Bloodborne Pathogens (BBP) PDF

6/26/2024 BBP: Blood Borne PathogensAir borne pathogensBB 1 Blood Borne Pathogens Blood borne pathogens are disease causing microorganisms that may be present in human blood. They may be transmitted with any expo...

6/26/2024 BBP: Blood Borne PathogensAir borne pathogensBB 1 Blood Borne Pathogens Blood borne pathogens are disease causing microorganisms that may be present in human blood. They may be transmitted with any exposure to blood or other potentially infectious materials (OPIM). 1  6/26/2024 General background PATHOGEN: a microorganism that can cause disease Four main groups of microorganisms: Examples very small, packages of genetic HIV, Viruses material; need living hosts to influenza reproduce one-celled living organisms; do not E. coli, Bacteria need living hosts to reproduce salmonella includes yeasts and molds; plants that live by decomposing and Aspergillis, Fungi absorbing the organic material in Stachybotrys which they grow plants or animals that live upon, or within, other living hosts from Giardia, Parasites which they obtain some advantage, trichinella like nutrients Mode of Transmission Transmitted when blood or OPIM come in contact with mucous membranes or non-intact skin. Non-intact skin includes, but is not limited to: cuts, abrasions, burns, rashes, acne, paper cuts and hangnails. May also be transmitted by: blood splash or spray handling or touching contaminated items or surfaces Injection under the skin by puncture wounds or cuts from contaminated sharps 2  6/26/2024 Mode of Transmission Most occupational HIV transmission has occurred through puncture injury. Documented transmission has occurred through non-intact skin and mucous membranes. One incident of HIV transmission has been documented after a splash of blood to the eyes. Infection Control Types of Infection Communicable infections Nosocomial infections The chain of infection Components of the chain Breaking the chain 6 3  6/26/2024 Components of the Chain 1. Infectious (causative) agent 2. Reservoir 3. Exit pathway 4. Means of transmission Airborne Contact Droplet Vector Vehicle 5. Entry pathway 6. Susceptible host 7 Chain of Infection 8 4  6/26/2024 Breaking the Chain Means: Stopping infections at the source Preventing contact with substances from exit pathways Eliminating means of transmission Blocking exposure to entry pathways Reducing or eliminating the susceptibility of potential hosts 9 Breaking the Chain Ways to prevent transmission: Proper hand hygiene Good nutrition, adequate rest, reduction of stress Immunization against common pathogens Insect and rodent control Isolation procedures Decontamination of surfaces and instruments Proper disposal of sharps and infectious waste Use of gloves, gowns, masks, respirators, and other PPE when indicated Use of needle safety devices during blood collection 10 5  6/26/2024 Infection Control Programs Employee screening and immunization TB & RPR MMR, HBV, & tetanus Evaluation and treatment Surveillance Monitoring patients and employees Evaluating infection data 11 Infection Control Methods Hand washing Protective attire Gloves Gowns Lab coats Masks, face shields, and goggles Respirators 12 6  6/26/2024 Hand Washing Before and after laboratory procedures Procedure Wet hands with water Dispense 1-2 teaspoons of soap into hands Rub hands together vigorously for 15-20 seconds covering all surfaces of hands and fingers Be sure to use friction and get in between fingers Rinse hands in downward motion with water Dry thoroughly with towels Get a clean, dry towel and turn off water 13 14 7  6/26/2024 Guidelines for Aseptic Techniques Frequent hand washing The #1 procedure that can reduce nosocomial infections Use of Personal Protective Equipment (PPE) Waste management of contaminated materials Use of proper cleaning solutions Following standard precautions Using sterile procedures when necessary 15 Use of PPE’s Personal Protective Equipment PROPER Order to put on and remove ON – gown, mask, gloves OFF – gloves, mask, gown 16 8  6/26/2024 General Lab Safety Never eat, drink, smoke, or chew gum in the laboratory Never put pencils or pens in the mouth Never place food or beverages in a refrigerator used for storing reagents or specimens Never apply cosmetics, handle contact lenses, or rub eyes in the laboratory Never wear long chains, large or dangling earrings, or loose bracelets 17 General Lab Safety Always wear a fully buttoned lab coat when engaged in lab activities. Never wear a lab coat to lunch, on break, or when leaving the lab to go home. Never wear personal protective equipment outside the designated area for its use Always tie back hair that is longer than shoulder length 18 9  6/26/2024 General Lab Safety (cont’d) Always keep finger nails short and well manicured. Do not wear nail polish or artificial nails. Never bite nails or cuticles Always wear a face shield when performing specimen processing or any activity that might generate splashes or aerosol of bodily fluids Always wear gloves for phlebotomy procedures and when processing specimens 19 Major Blood Borne Pathogens Bloodborne Pathogens Any infectious microorganism present in blood and other body fluids and tissues One of the most significant biohazards Most