4. OBJECTIVESOBJECTIVES
To have a basic understanding ofTo have a basic understanding of
bloodborne pathogens and the role ofbloodborne pathogens and the role of
OSHA.OSHA.
To understand how to report anTo understand how to report an
exposure.exposure.
To understand the role of the employeeTo understand the role of the employee
in an exposure.in an exposure.
To properly dispose of medical waste.To properly dispose of medical waste.
5. WHY TRAIN?WHY TRAIN?
1.1. Through education and understanding, theThrough education and understanding, the
employee will be protected and the risk ofemployee will be protected and the risk of
an exposure can be reduced.an exposure can be reduced.
2.2. IT IS AN OSHA FEDERAL and STATEIT IS AN OSHA FEDERAL and STATE
REQUIREMENTREQUIREMENT
6. WHAT IS OSHA?WHAT IS OSHA?
OCCUPATIONALOCCUPATIONAL
SAFETY ANDSAFETY AND
HEALTHHEALTH
ADMINISTRATIONADMINISTRATION
7. OSHA STANDARDOSHA STANDARD
ADDRESSESADDRESSES::
RULES FOR PROTECTINGRULES FOR PROTECTING
WORKERS FROM OCCUPATIONALWORKERS FROM OCCUPATIONAL
EXPOSURE TO BLOOD ANDEXPOSURE TO BLOOD AND
CERTAIN OTHER BODY FLUIDSCERTAIN OTHER BODY FLUIDS
POTENTIALLY CONTAININGPOTENTIALLY CONTAINING
BLOODBORNE PATHOGENS.BLOODBORNE PATHOGENS.
8. SCHOOL DISTRICT’S EXPOSURESCHOOL DISTRICT’S EXPOSURE
CONTROL PLAN (ECP) MUST BECONTROL PLAN (ECP) MUST BE
BASED ON :BASED ON :
29 CFR 1910.103029 CFR 1910.1030
BloodborneBloodborne
Pathogens StandardPathogens Standard
Federal Register - December 6, 1991Federal Register - December 6, 1991
9. EXPOSURE CONTROLEXPOSURE CONTROL
PLAN is written to:PLAN is written to:
MINIMINZE exposure to blood andMINIMINZE exposure to blood and
other potentially infectious materialsother potentially infectious materials
(OPIM)(OPIM)
MANAGE exposures properly andMANAGE exposures properly and
medicallymedically
DESCRIBE engineering and workDESCRIBE engineering and work
practice controls which reduce risk.practice controls which reduce risk.
10. SCHOOL EXPOSURESCHOOL EXPOSURE
CONTROL PLANCONTROL PLAN
Must be reviewed and updated at leastMust be reviewed and updated at least
annually and whenever necessary toannually and whenever necessary to
reflect new or modified tasks andreflect new or modified tasks and
procedures which affect occupationalprocedures which affect occupational
exposure and to reflect new or revisedexposure and to reflect new or revised
employee positions with occupationalemployee positions with occupational
exposure.exposure.
11. At the time of initial assignment toAt the time of initial assignment to
tasks where occupational exposuretasks where occupational exposure
may take place (e.g. upon hire)may take place (e.g. upon hire)
ANNUALLY for employees inANNUALLY for employees in
positions with occupational exposurepositions with occupational exposure
BBP TRAINING ISBBP TRAINING IS
MANDATORY!!MANDATORY!!
