stable Virus can survive outside of the body after blood dries for a least four hours but no longer then sixteen days. • Sixty to seventy percent of persons infected have no signs or symptoms of infection. • Seventy-five to eighty-five percent of infected persons continue to have chronic infections and are able to spread the infection to others. • Can range from acute illness to chronic liver cirrhosis and death.

12. Mode of Transmission of HCV • Most common transmission mode is through sharing needles and syringes to inject drugs. Needle stick injuries in healthcare settings Being born to a mother who has HCV • Less common way of transmission is sharing personal items that may have come in contact with another persons blood (razors and toothbrushes). Having sexual contact with an infected person (though risk is low).

13. Signs and Symptoms of HCV • Jaundice – yellow color to the skin and whites of the eyes. • Fatigue • Fever • Headaches • Abdominal pain • Loss of appetite • Nausea and vomiting • Dark urine Symptoms may not become noticeable for two weeks to six months after exposure. However many people do not develop symptoms.

14. Course of HCV Infection • Most people with chronic HCV do not show symptoms, though those infected over a course of years may have liver damage. • It is the leading cause of cirrhosis and liver cancer. It is also the leading reason for liver transplants in the US. • There is no vaccine or medical treatment available for HCV. • Approximately 8,000 to 10,000 people die every year from HCV related liver disease. • What are the long-term effects of hepatitis C? Of every 100 people infected with the hepatitis C virus, about 75–85 people will develop chronic hepatitis C virus infection; of those, 60–70 people will go on to develop chronic liver disease 5–20 people will go on to develop cirrhosis over a period of 20–30 years 1–5 people will die from cirrhosis or liver cancer

15. Specific Bloodborne Pathogens Continued Human Immunodeficiency Syndrome (HIV) • HIV can cause acquired immune deficiency syndrome (AIDS) • Risk of a HIV infection from a puncture injury which allows exposure to HIV infected blood is extremely - low - 0.3% - but can still happen. • HIV is a fragile virus which cannot survive outside of the body for an extended period of time after body fluid dries.

16. Mode of Transmission of HIV • HIV (human immunodeficiency virus) is the virus that causes AIDS. • This virus may be passed from one person to another when infected blood, semen, or vaginal secretions come in contact with an uninfected person’s broken skin or mucous membranes. • In addition, infected pregnant women can pass HIV to their baby during pregnancy or delivery, as well as through breast-feeding. • People with HIV have what is called HIV infection. Some of these people will develop AIDS as a result of their HIV infection.

17. Signs and symptoms of HIV • Weight loss • Night sweats or fever • Gland swelling or pains • Muscle and/or joint pains • Dry cough • Unexplained fatigue • Memory loss, depression or other neurological disorders • Other symptoms may vary by individual basis. The only way to know if you are infected with HIV is to be tested for HIV infection.

18. Course of HIV Infection • Many people who are infected with HIV do not show any symptoms for ten years or more. • There is no vaccine or medical treatment for the cure of HIV but there are antiretroviral treatments in existence to slow the process of HIV turning into the AIDS virus.

19. Transmission of Bloodborne Pathogens Anytime there is blood-to-blood contact with infected blood or body fluids there is potential for transmission. Unbroken skin forms a barrier against bloodborne pathogens but infected blood can enter your system through open cuts, sores, abrasions, acne, burns open rashes or blisters. There is also the potential for transmission of infection through body fluid contacts of mucous membranes such as the lining of your eyes, nose and mouth.

20. How does a person become infected? Three conditions must exist • Source blood must be infected • Port of exit from infected person such as an injury, needle stick, etc. • Port of entry into susceptible person such as a break in the skin, mucous membrane,(i.e. nose, mouth, eyes).

21. Personal Risk Factors • Unprotected sexual contact • Sharing used needles or other sharps • Drug use, body piercing, razors, toothbrushes, tattooing • Perinatal (mother to baby during birth) • Blood transfusion (low risk)

22. Exposure Prevention • Universal Precautions Treat all blood and certain body fluids as if they are known to contain bloodborne pathogens.

