This training module is designed to provide a basic understanding of bloodborne pathogens, common modes of transmission, methods of prevention,and other pertinent information. A copy of company's exposure control program is available in the facility's copy of the Standard Operating Procedures (SOP). The regulatory text can be obtained by requesting it from your local management team or from OR OAHA. This program is designed to meet the requirements of OSHA's Bloodborne Pathogen Standard. The purpose of the standard is to reduce worker risk by eliminating or minimizing employee exposure incidents to bloodborne pathogens, such as Hepatitis B Virus (HBV) and Human Immunodeficiency Virus (HIV). BLOODBORNE DISEASES Bloodborne pathogens mean pathogenic microorganisms that are present in human blood and can cause disease in humans. These pathogens include, Immunodeficiency Virus (HIV). These pathogens, or microorganisms, are viruses or bacteria that are carried in blood and can cause disease in people. There are many different bloodborne pathogens including malaria, syphilis, and brucellosis. By incorporating the information presented on these disease states regarding the modes of transmission and prevention, the same principles will protect the worker against exposure to other bloodborne diseases, such as hepatitis C, delta hepatitis, syphilis, malaris, and others. Because it is the exposure to the blood or other body fluids that carries the risk of infection, those individuals whose occupational duties place them at risk of exposure to blood and other potentially infectious materials are also at risk of becoming infected with these bloodborne pathogens, developing disease, and in some cases, dying. Over 5.5 million health care workers are at risk under this standard and, therefore, compliance is mandatory. The standard encompasses workers in physician office settings, nursing homes, hospitals, laboratories, dentist offices, emergency personnel, housekeeping, linen services, and others who may come in contact with blood and other potentially infectious materials in the performance of their duties. Hepatitis B (HBV) Approximately 300,000 people, in the United States, are infected with HBV annually. Some of these are fatal. HEPATITIS means inflammation of the liver and can be caused by a number of agents or conditions, including drugs, toxins, autoimmune disease, and infectious agents, including viruses. The most common causes of hepatitis are viruses. There are four types of viral hepatitis important in the U.S. d Page 1 of 1
1. Hepatitis A, formally called infectious hepatitis is spread by fecal contamination and is not generally considered a significant risk to health care workers. 2. Hepatitis B, formally called serum hepatitis is transmitted by blood contact and is a major risk to health care workers. 3. Delta Hepatitis may co-infect with Hepatitis B or may infect persons already infected with HBV and can increase the severity of acute and chronic liver disease. Nosocomial (contracted in healthcare facilities) infection has been reported. 4. Non-A, non-b Hepatitis is caused by viral agents other than Hepatitis A and Hepatitis B. Two that have been identified are Hepatitis E transmitted by oral-fecal route, and Hepatitis C spread by blood contact. Of the types of Hepatitis listed, Hepatitis B virus is the major infectious bloodborne occupational hazard to health care workers. The Centers for Disease Control (CDC) estimates there are approximately 8,700 infections in health care workers with occupational exposure to blood and other potentially infectious materials in the U.S. each year. Approximately 200 deaths each year are reported due to these occupational exposures. Infected health care workers can spread the infection to family members, or rarely, to their patients. The use of Hepatitis B vaccine, engineering and work practice controls, and personal protective equipment, will work in conjunction to prevent almost all of these occupational exposures. Hepatitis B is caused by the Hepatitis B virus (HBV) that attacks and replicates in lilver cells. There is a laboratory test to determine its presence in blood, and indicate an individual who is currently infected, and therefore, is potentially infectious to others. All types of viral hepatitis look basically the same. Unfortunately, the destruction of liver cells, is clinically apparent in Hepatitis B. Symptoms of Hepatitis B Approximately one-third (1/3) of those infected will have a severe clinical course with jaundice (yellowing of the eyes and skin), dark urine, extreme fatigue, anorexia, nausea, abdominal pain, and sometimes joint pain, rash, and fever. About twenty percent (20%) of jaundice cases will require hospitalization, and will cost several weeks to months of work loss. However, not all infected individuals will demonstrate these clinical signs. Approximately one-third (1/3) will show no symptoms when infected with the virus. These individuals, however, are still considered infectious.
