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New

York State Infection Control


& Barrier Precautions Training
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Copyright (C) 2011 VMD Health Care Training

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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

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}OSHA estimates that 8 million workers in the


health care industry and related occupations are
at risk of occupational exposure to bloodborne
pathogens.
Occupational exposure to blood or other potentially
infectious materials (OPIM) puts you and your patients at
risk for serious illness or death.

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}In environments where workers are potentially


exposed to blood or body fluids, the risks of
infection are undeniable.
Knowledge about how exposure occurs, the risk of
transmission and how to prevent it can help you work
safely and without unnecessary fear or anxiety.

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}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.

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}Methods for compliance


Participation in required infection prevention and control
training
Adherence to accepted principles and practices of
infection prevention and control

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}Knowledge of the consequences of failing to


follow accepted standards of infection prevention
and control:
Increase risk of adverse health outcomes for patients
and health care workers
Subject to charges of professional misconduct.
Mechanisms for reporting misconduct
Complaint investigation
Possible outcomes
1) Disciplinary action
2) Revocation of professional license
3) Professional liability

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}New York State:


Rules of the Board of Regents, Part 29.2 (a)(13)
Part 92 of Title 10 (Health) of the Official Compilation of
Codes, Rules and Regulations of New York

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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

Copyright (C) 2011 VMD Health Care Training

}Pathogen or infectious agent:


A biological, physical, or chemical entity capable of
causing disease. Biological agents may be bacteria,
viruses, fungi, protozoa, helminthes, or prions.

}Portal of entry:
The means by which an infectious agent enters the
susceptible host.

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}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.

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}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.

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}Healthcare-associated infections (HAIs):


Infections associated with healthcare delivery in any
setting (e.g., hospitals, long-term care facilities,
ambulatory settings, home care).

}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.

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}Injection safety (or safe injection practices):


A set of measures taken to perform injections in an optimally
safe manner for patients, healthcare personnel, and others. A
safe injection does not harm the recipient, does not expose the
provider to any avoidable risks and does not result in waste
that is dangerous for the community. Injection safety includes
practices intended to prevent transmission of bloodborne
pathogens between one patient and another, or between a
healthcare worker and a patient, and also to prevent harms
such as needlestick injuries.

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} Single-use medication vial:

A bottle of liquid medication that is given to a patient through a


needle and syringe. Single-use vials contain only one dose of
medication and should only be used once for one patient, using a
new needle and new syringe.

} Multi-dose medication vial:

bottle of liquid medication that contains more than one dose of


medication and is often used by diabetic patients or for
vaccinations.

} Work practice controls:

Controls that reduce the likelihood of exposure to bloodborne


pathogens by altering the manner in which a task is performed
(e.g., prohibiting recapping of needles by a two-handed
technique).

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}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

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} Concept of "The Chain of Infection"


1. Pathogen or infectious agent
2. Reservoir (human, animal, environmental)
3. Portal of exit
a. Sites (respiratory tract, gastrointestinal tract, genitourinary tract,
skin/mucous membrane, transplacental, blood)
b. Mechanisms (drainage, excretions, secretions)

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

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}Concept of "The Chain of Infection"


5. Mode of transmission
a. Contact with pathogen

1) Direct
2) Indirect
3) Droplet
4) Airborne

b. Common vehicle (e.g., food, water)


c. Vectorborne

6. Susceptible host

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} Factor influencing the outcome of exposures


1. Host factors
a. Natural barriers (e.g., intact skin, respiratory cilia, gastric acid
and motility, tears, normal flora)
b. Host immunity (e.g., inflammatory response, humoral immunity,
cell-mediated immunity, immune memory)

2. Pathogen or infectious agent factors

a. Infectivity
b. Pathogenicity
c. Virulence
d. Size of innoculum
e. Route of exposure
f. Duration of exposure

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}Factor influencing the outcome of exposures


3. Environmental factors
Contamination of environment
Contamination of equipment

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}Standard precautions
Respiratory hygiene/cough etiquette
Safe injection practices (see Element III)
Use of masks during spinal/epidural access procedures

}For patients infected with organisms other than


bloodborne pathogens
Early identification
Prompt isolation
Appropriate treatment

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}Control of routes of transmission


1. Hand hygiene
Appropriate selection and use of agents (e.g., soap and
water, alcohol based hand sanitizers)
Factors influencing hand hygiene efficacy
Sources of potential contamination or cross-contamination of
hand hygiene materials

2. Use of appropriate barriers


Appropriate selection, donning, doffing, and disposal of
personal protective equipment (PPE)

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}Control of routes of transmission


3. Appropriate isolation/cohorting of patients infected with
communicable diseases
Standard precautions for all patients
Transmission based precautions for other pathogens
1) Contact (direct, indirect)
2) Droplet
3) Airborne

Host support and protection


1) Vaccination
2) Pre-and post-exposure prophylaxis
3) Protecting skin and immune system integrity

Copyright (C) 2011 VMD Health Care Training

}Control of routes of transmission


Environmental control measures
1) Cleaning, disinfection, and sterilization of patient care
equipment
2) Environmental cleaning (housekeeping)
3) Appropriate ventilation
4) Waste management
5) Linen and laundry management
6) Food services

Engineering and work practice controls


Training and education of healthcare workers

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}Both blood and other potentially infectious


materials (OPIM) may contain bloodborne
pathogens.
Bloodborne pathogens are bacteria and viruses present
in the blood and body fluids of an infected person that
can cause disease to others.