23. Materials That Require Precautions • Blood • Semen • Vaginal secretions • Cerebrospinal, synovial or pleural fluid • Body fluids containing visible blood • Any unidentifiable body fluid • Saliva from dental procedures

24. Materials That Do Not Require Precautions • Universal Precautions do not apply to these fluids UNLESS blood is visible: • Feces • Sputum • Nasal secretions • Sweat • Urine • Vomit

25. Exposure Prevention • Treat all blood and body fluids as if they are infectious • Use personal protective equipment such as gloves when applying first aid. Wash hands after removing gloves • Use a pocket mask or other respiratory device when you have to resuscitate someone in an emergency

26. Exposure Prevention • Dispose of needles and other sharp objects in puncture-proof containers. Each school health office is equipped with a sharps container. • Do not share razors or toothbrushes. • Proper hand washing!

27. Proper Handwashing Technique • Use liquid soap. • Use running water ( NO standing water). • Lather all surfaces creating ample friction for at least 30 seconds. • Rinse well. • Dry thoroughly with paper towels. • Turn off faucet with same paper towel. • Discard paper towel.

28. Personal Protective EquipmentPPE • Gloves • Masks • Aprons/Gowns • Goggles/Eye shields • Resuscitation devices

29. Exposure Prevention • Disinfect surfaces contaminated with blood and body fluid. Contact building custodian for correct disinfectant solutions and PPE. • Double-bag items contaminated with blood or body fluid for disposal. • “Regulated” waste that should be double-bagged: Contains blood or bloody fluids.

30. Communications of Hazards • Labels and Signs • Warning labels should be affixed to containers of contaminated sharps and regulated waste and include the following legend.

31. Labels and Signs • Red bags or red containers may be substituted for labels.

32. Exposure Prevention • Get vaccinated. The only bloodborne pathogen for which a vaccine is available is Hepatitis B (HBV). • This vaccine is available to everyone through primary care providers and other agencies.

33. Occupational Risk Factors What are the risks involved in a school setting. • Contact with infectious body fluid to broken skin or mucous membranes. • Playground injuries, shop classes, athletic or physical education injuries, and fights. • Puncture wounds with used needles or other sharps objects. • In the Health offices • During any scientific class dissections.

34. Exposure Classifications • All school district employees in the following job classifications have been identified as having • occupational exposure risk to bloodborne pathogens. • Daily Risk of Exposure • 􀂃 Nurses/Health Assistants • 􀂃 Security Officers • 􀂃 Coaches/Athletic Director • 􀂃 Special Education Teachers/Assistants • 􀂃 Physical Education Teachers/Assistants • 􀂃 Custodians • Occasional Risk of Exposure • 􀂃 Administrators • 􀂃 Classroom Teachers • 􀂃 Secretaries • 􀂃 Educational Assistants • 􀂃 Food Service Workers • 􀂃 Maintenance Workers • 􀂃 Bus Drivers • 􀂃 Bus Aides • 􀂃 Students who work with children in nursery, work as lab assistants or work in coop programs

35. Lovington Municipal SchoolsEmergency Exposure Procedures • Although most contact does not result in infection, there are procedures that must be followed when there is the possibility of exposure to bloodborne pathogens • The following procedures can reduce the risk and are required by the district.

36. Emergency Exposure Procedures • If you have accidental contact with blood or bloody fluids: WASH: Immediately wash affected area with sudsy soap and running water. May need to flush eyes with large amounts of water or saline. DISINFECT: All spills of blood or bloody fluid must be disinfected. If clean up is needed, contact the building custodian who has training and materials to disinfect area.