And one-third (1/3) will have a relatively mild clinical course with flu-like symptoms, which is not diagnosed as Hepatitis. These individuals, however, are still considered infectious. After exposure it can take 1-9 months before symptoms become noticeable. Development of chronic HBV infection has more severe long-term consequences. About six to ten percent (6-10%) of newly infected adults cannot clear the virus from their liver cells, and become chronic HBV carriers. These carriers are at high risk of developing Chronic Persistent Hepatitis, Chronic Active Hepatitis Cirrhosis of the Liver, and primary Liver Cancer. Chronic Active Hepatitis is a progressive, debilitating disease that often leads to Cirrhosis of the Liver after five to ten (5-10) years. Chronic HBV infection has been estimated to cause ten percent (10%) of the 25-30,000 deaths that occur due to Cirrhosis each year. Groups as diverse as the AMA stated, the loss of health care workers to Hepatitis B virus infection overshadows the risk of AIDS and is almost entirely preventable. Human Immunodeficiency Virus (HIV) AIDS, or acquired immune deficiency syndrome, is caused by a virus called the human immunodeficiency virus, or HIV. Once a person has been infected with HIV, it may be many years before AIDS actually develops. HIV attacks the body's immune system, weakening it so that it cannot fight other deadly diseases. AIDS is a fatal disease, and while treatment for it is improving, there is no known cure. Estimates on the number of people infected with HIV vary, but some estimates suggest that an average of 35,000 people are infected every year. Many people who are infected with HIV may be completely unaware of it. The HIV virus is very fragile and will not survive very long outside of the human body. All employees who work in assisted living and have the potential to come in contact with blood or other potentially infected body materials should use Universal Precautions and treat all suspect fluids as if they were infectious. It is estimated that the chance of contacting HIV in a workplace environment are only 0.4%. However, because it is such a devastating disease, all precautions should be taken to avoid exposure. AIDS infection essentially occurs in three broad stages. The first stage happens when a person is actually infected with HIV. After the initial infection, a person may show few or no signs of illness for many years. Eventually, in the second stage, an individual may begin to suffer swollen lymph glands or other lesser diseases which begin to take advantage of the body's weakened immune system. The second stage is believed to eventually lead to AIDS, which is the third and final stage, in all cases. In this stage, the body becomes completely unable to fight off life-threatening diseases and infections.
Symptoms of HIV Symptoms of HIV can vary, but often include weakness, fever, sore throat, nausea, headaches, diarrhea, a white coating on the tongue, weight loss, and swollen lymph glands. Modes of Transmission Bloodborne pathogens such as HBV and HIV can be transmitted through contact with infected human blood and other potentially infectious materials. All staff should follow Universal Precautions and treat all body fluids or fluids of unknown origin as potentially infectious hazards. HBV and HIV are most commonly transmitted through: Sexual Contact Sharing Hypodermic Needles Accidental Puncture From Contaminated Needles Broken Glass or Other Sharps Contact Between Broken or Damaged Skin and Infected Body Fluids Contact Between Mucous Membranes and Infected Body Fluids In as assisted living setting, transmission is most likely to occur because of accidental puncture from contaminated needles, broken glass, or other sharps; contact between broken or damaged skin and infected body fluids; or contact between mucous membranes and infected body fluids. Infected body fluids can enter your body through: Open Sores Cuts Abrasions Acne Any Sort of Damaged or Broken Skin Such as Sunburn or Blisters Infected body fluids can also enter your body through the mucus membranes of the : Eyes Nose Mouth For example a splash of potentially contaminated body fluid to your eyes, nose, or mouth could result in transmission.
