ANNUAL OSHA UPDATE for Home Health Aides

Transcription

1 ANNUAL OSHA UPDATE for Home Health Aides Hospice Education Network Erin E. Murray, RN, BSN, MHA, CLNC DOWNLOAD THE HANDOUTS Make sure you download a copy of the workshop handouts Click on the LINKS button Handouts are in PDF format Save it, then print it TOPICS OF DISCUSSION OSHA Infectious Disease Transmission Infection Control Handwashing Bloodborne Pathogens: Hepatitis B & Hepatitis C HIV Universal Precautions Personal Protective Equipment Occupational Exposures Post-Exposure Followup 1

2 WHAT IS OSHA? Acronym stands for: Occupational Safety & Health Administration Facts: Federal agency: Department of Labor (1970) Publishes and enforces safety & health regulations for most businesses & industries Mission is to: Prevent work-related injuries, illnesses, and deaths by issuing and enforcing rules (called standards) to promote and enforce safety and health in the workplace INFECTIOUS DISEASE Micro-organism: Microscopic life form Can cause disease in man and animals Examples: bacteria, viruses, mold, algae, fungi Pathogen: A micro-organism which is capable of causing disease TRANSMISSION OF DISEASE Knowing the methods in which a disease is transmitted is important for implementing proper infection control measures Types of Transmission: Direct contact Indirect contact Droplet contact Airborne contact 2

3 Requires: TRANSMISSION: DIRECT CONTACT Close physical contact with infected person Physical transfer of micro-organisms Occurs: Usually between members of the same household or close friends and family Spread by: Touching an infected individual, kissing, sexual contact, contact with oral secretions, or contact with body lesions TRANSMISSION: INDIRECT CONTACT Refers to situations where: Susceptible person is infected from contact with contaminated surface Hardy organisms: Survive for extended periods of time Hepatitis B: 1 week, room temp INDIRECT CONTACT: Prevention Properly disinfect frequently touched surfaces: Lysol, antibacterial spray, bleach solution, etc. Special attention to: Door knobs/handles, handrails, bedrails Bedside tables, beds, chairs Bathroom surfaces Kitchen items Devices with buttons, especially phones 3

4 DROPLET CONTACT Explanation Droplets containing micro-organisms are propelled a short distance through the air and deposited into the eyes, nose, or mouth of another person Too large to be airborne for long periods of time Quickly settle out of air DROPLET CONTACT Examples Spread by: coughing, sneezing, or talking Prevent by: Use of personal protective barriers (face masks, goggles, etc.) Disease Examples: Measles Severe acute respiratory syndrome (SARS) AIRBORNE TRANSMISSION Definition and Characteristics Airborne dissemination of either airborne droplet nuclei or evaporated droplets containing micro-organisms Droplets remain suspended in air long time Organisms must be capable of surviving for long periods of time outside the body Must be resistant to drying 4

5 AIRBORNE TRANSMISSION Spread Airborne transmission allows organisms to enter the upper and lower respiratory tracts Widely dispersed by air currents May be inhaled by persons at a distance away from the source patient Very similar to droplet transmission Only a limited number of diseases are capable of this Disease Examples: Influenza, Whooping Cough, Pneumonia, Tuberculosis, Polio INFECTION CONTROL: Three Things You Can Do Handwashing: Cleanse hands of germs Prevent contamination between patients and caregivers Universal Precautions Personal Protective Equipment (PPE) HANDWASHING TECHNIQUE: Process Wet hands: warm running water, soap up Rub hands together: Lots of lather and friction Do this away from the running water for at least fifteen seconds (water running) Front and back of your hands, between fingers and under finger nails Wash from the wrists downward while keeping hands and forearms lower than elbows 5

6 HANDWASHING TECHNIQUE: Process, cont. Rinse your hands well under warm running water Dry hands thoroughly: clean paper towel or cloth Turn off the faucet using new (dry) paper towel: Wet towels and wet hands allow for the transfer of pathogens Remember, germs thrive on moist surfaces SOAP CHOICE Any type of soap may be used: Liquid soap (dispenser): most hygienic Bar soap: Keep in a self draining holder Clean well each time a new bar is opened Bar should be rinsed off prior to putting it back in the soap dish KEEPING HANDS HEALTHY Do s and Don ts: DO prevent hands from becoming chapped Use mild soap Pat hands dry (no rubbing) Apply lotion liberally & frequently DON'T: Use a standing basin of water to rinse/ wash hands Use a common hand towel. Always use disposable towels when available. If paper towels not typically available, bring your own clean towel with you 6