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}Bloodborne pathogens include, but are not limited


to:
Hepatitis B Virus (HBV)
Hepatitis C Virus (HCV)
Human Immunodeficiency Virus (HIV).

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}Other potentially infectious materials (OPIM)


include:
Human body fluids:
Seminal
Vaginal
Cerebrospinal
Synovial
Pleural
Pericardial
Peritoneal
Amniotic
All body fluids in situations where it is difficult or
impossible to differentiate between body fluids.

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Hepatitis B Virus (HBV)


} Description:
Serious disease caused by a virus that attacks and
causes inflammation of the liver.
HBV can cause lifelong infection, scarring of the liver,
liver cancer, liver failure, and death.

Hepatitis B virus
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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%.

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} HBV Signs & Symptoms:

Jaundice (yellowing of skin)


Fatigue
Abdominal pain
Loss of appetite
Nausea, vomiting
Joint pain

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HBV Transmission
} Occurs when blood from an infected person
enters the body of a person who is not infected.

Sex with an infected person without a condom


Injecting drugs with shared needles
Needlesticks or sharps exposures on the job
From an infected mother to her baby at birth

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} HBV is not transmitted by:

Sneezing or coughing
Kissing or hugging
Sharing eating utensils or drinking glasses
Breastfeeding
Food or water
Casual contact (such as an office setting)

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HBV Prevention:
} Hepatitis B vaccine is the best protection.

Proper use of condoms may reduce transmission.


Do not inject drugs. Never share needles or syringes.
Do not share personal care items that might have
blood on them (razors, toothbrushes).

Copyright (C) 2011 VMD Health Care Training

HBV Prevention (continued):


Consider the risks if you are thinking about getting a
tattoo or body piercing.
If you are a designated first aid provider, health care
or public safety worker, assume that the blood and
other body fluids from all patients/victims are
potentially infectious.
Always follow universal precautions and safely handle
needles and other sharps.

Copyright (C) 2011 VMD Health Care Training

Hepatitis B Vaccine
} Description:

Used to prevent infection by the hepatitis B virus.


Works by causing your body to produce its own protection
(antibodies) against the disease.
Made without any human blood or blood products or any
other substances of human origin and cannot give you
HBV.

Copyright (C) 2011 VMD Health Care Training

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.

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Hepatitis B Vaccine
} Method of Administration:
Injected.
Vaccine is available only from your doctor or other
authorized health care professional.

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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.

Copyright (C) 2011 VMD Health Care Training

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.

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If declined, the employee must sign a


document with the following statement:
I understand that due to my occupational exposure to blood or other potentially
infectious materials I may be at risk of acquiring hepatitis B virus (HBV) infection. I
have been given the opportunity to be vaccinated with hepatitis B vaccine, at no
charge to myself. However, I decline hepatitis B vaccination at this time. I
understand that by declining this vaccine, I continue to be at risk of acquiring
hepatitis B, a serious disease. If in the future I continue to have occupational
exposure to blood or other potentially infectious materials and I want to be
vaccinated with hepatitis B vaccine, I can receive the vaccination series at no
charge to me.

Copyright (C) 2011 VMD Health Care Training

Hepatitis C Virus (HCV)


} Description:
HVC is a serious disease caused by a virus that
attacks the liver and causes inflammation.
HCV can cause lifelong infection, scarring of the liver,
liver cancer, liver failure and death.

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HCV Incidence:
}

Number of new infections per year has declined from 240,000 (1980s) to
26,000 (2004).

Most infections are due to illegal injection drug use.


Transfusion-associated cases occur in less than one per 2 million transfused
units of blood.
Estimated 3.9 million (1.6%) Americans have been infected with HCV, of whom
3.2 million are chronically infected.

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} HCV Signs & Symptoms:

Jaundice (yellowing of skin)


Fatigue
Dark urine
Abdominal pain
Loss of appetite
Nausea
Note: 80% of persons have no signs or symptoms

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} Transmission:

Occurs when blood from an infected person enters the


body of a person who is not infected.
HCV is spread by injecting drugs with shared needles,
through needlesticks or sharps exposures on the job,
or from an infected mother to her baby during birth.
HCV can be spread by sex, but this is rare.
Persons at risk for HCV infection might also be at risk
for infection with hepatitis B virus or HIV.

