tfmpp bloodborne pathogens training
TRANSCRIPT
AWARENESS TRAINING
BLOODBORNEPATHOGEN
PRESENTED BYTexas Family Medicine Preceptorship Program
UT Medical School at Houston - Environmental Health & Safety
HOW INFORMED ARE YOU?Name three bloodborne pathogens (BBP) that are transmitted through bodily fluids.
Name three ways you can be exposed to BBP.
How many people does tuberculosis affect worldwide?
True or False - it is okay to recap a needle?
What is a negative pressure room? What is it used for?
What cleaning agent should be used when cleaning up a blood spill?
What are standard precautions?
Can alcohol sanitizers be used to remove blood off hands?
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2
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What is a bloodborne pathogen?
TRAINING OUTLINE
What do UTHSC-H statistics say?
Preventive measures
Needlestick injury & exposure information
TB presentation & isolation
Your rights
Blood or other potentially infectious material (OPIM) spill clean up
The standard was originally issued in 1991, and was later revised for the prevention of contaminated sharps injuries, needlesticks
OSHA Bloodborne Pathogen Standard29 CFR 1910.1030 OSHA Bloodborne Pathogen Standard
• Education and selection of sharps injury reduction devices (e.g., self-sheathing needles)
In 2001 the revised standard, Needlestick Safety and Prevention Act included:
• Maintenance of a contaminated Sharps Injury Log
POWERPOINT PRESENTATION
Texas Department of State Health Service
• Reflect advanced technology that eliminate or reduce exposures
Exposure Control Plan:
• Document annually consideration for safer medical devices
BLOODBORNE PATHOGEN CONTROL
• Solicit input from employees at higher risk of occupational exposure.
B loodbornePATHOGENS (BBP)Pathogenic microorganisms present in human blood or other potentially infectious material (OPIM), and can infect and cause disease in humans. These pathogens include, but are not limited to, hepatitis B virus (HBV), hepatitis C virus, and human immunodeficiency virus (HIV).
B loodbornePATHOGENS (BBP)- HIV- HBV- HCV- T. pallidum- Herpes Virus- M. tuberculosis
- typically an aerosol hazard- Human T-Lymphotropic Virus Type l (HTLV-l)
B loodbornePATHOGENS (BBP)Body fluids that can harbor BBP:
- Blood- Semen and vaginal secretions- Saliva involved in dental procedures- Synovial fluid- Cerebrospinal fluid- Human tissue and cell cultures- All body fluids containing blood e.g. fluids: pleural, pericardial, amniotic
OCCUPATIONAL EXPOSURE*
FIRST SECOND THIRDMucous membrane contact- Splash in eyes, nose, or
mouth
Percutaneous inoculation- Misuse of sharps
(broken glass, needles, scalpels)
Exposure to broken/damaged skin- Risk increases if contact
involves a large area of broken/damaged skin or if contact is prolonged
2 3
* Risk increases with high titer levels in the source
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How do you get exposed?
What should I do if I get exposed?
• Needlesticks or cuts from used needles or sharps• Contact of eyes, nose, mouth or broken skin with blood• Assaults – bites, cuts, knife wounds• Punctures• Splashes
REPORT ASAP, then:• Needlestick and cuts – wash with soap and water• Splashes – flush nose, mouse, or skin with water• Splashes in the eyes – irrigate with water, saline, or sterile wash
Engineeringcontrols
PersonalProtectiveEquipment
(PPE)
Administrativecontrols
Work placepractices
PREVENTIVE MEASURES
Leak-proof containers
• Use for storage & transportation of ALL bloodborne pathogen material
Sharps containers
• Fill no greater than ¾ full
Needleless devices
• Use retractable syringes, self-sheathing needles
Engineering controlsBiosafety cabinet (BSC)
Directional air flow
High efficiency particulate air (HEPA) filtration
Access control
Face protection
• Goggles or safety glasses with side shields
Clothing
• Lab coats, scrubs, disposable gowns (long pants only and no open toed shoes)• Replaced immediately when contaminated• Lab clothing restricted to work area
Gloves
• Replaced immediately if torn• Not worn outside the lab area!
Personal Protective Equipment
How toproperly remove gloves
Personal Protective Equipment (cont.)
