Bloodborne Pathogens/TB An OSHA Mandated Drill Introduction OSHA mandates that upon hire each individual who works in a high-risk environment must received.

Bloodborne Pathogens/TBBloodborne Pathogens/TB

An OSHA Mandated DrillAn OSHA Mandated Drill

IntroductionIntroduction

OSHA mandates that upon hire each OSHA mandates that upon hire each individual who works in a high-risk individual who works in a high-risk environment must received bloodborne environment must received bloodborne pathogens training.pathogens training.

OSHA also mandates that this topic be OSHA also mandates that this topic be reviewed annuallyreviewed annually

ObjectivesObjectives

Identify the pathogens that are transmitted via Identify the pathogens that are transmitted via bloodblood

Identify modes of transmission of BBPIdentify modes of transmission of BBP Identify risks of transmission in the workplaceIdentify risks of transmission in the workplace Identify appropriate use of PPEIdentify appropriate use of PPE Identify correct procedure to follow if exposedIdentify correct procedure to follow if exposed Identify requirements of HBV seriesIdentify requirements of HBV series Understand importance of infectious waste Understand importance of infectious waste

disposaldisposal Identify locations at both companies for decon Identify locations at both companies for decon

and infectious waste disposaland infectious waste disposal

Objectives (cont’d)Objectives (cont’d)

Identify those at risk for development of Identify those at risk for development of TBTB

Differentiate between TB Disease and TB Differentiate between TB Disease and TB InfectionInfection

Identify methods of diagnosing TBIdentify methods of diagnosing TBUnderstand treatment of TBUnderstand treatment of TBUnderstand risks of rabies exposure to Understand risks of rabies exposure to

emergency respondersemergency responders

Bloodborne PathogensBloodborne Pathogens

Hepatitis B,C,D,E,F,GHepatitis B,C,D,E,F,GHIVHIVViral Hemorrhagic Fevers (Ebola, Viral Hemorrhagic Fevers (Ebola,

Marburg)Marburg)

HepatitisHepatitis

Hepatitis is an infection that occurs in the liver Hepatitis is an infection that occurs in the liver after exposure to the virus through blood.after exposure to the virus through blood.

Symptoms of hepatitis include: jaundice, fever, Symptoms of hepatitis include: jaundice, fever, weight loss, loss of appetite, fatigue, dark weight loss, loss of appetite, fatigue, dark urine, joint pain, abdominal pain, diarrhea, urine, joint pain, abdominal pain, diarrhea, nausea, and vomiting.nausea, and vomiting.

Incubation periods vary depending on the Incubation periods vary depending on the type.type.

HBV average is 120 days (ranges from 45-160 HBV average is 120 days (ranges from 45-160 days)days)

HCV average is 45 days (ranges from 14- 180)HCV average is 45 days (ranges from 14- 180)

Hepatitis (cont’d)Hepatitis (cont’d)

Death from chronic liver disease occurs in 15-Death from chronic liver disease occurs in 15-25% of chronically infected persons.25% of chronically infected persons.

People with chronic HBV infection have a much People with chronic HBV infection have a much greater risk of developing liver failure & liver greater risk of developing liver failure & liver cancercancer

Chronic infection with HCV occurs in 55-85% of Chronic infection with HCV occurs in 55-85% of infected persons and 70% of chronically infected infected persons and 70% of chronically infected persons go on to develop chronic liver diseasepersons go on to develop chronic liver disease

Those with chronic HCV have a much higher risk Those with chronic HCV have a much higher risk of suffering from liver failure and liver cancerof suffering from liver failure and liver cancer

Hepatitis Vaccine Hepatitis Vaccine

HBV series is a series of 3 shots over a period of HBV series is a series of 3 shots over a period of 6 months6 months

OSHA mandates that all employees in a high-OSHA mandates that all employees in a high-risk setting must be offered the vaccine free of risk setting must be offered the vaccine free of charge.charge.

If you decline the vaccine, you must sign a If you decline the vaccine, you must sign a waiver.waiver.

31-60 days after receiving the 331-60 days after receiving the 3rdrd shot you shot you should have a titre drawn to check for immunity.should have a titre drawn to check for immunity.