7 FINGER NAILS & INFECTION CONTROL Healthcare workers with artificial nails/extenders are: More likely to harbor pathogens on fingertips versus those with natural nails: both before & after handwashing Nail length: Less than ¼ inch long: recommended Especially when working with patients who are high risk for spreading bloodborne pathogens HANDWASHING WITHOUT WATER: CDC Guidelines Center for Disease Control (CDC) If hands are not visibly soiled, an alcoholbased hand sanitizer may be used for routine decontamination Visibly dirty hands should be washed with soap & water, because the debris on one s hands can make the alcohol in alcoholbased hand sanitizers less effective ALCOHOL-BASED SANITIZERS: The Facts Alcohol-based hand sanitizers are: More effective at removing bacteria and some viruses from the hands than washing Only use if the hands are not visibly soiled It s perfectly acceptable to use both methods if you so desire Only use alcohol-based products Suggested that only sanitizers with at least 60% alcohol content be used 7

8 ALCOHOL-BASED HAND SANITIZER The Process: Sanitizer should be: Rubbed into the hands until dry: about 30 seconds (all surfaces including nails) If hands are dry after only seconds, not enough sanitizer was used Suggested Amount: Varies due to hand size Enough to not dry < 15 seconds WHEN TO WASH YOUR HANDS? After using the bathroom (self and assisting others): Changing children s diapers or adult incontinence briefs After touching animals or animal waste. Before and after preparing food, especially if you handle raw chicken, fish, or meat WHEN TO WASH YOUR HANDS, cont. Before eating After blowing your nose: Assisting someone else Before and after touching someone who is sick (contagious) After handling garbage 8

9 BLOODBORNE PATHOGENS: Definition Microorganisms that can cause disease when transmitted from an infected individual to another individual through blood and certain body fluids Bloodborne pathogens are capable of causing serious illness or death BLOODBORNE PATHOGENS: Most Common Illnesses Hepatitis B (HBV) Hepatitis C (HCV) Acquired immunodeficiency syndrome (AIDS) From the HIV, or human immunodeficiency virus WHAT IS HEAPATITIS B (HBV)? Hepatitis means: Inflammation of the liver Caused by: drugs, toxins, autoimmune diseases, and infectious agents, including viruses. HBV is a virus that causes Hepatitis B Hepatitis B is: A life-threatening bloodborne pathogen A major risk to employees in jobs where there is exposure to blood and other potentially infectious material (OPIM) 9

10 Healthy adults: HEPATITIS B FACTS 90% infected with Hepatitis B will recover and develop protective antibodies against future Hepatitis B infections Adults with Hepatitis B 5-10% of adults with Hepatitis B will be unable to get rid of the virus and will develop chronic infections Infants and small children: 90% of infants and up to 50% of young children infected with Hepatitis B will develop chronic infections Vaccination is imperative for children Hepatitis B is: HEPATITIS B FACTS Continued: 100 times more infectious than HIV Unlike HIV, it can be prevented with a safe and effective vaccine Vaccine: Not of use to the 400 million people worldwide who are already chronically infected HEPATITIS B World Statistics: 400 million: chronically infected million: become infected each year 2 billion: have been infected (1 in 3) 1 million (approx): die each year from Hepatitis B and its complications 2 people (approx): die each minute 10

11 HEPATITIS B U.S. Statistics: 12 million: have been infected (1 out of 20) More than one million people are chronically infected Up to 100,000 new people will become infected each year 5,000 people: will die each year Approximately 1 health care worker dies each day from Hepatitis B YOU CAN PREVENT HEPATITIS B! GET VACCINATED Under OSHA regulations: Employers must make the Hepatitis B vaccination series available to all employees who have occupational exposure to bloodborne pathogens Vaccinations and all related medical evaluations and follow-up (including booster shots) must be: Provided at no cost to the employee Provided at a reasonable time and place Performed by or under the supervision of a licensed health care professional THE HEPATITIS B VACCINE For employees who do no wish to be vaccinated: A declination form must be signed The vaccine must be offered: Within 10 working days of initial assignment The vaccine consists of three injections. 2nd injection: one month after the first injection 3rd injection: six months after the first injection 2 week grace period: 2nd and 3rd injections 11

12 HEPATITIS B VACCINE Post Treatment: CDC recommends that everyone: Get tested for antibodies to Hepatitis B surface antigen 1-2 months after the 3rd injection No response to 1st vaccine series: must be revaccinated (3 doses) and retested No response to 2nd vaccine series: must be evaluated by a physician WHAT IS HEPATITIS C (HCV)? HBC: The virus that causes Hepatitis C In the United States: Most common blood-borne infection Is a major cause of liver damage Two types: Acute: short duration and relatively severe Chronic: continuing for a long period of time HOW IS HEPATITIS C SPREAD? Primarily: Through contact with infected blood However, it can occasionally be spread in other ways Ways it can be spread: Injecting drugs with shared needles Receiving HCV-infected blood transfusions (pre-1992) Accidentally stuck by an HCV-infected needle Sharing toothbrushes, razors, nail clippers, or other personal hygiene items that have HCVinfected blood on them 12