Source: Globus
Medical surveillance
• TB skin test (PPD)
Immunizations
• Hepatitis B series
Training
Management of staff (SOP compliance)
Background checks, security clearance
Administrative Controls
Universal / Standard precautions• Treat all human blood
and body fluids as if known to be infectious for HIV, HBV, or other potentially infectious material (OPIM)
GOOD WORKPLACE PRACTICES
NEVER recap needles!
Follow SOPs
Survey work area• Note locations of all necessary equipment, waste
containers, disinfectants, and soaps
Establish & maintain clean & dirty zones
DO NOT eat, drink, or apply cosmetics in the work area
GOOD WORKPLACE PRACTICES
Decontaminate work surfaces• At start and end of procedures• Immediately after spill• Before removal of equipment
Dispose of waste properly
Label containers – hazard communication• Chemical & biological working stocks
Wash hands frequently, always between patients & always before leaving work area!
GOOD WORKPLACE PRACTICES (cont.)
• Get the hepatitis B vaccine• Review the employer’s Exposure Control Plan• Dispose of sharps PROMPTLY into an appropriate container• Use sharps devices with safety features• Clean work surfaces• Use personal protective equipment (such as gloves and face shields)
GOOD WORKPLACE PRACTICES (cont.)
How can you protect yourself overall?
BLEACH
ALCOHOL
CIDEX
Cleaning agents/disinfectants you will encounterStart from perimeter and work your way in
ROUTINE DECONTAMINATION
On average only 40% of healthcare
workers regularly
wash their hands
Hand Hygiene Hospital acquired infections result in transmission of:
• MRSA – Methicillin resistant S. aureus• 1.2 million infections; 48,000 patient deaths yearly
• VRE – Vancomycin resistant Enterococci• $4.5 billion yearly cost for treatment
Methods of contamination:
• Moving patients• Taking blood pressure• Touching bedrails
Source: Hand Hygiene Resource Center http://www.handhygiene.org/
The Inanimate Environment Can Facilitate Transmission
Contaminated surfaces increase cross-contamination
X RepresentsVRE culture positive sites
Source - Abstract: The Risk of Hand and Glove Contamination after Contact with a VRE (+) Patient Environment.
Hayden M, ICAAC, 2001, Chicago, IL.
Proper hand washing is
VITAL to infection prevention!
You may not realize you have germs on
your hands!
Hand Hygiene (cont.) Wash your hands, even if gloves have been worn…
• Before patient contact, including between different patients
• AFTER contact with anything contaminated
• During patient care• Before and after invasive procedure• Before and after contact with wound• Between procedures on different body parts
of the same patient• Between glove changes• Immediately if skin is contaminated or if an
injury occurs
Proper Hand WashingWet hands with warm (not hot) water
Apply soap on hands• Liquid soap is better (germs can live on wet soap bars)
Rub hands together for at least 15 seconds• Wash longer if there is visible dirt on hands• Cover all surfaces of hands and fingers – including
between fingernails, backs of hands, thumbs, and under fingernails
Rinse hands thoroughly with warm water
Dry hands thoroughly• If using blow dryer, push
button with elbow• If available, use towel to
turn off water
WHAT SONG IS ABOUT 15 SECONDS LONG?
Source: Hand Hygiene Resource Center http://www.handhygiene.org/
“Happy Birthday” Song
-or-
“ABC” Song
WHERE WE
MISS
Hand Hygiene (cont.)
Alcohol sanitizers
• 62% ethyl alcohol• Accepted as effective under certain
conditions• Should not be used when there is
visible dirt or grime
Hand Hygiene (cont.)
