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Section 1: Introduction
Section 2: Bloodborne Pathogens and OPIM
Section 3: Safety and Prevention in the Workplace
Section 4: Exposure Incidents and Follow Up
}Employers must:
Make certain that all employees with an occupational
exposure to bloodborne disease participate in a training
program
Ensure that workers receive regular training that covers:
The dangers of bloodborne pathogens to self and others
Safety and prevention practices.
Post-exposure procedures.
}
}
}
}
Section 1: Introduction
Section 2: Bloodborne Pathogens and OPIM
Section 3: Safety and Prevention in the Workplace
Section 4: Exposure Incidents and Follow Up
}Portal of entry:
The means by which an infectious agent enters the
susceptible host.
}Portal of exit:
The path by which an infectious agent leaves the
reservoir
}Reservoir:
Place in which an infectious agent can survive but may or
may not multiply. Healthcare workers may also be
reservoirs for a number of nosocomial organisms.
}Standard precautions:
A group of infection prevention and control strategies that
combine the major features of Universal Precautions and Body
Substance Isolation and are based on the principle that all blood,
body fluids, secretions, excretions except sweat, non-intact skin,
and mucous membranes may contain transmissible infectious
agents.
}Susceptible host:
A person or animal not possessing sufficient resistance to a
particular infectious agent to prevent contracting infection or
disease when exposed to the agent.
}Engineering controls:
Controls (e.g., sharps disposal containers, self-sheathing
needles, safer medical devices, such as sharps with
engineered sharps injury protections and needleless
systems) that isolate or remove the bloodborne
pathogens hazard from the workplace.
}Transmission:
Any mechanism by which a pathogen is spread by a
source or reservoir to a person
}Common vehicle:
Contaminated material, product, or substance that serves
as an intermediate means by which an infectious agent is
introduced into a susceptible host through a suitable
portal of entry
4. Portal of entry
a. Sites (respiratory tract, gastrointestinal tract, genitourinary tract,
skin/mucous membrane, transplacental, parenteral)
b. Mechanisms (percutaneous injury, invasive devices/procedures
(e.g., vascular access), surgical incision
1) Direct
2) Indirect
3) Droplet
4) Airborne
6. Susceptible host
a. Infectivity
b. Pathogenicity
c. Virulence
d. Size of innoculum
e. Route of exposure
f. Duration of exposure
}Standard precautions
Respiratory hygiene/cough etiquette
Safe injection practices (see Element III)
Use of masks during spinal/epidural access procedures
Hepatitis B virus
Copyright (C) 2011 VMD Health Care Training
HBV Incidence:
} Estimated 1.25 million chronically infected
Americans.
20-30% acquired infection in childhood.
Following widespread hepatitis B vaccination,
percentage of cases from occupational exposure to
blood is now about 0.5%.
HBV Transmission
} Occurs when blood from an infected person
enters the body of a person who is not infected.
Sneezing or coughing
Kissing or hugging
Sharing eating utensils or drinking glasses
Breastfeeding
Food or water
Casual contact (such as an office setting)
HBV Prevention:
} Hepatitis B vaccine is the best protection.
Hepatitis B Vaccine
} Description:
Hepatitis B Vaccine
} Safety and Effectiveness:
Medical, scientific, and public health communities
strongly endorse hepatitis B vaccine as safe and
effective for infants, children, and adults.
There is no evidence that hepatitis B vaccine can
cause chronic illnesses.
Hepatitis B Vaccine
} Method of Administration:
Injected.
Vaccine is available only from your doctor or other
authorized health care professional.
Hepatitis B Vaccine
} Benefits:
Vaccine prevents hepatitis B disease and its serious
consequences like liver cancer.
Free.
OSHA requires employer to make the vaccine available
at no cost to all employees who have potential
occupational exposure.
Hepatitis B Vaccine
} Requirements:
Employer must make vaccination available after
employee has received blood borne pathogens
training.
Must be done within 10 working days of when
employee is assigned to a job with potential
occupational exposure.
An employee may decline the vaccination but decide
to accept it at a later date.
HCV Incidence:
}
Number of new infections per year has declined from 240,000 (1980s) to
26,000 (2004).
} Transmission:
Sneezing or coughing
Kissing or hugging
Sharing eating utensils or drinking glasses
Breastfeeding
Food or water
Casual contact (such as an office setting)
} HCV Prevention:
There is no vaccine to prevent HCV.