PERSONAL PROTECTIVE EQUIPMENT (PPE), SAFE WORK PRACTICES, AND ENGINEERING CONTROLS Universal Precautions is the name used to describe a prevention strategy in which all blood and potentially infectious materials are treated as if they are, in fact, infectious, regardless of the of the source individual. Many residents of assisted living facilities have had medical problems which have resulted in the need for blood transfusions, therefore, causing them to be unwitting carriers of a disease. Whether or not you think the blood/body fluid of an individual is infected with bloodborne pathogens, you treat it as if it is. Use this approach in all situations where exposure to blood or potentially infectious materials is possible. Personal Protective Equipment (PPE) The first thing to do in any situation where you may be exposed to bloodborne pathogens is to ensure you are wearing the appropriate PPE. For instance, employees in assisted living should always wear latex gloves when they have the potential for encountering potentially infectious body fluids. This is a simple precaution that people take to prevent blood or other potentially infectious materials from coming in contact with their skin. IT IS ESSENTIAL TO HAVE A BARRIER BETWEEN YOUR AND THE POTENTIALLY INFECTIOUS MATERIAL. Always follow these rules: Always wear PPE in any situation where you might be exposed to unknown fluids or body fluids. Remove PPE that is torn or punctured, or has lost its ability to provide a barrier between you and the potentially infectious material. Remove and replace PPE that is torn or punctured. Remove PPE before leaving the work area. PPE should always be readily accessible. Inspect the PPE before you use it. Once contaminated, PPE should be placed in appropriately labeled bags or containers until it is disposed of, decontaminated, or laundered. Always locate contaminated PPE containers before you need them. Gloves Gloves should be made of latex or other material that is impervious to liquids. If necessary, double gloving can provide an added layer of protection in certain circumstances. If you know that you have cuts or sores on your hands you should cover these with a bandage to provide additional protection before you put on gloves. Always inspect your gloves for tears or punctures before you use them. IF A GLOVE IS DAMAGED DON'T USE IT! When you take off potentially contaminated gloves make sure that you don t touch the outside of the gloves with any bare skin and then dispose of them in a properly dispose of them so that no one else will become contaminated. To
ensure that a glove does not have any holes in it, blow it up like you would a balloon and hold it for several seconds. If you notice a leak do not use the glove. Goggles Anytime there is a risk of splashing or vaporization of contaminated fluids, goggles and/or other eye protection should be used to protect your eyes. Bloodborne pathogens can be transmitted to through the membranes of and around the eyes. Splashing could occur while cleaning up a spill, cleaning up an accidental discharge of body fluids (such as vomit or urine) or while providing medical assistance. Face Shields Face shields should be worn whenever there is a potential for fluid to splash into the mucous membranes of the eyes, nose, or mouth. Aprons Protective aprons should be worn to protect your clothing and to keep potentially contaminated fluids from reaching your skin. Normal clothing that becomes contaminated with blood should be removed as soon as possible to prevent fluids from coming in contact with skin. Contaminated laundry should be handled as little as possible to prevent further contamination of people and other surfaces. Contaminated laundry should be placed in an appropriately labeled bag or container until it is decontaminated, laundered, or disposed of. Hygiene Practices Handwashing is one of the most important and easiest practices used to prevent transmission of bloodborne pathogens. Hands should be washed with hot soapy water up to the elbow for at least twenty seconds before you put on gloves, after you take off gloves, whenever you change tasks, or whenever you may have had an exposure incident. Soap does not disinfect unless it is a special disinfectant soap. Soap helps to provide a means of removing contaminated material from your hands by washing. If you see a soap or towel dispenser that is not operable report it immediately. If you are working in an area where there is a reasonable likelihood of exposure, you should never: Eat Drink Smoke Apply Cosmetics Handle Contact Lenses No food or drink should be kept in refrigerators, freezers, shelves, cabinets, or on counter tops where blood or potentially infectious materials are present.