WASH BEFORE WASH AFTEREating
Caring for someone who is sick
Using Toilet
Blowing nose, coughing, or sneezing
Caring for someone who is sick
Most Cited Sources of Needlestick
IMPROPERLIGHTING
IMPROPER HANDLING
NOT FAMILIAR
WITHDEVICE
IMPROPER SHARPS DISPOSAL
UNCOOPERATIVE PATIENTS
Overfilled sharps
containers
Passing to other
personnel
Impropersuture
technique
EXPOSURE
NEEDLESTICKPOSSIBLE
APPLY ROUTINE FIRST AID IMMEDIATELYClean site of injury with soap & flush with water for at least 15
minutesFlush mucous membranes with water or saline for at least 15 minutes
NOTIFY SUPERVISOR / PRECEPTORComplete First Report of Injury
• Used to process insurance claims & helps identify trends
SEEK MEDICAL ATTENTIONStudent Health Services Clinic – look in your student handbook
• Baseline Labs
• HIV antibody (with consent)• RPR (Syphilis)• Hepatitis B surface antibody• HCV antibody
• If source is known to be Hepatitis C+, also obtain liver function & HCV RNA tests
• CBC with differential and platelets, chemistry profile, urine pregnancy test if source is known HIV+ and if exposed personnel chooses to utilize post-exposure prophylaxis
Medical Surveillance for injury• Hepatitis B Vaccination
• Tuberculosis skin test, Quantiferon test
Percutaneous injury transmission rates with blood or blood products
• Hepatitis B 2 – 40%
• Hepatitis C 3 – 10%
• HIV 0.2 – 0.5%
CDC Exposure Risk
Cough
Chest Pain
Coughing up blood
Weakness
Fever and/or night sweats
Weight loss
TB Presentation & Isolation
WHO TUBERCULOSIS DATA
TEXAS TUBERCULOSIS DATA
TB Presentation & Isolation (cont.)Routinely ask all patients: • History of TB disease?• Symptoms suggestive of TB?
Patients with history or symptoms of undiagnosed TB: • Refer promptly for medical evaluation of
possible active infection• Wear surgical mask• Provide urgent care in TB isolation areas
(i.e., negative pressure rooms)
TB ReportingIn Texas:
512.533.3000
TB Presentation and Isolation (cont.)
REMINDERBloodborne Pathogens can be transmitted via the following routes:
• Airborne
• Droplet
• Contact
How to protect yourself & the patient
REMEMBER
Place mask on patient
Use an N-95 respirator when caring for the patient (get fitted)• Routine duties• Sputum-inducing procedure
Enforce cough etiquette
In the event of a possible exposure to bloodborne pathogens, the person is entitled to:
• Confidential medical evaluation and follow-up
• Documentation of routes of exposure
• Identification, documentation, testing, and results of the source individual
• Counseling
• Evaluation of reported illness
• Source patient blood draw
YOUR RIGHTS
Blood (or OPIM) Spill Clean UpClean all blood (or OPIM) spills with a 10% bleach solution or another EPA-approved disinfectant
Apply the approved disinfectant to perimeter of spill
Allow at least 15 minutes of disinfectant contact time• Slowly proceed inwards
Dispose all materials used to clean up spill (e.g. towels, gloves) in a biohazard bag
Biological Waste DisposalPlace red biohazard bags inside hard-walled, leak-proof secondary containment
• Do not over fill!
Place sharps in an appropriate hard-walled, leak-proof sharps container
• Do not recap needles!• Do not over fill (no more than ¾
full)!• Let clinic administrator or
manager know if it needs to be replaced
What is Biological Waste & What is Trash?
Bloody Gloves
Used Needles
Disposable Gowns (Unsoiled)
UA Dipstick
Unsoiled Exam Gloves
Identify which receptacle these (below) belong in
What is Biological Waste & What is Trash?
Unsoiled Exam Gloves
Disposable Gowns (Unsoiled)
Bloody GlovesUsed Needles
UA Dipstick
INFORMATION RESOURCESAvailable resources about bloodborne pathogens
• Contact your Occupational or Employee Health Clinic or report to the Institutional Emergency Department IMMEDIATELY
• Biological Safety Manual (in every lab & website)
• OSHA Bloodborne Pathogen Standard
• Center for Disease Control
• Texas Department of State Health Services
REMEMBER!You are responsible for knowing and practicing all the BBP training and safety precautions outlined in this presentation while participating in your Family Medicine preceptorship.
Make sure you have your preceptors number and tell someone immediately when you are exposed to any bloodborne pathogens.
QUESTIONS?Refer to your Student Handbook
Please remember:Contact your preceptor immediately following any exposures
Go to the nearest Occupational or Employee Health Clinic or go to the Emergency Department for treatment
THANK YOU FOR LEARNING