Proper use of condoms may reduce transmission.
If you are pregnant, you should get a blood test for
hepatitis C.
Do not inject drugs. Never share drugs, needles, or
syringes.
Do not share personal care items that might have blood
on them (for example, razor or, toothbrushes).
AIDS Incidence:
} Has killed more than 25 million people since
1981
More than 3 million died in 2005 - 570,000 of them children.
More than 900,000 cases of AIDS have been reported
in the US since 1981.
As many as 950,000 Americans may be infected.
More than 230,000 are unaware of their infection.
Fever
Headache
Tiredness
Enlarged
Large lymph nodes or "swollen glands"
Lack of energy.
Weight loss.
Frequent fevers and sweats.
Persistent or frequent yeast infections (oral or vaginal).
Persistent skin rashes or flaky skin.
Pelvic inflammatory disease in women that does not
respond to treatment.
Short-term memory loss.
} AIDS Transmission:
Having sex with infected person.
Sharing needles and syringes with infected person.
Infants: Exposure to HIV before or during birth, or
through breast feeding.
Shaking hands
Hugging or a casual kiss
Toilet seats
Drinking fountains
Door knobs
Dishes
Drinking glasses
Food
Pets, Mosquitoes, or bedbugs
Prevention:
} There is no vaccine to prevent HIV
Abstain from having sex or use condoms. Proper use
may reduce transmission.
Do not inject drugs. Never share drugs, needles, or
syringes.
Consider the risks if you are thinking about getting a
tattoo or body piercing.
Prevention (continued):
A deep injury
Late-stage HIV disease in the source patient
Visible blood on the device that caused the injury
Injury with a needle that had been placed in a source
patient's artery or vein
Statistics:
}
}
}
}
Section 1: Introduction
Section 2: Bloodborne Pathogens and OPIM
Section 3: Safety and Prevention in the Workplace
Section 4: Exposure Incidents and Follow Up
}Contamination:
}Cleaning:
}Critical device:
}Decontamination:
The use of physical or chemical means to remove,
inactivate, or destroy bloodborne pathogens on a surface
or item to the point where they are no longer capable of
transmitting infectious particles.
}Disinfection:
The use of a chemical procedure that eliminates virtually
all recognized pathogenic microorganisms but not
necessarily all microbial forms (e.g., bacterial
endospores) on inanimate objects.
}Sterilization:
The use of a physical or chemical procedure to destroy
all microbial life, including highly resistant bacterial
endospores.
} Engineering Controls
Equipment or devices that help reduce exposure to
potential hazards either by isolating the hazard or by
removing it from the work environment (i.e., sharps
container).
Engineering controls must be examined and
maintained or replaced on a regular schedule.
} Engineering Controls
C. Providers should:
1. Maintain aseptic technique throughout all aspects of
injection preparation and administration:
a. Medications should be drawn up in a designated "clean"
medication area that is not adjacent to areas where potentially
contaminated items are placed.
b. Use a new sterile syringe and needle to draw up medications
while preventing contact between the injection materials and the
non-sterile environment.
c. Ensure proper hand hygiene before handling medications.
} Universal Precautions
An approach to infection control.
To observe universal precautions means that whether
or not you think the victims blood or body fluid is
infected, you act as if it is.
Always place a barrier between you and a persons
blood or body fluid.
} PPE
Employers must provide at appropriate PPE such as,
disposable gloves, gowns, laboratory coats, face
shields, eye protection, pocket masks, or bag-mask
devices (used for resuscitation) at no cost to the
employee.
Employers must make certain that employees use
PPE.
} Selecting PPE:
All PPE clothing and equipment should be of safe
design and construction, and should be maintained in a
clean and reliable fashion.
Select PPE that fits well and is comfortable to wear.
Most PPE are available in multiple sizes.
} PPE Training:
} Disposable Gloves:
} Recommended Technique
} Eye Protection:
Bloodborne viruses can be transmitted through the
mucous membranes of the eyes from blood splashes or
from touching the eyes with contaminated fingers or
other objects.
Eye protection provides a barrier to this transmission.
} Eye Protection
Bag-Mask Device
Pocket Mask
Copyright (C) 2011 VMD Health Care Training
} Contaminated PPE:
} Hand Hygiene:
Handwashing is one of the most important and easy
work practices used to prevent transmission of
bloodborne pathogens.
