The OSHA Standard. The OSHA Standard. The OSHA Standard

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1 Bloodborne Pathogen Training 1 What are Bloodborne Pathogens? We already have learned that pathogens are infectious agents that can cause us to get sick like viruses or bacteria or germs or parasites. Bloodborne Pathogens are just pathogens carried in the blood. If we want to avoid getting sick from these pathogens we need some special training to know how to protect ourselves. 2 OSHA What is OSHA? It is a federal agency charged with the job of protecting Americans from dangers that may exist at the workplace. The letters OSHA stand for the Occupational Safety and Health Administration. 3

2 The OSHA Standard The OSHA Standard referred to in this training section is the OSHA standard concerning Bloodborne Pathogens (See handouts for a copy of the standard) This standard says that any one at risk of occupational (work place) exposure to blood and Bloodborne Pathogens needs to have training annually. 4 The OSHA Standard Does this include people who work in the field Early Childhood Care and Education? Yes, because if you work with children for very long you will be exposed to blood at the workplace sooner or later. This blood might be from cuts or scrapes, nosebleeds, severe diaper rash, blood in the stool with severe diarrhea or even from a tooth being knocked out. Therefore, because of this risk of exposure, people in early childhood programs caring for children are covered under these regulations. 5 The OSHA Standard Requires that annual training be at no cost to the employee Requires that training be offered during work hours Requires that training be done annually. Requires that certain items be covered in the training and that documentation that those items have been covered is kept on file (see sample documentation sheet in handouts). 6

3 Types of Bloodborne Pathogens Hepatitis B -HBV Hepatitis C - HCV HIV The Aids Virus 7 Hepatitis B - HBV Virulent Virus causing infection to the liver. Symptoms- loss of appetite or weight, tiredness, mild fever, aching muscles or joints, stomach pain, nausea, diarrhea.(sounds like flu doesn t it?) Or, may have no symptoms at all and go undiagnosed. 85% recover within 6-8 weeks Others experience mild illness, chronic lasting infection, liver damage (cirrhosis), liver cancer, and death due to liver failure. 8 Hepatitis C - HCV Now the most common Bloodborne infection in the U.S. Virus causes infection of the Liver Over 4 million Americans are infected with 30,000 new cases annually. Only 25% of newly infected are diagnosed Symptoms: fatigue, loss of appetite, abdominal or joint pain, nausea or vomiting, (sounds like flu doesn t it?) or, no acute symptoms most don t know they are infected called the silent killer it may lie dormant for years. 9

4 Hepatitis C - HCV No vaccine available for Hepatitis C yet. Hepatitis C is serious for some people and not for others. Out of every 100 persons infected with HCV: 85 develop long term infection 70 develop chronic liver disease 15 may develop cirrhosis over a period of years 5 people may die from cirrhosis or cancer of the liver. 10 Human Immunodeficiency Virus - HIV Virus that causes Aids which effects the immune system making it less effective in preventing diseases Symptoms night sweats, weight loss, fever, fatigue, glandular pain and swelling, muscular or joint pain. (Sounds like flu doesn t it?) Or, a person may have no symptoms at all for up to 10 years but still be able to spread the virus. Aids has no vaccine to prevent it and no cure and may eventually cause death because the body is unable to fight off other diseases and illnesses. For example, many die of pneumonia. 11 Transmission and True Exposure Mode of Transmission for Bloodborne pathogens Direct or indirect contact with another person s blood or other potentially infectious bodily materials (referred to as opim s in the standard these may include any body fluid with visible blood or unidentifiable body fluids, semen, vaginal secretions, saliva from dental procedures, synovial (joint) fluid or cerebral spinal fluid.) True exposure requires direct or indirect contact between someone else s blood or opim and your: Non intact or punctured skin including cuts scrapes, abrasions, burns, rashes, paper cuts, and even hang nails or bites or needle punctures Eye, mouth, or mucous membranes (This is why dentists wear masks and goggles) 12

5 Prevention 5 Prevention Strategies Immunization Engineering controls structural or mechanical devices company provides like sinks, blood spill kits or containers for sharps objects that are contaminated with blood. Work Practice controls Training or knowledge of how to use equipment supplied by the company correctly and know proper hand washing procedures, for example. Personal protective equipment gloves, masks, gowns etc. provided by employers (in child care situations this is generally limited to gloves and CPR masks and shields) Universal Precautions - All blood and certain body fluids are treated as if they are contaminated and capable of making you ill. 13 Immunizations Hepatitis B vaccine Given within 10 days of employment or 24 hours after a true exposure to blood incident. Given during work hours At no cost to the employee 3 doses in the deltoid muscle (upper arm) Receive 1 st dose 2 nd dose 1 month later 3 rd dose 6 months after the 1 st dose. 14 Immunizations Note: as with any vaccination there may be side effects and contraindications that you should be aware of. For example, if you are allergic to yeast you should avoid this vaccine. You may experience a rash over your body or a warmth, redness and swelling at the injection site. Some people experience flu like symptoms that usually do not last beyond 48 hours. Some people however, may have a more serious reaction including anaphylaxis which is very dangerous or other complications. Women who may be pregnant or nursing or anyone with questions about whether or not he/she should receive this shot, should 15 consult a physician.