publicized bloodborne pathogens HBV and HBD HCV HIV Other bloodborne pathogens Cytomegalovirus Creutzfeldt-Jakob 20 10  6/26/2024 HBV - Hepatitis B General Facts Hearty - can live for 7+ days in dried blood 100 times more contagious than HIV Approximately 78,000 new infections per year (2001) 1.25 million carriers 5,000 deaths/year No cure, but there is a preventative vaccine HBV - Hepatitis B Clinical Features Average 60-90 days Incubation period Range 45-180 days No sign or symptoms 30% Acute illness (jaundice) 30%-50% (5 years old) Chronic infection (carrier) 2%-10% (of infected adults) - Premature death from chronic liver disease 15-25% (of chronically infected) Immunity Protected from future infection 11  6/26/2024 HBV - Hepatitis B Symptoms flu-like symptoms fatigue abdominal pain Normal eyes loss of appetite nausea, vomiting joint pain jaundice Jaundiced eyes Transmission of HBV Contact of mucous membranes or open skin breaks with HBV contaminated surfaces can result in the transmission of the virus. Unprotected sex with multiple partners Sharing needles during injecting drug use From infected mother to child during birth Sharps/needle sticks Remember HBV can live on countertops for 7 days! Decontaminate all surfaces DAILY with 10% bleach 12  6/26/2024 Hepatitis B Vaccination Recommended for all high risk groups Healthcare providers: physicians, nurses, EMTs, home health care workers, etc. Clinical and research laboratory technicians Defense against HBV Series if 3 injections Initial 1 month after initial 6 months after initial Protects against HDV also 25 HCV - Hepatitis C General Facts The most common chronic bloodborne infection in the U.S. 3.9 million (1.8%) Americans infected; 2.7 million chronically infected 25,000 new infections per year (2001) Leading cause of liver transplantation in U.S. 8,000-10,000 deaths from chronic disease/year No broadly effective treatment No vaccine available 13  6/26/2024 HCV - Hepatitis C Clinical Features Average 6-7 weeks Incubation period Range 2-26 weeks No sign or symptoms 80% Acute illness (jaundice) 20% (Mild) 75%-85% Chronic infection Age- 10%-70% (most are Chronic liver disease related asymptomatic) Deaths from chronic liver 1%-5% disease No protection from future Immunity infection identified HCV - Hepatitis C Symptoms flu-like symptoms jaundice fatigue dark urine abdominal pain loss of appetite nausea 14  6/26/2024 HCV - Hepatitis C HCV Transmission Injecting drug use Hemodialysis (long-term) Blood transfusion and/or organ transplant before 1992 From infected mother to child during birth Occupational exposure to blood - mostly needle sticks Sexual or household exposures - rare Human Immunodeficiency Virus (HIV) General Facts Fragile – few hours in dry environment Attacks the human immune system Cause of AIDS More than 1 million infected persons in U.S. No cure; no vaccine available HIV - seen as small spheres on the surface of white blood cells 15  6/26/2024 Human Immunodeficiency Virus (HIV) HIV Infection AIDS Many have no symptoms or mild flu-like symptoms Most infected with HIV eventually develop AIDS Incubation period 10-12 yrs Opportunistic infections & AIDS-related diseases - TB, toxoplasmosis, Kaposi’s sarcoma, oral thrush (candidiasis) Treatments are limited; do not cure Human Immunodeficiency Virus (HIV) HIV Transmission Sexual contact Sharing needles and/or syringes From HIV-infected women to their babies during pregnancy or delivery Breast-feeding Needlesticks 16  6/26/2024 HIV Exposure Risk Chances of HIV infection if you are exposed to HIV infected blood/body fluids: A dirty needle/sharp: 3 in 1000 (0.3%) Mucous membrane splash: 1 in 1000 (0.1%) Non intact skin: 1 in 1000 (0.1%) Prompt antiviral treatment after exposure can reduce risk of infection by 60 – 80% Blood Borne Pathogens Standard OSHA put the standard into force Meant to minimize occupational exposure to blood borne pathogens Requires engineering and work practice controls Requires availability of PPEs Revised to conform to Needlestick Safety and Prevention Act 34 17  6/26/2024 Biohazard Symbol 35 Needle stick Safety And Prevention Act Directed the following revisions of the BBP standard: Revision and updating of the exposure control plan Solicitation of employee input for safety upgrades Modified definitions related to engineering controls New record-keeping requirements 36 18  6/26/2024 OSHA BBP Standard contains: Exposure control plan Occupational exposure to blood borne pathogens Procedure for needle sticks and other exposure incidents Decontamination of surfaces Blood spill cleanup Biohazardous waste disposal 37 Exposure Control Plan BBP standard requirement includes Exposure determination Methods of implementation and compliance Hepatitis B vaccine and post-exposure follow-up Communication of hazards to employees Record keeping 38 19  6/26/2024 Occupational Exposure to Blood Borne Pathogens Can happen if any of the following occur: Skin pierced by a contaminated needle or sharp object Blood or body fluid splashed into the eye, nose, or mouth Blood or body fluid comes in contact with cut, scratch, or abrasion A human bite breaking the skin 39 Exposure Plan WHAT DO I DO…. 