Hands or other exposed skin should be thoroughly
washed as soon as possible following an exposure
incident and after removal of gloves or other personal
protective equipment.
} Hand Hygiene:
Recommended Technique
Alcohol-Based Hand Rub
Apply product to palm of one hand.
Rub hands together, covering all surfaces of hands and
fingers, until hands are dry.
} Hand Hygiene:
Recommended Technique
Soap and Water
Wet hands first with warm water.
Apply soap to hands. Rub hands and fingers together
vigorously for at least 15 seconds.
Rinse hands with water and dry thoroughly with a disposable
towel.
Use towel to turn off the faucet
} Decontamination:
A work practice control using physical or chemical
means to remove, inactivate, or destroy bloodborne
pathogens on a surface.
All spills of blood or OPIM must be immediately
contained and cleaned up by professionals or properly
trained staff.
Gross contamination should be cleaned up first with a
soap and water solution.
} Disinfectants:
Dilute 1/4 cup household bleach (5.25% sodium
hypochlorite) in 1 gallon of cool water.
Bleach and water loses its strength and is weakened
by heat and sunlight.
Mix a fresh bleach solution every day for maximum
effectiveness.
Contact time for bleach is generally considered to be
the time it takes the product to air dry.
} Disinfectants (continued):
Other disinfectants include EPA registered antimicrobial
products and hospital grade disinfectants cleared by
the FDA.
Effectiveness of a disinfectant is governed by strict
adherence to the instructions on the label.
Employees must be trained in their proper use.
Recommended Technique
} Reusable Containers:
Bins, pails, cans, or similar containers that are reused
and may be contaminated with blood or OPIM must be
inspected regularly and decontaminated immediately or
as soon as possible if they are visibly contaminated.
} Broken Glass:
Do not pick up broken glassware directly with your
hands; use mechanical means, such as use a brush
and dustpan, tongs, or forceps.
Place the glassware into an appropriate sharps
container.
} Laundry:
Handle contaminated laundry as little as possible.
Place wet contaminated laundry in leak-proof and
color-coded or labeled containers, at the location where
it was used.
Normal laundry cycles should be used following the
washer and detergent manufacturer's
recommendations.
} Universal principles
A. Instruments, medical devices and equipment should be
managed and reprocessed according to recommended/
appropriate methods regardless of a patients diagnosis except
for cases of suspected prion disease.
Special procedures are required for handling brain, spinal, or nerve
tissue from patients with known or suspected prion disease (e.g.,
Creutzfeldt-Jakob disease [CJD]). Consultation with infection control
experts prior to performing procedures on such patients is
warranted.
}Universal principles
B. Industry guidelines as well as equipment and chemical
manufacturer recommendations should be used to
develop and update reprocessing policies and
procedures.
C. Written instructions should be available for each
instrument, medical device, and equipment reprocessed.
} Steps of Reprocessing
A. Pre-cleaning
Removes soil, debris, lubricants from internal and external surfaces
To be done as soon as possible after use
B. Cleaning
Manual (e.g., scrubbing with brushes)
Mechanical (e.g., automated washers)
Appropriate use and reprocessing of cleaning equipment (e. g.,
do not reuse disposable cleaning equipment)
Frequency of solution changes
}Steps of Reprocessing
C. Disinfection- requires sufficient contact time with
chemical solution
D. Sterilization- requires sufficient exposure time to heat,
chemicals, or gases
C. Sterilization
1. Selection and use of methods
a. Biologic monitors
b. Process monitors (tape, indicator strips, etc.)
c. Physical monitors (pressure, temperature gauges)
d. Record keeping and recall/ tracking system for each sterilization
processing batch/item
Corrosiveness
Penetrability
Leaching
Disintegration
Heat tolerance
Moisture sensitivity
iv. Toxicity
v. Residual effect
Antibacterial residual
Patient toxicity/allergy.
vii. Stability
Concentration
Potency
Efficacy of use
Effect of organic material
viii. Odor
ix. Cost
x. Monitoring
Frequency
FDA regulations for reprocessing single use devices (refer to the
FDA web site at:
http://www.fda.gov/cdrh/reprocessing/
}
}
}
}
Section 1: Introduction
Section 2: Bloodborne Pathogens and OPIM
Section 3: Safety and Prevention in the Workplace
Section 4: Exposure Incidents and Follow Up
Congratulations!
This completes the
New York State Infection Control and Barrier Precautions
Training...
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