Blood borne pathogens in Surgical Practice.pdf

Blood borne Pathogens in Surgical Practice Dr. OI Aisuodionoe-Shadrach  Blood borne Pathogens Any pathogenic microorganisms or OPIM (other potentially infectious materials) present in human blood that can cause disease in humans. Examples include: Hepatitis B virus (HBV), Huma...

Blood borne Pathogens in Surgical Practice Dr. OI Aisuodionoe-Shadrach  Blood borne Pathogens Any pathogenic microorganisms or OPIM (other potentially infectious materials) present in human blood that can cause disease in humans. Examples include: Hepatitis B virus (HBV), Human Immunodeficiency virus (HIV), Hepatitis C virus (HCV), and other blood borne pathogens  Other Potentially Infectious Materials (OPIM) Synovial, pleural, Any unfixed tissue or pericardial, and organ from a human peritoneal fluid Any body fluid visibly Cerebrospinal fluid contaminated with Semen blood Vaginal secretions All body fluid where it is Amniotic fluid difficult to distinguish between body fluids Saliva (in dental procedures) Cell or tissue cultures that were HIV or HBV infected  Job descriptions associated with possible Blood borne Exposure Drawing/processing blood/body fluids Working in an area where HIV or HBV is produced or research is being performed Cleaning glassware or disposing of waste contaminated with blood or OPIM Transporting blood or OPIM Working in a laboratory area where equipment or work benches can become contaminated either by a spill or accident Handling laundry, spills or containers of infectious wastes First aid, removing bandages Job classifications in the hospital who may have occupational exposure to BBP: MD’s, Residents, Security Personnel Interns, PA’s Laboratory Staff Nursing Staff: RN's, Housekeeping NA's Facilities services staff Scientific Department Personnel Laundry staff  Blood borne Pathogens Standard Exposure Control Plan updated once a year with input from staff Hepatitis B vaccine Follow-up protocol after a blood borne exposure Safety devices and PPE  The BBP Standard applies to all employers with employees with reasonably anticipated occupational exposure to blood or OPIM. The Needle stick Safety and Prevention Act modified the Blood borne Pathogens standard expand the requirement that employers identify, evaluate, and make use of effective safer medical devices  Modes of transmission of BBP Percutaneous - the direct inoculation of infectious material by piercing through the skin barrier (needle stick or other accidental injury with a sharp, contaminated object) Direct inoculation - exposure of blood or OPIM to pre-existing lesions, cuts, abrasions, or rashes (dermatitis) provides a route of entry into the body. Mucous membrane contact - splashing blood or serum into an individual's unprotected eyes, nose, or mouth  Penetration by contaminated sharps is the most common mode of transmission of blood borne pathogens in the workplace.  Hepatitis B Virus (HBV) Hepatitis B is caused by a virus that attacks the liver and can cause lifelong infection, cirrhosis, liver cancer, liver failure, or death. In 2003, an estimated 73,000 people were infected with HBV. People of all ages get hepatitis B and about 5,000 die per year of sickness caused by HBV.  About 30% of infected persons have no sign or symptoms of HBV. If symptoms occur, they usually begin to appear on the average of 12 weeks (range 9-21 weeks) after exposure to hepatitis B virus. If you have symptoms, they might include: jaundice abdominal discomfort dark urine clay-colored bowel movements joint pain fatigue loss of appetite nausea  HBV IS PREVENTABLE! A safe & effective vaccine is available. If the vaccine is administered before infection, it prevents the development of the disease and the carrier state in almost all individuals. Hepatitis B vaccine consists of a series of three injections – initial, one a month later, and one six months from the first. Available FREE of charge from employer for high-risk employees  HIV HIV (human immunodeficiency virus) is the virus that causes AIDS (Acquired Immune Deficiency Syndrome). Once a person has been infected with HIV, it may be many years before AIDS actually develops. HIV kills or damages cells in the body’s immune system, gradually destroying the body’s ability to fight infection and certain cancers.  As of December 2001, occupational exposure to HIV has resulted in 57 documented cases of HIV seroconversion among healthcare personnel (HCP) in the US. The average risk for HIV transmission after a percutaneous exposure to HIV-infected blood has been estimated to be approximately 0.3%. HIV does not survive well outside the body, making the possibility of environmental transmission remote.  Some infected with HIV have no symptoms for up to ten years. Within a month or two after exposure to the virus some experience flu-like illness such as: fever, headache, fatigue, weight loss, diarrhea, night sweats, enlarged lymph nodes These symptoms usually disappear within a week to a month and are often mistaken for those of another viral infection. During this period, the individual is very infectious.  