12. BBP TRAINING INCLUDES:BBP TRAINING INCLUDES:
NEW HIRE EDUCATION ANDNEW HIRE EDUCATION AND
TRAININGTRAINING
ANNUAL EDUCATION AND TRAININGANNUAL EDUCATION AND TRAINING
AVAILABILITY OF PPEAVAILABILITY OF PPE
OFFERING OF HEPATITIS B TO ATOFFERING OF HEPATITIS B TO AT
RISK EMPLOYEESRISK EMPLOYEES
PROPER REPORTING OFPROPER REPORTING OF
NEEDLESTICK AND BLOOD/BODYNEEDLESTICK AND BLOOD/BODY
FLUID EXPOSURESFLUID EXPOSURES
13. OFFERING HEPATITIS BOFFERING HEPATITIS B
IMMUNIZATIONIMMUNIZATION
High risk employees determined by LocalHigh risk employees determined by Local
Education Agency (LEA) policyEducation Agency (LEA) policy
BBP Training – offer Hep B series within 10BBP Training – offer Hep B series within 10
days of BBP training (OSHA)days of BBP training (OSHA)
Hep B Series: 0 – 1 month – 5 monthsHep B Series: 0 – 1 month – 5 months
Hep B Titer: 4 to 6 weeks post 3Hep B Titer: 4 to 6 weeks post 3rdrd
vaccinevaccine
FormsForms
– ConsentConsent
– Refusal /DeclinationRefusal /Declination ((OSHA 1910.1030 Appendix A)
– Vaccine Information Statement (CDCVaccine Information Statement (CDC))
14. NO DIFFERENCE INNO DIFFERENCE IN
STATUSSTATUS
ALL AT RISK EMPLOYEESALL AT RISK EMPLOYEES
DEPENDING ON JOBDEPENDING ON JOB
DESCRIPTIONDESCRIPTION
PART TIMEPART TIME
FULL TIMEFULL TIME
TEMPORARYTEMPORARY
““Per Diem” or “Leased” Healthcare WorkersPer Diem” or “Leased” Healthcare Workers
15. REVIEW SOME TERMS THATREVIEW SOME TERMS THAT
ARE LOCATED IN THE ECPARE LOCATED IN THE ECP
STANDARD PRECAUTIONSSTANDARD PRECAUTIONS
AT-RISK EMPLOYEESAT-RISK EMPLOYEES
PPEPPE
WORK PRACTICE CONTROLSWORK PRACTICE CONTROLS
ENGINEERING CONTROLSENGINEERING CONTROLS
OPIMOPIM
PEPPEP
16. STANDARD PRECAUTIONSSTANDARD PRECAUTIONS
TREAT ALL BLOOD ANDTREAT ALL BLOOD AND
BODY FLUIDS AS IF THEYBODY FLUIDS AS IF THEY
ARE KNOWN TO BEARE KNOWN TO BE
INFECTIOUSINFECTIOUS
17. AT-RISK EMPLOYEESAT-RISK EMPLOYEES
Those employees who byThose employees who by
nature of task have the potentialnature of task have the potential
to be exposed to blood, bodyto be exposed to blood, body
fluids or other potentiallyfluids or other potentially
infectious materials.infectious materials.
18. PPE = PERSONALPPE = PERSONAL
PROTECTIVE EQUIPMENTPROTECTIVE EQUIPMENT
GLOVESGLOVES
MASKSMASKS
EYE PROTECTIONEYE PROTECTION
FACE SHIELDSFACE SHIELDS
RESPIRATORS – WHAT KIND?RESPIRATORS – WHAT KIND?
GOWNS, APRONS, LAB COATGOWNS, APRONS, LAB COAT
19. WORK PRACTICEWORK PRACTICE
CONTROLSCONTROLS
HAND WASHINGHAND WASHING
PROPER USE OF SHARPSPROPER USE OF SHARPS
CONTAINERCONTAINER
STORAGE and SHIPPING ofSTORAGE and SHIPPING of
CONTAMINATED EQUIPMENTCONTAMINATED EQUIPMENT
NO EATING, DRINKING, SMOKING,NO EATING, DRINKING, SMOKING,
HANDLING CONTACT LENSES andHANDLING CONTACT LENSES and
APPLYING MAKE-UP at work areas,APPLYING MAKE-UP at work areas,
including school health officeincluding school health office
21. OPIM = OTHER POTENTIALLYOPIM = OTHER POTENTIALLY
INFECTIOUS MATERIALINFECTIOUS MATERIAL
ANY BODY FLUID THAT ISANY BODY FLUID THAT IS
GROSSLY CONTAMINATED WITHGROSSLY CONTAMINATED WITH
BLOOD OR ANY INTERNAL BODYBLOOD OR ANY INTERNAL BODY
CAVITY FLUIDCAVITY FLUID
22. PEP = POST EXPOSUREPEP = POST EXPOSURE
PROPHYLAXISPROPHYLAXIS
MEDICATION REGIMEN AVAILABLEMEDICATION REGIMEN AVAILABLE
TO EXPOSED PERSON IF SOURCETO EXPOSED PERSON IF SOURCE
IS POSITIVE FOR:IS POSITIVE FOR:
– HEP B – NON-RESPONDER (HEP BHEP B – NON-RESPONDER (HEP B
VACCINE = IMMUNITY)VACCINE = IMMUNITY)
– HIV – SEVERAL MEDICATIONSHIV – SEVERAL MEDICATIONS
AVAILABLEAVAILABLE
– HEP C – NO PEP AVAILABLEHEP C – NO PEP AVAILABLE
24. BBP’s: BLOOD/BODYBBP’s: BLOOD/BODY
FLUIDSFLUIDS
If saliva, tears, urine, feces,If saliva, tears, urine, feces,
vomitus, sweat or sputum isvomitus, sweat or sputum is
grossly bloody then . . . it isgrossly bloody then . . . it is
considered contaminated.considered contaminated.