37. Reporting Procedure • If you have accidental contact with blood or bloody fluids: Inform your principal, supervisor and/or school nurse immediately Seek medical advice if recommended Complete the appropriate forms: Notice of Accident Form AND

38. Lovington Municipal SchoolsPotentially Infectious Exposure Form • CONFIDENTIAL • Incident Reporting Form • for exposure to blood or other potentially infectious material • SCHOOL DISTRICT ____________________________________________ • DATE OF INCIDENT________________________LOCATION OF INCIDENT _____________________ • NAME OF PERSON'S INVOLVED________________________________________________________ • SOURCE INDIVIDUAL _________________________________________________________________ • EMPLOYEE'S WORKSITE _____________________________________________________________ • DESCRIPTION OF INCIDENT BY INDIVIDUAL/S INVOLVED __________________________________ • ____________________________________________________________________________________ • ____________________________________________________________________________________ • ____________________________________________________________________________________ • ____________________________________________________________________________________ • ____________________________________________________________________________________ • ____________________________________________________________________________________ • INVESTIGATIVE DESCRIPTION OF INCIDENT_____________________________________________ • ____________________________________________________________________________________ • ____________________________________________________________________________________ • ____________________________________________________________________________________ • ____________________________________________________________________________________ • ____________________________________________________________________________________ • ____________________________________________________________________________________ • EXPOSURE CONTROL PLAN GUIDELINES FOLLOWED ____ YES ____ NO (If NO, describe.) • ____________________________________________________________________________________ • ____________________________________________________________________________________ • ____________________________________________________________________________________ • ____________________________________________________________________________________ • ____________________________________________________________________________________ • ____________________________________________________________________________________ • DETERMINATION OF EXPOSURE INCIDENT ____YES ____NO • EXPOSURE ROUTE________________________________________________________ • REPORT COMPLETED BY___________________________________DATE___________

39. Medical Evaluation Post Exposure • Entitled to confidential medical evaluation • It is your personal decision about blood testing. • Blood may be tested only with a persons consent. • Interpretation of any test result occurs with a health care provider. MEDICAL RECORDS ARE CONFIDENTIAL

40. Questions?

41. Bloodborne Pathogens Exposure Quiz You are considered to be exposed to Bloodborne Pathogens if blood or other potentially infectious materials come in contact with … A) dresses, scarves, coats and pants B) gloves C) mucous membranes of the eyes, mouths or nose or if a contaminated sharp object punctures the skin D) pencils

42. ANSWER C) Mucous membranes of the eyes, mouth or nose or if a CONTAMINATED sharp object punctures the skin.

43. Bloodborne Pathogens Exposure Quiz HBV and HVC are both infections of the… A) Lungs B) Lymphatic Systems C) Intestines D) Liver

44. ANSWER • Liver The liver is the largest organ in the body and provides many functions that are necessary for survival.

45. Bloodborne Pathogens Exposure Quiz All of the following are ways to protect yourself from exposure except… A) follow the instructions in the exposure control B) treat everyone as if they are infected C) always use a barrier mouthpiece when performing CPR D) never get the Hepatitis B vaccine series

46. ANSWER • Never get the Hepatitis B vaccine series. If you are in a high risk category you are offered at no charge the vaccine series. You can accept or decline the vaccine series. If you decline you do have the right to receive the vaccine in the future if you are in a high risk category.

47. Bloodborne Pathogens Exposure Quiz The first thing you must do when you have been exposed to bloodborne pathogens is… A) call your wife /husband B) call your doctor C) immediately wash the exposed area with warm water and soap or flush mucous membranes and eyes with large amounts of water D) notify your principal

48. ANSWER • Immediately wash the exposed area with warm soap and water and or flush mucous membranes or eyes with large amounts of water or saline. Then notify your supervisor and/or principal.

49. Bloodborne Pathogens Exposure Quiz • As an employee of the school system, your chances of contracting HIV are much greater than contracting HBV and HBC. • True of False

50. ANSWER • FALSE HIV is a fragile virus that usually dies outside the body when body fluid dries. HBV and HCV are stable viruses that can survive up to a week outside the body.