HCV Hepatitis C virus (HCV) is a liver disease After a needle stick or sharps exposure to HCV positive blood , about 1.8% healthcare workers will get infected with HCV. Recent studies suggest that HCV may survive on environmental surfaces at room temperature at least 16 hours, but no longer than 4 days. 80% of infected persons with HCV may have no signs or symptoms. If they do, it may include jaundice abdominal pain fatigue loss of appetite dark urine nausea Occupational Exposure Prevention The risk of occupational exposure can be minimized or eliminated using a combination of engineering and work practice controls, personal protective clothing and equipment, training, medical surveillance, warning signs or labels, and other provisions described in this next section.  Standard Precautions Guidelines to decrease the risk of occupational exposure to blood or body fluids A system of infection control which assumes that every direct contact with body fluids is infectious and requires every employee exposed to direct contact with body fluids to be protected as though such body fluids were infected with a blood borne pathogen Provides adequate protection against blood borne infections from both humans and animals  Engineering Controls means controls (e.g., sharps disposal containers, self-sheathing needles or shielded needle devices, needleless devices, blunt needles, plastic capillary tubes) that isolate or remove the blood borne pathogens hazards from the workplace. Work Practice Controls means controls that reduce the likelihood of exposure by altering the manner in which a task is performed such as prohibiting recapping of needles by a two-handed technique.  Engineering and Work Practice Controls The employer must: – Evaluate available engineering controls (safer medical devices) – Train employees on safe use and disposal – Implement appropriate engineering controls/devices  Personal Protective Equipment (PPE) Gloves (latex or nonlatex) – When to use them: when there is reasonable anticipation of employee hand contact with blood, OPIM, mucous membranes, or non-intact skin when handling or touching contaminated surfaces or items.  Gowns, aprons, fluid-resistant clothing Face shields, eye protection (safety glasses, goggles) Surgical mask and/or N-95 respirator Surgical caps, shoe covers  Even though the use of PPE is very important in controlling exposure to BBPs, it is your last line of defense against exposure if engineering and work practice controls fail. Do not rely only on PPE for protection.  Housekeeping- Sharps disposal keep sharps container upright and readily available for use NEVER place sharps into regular trash Use leak-proof, puncture resistant sharps container with a biohazard label DO NOT OVERFILL- dispose sharps container when 2/3rd full  Training All employees with occupational exposure risk participate in a training program initially when assigned to the task and thereafter annually  Warning signs and Labels Provide fluorescent orange or orange-red label with the word BIOHAZARD on the following: 1. Containers of regulated waste 2. Refrigerators used to store blood/OPIM 3. Containers used to store or transport blood/OPIM 4. Contaminated equipment  What is the difference between cleaning and disinfecting? Cleaning and disinfecting are not the same thing. In most cases, cleaning with soap and water is adequate. It removes dirt and most of the germs. You should disinfect areas where there are both high concentrations of dangerous germs and a possibility that they will be spread to others. Disinfectants, including solutions of household bleach, have ingredients that destroy bacteria and other germs.  Exposure Control Plan The ECP must be updated annually to include: changes in technology that reduce/eliminate exposure annual documentation of consideration and implementation of safer medical devices solicitation of input from non-managerial employees  Employee Responsibilities Completing training/orientation as required Following the Exposure Control Plan and the Standard Precautions Policy Using work practices, engineering controls, and personal protective equipment as outlined in the Exposure Control Plan Obtaining the HBV vaccine or signing the declination form  Reporting exposure incidents to their supervisor and assisting the supervisor in completing First Report of Injury/Illness and EPINet Forms Pursuing follow-up care after an occupational exposure  Record keeping Keep a sharp injury log 1. Type of device involved and incident description Training Records for 3 years Confidential Medical Records for the period of employment + 30 years after. Where to go and what do I do if exposed to blood borne pathogens?  Any blood borne pathogens exposure incident is an event for which immediate attention must be sought, as the effectiveness of prophylaxis depends on the immediacy of its delivery. Seek medical attention in the same manner that it would be sought should any occupational injury occur (e.g., emergency room, physician's office, urgent care clinic).  What to do post-exposure Wash exposed area with soap and water for 5 minutes- if eye or mucous membrane is involved, flush with sterile water or normal saline for 5 minutes Report incident to supervisor Report for medical evaluation  It is VERY important to bring the patient’s source blood (if available) with you when you report for initial evaluation. Your care is dependent on the HIV, HBV, and HCV status of the source patient to whom you were exposed. Similarly, when dealing with nonhuman primates it is important to note which monkey was the source for the bite/scratch to allow for proper evaluation of infection in the source animal.