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} HCV is not transmitted by:

Sneezing or coughing
Kissing or hugging
Sharing eating utensils or drinking glasses
Breastfeeding
Food or water
Casual contact (such as an office setting)

Copyright (C) 2011 VMD Health Care Training

} 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).

Copyright (C) 2011 VMD Health Care Training

} HCV Prevention (continued):


Consider the risks if you are thinking about getting a
tattoo or body piercing.
If you are a designated first aid provider, health care
or public safety worker, assume that the blood and
other body fluids from all patients are potentially
infectious.
Always follow universal precautions and safely handle
needles and other sharps.
If you have or had hepatitis C, do not donate blood,
organs, or tissue.

Copyright (C) 2011 VMD Health Care Training

Human Immunodeficiency Virus (HIV)


Acquired Immune Deficiency Syndrome
(AIDS)
} Description:
AIDS is a term used to apply to the most advanced
stages of HIV infection.
HIV kills or damages cells of the body's immune
system.

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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.

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AIDS Incidence (continued):


} Growing most rapidly among minority
populations.

Leading killer of African-American males ages


25 to 44.
Almost 5 million people newly infected in 2005 (worldwide).
Risk of health care workers being exposed to HIV on the job is very
low.

Average risk of HIV transmission after a needle-puncture of the skin with


HIV-infected blood is about 0.3% and after a mucous membrane
exposure (eyes/mouth) about 0.09%.

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Early Signs & Symptoms.


} Within a month or two after exposure to the
virus, symptoms may imitate a flu-like illness:

Fever
Headache
Tiredness
Enlarged
Large lymph nodes or "swollen glands"

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} Other symptoms often experienced months to


years before the onset of AIDS include:

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.

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} 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.

Cell infected with HIV and covered


with virus particles
Berkeley National Laboratory
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} HIV is not transmitted by:

Shaking hands
Hugging or a casual kiss
Toilet seats
Drinking fountains
Door knobs
Dishes
Drinking glasses
Food
Pets, Mosquitoes, or bedbugs

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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.

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Prevention (continued):

If you are a designated first aid provider, health care or


public safety worker, assume that the blood and other body
fluids from all patients are potentially infectious.
Always follow universal precautions and safely handle
needles and other sharps.

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Certain specific factors may mean a percutaneous


injury carries a higher risk, for example:

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

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Percutaneous injury (cont.):


If percutaneous exposure occurs then the site of
exposure should be washed liberally with soap and
water but without scrubbing.
Bleeding should be encouraged by pressing gently
around the site of the injury (but taking care not to
press immediately on the injury site).
It is best to do this under a running water tap.

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Post-expose Prophylaxis (PEP):


The risk of infection with HIV can be reduced by 80% if
prophylactic treatment is taken within 24 hours of an
exposure.
Treatment should ideally be started within one hour of
an exposure. The recommended treatment is a 28 day
course of three anti-viral drugs used in the treatment of
established HIV disease.

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Post-expose Prophylaxis (PEP):

Sufficient epidemiological data is available to


demonstrate that treatment with one of the drugs,
Zidovudine (AZT), can reduce the risk of transmission
by 80%. Use of a combination of drugs is likely to
further reduce transmission rates.
The long term effects of use of the drugs for prevention
of infection has not been fully evaluated, and they have
not been licensed for this, although their use is
recommended by most authorities and almost all HIV
specialist.

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Post-expose Prophylaxis (PEP):

The decision on whether to use PEP after an accident is a


personal one. Theres no right answer. Infection after an
inoculation injury is relatively uncommon. The drugs
commonly cause the person taking them to feel unwell and,
rarely, have been associated with serious side effects. The
prescribing doctor can help calculate the probability of
infection occurring, discuss the pros and cons of taking PEP
with you and usually recommend whether or not to take
treatment but, in the end, you will need to decide.

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Statistics:

Up until December 2006, health care workers in the US


reported 57 occupational HIV infections.
Of these, 48 had percutaneous exposure; 5, mucocutaneous
exposure; 2, both percutaneous and mucocutaneous exposure;
and 2, an unknown route of exposure.
In addition, 140 possible occupational transmissions have
occurred among healthcare personnel. These are cases in
which a worker is infected with HIV and has a history of
occupational exposure, but did not have a test immediately
before and after the possible exposure. As no other risk factors
are reported, it is most likely that the infection has occurred as a
result of that occupational exposure.

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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

Copyright (C) 2011 VMD Health Care Training

}Reason for Learning


Prevention of occupational exposure to bloodborne
pathogens and OPIM requires a broad approach
including risk assessment exposure control planning,
engineering, work practice controls and proper use of
personal protective equipment.
This section provides an overview of these critical
elements of safety and prevention in the workplace, as it
involves you and those you care for

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}Contamination:

The presence of microorganisms on an item or surface.

