Blood Borne Pathogens

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Blood Borne Pathogens Standard Precautions

• CREATED BY
• JAYNE LUTZ
• Edited 7/06, 7/07

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Major Blood Borne Pathogens

• HIV
• HEP B
• HEP C

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Hepatitis B

• Immunized per UNCG SON policy
• No routine booster recommended for series
  completed prior to 1999
• Have a titer drawn only if exposed
• If titer low then get a booster
• Repeat titer
• If titer remains low after booster-
• Repeat the entire series x 1

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HBV (Continued)

• Receiving Immunization Series for the First time
  after 2000
• Get test for surface antigen 1-2 mo after series
  completed-do not wait longer or you may not get
  accurate results!
• If this is negative repeat series
• Repeat the titer again in 1-2 mo
• If negative again, do not repeat series..you
  are most likely protected but do not sero-convert

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HBV (Continued)

• Can be transmitted to the newborn at time of
  delivery
• Immunization given to newborns and 6th graders.
  NC initiative for 6th graders completed. More
  then 500,000 6th graders
• vaccinated in
• past decade.

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Hepatitis C

• No immunization available
• Can live in a drop of dried blood for as long as
  30 days-HIV lives outside the body for only a few
  seconds
• At least 40 million Americans infected-epidemic
  stage in the US

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Hepatitis C (Continued)

• Develops into a chronic infection in 75 of all
  infected persons
• Estimated that HEP C will actually cause more
  deaths in the USA than AIDS in the next decade
• HCV related deaths will most likely double or
  triple in the next 10-20 years.
• Many with chronic disease are now in the 40-65
  age range.

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Hepatitis C (Continued)

• Treatment Between 40-80 successful. Success
  and length of treatment depends on the point when
  treatment begins and the specific strain. More
  successful if started early in the course of the
  disease.
• Interferon alfa-2a 2b (Pegasys-injection)
  and
• Ribavirin (Copegus and Rebetol-oral meds)
• Liver transplantation is the only treatment for
  decompensated cirrhosis from Hep C

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Hepatitis C (Continued)

• Hepatitis C is the major
• cause of liver cancer

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Hepatitis CThe Course of the Disease

• Acute infection rarely recognized
• Acute stageflu-like symptoms or no symptoms
• Evolution from acute phase to cirrhosis usually
  requires decades average time is 20-30 years
• When disease discovered, damage to the liver has
  most likely occurred.

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Recommendation for HCV

• If you are a nurse with an exposure history
• get tested.
• If you have any of these risk factors get
  tested.
• Injection drug use
• Blood transfusion before 1982
• Use of blood clotting components before 1987
• Tatoos/piercings with questionable sterile
  technique
• Occupational exposure to blood
• Sexual contact with an infected partner (risk
  less)

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Hepatitis C The Good News

• There has been a recent decline in diagnosed new
  cases
• Hepatitis C is rarely spread from the mother to
  the baby at time of delivery

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HIV-Interesting Facts

• Adolescents show the most rapid increase in HIV
  at present (age 15-24)
• The number of older adults who are infected has
  been rapidly increasing
• NC ranks 10 in the US for the rate of persons
  contracting HIV

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HIV

• What is your risk?

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HIV

• Less than 1 seroconversion rate for health care
  professionals if exposed to a know HIV positive
  source.

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HIV Interesting Facts, cont.

• NC is ranked 16 in the US for the number of
  reported cases
• Atripla-a once daily pill approved for treatment
  in July 2006 is a combination of 3 common drugs
  in the cocktail
• Go to http//www.atripla.com for info on this
  medication

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Standard Precautions

• A set of precautions designed to prevent
  transmission of HIV, HBV, and other blood borne
  pathogens
• Blood and certain body fluids of all patients are
  considered potentially infectious
• Universal precautions are actually a part of what
  is now referred to as Standard Precautions.

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Standard Precautions

• Standard Precautions were developed for hospitals
  and expand on Universal Precautions (developed in
  the 1980s)
• with minor changes.
• Additional categories of Airborne, Droplet
  Contact Precautions have been developed-Transmissi
  on Based Precautions.

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Does the Change to Standard Transmission-Based
Precautions Make Any Difference in Care?

• No.
• Continue to practice Universal Precautions you
  will be compliant with Standard Precautions!