13 HOW IS HEPATITIS C SPREAD? Continued Unsterilized equipment: Tattoo, body piercing, or acupuncture During childbirth: infected mom can pass the virus onto her baby Having sexual contact with someone infected with HCV HEPATITIS C CANNOT BE SPREAD BY Hugging or kissing Sharing eating utensils Casual household contact No reason to stay away from people at work or at play No vaccine is available: use safe work practices make smart life style choices HEPATITIS C STATISTICS About 15% of cases: Are acute, in which the immune system is able to completely destroy the virus In about 85% of infected people: The immune system is not able to completely get rid of the Hepatitis C virus, and they end up having a long-term liver infection Approximately 300 million people worldwide are infected with the Hepatitis C virus 13

14 In the U.S.: HEPATITIS C STATISTICS Continued: About 3.9 million people have chronic Hepatitis C The number of new infections per year has declined: 1980 s: average of 240, : 26,000 Most people who are chronically infected are: Not aware of their infection (not clinically ill) Very dangerous: can pass it onto with no knowledge WHAT IS HIV? Human immunodeficiency virus The virus that causes AIDS (acquired immune deficiency syndrome) The HIV Virus: Lives and reproduces in certain white blood cells It disrupts the normal activity of these "host" cells Since white blood cells help the body fight disease, infection with HIV reduces the body's ability to fight disease AIDS STATISTICS IN THE U.S. In 2005: Estimated number of new diagnoses: 44,198 Adult and adolescent AIDS cases: 44,140. Children under the age of 13: 58 cases Males: 32,430 Females: 11,710 Cumulative (estimated) number of diagnoses through 2005: 956,666 14

15 STATISTICS OF ESTIMATED AIDS DIAGNOSES THROUGH 2005 Of 956,666 estimated cumulative number of AIDS diagnoses in 2005: 947,585 were adults and adolescents 9,078 were children under 13 years of age 764,763 were males 182,822 were females GLOBAL AIDS STATISTICS As of the end of 2005: An estimated 40.3 million people around the world were living with HIV/AIDS 4.9 million (new) people acquired HIV It claimed an estimated 3.1 million lives Two-thirds of all people living with HIV are in Sub-Saharan Africa as are 77% of all women with HIV UNIVERSAL PRECAUTIONS Definition: Universal precautions: A method of infection control, which requires employers and employees to assume that all human blood and specified human body fluids are infected with HIV, Hepatitis B & C and other bloodborne pathogens It encompasses a variety of practices to prevent occupational exposure, such as: The use of personal protective equipment (PPE) Safe disposal of sharps Safe housekeeping practices 15

16 WHAT BODY FLUIDS DO UNIVERSAL PRECAUTIONS APPLY TO? Vomit Sputum (from the respiratory tract) Feces Urine Semen Vaginal secretions Cerebrospinal fluid (CSF) Amniotic fluid UNIVERSAL PRECAUTIONS Other Body Fluid Concerns: Use universal precautions when other body fluids contain visible blood or OPIM Nasal secretions, saliva, sweat, and tears When differentiation between types of body fluids is difficult or impossible, all body fluids are to be considered potentially infectious PERSONAL PROTECTIVE EQUIPMENT Definition: Equipment designed to reduce the risk of disease transmission between patients and caregivers Types of PPE include, but are not limited to: Gloves Gowns Masks Eye protection Face shields CPR mouthpieces 16

17 PPE: EMPLOYER S RESPONSIBILITY Supply all appropriate PPE: To employees at risk for occupational exposure Free of charge Variety of sizes Hypoallergenic gloves or similar alternatives (e.g. latex free) must be made available to employees who have an allergic sensitivity to gloves WHEN IS PPE USED? Whenever occupational exposure is expected (known) to occur or when it may occur: Exposure to blood or OPIM When in doubt, use PPE Wear disposable gloves when: There s a chance of coming in contact with blood or OPIM Handling or touching contaminated items or surfaces WHEN IS PPE USED?, cont. The type of PPE depends upon the task and degree of exposure anticipated Gown, apron, face mask, goggles, etc. Wear face and eye protection: Whenever splashes, sprays, spatters, or droplets of blood or OPIM may reach the eyes, nose, or mouth Mask with goggles or chin-length face shield 17