}Cleaning:

The process of removing all foreign material (i.e., dirt,


body fluids, lubricants) from objects by using water and
detergents or soaps and washing or scrubbing the object

}Critical device:

An item that enters sterile tissue or the vascular system.


These must be sterile prior to contact with tissue.

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}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.

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}High level disinfection:


Disinfection that kills all organisms, except high levels of
bacterial spores, and is effected with a chemical
germicide cleared for marketing as a sterilant by the U.S.
Food and Drug Administration (FDA).

}Intermediate level disinfection:


Disinfection that kills mycobacteria, most viruses, and
bacteria with a chemical germicide registered as a
"tuberculocide" by the U.S. Environmental Protection
Agency (EPA).

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}Low level disinfection:


Disinfection that kills some viruses and bacteria with a
chemical germicide registered as a hospital disinfectant by
the EPA.

}Non critical device:


An item that contacts intact skin but not mucous
membranes. It requires low level disinfection.

}Semi critical device:


An item that comes in contact with mucous membranes or
non intact skin and minimally requires high level
disinfection.

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}Sterilization:
The use of a physical or chemical procedure to destroy
all microbial life, including highly resistant bacterial
endospores.

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}Exposure Control Plan


Every employer that has employee(s) with a risk of
occupational exposure to blood or OPIM must perform an
assessment of this risk and develop a written plan to
eliminate or minimize it.
The plan must be accessible whenever an employee or
his or her designated representative requests it.

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}Exposure Control Plan


The plan must contain:
Exposure determination.
A list of all job classifications, tasks and procedures with a risk of
occupational exposure to blood or OPIM.

Schedule and method of implementation.


A written description of how employers put bloodborne pathogen
compliance into practice.

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}Exposure Control Plan


The plan must contain (continued):
Documentation that engineering controls (such as
needleless systems) have been considered and where
possible, implemented.
Procedures for evaluating the circumstances surrounding an
exposure incident.

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} Exposure Control Plan

Must be reviewed and updated at least


annually.
Must document that the employer has
requested input in the identification,
evaluation, and selection of effective
engineering and work practice controls from
employees.
Particularly from front line healthcare
workers who are responsible for providing
patient care.

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} 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.

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} Engineering Controls

Signs and warning labels are a type of engineering control.


Must be attached to all containers that are used to store,
transport or ship blood or OPIM.
Containers must be marked with either a biohazard symbol or
placed in a colored-coded container such as a red bag.

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} Work Practice Controls


Procedures that reduce the likelihood of exposure by
altering the manner in which a task is performed (for
example, not bending or recapping contaminated
needles).

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}High risk practices and procedures:


A. Percutaneous exposures

1. Exposures occurring through handling/disassembly/


disposal/reprocessing of contaminated needles and other
sharp objects:
a. Manipulating contaminated needles and other sharp objects
by hand (e.g., removing scalpel blades from holders, removing
needles from syringes),
b. Delaying or improperly disposing (e.g., leaving contaminated
needles or sharp objects on counters/workspaces or disposing
in non-puncture-resistant receptacles),
c. Recapping contaminated needles and other sharp objects
using a two-handed technique.

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}High risk practices and procedures:


2. Performing procedures where there is poor visualization,
such as:
a. Blind suturing,
b. Non-dominant hand opposing or next to a sharp,
c. Performing procedures where bone spicules or metal
fragments are produced.

B. Mucous membrane/non-intact skin exposures

1. Direct blood or body fluids contact with the eyes, nose,


mouth, or other mucous membranes via:
a. Contact with contaminated hands,
b. Contact with open skin lesions/dermatitis,
c. Splashes or sprays of blood or body fluids (e.g., during
irrigation or suctioning).

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}High risk practices and procedures:


C. Parenteral exposures
1. Injection with infectious material may occur during:
a. Administration of parenteral medication,
b. Sharing of blood monitoring devices (e.g., glucometers,
hemoglobinometers, lancets, lancet platforms/pens),
c. Infusion of contaminated blood products or fluids.

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}Safe injection practices and procedures


designed to prevent disease transmission from
patient to patient and healthcare worker to
patient.
A. Unsafe injection practices have resulted in one or
more of the following:

Transmission of bloodborne viruses, including hepatitis B


and C viruses to patients;
Notification of thousands of patients of possible exposure to
bloodborne pathogens and recommendation that they be
tested for hepatitis C virus, hepatitis B virus, and human
immunodeficiency virus (HIV);

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} Safe injection practices (cont)

Referral of providers to licensing boards for disciplinary action; and


Malpractice suits filed by patients.