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Potentially Harmful Body Fluids with
Universal/Standard Precautions

• Blood Semen
• Vaginal Secretions Pleural Fluid
• Cerebrospinal Fluid Synovial Fluid
• Synovial Fluid Pleural Fluid
• Peritoneal Fluid Pericardial Fluid
• Amniotic fluid

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Fluids to Which Universal/Standard Precautions Do
Not Apply Unless Blood is Visible

• Urine
• Saliva-except in
• dental situations
• Breast milk
• only in large quantities (breast milk bank or
  dental work)

• Feces
• Nasal secretions
• Sputum
• Sweat
• Tears
• Vomitus

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Protect Yourself

• Gloves
• Gown
• Apron
• Masks
• Hand washing
• Safety precautions with sharps
• Eye shields

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Biohazard Areas

• Items/
• Activities
• not allowed
• Drink
• Food
• Cosmetics
• Lip balm

• The handling of contact lenses

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!!!! EXPOSED !!!!

• ?????????????????????????????????????????????????
  ??????????????????????????????????????????????
• What do you do?

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Course of Action

• Flush the exposed area with water
• Report to faculty-preceptor
• Seek counseling/care according to
• (1) Location
• If treatment is needed, treatment should
  start 1-2 hrs after exposure

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Course of Action, (Continued)

• (2) The location of your treatment is your
  choice
• Your clinical site if they have agreed have the
  medication you may need
• Your personal physician
• Gove Student Health Center
• M-F 8a-8p Sat. 9-12 Sun. 5-8.
• Phone [phone]

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Phone Calls You Need to Makeif You Are Exposed

• Gove Student Health Center 334-5230
• If you receive your counseling at this site, they
  will contact Moses Cone and facilitate care for
  you there if they determine you need treatment.
• Notify the Medical Director of the Gove Student
  Health Center even if you did not go to this
  facility. The Health Center may want to perform
  follow-up blood work.
• Notify the OSHA Trainer of the School of
  Nursing. 336-334-5238.

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Why Counseling?

• To determine if an exposure actually occurred
• To determine the risk status of the source
• To determine your risk status

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Care You May Need

• Baseline blood test for you and the source HBV,
  HCV, HIV
• If source known HIV positive your risk status
  warrants
• 4 weeks of zidovudine 600mg qd lamivudine
  150mg bid for a low risk exposure (small amount
  of blood and no deep puncture)
• Expanded exposure large volume of blood
  and/or high titer in source blood deep
  puncture
• basic treatment plus either indiavir 800 me q 8
  hr or nelfinavir 750 mg tid

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Who Pays for Your Care?

• You are responsible
• You should be covered by health insurance which
  all students are now required to have.

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MSDS

• What are these and why are they important to you?

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MSDS

• Material Safety Data Sheets
• information
• All hazardous supplies in a clinical site have
  such a sheet
• The sheet explains the procedure to follow if you
  are exposed to the product
• Read all MSDS information and sign the student
  list at the beginning of the semester
• This is required by OSHA in the Health Centers
  and performance labs

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HIPAA

• Health Insurance Portability and Accountability
  Act
• A Federal Law that sets standards to protest a
  patients health information
• Standards protect the use and sharing of verbal,
  written, and electronic patient information

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What is Protected Health Information-PHI?

• Information that
• Identifies the individual
• Relates to the patients health, treatment or
  payment plan
• Is kept or released
• Electronically
• On paper
• Orally

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Why is Privacy Important?

• Patients have a right to privacy
• Violation of patients privacy (confidentiality)
  can affect the personal lives and careers of
  patients
• It is your job to protect patient privacy

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What is Your Role with HIPAA?

• Keep oral, written, printed, electronic reports
  private and secure
• Keep telephone calls confidential
• Protect computer passwords
• Remove patient names or other identifying
  information before throwing away papers
• The best action is to shred all such papers.

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Information May Be Given Out Without Prior
Consent For

• Some medical emergencies as life or death no
  one is available to give consent
• Abuse neglect. Healthcare workers follow legal
  guidelines for reporting this information
• Subpoenas or court orders

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Information Given Out Without Prior Consent,
continued.

• Communicable disease. Certain diseases must be
  reported to Public Health Agencies.
• To verify medical treatment for insurance claims
  including Medicare payments.

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Questions or Concerns?
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WEB SITES

• http//www.cdc.gov/ncidod/hip/Blood/UNIVERSA.HTM
• http//aepo-xdv-www.epo.cdc.gov/wonder/prevguid/p0
  000255/p0000255.asp

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THE END