OtherwiseOtherwise NONO risk (Not a BBPrisk (Not a BBP
Exposure).Exposure).
25. FACTORS INCREASINGFACTORS INCREASING
TRANSMISSION PROBABILITY OFTRANSMISSION PROBABILITY OF
BBPBBP (CDC1995)(CDC1995)
DEEP INJURYDEEP INJURY
VISIBLE BLOOD ON DEVICEVISIBLE BLOOD ON DEVICE
DEVICE PLACED DEEPLY IN VEIN ORDEVICE PLACED DEEPLY IN VEIN OR
ARTERYARTERY
TERMINAL ILLNESS IN SOURCE (DEATHTERMINAL ILLNESS IN SOURCE (DEATH
FROM AIDS WITHIN 2 MONTHS OFFROM AIDS WITHIN 2 MONTHS OF
EXPSOURE)EXPSOURE)
LARGE VOLUME OF BLOODLARGE VOLUME OF BLOOD
AAOHN JOURNAL, JANUARY 2003.AAOHN JOURNAL, JANUARY 2003.
26. ELEMENTS OF ANELEMENTS OF AN
INFECTIONINFECTION
THREE ELEMENTS NEEDED FOR ANTHREE ELEMENTS NEEDED FOR AN
INFECTION:INFECTION:
1.1. HOSTHOST
2.2. INFECTIOUS DOSEINFECTIOUS DOSE
3.3. ROUTE OF ENTRYROUTE OF ENTRY
27. TERMINOLOGY:TERMINOLOGY:
“EXPOSUREEXPOSURE” = a behavioral event/ incident
(e.g. needle stick, mucous membrane
splash)
“INFECTIONINFECTION” = a biologic/ immunologic event
(i.e. growth of organism, antibody
response = seroconversion)
“DISEASEDISEASE” = a clinical event
(i.e., symptoms and/or signs of the
infection)
R. Ball, MD, MPH
28. WHAT IS HEPATITIS B?WHAT IS HEPATITIS B?
VIRAL INFECTION OF THE LIVERVIRAL INFECTION OF THE LIVER
SYMPTOMS - NONESYMPTOMS - NONE/MILD//MILD/SEVERESEVERE
CHRONIC CARRIERS (5%) CAN DEVELOPCHRONIC CARRIERS (5%) CAN DEVELOP
CHRONIC LIVER DISEASE AND CANCHRONIC LIVER DISEASE AND CAN
INFECT OTHERSINFECT OTHERS
95% SPONTANEOUS RESOLUTION95% SPONTANEOUS RESOLUTION
INCUBATION PERIOD – AVERAGE 60-90INCUBATION PERIOD – AVERAGE 60-90
DAYS. RANGE 45-180 DAYS.DAYS. RANGE 45-180 DAYS.
HEPATITIS B VACCINE – PROVIDESHEPATITIS B VACCINE – PROVIDES
IMMUNITY IN MAJORITY – MAY HAVEIMMUNITY IN MAJORITY – MAY HAVE
NON-RESPONDERSNON-RESPONDERS
29. WHAT IS HEPATITIS C?WHAT IS HEPATITIS C?
VIRAL INFECTION OF THE LIVERVIRAL INFECTION OF THE LIVER
CAN LEAD TO CIRRHOSIS AND CANCER.CAN LEAD TO CIRRHOSIS AND CANCER.
LEADING INDICATOR FOR LIVERLEADING INDICATOR FOR LIVER
TRANSPLANTTRANSPLANT
FLU-LIKE SYMPTOMS OR NO SYMPTOMSFLU-LIKE SYMPTOMS OR NO SYMPTOMS
INCUBATION PERIOD – AVERAGE 6-7INCUBATION PERIOD – AVERAGE 6-7
WEEKS. RANGE 2-26 WEEKS.WEEKS. RANGE 2-26 WEEKS.
NO VACCINE OR PEP AVAILABLE.NO VACCINE OR PEP AVAILABLE.
30. HEPATITIS C VIRUSHEPATITIS C VIRUS
CLINICALCLINICAL::
– 60-70% - No Symptoms60-70% - No Symptoms
– 10-20% - Mild Symptoms10-20% - Mild Symptoms
– 20-30% - Symptoms (Jaundice)20-30% - Symptoms (Jaundice)
~85% become chronic (lifelong)~85% become chronic (lifelong)
carriers!carriers!