There is no vaccine for HCVThere is no vaccine for HCV

Transmission of HepatitisTransmission of Hepatitis

HBV is found in blood and certain body HBV is found in blood and certain body fluids. It is spread through these fluids fluids. It is spread through these fluids from an infected person to a non-immune from an infected person to a non-immune person.person.

Spread via unprotected sex, sharing Spread via unprotected sex, sharing needles, exposure to needlesticks/sharps needles, exposure to needlesticks/sharps in the workplace, and from an infected in the workplace, and from an infected mother to her child during birthmother to her child during birth

HIVHIV

Human Immunodeficiency Virus is a retrovirus Human Immunodeficiency Virus is a retrovirus that causes Acquired Immune Deficiency that causes Acquired Immune Deficiency Syndrome (AIDS).Syndrome (AIDS).

The Immune system progressively deteriorates The Immune system progressively deteriorates leading to opportunistic infections that ultimately leading to opportunistic infections that ultimately leads to death.leads to death.

There is no vaccine for HIVThere is no vaccine for HIV Antiretroviral medications are used to treat HIV Antiretroviral medications are used to treat HIV

and have been shown to prolong the lifespan of and have been shown to prolong the lifespan of those with HIV. There is no cure. those with HIV. There is no cure.

HIV (cont’d)HIV (cont’d)

HIV was first discovered on December 1, HIV was first discovered on December 1, 1981. Since that time the World Health 1981. Since that time the World Health Organization (WHO) estimates that AIDS Organization (WHO) estimates that AIDS has killed more than 25 million people.has killed more than 25 million people.

In 2005 AIDS claimed 2.4-3.3 million lives In 2005 AIDS claimed 2.4-3.3 million lives of which, more than 570,000 were of which, more than 570,000 were children.children.

It is one of the most destructive pandemics It is one of the most destructive pandemics in recorded history.in recorded history.

HIV TransmissionHIV Transmission

The three major routes of transmission of The three major routes of transmission of HIV are:HIV are:

Unprotected sexual intercourseUnprotected sexual intercourse Contaminated needlesContaminated needles Infected mother to unborn child /breast Infected mother to unborn child /breast

milk to nursing infantmilk to nursing infantScreening of blood products has virtually Screening of blood products has virtually

eliminated transmission via that routeeliminated transmission via that route

HIV Symptoms (Early)HIV Symptoms (Early)

Many people do not develop symptoms when Many people do not develop symptoms when first infected.first infected.

Some people develop flu-like symptoms within Some people develop flu-like symptoms within 3-6 weeks of exposure (Acute HIV Syndrome). 3-6 weeks of exposure (Acute HIV Syndrome). There may also be enlargement of lymph nodes There may also be enlargement of lymph nodes during this phase of illness.during this phase of illness.

This phase usually lasts a week to a month & is This phase usually lasts a week to a month & is often mistaken for another viral infectionoften mistaken for another viral infection

HIV Symptoms (Late)HIV Symptoms (Late)

Lack of energy, swelling or hardening of glandsLack of energy, swelling or hardening of glands Weight loss, long bouts of diarrheaWeight loss, long bouts of diarrhea Frequent fevers & sweatsFrequent fevers & sweats Thrush accompanied by sore throatThrush accompanied by sore throat Severe or recurring yeast infectionsSevere or recurring yeast infections Chronic pelvic inflammatory diseaseChronic pelvic inflammatory disease Periods of extreme & unexplained fatiguePeriods of extreme & unexplained fatigue Headaches, lightheadedness, dizzinessHeadaches, lightheadedness, dizziness Bruising easilyBruising easily

What are the Chances?What are the Chances?

HBV –5-30 out of 100HBV –5-30 out of 100HIV – 1 in 300HIV – 1 in 300HCV – 1.8 in 100HCV – 1.8 in 100

PrecautionsPrecautions

Standard PrecautionsStandard Precautions- combines major - combines major features of universal precautions and body features of universal precautions and body substance isolation (BSI). Applies to substance isolation (BSI). Applies to allall body fluids, secretions, and excretions body fluids, secretions, and excretions regardless of whether or not they regardless of whether or not they contain visible blood.contain visible blood.