40 20  6/26/2024 Post Exposure Plan for Students Exposure is defined as a needle stick, splashing mucous membranes, or contamination of ANY break in the skin with contaminated fluids. 1. Wash the wound thoroughly and immediately. 2. Contact the instructor and fill out an Incident Report Form detailing event on the SAME DAY as the event. 3. If possible, have the person’s blood with which you have been exposed tested for HIV, hepatitis B (HBV) and hepatitis C (HCV). 4. Instructor will forward the report to the Infection Control Officer, Christine Yarbrough 5. Fill out Student Consent Form for Testing and the instructor will forward to Infection Control Officer 41 Post Exposure Plan for Students 6. Go to nearest physician or immediate care facility to have your baseline laboratory testing done for the following tests: Hepatitis B; Hepatitis C and HIV 7. Infection Control Officer, Dr. Yarbrough will follow-up with student for further testing 42 21  6/26/2024 Post Exposure Summary Initially, decontaminate and report incident to supervisor Medical evaluation involves Employee or student tested for HIV, Hep B and C Source patient tested for HIV; Hep B & C if patient permits Given immune globulin, if patient not tested or HIV+ Counseled and tested at periodic intervals, if patient HIV+ Employee alerted about acute viral symptoms within 12 weeks of exposure 43 Physical Forms Infection control programs also monitor employee health programs Primary objective is to minimize risk of infection to patients Employees and students are screened for the following diseases before allowed in the facility Measles Mumps Tuberculosis Hepatitis Chicken pox If students are not immune, they must be immunized 44 22  6/26/2024 Biohazard Cleanup and Disposal Decontamination with 1:10 bleach or EPA-approved disinfectant Gloves must be worn during cleanup Large blood spills need clay or chlorine-based powder Concentrate on absorbing and keeping it from spreading Finally, wipe area with disinfectant 45 What are Airborne Pathogens Airborne pathogens are disease causing microorganisms that may be spread through the air. Mycobacteria (M. tuberculosis, M. africanum, and M. bovis can cause Tuberculosis or other similar diseases. 23  6/26/2024 Mode of Transmission TB mycobacterium can be spread when an individual with an active infection coughs or sneezes expelling tiny particles into the air. c Depending on the environment, these droplets may be suspended in the air for several hours.. Transmission may occur if another individual inhales these droplets. Mode of Transmission Transmission is contingent upon the following conditions:. 1. Length of exposure 2. The environment in which exposure occurred 3. How contagious the infected individual is 24  6/26/2024 Symptoms of TB Infections The general symptoms of active TB disease include Unexplained weight loss Loss of appetite Night sweats Fever Fatigue Chills The symptoms of TB of the lungs include Coughing for 3 weeks or longer Hemoptysis (coughing up blood) Chest pain Exposure One must understand that inhaling droplets does not automatically=infection.. The majority of droplets end up in the upper respiratory tract where infection is not likely to cultivate.. The mycobacterium bacilli must reach the alveoli of the lungs for an infection to occur. 25  6/26/2024 TB Exposure In the event that an exposure has occurred, contact the Exposure Control Coordinator, Dr. Christine Yarbrough at 770-732-5926.. Fill out an Accident/Incident Report form detailing the exposure. Diagnosis of Infection A tuberculin skin test (PPD)is the first method utilized in determining TB infection.. Individuals born outside of the U.S. may have received a BCG vaccine which will generate a positive PPD.. If the tuberculin test comes back positive, sputum smears, a chest x-ray or possibly CT scan may be required to determine whether or not the infection is active. 26  6/26/2024 Latent Infection Persons with latent TB infection do not feel sick and do not have any symptoms. They are infected with M. tuberculosis, but do not have active TB disease. The only sign of TB infection is a positive reaction to the tuberculin skin test or special TB blood test. Persons with latent TB infection are not infectious and cannot spread TB infection to others. Active Infection In some people, TB bacteria overcome the defenses of the immune system and begin to multiply, resulting in the progression from latent TB infection to active TB disease. This can occur soon after infection or years later when the immune system becomes weak. Persons with active TB disease are considered infectious and may spread TB bacteria to others. If TB disease is suspected, persons should be referred for a complete medical evaluation. If it is determined that a person has active TB disease, therapy is given to treat it. TB disease is a serious condition and can lead to death if not treated. 27  6/26/2024 Drug Therapy for Active Infections If you have active TB disease, you will need to take several different medicines. This is because there are many bacteria to be killed. Taking several medicines will do a better job of killing all of the bacteria and preventing them from becoming resistant to the medicines. The most common medicines used to treat TB are isoniazid (INH) rifampin (RIF) ethambutol pyrazinamide 28