31. HEPATITIS C VIRUSHEPATITIS C VIRUS
RISK FACTORSRISK FACTORS
(90% New Acute Hep C) – diagnosed cases(90% New Acute Hep C) – diagnosed cases
– Injecting drug use (~60%) > sexualInjecting drug use (~60%) > sexual
exposures (15%) > transfusions (1% -exposures (15%) > transfusions (1% -
prev. 10% prior to 1992) >prev. 10% prior to 1992) > occupationaloccupational
(HCWs – 1-2%)(HCWs – 1-2%) >>
unknown (10-20%)unknown (10-20%)
~3-4 million chronic carriers in USA (CDC)~3-4 million chronic carriers in USA (CDC)
~36, 000 new infections annually in US~36, 000 new infections annually in US
50,000 - 70,000 cases estimated in South50,000 - 70,000 cases estimated in South
CarolinaCarolina
32. WHAT IS HIV?WHAT IS HIV?
HIV=VIRUS THAT CAUSES AIDSHIV=VIRUS THAT CAUSES AIDS
– Human Immunodeficiency Virus that Destroys THuman Immunodeficiency Virus that Destroys T
Cells (Necessary for Healthy Immune System)Cells (Necessary for Healthy Immune System)
INCUBATION PERIOD: Conversion to HIV +INCUBATION PERIOD: Conversion to HIV +
Within 25 Days to 3 months. Rarely Longer ThanWithin 25 Days to 3 months. Rarely Longer Than
6 Months.6 Months.
– Can Be HIV POSITIVE But Not Have AIDS.Can Be HIV POSITIVE But Not Have AIDS.
– PEP is available – initiate as soon as possible!!PEP is available – initiate as soon as possible!!
Interval after which there is no benefit for humansInterval after which there is no benefit for humans
is undefined.is undefined.
33. AIDS = ACQUIREDAIDS = ACQUIRED
IMMUNODEFICIENCY SYNDROMEIMMUNODEFICIENCY SYNDROME
– ½ People who are HIV + Develop½ People who are HIV + Develop
AIDS Within 10 YearsAIDS Within 10 Years
– HIV + Opportunistic Diseases/HIV + Opportunistic Diseases/
Destroyed T Cells = AIDSDestroyed T Cells = AIDS
34. RISK OF INFECTION WITHRISK OF INFECTION WITH
HEP C, HEP B, and HIVHEP C, HEP B, and HIV
AFTER ONE NEEDLESTICK EXPOSURE-------AFTER ONE NEEDLESTICK EXPOSURE-------
HEP B: 30% (UNLESS VACCINE IMMUNITY)HEP B: 30% (UNLESS VACCINE IMMUNITY)
HEP C: 1 – 3%HEP C: 1 – 3%
HIV : 0.3%HIV : 0.3%
AFTER MUCOUS MEMBRANE EXPOSURE,AFTER MUCOUS MEMBRANE EXPOSURE,
EXAMPLE - SPLASH---------EXAMPLE - SPLASH---------
HEP B: 10% (UNLESS VACCINE IMMUNITY)HEP B: 10% (UNLESS VACCINE IMMUNITY)
HEP C: 1%HEP C: 1%
HIV: 0.1 %HIV: 0.1 %
35. HEPATITIS B, HEPATITIS C,HEPATITIS B, HEPATITIS C,
& HIV& HIV
Life-threatening BBPLife-threatening BBP
Transmitted through exposure to bloodTransmitted through exposure to blood
and other infectious body fluidsand other infectious body fluids
Anyone with occupational exposure isAnyone with occupational exposure is
at riskat risk
Workers must use PPE andWorkers must use PPE and
engineering controlsengineering controls
36. OCCUPATIONAL EXPOSURES:OCCUPATIONAL EXPOSURES:
HCW (HCP) RESPONSIBILITIESHCW (HCP) RESPONSIBILITIES
KNOW BASIC BBP (HBV, HCV,KNOW BASIC BBP (HBV, HCV,
HIV) ISSUESHIV) ISSUES
ATTEND ANNUAL BBP TRAININGATTEND ANNUAL BBP TRAINING
KNOW WHAT IS A BONA FIDEKNOW WHAT IS A BONA FIDE
EXPOSUREEXPOSURE
REPORT IT!!!! Per School Policy.REPORT IT!!!! Per School Policy.
If you don’t know, ASK!!!!If you don’t know, ASK!!!!