Transmission-Based Transmission-Based PrecautionsPrecautions

AirborneAirborne – TB, Chickenpox – TB, ChickenpoxDropletDroplet – Whooping cough, measles, – Whooping cough, measles,

SARS, fluSARS, fluContactContact – MRSA, VRE, C-Diff – MRSA, VRE, C-Diff

Personal Protective EquipmentPersonal Protective Equipment

PPEPPEGlovesGlovesGogglesGogglesMasks (N95 and surgical)Masks (N95 and surgical)Gowns/ApronsGowns/Aprons Tyvek suitsTyvek suits BVMBVM

Post Exposure Follow upPost Exposure Follow up

Report your exposure immediately to OICReport your exposure immediately to OICComplete Incident reportComplete Incident reportYou will be sent for a confidential medical You will be sent for a confidential medical

evaluation (evaluation (You have the right to refuse You have the right to refuse testingtesting))

Disposal of Infectious Waste & Disposal of Infectious Waste & Decontamination ProceduresDecontamination Procedures

Work area to be kept clean & sanitaryWork area to be kept clean & sanitaryUse appropriate disinfectants and mix Use appropriate disinfectants and mix

according to manufacturer’s directionsaccording to manufacturer’s directionsAll dressings & disposables must be All dressings & disposables must be

bagged per infection Control policy in bagged per infection Control policy in red biohazard bags.red biohazard bags.

Company OneCompany One

White biohazard containers located by White biohazard containers located by EMS room.(Lids must be on at all times)EMS room.(Lids must be on at all times)

Contaminated equipment cleaned in Contaminated equipment cleaned in decon shower at far end of bay in decon decon shower at far end of bay in decon shower.shower.

Contaminated gear & clothing washed in Contaminated gear & clothing washed in machines under stairwell at far end of baymachines under stairwell at far end of bay

Biohazard shed kept locked at all times.Biohazard shed kept locked at all times.

Company TwoCompany Two

White biohazard containers located next to White biohazard containers located next to bay storage doors. bay storage doors.

Medical waste transported back to Medical waste transported back to Company 1 medical waste shedCompany 1 medical waste shed

Contaminated gear & clothing transported Contaminated gear & clothing transported to Company 1 for proper handling.to Company 1 for proper handling.

Protecting Yourself On SceneProtecting Yourself On Scene

USE YOUR HEAD!!!USE YOUR HEAD!!! Take an extra few seconds to Take an extra few seconds to

survey the scene for potential exposure survey the scene for potential exposure hazards & choose your PPE accordingly.hazards & choose your PPE accordingly.

Be efficient but don’t rush. (Fools rush in!)Be efficient but don’t rush. (Fools rush in!)YouYou are ultimately accountable for your are ultimately accountable for your

own protection.own protection.

TuberculosisTuberculosis

Tuberculosis is spread by the Tuberculosis is spread by the airborne route.airborne route.

Primarily associated with the lungs, Primarily associated with the lungs, but can be found in other parts of but can be found in other parts of the body such as the kidney and the body such as the kidney and the bone.the bone.

It is reportable to the CT DPH by It is reportable to the CT DPH by law.law.

There are specific laws that dictate There are specific laws that dictate how it should be managed.how it should be managed.

Symptoms of TB•Feeling weak or sick

•Weight loss

•Fever

•Night Sweats

•Persistent Cough

•Chest Pain

•Coughing Up Blood

Who is at Risk?

•People who share the same breathing space as someone with TB disease.

•Poor people

•Homeless People

•Foreign born people from countries with high incident of TB

•Nursing Home Residents

•Prisoners

•Alcoholics and IV Drug abusers

•People with diabetes, certain types of cancer, and being underweight

•People with HIV

TB Disease vs. TB InfectionTB Disease:

•Person is sick with germs that are active in the body

•Usually have one or more symptoms of TB

•Can pass disease on

•Permanent body damage and death can occur

•Medicine is prescribed that can cure TB

TB Infection:

•Person is healthy

•Strong immune system

•No Symptoms

•Cannot spread the infection

•Can develop TB disease in the future

•Medicine prescribed to prevent development of TB disease

Diagnosis of TB•Skin Test

•Doctors Office or local Health Department

•If positive other tests will be done to see if you have infection vs. disease

•Small needle used to implant tuberculin under the skin

•Usually done inside of your forearm

•Test is read in 48 to 72 hours to check for reaction

•Size of reaction is measured

•Less than 10mm is negative

Negative vs. PositiveNegative Test:

•Usually means person is not infected

•Maybe falsely negative if person has been recently infected

•Usually takes 2 to 10 weeks after exposure for test to become positive

Positive Test:

•Usually means the person has been infected with the TB germ

•Does not necessarily mean person has TB disease

•Other testing such as X-Ray or Sputum testing will be ordered

Treatment of TB•Compliance with medications is mandatory

•Common medications include INH and Rifampin

•Routine follow up Chest X-Rays

•Routine follow up with Physician

RabiesRabiesVirus spread by warm blooded mammals Virus spread by warm blooded mammals

(raccoons, skunks, foxes, coyotes, (raccoons, skunks, foxes, coyotes, woodchucks and bats.woodchucks and bats.

A Bat’s teeth & claws are so small that a A Bat’s teeth & claws are so small that a bite may not bleed or even hurtbite may not bleed or even hurt

People sleeping in a room where a bat is found, or children who may have been alone in a room with a bat, should see a doctor. If possible the bat should be saved for testing, but never handle it without protective gloves.

Domestic PetsDomestic PetsDogs, cats, ferrets & farm animals can act Dogs, cats, ferrets & farm animals can act

as a bridge between wild animals and as a bridge between wild animals and people.people.

If pets appear to have been in a fight, use If pets appear to have been in a fight, use caution, and handle with gloves. Cover caution, and handle with gloves. Cover pet with fluid impervious material & see pet with fluid impervious material & see Vet.Vet.

How Does Rabies Work?How Does Rabies Work?Attacks brain cells & nervesAttacks brain cells & nervesSlowly & painfully kills its victim if not Slowly & painfully kills its victim if not

treated quickly.treated quickly.Prevention vaccine available for bite Prevention vaccine available for bite

victimsvictims Incubation period is 4-6 weeksIncubation period is 4-6 weeks

Rabies VaccineRabies Vaccine Involves a total of 5 shots over several Involves a total of 5 shots over several

days & 1 shot of Human Rabies Immune days & 1 shot of Human Rabies Immune Globulin (HRIG) which is given Globulin (HRIG) which is given immediately.immediately.

On SceneOn SceneFire & EMS personnel should be wary of Fire & EMS personnel should be wary of

stray or roaming animalsstray or roaming animals If bitten, you must report it immediately & If bitten, you must report it immediately &

seek medical attention…untreated rabies seek medical attention…untreated rabies can be & usually is fatal.can be & usually is fatal.

TransmissionTransmissionTransmitted through a bite, scratch, lick, Transmitted through a bite, scratch, lick,

and even petting.and even petting.The virus is in the animal’s saliva.The virus is in the animal’s saliva.

MythsMythsAll Rabid dogs froth at the mouth.All Rabid dogs froth at the mouth.A rabid dog will be vicious & snap at A rabid dog will be vicious & snap at

everythingeverythingA rabid dog will not drink water & will A rabid dog will not drink water & will

exhibit fear of waterexhibit fear of water If a suspected dog acts friendly, its not If a suspected dog acts friendly, its not

rabid.rabid.The dog had his shots, it doesn’t have The dog had his shots, it doesn’t have

rabiesrabies

Avoiding RabiesAvoiding RabiesAvoid being bittenAvoid being bittenTreat any animal bite as a potential rabies Treat any animal bite as a potential rabies

exposure.exposure. If bitten, immediately wash area with soap If bitten, immediately wash area with soap

& warm water then& warm water then wash wound with 1% wash wound with 1% providone-iodine.providone-iodine.

Capture/confine the animalCapture/confine the animal

Avoiding Rabies cont’dAvoiding Rabies cont’dSuspect strays should be destroyed & Suspect strays should be destroyed &

tested by health officials.tested by health officials.Pets who’s owner can’t provide proof of Pets who’s owner can’t provide proof of

vaccine should be confined for 10 days.vaccine should be confined for 10 days.All animal corpses should be treated as All animal corpses should be treated as

HIV contaminated (Use PPE when HIV contaminated (Use PPE when handling)handling)

Notify proper authorities of any suspected Notify proper authorities of any suspected rabid animalrabid animal

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