B. Pathogens including HCV, HBV, and human


immunodeficiency virus (HIV) can be present in sufficient
quantities to produce infection in the absence of visible blood.
Bacteria and other microbes can be present without clouding or
other visible evidence of contamination.
The absence of visible blood or signs of contamination in a used
syringe, IV tubing, multi- or single-dose medication vial, or blood
glucose monitoring device does NOT mean the item is free from
potentially infectious agents.

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}Safe injection practices (cont)


All used injection supplies and materials are potentially
contaminated and should be discarded.

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.

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}Safe injection practices (cont)


d. If a medication vial has already been opened, the rubber
septum should be disinfected with alcohol prior to piercing it.
e. Never leave a needle or other device (e.g. spikes) inserted
into a medication vial septum or IV bag/bottle for multiple uses.
This provides a direct route for microorganisms to enter the vial
and contaminate the fluid.
f. Medication vials should be discarded upon expiration or any
time there are concerns regarding the sterility of the medication.

2. Never administer medications from the same syringe to


more than one patient, even if the needle is changed.

Copyright (C) 2011 VMD Health Care Training

}Safe injection practices (cont)


3. Never use the same syringe or needle to administer IV
medications to more than one patient, even if the medication
is administered into the IV tubing, regardless of the distance
from the IV insertion site.
a. All of the infusion components from the infusate to the
patient's catheter are a single interconnected unit.
b. All of the components are directly or indirectly exposed to the
patient's blood and cannot be used for another patient.
c. Syringes and needles that intersect through any port in the IV
system also become contaminated and cannot be used for
another patient or used to re-enter a non-patient specific multidose medication vial.

Copyright (C) 2011 VMD Health Care Training

}Safe injection practices (cont)


d. Separation from the patient's IV by distance, gravity and/or
positive infusion pressure does not ensure that small amounts of
blood are not present in these items.

4. Never enter a vial with a syringe or needle that has been


used for a patient if the same medication vial might be used
for another patient.
5. Dedicate vials of medication to a single patient, whenever
possible.
a. Medications packaged as single-use must never be used for
more than one patient:
1) Never combine leftover contents for later use;

Copyright (C) 2011 VMD Health Care Training

}Safe injection practices (cont)


b. Medications packaged as multi-use should be assigned to a
single patient whenever possible;
1) Never use bags or bottles of intravenous solution as a common
source of supply for more than one patient.

6. Never use peripheral capillary blood monitoring devices


packaged as single-patient use on more than one patient:
a. Restrict use of peripheral capillary blood sampling devices to
individual patients.
b. Never reuse lancets. Consider selecting single-use lancets
that permanently retract upon puncture.

Copyright (C) 2011 VMD Health Care Training

}Safe injection practices and procedures


designed to prevent disease transmission from
patient to healthcare worker.
A. Refer to OSHA guidelines, available at:
http://www.osha.gov/pls/oshaweb

Copyright (C) 2011 VMD Health Care Training

} 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.

Copyright (C) 2011 VMD Health Care Training

} 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.

Copyright (C) 2011 VMD Health Care Training

} 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.

Copyright (C) 2011 VMD Health Care Training

} Selecting PPE (continued):


Care should be taken to select the proper size.
If your PPE does not fit properly, it can make the
difference between being safely protected or
dangerously exposed.

Copyright (C) 2011 VMD Health Care Training

} PPE Training:

Employers are required to train each employee who must use


PPE before they are allowed to perform any work requiring its
use.
You must know:

When PPE is necessary.


What PPE is necessary.
How to put on, take off, adjust, and wear PPE.
Limitations of the PPE.
Proper care, maintenance, useful life, and disposal of PPE.

Copyright (C) 2011 VMD Health Care Training

} Disposable Gloves:

Use disposable, single-use gloves to protect your


hands.
All cuts or sores on your hands should be covered with
a bandage as additional protection before applying
gloves.
Inspect gloves before putting them on. If a glove is
damaged, dont use it!
Wearing two pairs of gloves can provide an additional
barrier and further reduce risk.

Copyright (C) 2011 VMD Health Care Training

} Disposable Gloves (continued):

Never wash or reuse disposable gloves.


If you find yourself in a first aid situation and you dont have
any gloves - improvise. Use a towel, plastic bag, or some
other barrier to help avoid direct contact.
Make sure there is always a fresh supply of gloves in your
first aid kit.
When taking contaminated gloves off, do it carefully. Dont
snap them, this may cause blood to splatter.

Copyright (C) 2011 VMD Health Care Training

} Recommended Technique

Proper Removal of Contaminated Gloves

Copyright (C) 2011 VMD Health Care Training

} 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.