37. OCCUPATIONAL EXPOSURES:OCCUPATIONAL EXPOSURES:
RESPONSIBILITIESRESPONSIBILITIES
FIRST STEPS: Examine site of exposureFIRST STEPS: Examine site of exposure
FIRST AID (e.g. wash off blood, useFIRST AID (e.g. wash off blood, use
standard disinfectant)standard disinfectant)
IDENTIFY SOURCE PATIENT; REPORTIDENTIFY SOURCE PATIENT; REPORT
STATSTAT TO SUPERVISOR; CHECKTO SUPERVISOR; CHECK
PROTOCOLS/ PROCEDURESPROTOCOLS/ PROCEDURES
GET MEDICAL CONSULTATION;GET MEDICAL CONSULTATION;
FOLLOW UP per school post-exposureFOLLOW UP per school post-exposure
management planmanagement plan
Test the SOURCE if possible. If source is aTest the SOURCE if possible. If source is a
student, careful explanation to the parent ofstudent, careful explanation to the parent of
source. (usually negative = reassurance)source. (usually negative = reassurance)
Adapted from slide provided by R. BALLAdapted from slide provided by R. BALL
38. IF YOU THINK YOU HAVEIF YOU THINK YOU HAVE
BEEN EXPOSEDBEEN EXPOSED
IMMEDIATELYIMMEDIATELY TAKE CARE OFTAKE CARE OF
YOURSELF andYOURSELF and
IMMEDIATELYIMMEDIATELY NOTIFYNOTIFY
School AdministrationSchool Administration
School NurseSchool Nurse
39. PAPERWORK WILL BEPAPERWORK WILL BE
DONE BYDONE BY
the employee with thethe employee with the
help of the school nurse .help of the school nurse .
40. Human Bite Management & BBPsHuman Bite Management & BBPs
Recommendations: 2009Recommendations: 2009
Red BookRed Book
American Academy of PediatricsAmerican Academy of Pediatrics
CDC. MMWR June 29, 2001CDC. MMWR June 29, 2001
Updated US Public Health Service Guidelines...Updated US Public Health Service Guidelines...
““Feces, nasal secretions,Feces, nasal secretions, salivasaliva, sputum,, sputum,
sweat, tears, urine, and vomitus are notsweat, tears, urine, and vomitus are not
considered potentially infectious unless theyconsidered potentially infectious unless they
contain (visible) blood.” – CDCcontain (visible) blood.” – CDC
41. BITE MANAGEMENT ISSUESBITE MANAGEMENT ISSUES
ALWAYS HAVE 2 PERSONS INVOLVED:ALWAYS HAVE 2 PERSONS INVOLVED:
”BITER” & “BITEE””BITER” & “BITEE”
EVALUATE: did biter’sEVALUATE: did biter’s salivasaliva →→ bitee’s wound?bitee’s wound?
EVALUATE: did bitee’sEVALUATE: did bitee’s bloodblood →→ biter’s mouth?biter’s mouth?
HIV & Hep C are NOT transmitted via saliva “unlessHIV & Hep C are NOT transmitted via saliva “unless
visibly grossly bloody” (prior to bite); Hep B may be ifvisibly grossly bloody” (prior to bite); Hep B may be if
repetitiverepetitive
CONSIDER other (more likely) pathogens (i.e.CONSIDER other (more likely) pathogens (i.e.
bacteria)bacteria)
Consult physician re: testing both people for BBPsConsult physician re: testing both people for BBPs
R. Ball, MD, MPH
42. Student ExposuresStudent Exposures
Notify the school nurse of anyNotify the school nurse of any
possible/definite exposures immediately!possible/definite exposures immediately!
Recommend protocol in placeRecommend protocol in place
– Contacting parents of source and exposedContacting parents of source and exposed
childchild
– Determine protocol if source child needs toDetermine protocol if source child needs to
be testedbe tested
– Notify Risk ManagementNotify Risk Management
Review with legal if neededReview with legal if needed
43. Any ExposureAny Exposure
If you are in a location that does not have aIf you are in a location that does not have a
nurse you can contact any district nurse fornurse you can contact any district nurse for
direction. If you are unsure how to reach adirection. If you are unsure how to reach a
nurse, contact Student Services (981-1041)nurse, contact Student Services (981-1041)
and they will connect you with a nurse.and they will connect you with a nurse.
44. RESOURCE WEBSITESRESOURCE WEBSITES
www.cdc.govwww.cdc.gov
www.osha.govwww.osha.gov
www.nasn.orgwww.nasn.org
National Association of School NursesNational Association of School Nurses
– Occupational Exposure to BBPOccupational Exposure to BBP