6 Decision for Hepatitis B Immunization Yes- sign consent form (see handout), receive the vaccine offered within 10 days of employment or within 24 hrs of a true exposure incident. No- because you have a medical condition or allergy No because you have had prior exposure and are immune (may request a screening for immune status) No don t want the vaccine until after an exposure incident No have received the vaccine in the past 16 provide documentation to current employer Declination or Consent If you decide to have the immunization shot you must sign a consent form (see handout.) If you decide to decline the shot, you must sign a declination statement (see handouts.) Declining to have the shot now does not prevent you from changing your mind later or after an exposure incident. If you ever change your mind, all you need do is sign the consent form and the employer will have to provide the shots at their expense on company time etc. 17 Engineering Controls Examples of engineering controls include sharps containers. Centers should have a container to dispose of sharp items contaminated with blood that might pierce a regular trash bag. An example of a situation where this might be useful is if a child gets cut on a piece of glass on the playground. This glass needs to be disposed of in a sharps container. The Sharps container needs to be labeled with the biohazard symbol (see next slide.) 18

7 Sharps Container 19 Engineering Controls Other examples of engineering controls would be: resuscitation devices CPR micro-shields or masks (see following slides.) sinks commercial first aid supply kits for handling injuries involving blood (see following slides.) blood spill kits for cleaning up larger spills of blood (see following slides.) 20 CPR Micro Shield 21

8 CPR Mask Unassembled mask 22 CPR Mask Assembled Mask 23 Commercial First Aid Exposure to Blood Kit 24

9 Commercial First Aid Exposure to Blood Kit Biohazard Bag Gloves Absorbent towel Antimicrobial Hand Wipe 25 Blood Spill Surface Clean-up Kits 26 Blood Spill Surface Clean up Kits Absorbent Towel Germicidal Surface Wipe Antimicrobial Hand Wipe Biohazard Bag Gloves Scooper Fluid control solidifier (turns blood to a jello-like substance that can be scooped up.) 27

10 Note on First Aid and Blood Spill Kits These commercially prepared kits are not required by the OSHA standard but certainly are a low cost way for employers to assure that their staffs have all necessary equipment for handling emergencies. Most of the time centers have gloves and disposable cloths and disinfectant bleach solution around. What they might not have are the Biohazard waste bags. There are not required either but in lieu of these bags, centers should purchase biohazard stickers that could be placed on a trash bag because the waste must be properly identified. 28 Work Practice Controls Training on Proper Hand washing the single most important way to stop the spread of disease in child care. Training on the proper use of engineering controls or personal protective equipment that is supplied by the employer. Do you know the proper way to remove gloves, for example? Do you know what kind of CPR mask, shield or resuscitation device is available at your center? Do you know how to use it? If not, ask your center manager today to include that as training at the next staff meeting. 29 Personal Protective Equipment Gloves to remove gloves properly be sure that you remove the first glove without touching your skin with the contaminated glove surface and the glove should be turned inside out so that if anyone else comes into contact with it, they are not contaminated (See Steps 1 and 2 on following slides.) Removing the second glove should be done without touching the outside(contaminated) part of the glove and pulling it off so that it will be inside out when the process of pulling the glove off is complete (See steps 3 and 4 on following slides.) 30

11 Proper Glove Removal Step 1 31 Proper Glove Removal Step 2 32 Proper Glove Removal Step 3 33

12 Proper Glove Removal Step 4 34 Personal Protective Equipment Other examples of personal protective equipment might include: Micro-shields or Masks for CPR Disposable Gowns (See next slide) Eye-shields (See next slide) Masks (See next slide) Disposable booties to protect and cover shoes (See next slide.) 35 Personal Protective Equipment Gown Eye-shield and mask Booties 36

13 Universal Precautions Describes procedures that prevent the spread of bloodborne infections It means that all blood and body fluids containing blood from all person are treated as if they are infectious This means: Hand washing Use of gloves, biohazard bags, sharps containers, eye-shields, micro-shields or masks for CPR Disinfect contaminated surfaces Dispose of materials properly. 37 Universal Precautions According to the Bloodborne Pathogen Standard: Materials that require universal precautions include: blood or any body fluid with visible blood unidentifiable body fluids, Semen vaginal secretions saliva from dental procedures synovial or joint fluids and cerebral spinal fluids. For our purposes, in child care settings we are mostly concerned with blood and any body fluid with visible blood. 38 Universal Precautions According to the Bloodborne Pathogen Standard: Materials that do not require that we use universal precautions include normal: feces nasal secretions Sputum Sweat Tears urine and vomitus. 39

14 Post Exposure Reporting If a true exposure to blood incident occurs: Wash exposure site immediately Report exposure incident immediately to supervisor Have work site document details including source individual Employers should have forms and procedures Consider getting Hepatitis B vaccine if not already vaccinated. 40 Post Exposure Follow-Up You have the right to the vaccine within 24 hours if not already vaccinated. You have the right to request that the employer obtain consent and test the source blood You have the right to results of the source blood tests You have a right to a blood test for HBV or HIV and any post exposure prophylaxis (measures designed to preserve health) All at the employer s expense 41 Other Requirements The employer is required to have and maintain an exposure control plan This plan must be available to employees The plan must include proper disposal of contaminated items. This might include a contract between a center and a hospital or Doctor s office that agrees to take your biohazard waste; or, a contract with a biohazard waste management and disposal firm. You may not just throw biohazard waste in with your regular trash. 42

15 Exposure Control Plan Templates for exposure control plans that meet the requirements outlined in the OSHA Bloodborne Pathogen Standard may be purchased from first aid supply companies but are also available at a discounted rate from: NCCA ( National Child Care Association) 1029 Railroad St. Conyers, GA