Copyright (C) 2011 VMD Health Care Training

} Eye Protection

Goggles or glasses with solid side shields, or chin-length face


shields, must be worn whenever splashes, spray, spatter, or
droplets of blood or OPIM may be produced or reasonably
anticipated.
Appropriately fitted, indirectly-vented goggles with a
manufacturers anti-fog coating provide the most reliable
practical eye protection from blood splashes and sprays.

Copyright (C) 2011 VMD Health Care Training

} Protection during Resuscitation:

Resuscitation devices must be made readily available to


employees who are designated or can reasonably be
expected to perform resuscitation procedures (CPR).
These employees must be properly trained in the
various types, use and location of these devices
according to the manufacturer's instructions and/or
accepted medical practice.

Copyright (C) 2011 VMD Health Care Training

Although mouth-to-mouth breathing is


a quick and effective method to
provide oxygen to a person who is not
breathing, unprotected mouth-tomouth resuscitation should not be
used by any emergency response
personnel.

Bag-Mask Device

Pocket Mask
Copyright (C) 2011 VMD Health Care Training

} Protective Body Clothing:


Protective body clothing such as gowns, aprons,
laboratory coats, clinic jackets, surgical caps, or shoe
covers must be provided at no cost to the employee.

Copyright (C) 2011 VMD Health Care Training

} Contaminated PPE:

Any PPE that become soiled with infectious material must be


removed as soon as possible.
Handle with caution.
PPE that is dripping with blood or body fluids (grossly
contaminated) should be placed into a container that is
marked with a biohazard symbol or placed in a red bag.
PPE lightly soiled with spots of blood or OPIM can be
discarded in the regular trash.

Copyright (C) 2011 VMD Health Care Training

} Always place contaminated


sharps in a closable, appropriately
labeled or color coded, punctureresistant, and leak-proof container
immediately or as soon as
possible after use.

Copyright (C) 2011 VMD Health Care Training

} 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.

Copyright (C) 2011 VMD Health Care Training

} Hand Hygiene (continued):


Employers must provide handwashing facilities that
are readily accessible to employees.
When this is not possible, employers must provide
either an appropriate antiseptic hand-cleanser or
antiseptic towelettes.
The Centers for Disease Control and Prevention
recommends routinely decontaminating hands with an
alcohol-based hand rub.

Copyright (C) 2011 VMD Health Care Training

} Hand Hygiene (continued):


Compared with soap and water, alcohol-based hand
rubs are more effective in reducing bacteria on hands
and cause less skin irritation.
If an alcohol-based hand rub is not available, or your
hands are visibly soiled with blood or OPIM, wash with
either a non-antimicrobial soap and water or an
antimicrobial soap and water.

Copyright (C) 2011 VMD Health Care Training

} 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.

Copyright (C) 2011 VMD Health Care Training

} 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

Copyright (C) 2011 VMD Health Care Training

} 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.

Copyright (C) 2011 VMD Health Care Training

} 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.

Copyright (C) 2011 VMD Health Care Training

} 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.

Copyright (C) 2011 VMD Health Care Training

} Equipment and Surfaces:


All equipment and working surfaces must be cleaned
and decontaminated after contact with blood or OPIM.

Copyright (C) 2011 VMD Health Care Training

Recommended Technique

Clean Up and Disinfection of Blood or OPIM Spills


1.
2.
3.
4.
5.
6.
7.
8.

Locate and open spill clean-up kit


Put on appropriate protective clothing, including disposable aprons, caps and eye
protection.
Wear double gloves.
Pour an adsorbent material over the spill
Use a scoop to pickup material. Wipe up any remaining blood or OPIM with an
absorbent towel.
Apply a disinfectant to the area.
Place all cleanup supplies, including protective body clothing in a red bag for proper
disposal.
Thoroughly wash your hands.

Copyright (C) 2011 VMD Health Care Training

} 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.

Copyright (C) 2011 VMD Health Care Training

} 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.

Copyright (C) 2011 VMD Health Care Training

} 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.

Copyright (C) 2011 VMD Health Care Training

} 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.

Copyright (C) 2011 VMD Health Care Training

}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.

Copyright (C) 2011 VMD Health Care Training

} Potential for contamination is dependent upon


A. Type of instrument, medical device, equipment, or
environmental surface

Potential for external contamination (e.g., presence of hinges,


crevices).
Potential for internal contamination (e.g., presence of lumens).
Physical composition, design, or configuration of the instrument,
medical device, equipment, or environmental surface.

B. Frequency of hand contact with instrument medical device,


equipment, or environmental surface.