18 Replace gloves: PPE GUIDELINES Questionable integrity Never wash or decontaminate any PPE for reuse! Wash your hands every time you remove your gloves or any other PPE Clean body fluid spills Chemical germicide 1:10 solution of liquid bleach and water REMOVAL OF PPE Remove when: Contaminated Before leaving the work area Place used PPE in appropriately designated receptacles for: Storage Washing Decontamination Discarding RECEPTACLES FOR PPE Discarding contaminated disposable items Dispose in one trash receptacle, if possible Receptacles should be placed in work area Line containers that hold infectious disposables Tie up when ¾ full If contents in the bag have the potential for leaking through: Double Bag Prevent contamination of nearby surfaces 18

19 CONTAMINATED LAUNDRY Visibly Contaminated Laundry: Blood or OPIM Place in bags or containers: Impermeable to moisture Prior to transport for cleaning Gloves a must Stored separately from clean linen Washed separately: Hot soapy water Disinfected appropriately: bleach, color-fast bleach BIOHAZARD DEFINED An organism, or substance derived from an organism, that poses a threat to human health (primarily): Medical waste soiled with blood and/or bodily fluids is considered biohazardous waste The term and its symbol is: Used as a warning People at risk should take precautions BIOHAZARD SYMBOL 19

20 BIOHAZARD SYMBOL The Meaning: Indicates: proceed with caution Symbol may be affixed to: Door Object containing bio-hazardous waste Have appropriate PPE in place prior to: Entering room with symbol on door Touching anything with the symbol affixed EXPOSURE INCIDENT Defined: In healthcare, an exposure is when someone comes in contact with patient s blood or bodily fluids In order for it to be an exposure: Blood and/or bodily fluids need to have come in contact with the employees mucous membranes or break in skin MUCOUS MEMBRANES Defined: The moist inner surface that lines the: Mouth Nasal sinuses Stomach Intestines and many other parts of the body It secretes mucous which acts as a protective barrier and lubricant, as well as a medium for carrying enzymes 20

21 MUCOUS MEMBRANES: Body Areas Eyes Ears Nose Mouth/lips Genitalia Rectum/anus HOW DO EXPOSURES OCCUR? When someone else s blood or body fluids come in contact with the healthcare worker s mucous membranes or breaks in skin A break in skin defined: Area where skin integrity has been compromised: Cut, abrasion, puncture wound as from a needle stick or pin prick, rash, scrape, chapped area, etc. Mucous Membrane Exposure: Splash or splatter EXPOSURE PRECAUTIONS Use appropriate PPE Per OSHA, don t do the following in areas where occupational exposure could occur: Eat Drink Smoke Apply makeup or lip balm Handle contact lenses 21

22 POST-EXPOSURE FOLLOW-UP If breaks in skin or mucous membranes come in contact with blood or OPIM: Cleanse the affected areas ASAP Cleanse as follows: Intact skin: soap and water for 1 minute or longer Non-intact skin and needle sticks: soap and water as above POST-EXPOSURE CLEANSING Eyes: Flush with sterile water or luke warm tap water for 15 minutes Note: Remove contact lenses first Disinfect manufacturer's recommendations or discard Intra-oral exposure: Rinse mouth with water and spit (do not swallow) 15 minutes THREE CRUCIAL POST-EXPOSURE FOLLOW-UP STEPS First step once an exposure takes place: Wash skin or flush the mucous membranes Second step: Call your clinical supervisor for direction Your supervisor should: Direct you to your agency s dedicated healthcare provider for post-exposure treatment and prophylaxis, if recommended 22

23 POST EXPOSURE FOLLOW-UP TREATMENT 3rd Step: Imperative that you follow up with the authorized healthcare provider Timely manner (typically within 24 hours) Employer is responsible for: Paying for all medical follow-up and testing as it relates to your exposure IN CLOSING It s your responsibility to stay safe & healthy by: Following the infection control practices outlined here today Use universal precautions when appropriate Remember, handwashing and use of sanitizers: Are the best way to stop the spread of infection Take seconds of your time IN CLOSING Continued Each day, make sure you: Have appropriate PPE with you Evaluate your supply Ensure that you don t come up short Be safe, be smart, be well Thank you for your time Please proceed to the post-test 23

24 RESOURCES FOR INFORMATION Hepatitis B Foundation: Cause for a Cure Hepatitis C Fact Sheet: titis/c/fact.htm /core/app2.htm RESOURCES FOR INFORMATION Continued fm?id=388&chunkiid= html/rr5116a1.htm 24