Always try to minimize the amount of splashing, spraying, splattering, and generation of droplets when performing procedures involving blood or potentially hazardous materials. Emergency Procedures If you are exposed: Wash the exposed area thoroughly with soap and running water. Use nonabrasive antibacterial soap if possible. If a potentially hazardous material is splashed in your eye or mucus membrane, flush the affected area with running water for at least 15 minutes. Report all incidents of potential exposure to your supervisor immediately. Decontamination and Sterilization All surfaces of tools, equipment and other objects that come in contact with blood or potentially infectious materials must be decontaminated and sterilized as soon as possible after use. ALWAYS CLEAN AND DECONTAMINATE EQUIPMENT BEFORE PUTTING BACK INTO USE. Decontamination should be accomplished by using: A solution of household bleach diluted between 1:10 and 1:100 with water. The standard recommendation is to use at least a quarter cup of bleach to one gallon of water. An EPS registered tuberculocidal disinfectant. Check the label to ensure that the chemical is a registered tuberculocidal disinfectant. If you are cleaning up a spill of potentially infectious material, you should cover up the spill with paper towels or rags, then gently pour your disinfectant over the towels or rags, and leave it for at least 10 minutes. This will help to ensure that the bloodborne pathogens are killed before you actually begin cleaning up the spill. Covering the spill reduces the risk of a splash when you pour the disinfectant. If you are decontaminating equipment or other objects leave your disinfectant in place for at least 10 minutes before continuing the cleaning process. ALWAYS CLEAN AND DECONTAMINATE EQUIPMENT BEFORE PUTTING BACK INTO USE. This includes mops, sponges, buckets, pails, and other equipment. SHARPS Too often housekeepers, maintenance, med room personnel, and others are punctured or cut by improperly disposed of needles and broken glass. This, of course, exposes them to whatever infectious material may have been on the glass or needle. HANDLE
AND DISPOSE OF ALL SHARPS CAREFULLY IN ORDER TO PROTECT YOURSELF AND OTHERS. Needles or other sharps should NEVER be bent or recapped. Needles or sharps should never be picked up with hands, always use a dust pan and broom, forceps, or pliers Never break or shear needles Always dispose of needles in a properly labeled authorized sharps container If you or anyone you know has had a sharps injury tell them to contact management immediately. Management will see that the injured employee receives immediate medical treatment and follow up interventions. They will also make an entry in the sharps injury log. This log is required by law, and is designed to track incidents. By tracking incidents, we hope to use past experience to reduce or prevent further sharps injuries. Broken glassware that has been potentially been contaminated should be handled in the same way as other sharps: Broken glassware that has been contaminated must be sterilized with an approved disinfectant before it is disturbed or cleaned up Glassware that has been disinfected may be disposed off in an properly labeled authorized sharps container that is appropriate for the glassware Broken glassware should never be picked up with hands, always use a dust pan and broom, forceps, or pliers. Your facility annually reviews products designed to minimize sharps hazards. We may request your help in reviewing items such as safety needles, safety lancets, and other products designed to prevent injuries. Minimizing Risk Through Safer Tools This facility searches for safer sharps medical devices for employees to evaluate. As new devices are found and evaluated by staff management will address the issue of purchasing the safest reliable device that staff agree upon. If there is a change in one or more sharps safety devices all staff who use them will receive training before they are implemented. While we do strive for zero injuries, we realize that they may occur. It is critical for each employee who is injured by a medical sharps device to contact facility management immediately and obtain their assistance in seeking appropriate ongoing medical attention. SIGNS, LABELS, AND COLOR CODING Regulated waste is waste that:
Contains any liquid or semi-liquid blood or other potentially infectious materials Contaminated items that would leak or release blood or other potentially infectious materials Contaminated Sharps Pathological and microbiological wastes containing blood or other potentially infectious materials All regulated waste should be disposed of in properly labeled containers or red biohazard bags. Regulated waste is frequently incinerated and should not be put out with non-regulated garbage. Bags or containers used for biohazards should be labeled with a fluorescent orange, red, or orange-red and contain the biohazard symbol, as shown below. HEPATITIS B VACCINATIONS All employers whose workplace has the potential for occupational exposure to bloodborne pathogens must offer a Hepatitis B vaccine series to employees at no cost. Any employee may decline the vaccination in writing. A very small percentage of people are allergic to the vaccine. An allergic reaction could result in anaphylactic shock, which is life threatening. You may consult your physician before taking the vaccination if you desire. Even if you decline the initial offer, you may choose to receive the series at anytime during your employment thereafter, for example, if you are exposed on the job at a later date. The Hepatitis B vaccination is given in a series of three shots. The second shot is given one month after the first, and the third shot follows five months after the second. This series gradually builds up the body's immunity to the Hepatitis B virus. The vaccine itself is made from yeast cultures. There is no danger of contracting the disease from getting the shots, and, once vaccinated, a person does not need to
receive the series again. There are booster shots available and, in some cases, these may be recommended. If an employee thinks that he or she has been exposed to any bloodborne pathogen he should contact their supervisor immediately. CONCLUSION To protect your life and the lives of those around you, you should always follow the standards set forth in this paper. Always: Be alert Pay attention Wear PPE Follow Universal Precautions Never recap or bend needles Pay attention to signs, labels, and color coding Help others to remember these safe work practices You are the only one that can protect yourself.