Copyright (C) 2011 VMD Health Care Training

}Potential for contamination is dependent upon


C. Potential for contamination with body substances or
environmental sources of microorganisms.
D. Level of contamination.
Types of microorganisms
Number of microorganisms
Potential for cross-contamination

Copyright (C) 2011 VMD Health Care Training

} 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

Copyright (C) 2011 VMD Health Care Training

}Steps of Reprocessing
C. Disinfection- requires sufficient contact time with
chemical solution
D. Sterilization- requires sufficient exposure time to heat,
chemicals, or gases

Copyright (C) 2011 VMD Health Care Training

} Choice/Level of reprocessing sequence


A. Based on intended use:
Critical instruments and medical devices require sterilization.

Semi critical instruments and medical devices minimally require


high level disinfection.
Noncritical instruments and medical devices minimally require
cleaning and low level disinfection.

Copyright (C) 2011 VMD Health Care Training

}Choice/Level of reprocessing sequence


B. Based on manufacturer's recommendations
Compatibility among equipment components, materials, and
chemicals used
Equipment heat and pressure tolerance
Time and temperature requirements for reprocessing

Copyright (C) 2011 VMD Health Care Training

}Effectiveness of reprocessing instruments,


medical devices and equipment
A. Cleaning prior to disinfection
B. Disinfection
1. Selection and use of disinfectants
a. Surface products
b. Immersion products

2. Presence of organic matter


3. Presence of biofilms

Copyright (C) 2011 VMD Health Care Training

} Effectiveness of reprocessing instruments, medical


devices and equipment
4. Monitoring
a. Activity and stability of disinfectant
b. Contact time with internal and external components
c. Record keeping/tracking of instrument usage and reprocessing

5. Post-disinfection handling and storage

C. Sterilization
1. Selection and use of methods

Copyright (C) 2011 VMD Health Care Training

} Effectiveness of reprocessing instruments, medical


devices and equipment
2. Monitoring

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

3. Post-sterilization handling, packaging and storage (event-related


criteria)

Copyright (C) 2011 VMD Health Care Training

} Recognizing potential sources of crosscontamination in the healthcare environment


A. Surfaces or equipment which require cleaning between
patient procedures/treatments
B. Practices that contribute to hand contamination and the
potential for cross-contamination
C. Consequences of reuse of single-use/disposable
instruments, medical devices or equipment

Copyright (C) 2011 VMD Health Care Training

} Factors that have contributed to contamination in reported


cases of disease transmission

A. At any point in reprocessing or handling, breaks in infection control


practices can compromise the integrity of instruments, medical devices or
equipment.
B. Specific factors

Failure to reprocess or dispose of items between patients


Inadequate cleaning, disinfection, or sterilization
Contamination of disinfectant or rinse solutions
Improper packaging, storage and handling
Inadequate/inaccurate record keeping of reprocessing requirements

Copyright (C) 2011 VMD Health Care Training

} Expectations of health professionals with respect to


differing levels of disinfection and sterilization
methods and agents based on the area of
professional practice setting and scope of
responsibilities
A. Professionals who practice in settings where handling,
cleaning, and reprocessing equipment, instruments or medical
devices is performed elsewhere (e.g., in a dedicated Sterile
Processing Department):

Copyright (C) 2011 VMD Health Care Training

1. Understand core concepts and principles


a. Standard and Universal Precautions (e.g., wearing of personal
protective equipment)
b. Cleaning, disinfection, and sterilization described in Sections III
and IV above
c. Appropriate application of safe practices for handling instruments,
medical devices and equipment in the area of professional practice.
d. Designation and physical separation of patient care areas from
cleaning and reprocessing areas is strongly recommended by
NYSDOH

2. Verify with those responsible for reprocessing what steps are


necessary prior to submission
a. Pre-cleaning
b. Soaking

Copyright (C) 2011 VMD Health Care Training

B. Professionals who have primary or supervisory responsibilities


for equipment , instruments or medical device reprocessing (e.g.,
Sterile Processing Department staff or clinics and physician
practices where medical equipment is reprocessed on-site):
1. Understand core concepts and principles
a. Standard and Universal Precautions
b. Cleaning, disinfection, and sterilization described in Sections III and IV
above
c. Appropriate application of safe practices for handling instruments, medical
devices, and equipment in the area of professional practice
d. Designation and physical separation of patient care areas from cleaning
and reprocessing areas is strongly recommended by NYSDOH

Copyright (C) 2011 VMD Health Care Training

2. Determine appropriate reprocessing practices taking into


consideration:
a. Selection of appropriate methods
i. Antimicrobial efficacy
ii. Time constraints and requirements for various methods
iii. Compatibility among equipment/materials

Corrosiveness
Penetrability
Leaching
Disintegration
Heat tolerance
Moisture sensitivity

Copyright (C) 2011 VMD Health Care Training

iv. Toxicity

Occupational health risks


Environmental hazards
Abatement methods
Monitoring exposures
Potential for patient toxicity/allergy

v. Residual effect
Antibacterial residual
Patient toxicity/allergy.

vi. Ease of use


Need for specialized equipment
Special training requirements

Copyright (C) 2011 VMD Health Care Training

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/

Copyright (C) 2011 VMD Health Care Training

}
}
}
}

Section 1: Introduction
Section 2: Bloodborne Pathogens and OPIM
Section 3: Safety and Prevention in the Workplace
Section 4: Exposure Incidents and Follow Up

Copyright (C) 2011 VMD Health Care Training

}Reason for Learning


If the required controls are in place and the bloodborne
pathogens standard is correctly implemented, exposure
incidents should be uncommon events.
However, after an exposure incident has occurred,
immediate first aid, confidential medical evaluation and
follow-up are critical components to assure your health
and well-being.

Copyright (C) 2011 VMD Health Care Training

Copyright (C) 2011 VMD Health Care Training

}Post-exposure Evaluation and Follow-up.


Following a report of an exposure incident (and after
initial first aid), the employer must make a confidential
medical evaluation and follow-up immediately available.

Copyright (C) 2011 VMD Health Care Training

}The evaluation and follow up must include:


The routes of exposure and how the exposure occurred.
Identification and documentation of the source individual ,
unless identification is impossible or prohibited by law.
Arrangements to have the source individual tested in
order to determine if they are infected with HBV or HIV.

Copyright (C) 2011 VMD Health Care Training

}Evaluation and follow up (cont):


The source individual's test results with information about
laws protecting confidentiality.
Testing the employee's blood (after obtaining consent) as
soon as possible after exposure incident.
Results of the testing must be made available to the
exposed employee, and the employee must be informed
of all applicable laws and regulations concerning
disclosure of the identity and infectious status of the
individual.

Copyright (C) 2011 VMD Health Care Training

}Post-exposure evaluation and management


A. Bloodborne pathogens
1. Prompt evaluation by licensed medical professional
2. Risk assessment in occupational exposures
3. Recommendations for approaching source patient and
healthcare worker evaluations
4. Recommendations for post-exposure prophylaxis
emphasizing the most current NYSDOH and CDC guidelines

Copyright (C) 2011 VMD Health Care Training

} Post-exposure evaluation and management


5. Post-exposure management of patients or other healthcare
workers when exposure source is a healthcare worker
a. Professional obligation to inform patients exposed to a healthcare
workers blood or other potentially infectious material

B. Airborne or droplet pathogen


1. Tuberculosis
a. Recommendations for post-exposure prophylaxis emphasizing
the most current New York State guidelines for post-exposure
prophylaxis

2. Varicella, Measles, Mumps, Rubella, Pertussis


a. Consult the most current Federal, State, or local requirements for
post-exposure evaluation and management

Copyright (C) 2011 VMD Health Care Training

}Post-exposure evaluation and management


C. Notification of healthcare workers/public

Copyright (C) 2011 VMD Health Care Training

}Post-exposure vaccination for HBV or the use of


antiretroviral drugs to treat HIV infection should be
administered as soon as possible, preferably
within hours.
All medical records generated by an exposure incident
must be kept confidential and may not be disclosed or
reported without the employee's express written consent
to any person within or outside the workplace.

Copyright (C) 2011 VMD Health Care Training

}Employers must make certain that a responsible


person reviews the circumstances of all exposure
incidents.
The following factors must be documented:
Engineering controls in use at the time of the incident.
Work practices followed.
A description of the device being used (syringe, broken
glass, etc.).
PPE or clothing in use at the time of the incident

Copyright (C) 2011 VMD Health Care Training

}The following factors must be documented


(continued):
Location of the incident.
Procedure being performed at the time of the incident.
Employee's training.
All injuries from contaminated sharps must be recorded
in a Sharps Injury Log.

Copyright (C) 2011 VMD Health Care Training

} Evaluation of healthcare workers infected with HIV,


HBV and/or HCV or other bloodborne pathogens
A. Review New York State Department of Health Policy on HIV
testing of healthcare workers
B. Criteria for evaluating infected health care workers for risk
of transmission
1. Nature and scope of professional practice
2. Techniques used in performance of procedures that may pose a
transmission risk to patients
3. Assessed compliance with infection control standards
4. Presence of weeping dermatitis, draining or open skin wounds

Copyright (C) 2011 VMD Health Care Training

}Evaluation of healthcare workers infected with


HIV, HBV and/or HCV or other bloodborne
pathogens
5. Overall health
a. Physical health
B. Cognitive status

C. Expert panels for evaluation of healthcare workers


infected with bloodborne pathogens

Copyright (C) 2011 VMD Health Care Training

New York State Department of Health

NYS Infection Control Syllabus Elements (2010)

American Safety & Health Institute

Bloodborne Pathogens Course (2005)

Copyright (C) 2011 VMD Health Care Training

Congratulations!
This completes the
New York State Infection Control and Barrier Precautions
Training...
Please click Finish Course to proceed to the final quiz

Copyright (C) 2011 VMD Health Care Training

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