Bloodborne Pathogen Awareness And Prevention

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Bloodborne Pathogen Awareness And Prevention
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Bloodborne Pathogen Awareness And Prevention
By Richard C. Lavy, M.D. Chief, Division Of
Health And SafetyUnited States Coast Guard
Auxiliary
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Risk Assessment And Management

• Identify the hazard
• Identify the mission task
• Assess the risks
• Identify the options
• Evaluate the risk VS gain
• Execute your decision
• Monitor the situation

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Risk Assessment And Management The Hazard

• A substance that may contain a
• bloodborne pathogen
• Blood
• Semen
• Vaginal secretions
• Pus
• Amniotic fluid

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Risk Assessment And Management The Mission

• Report of the incident
• Arrival on scene
• Grossly bloody scene
• Airway management
• Emergency childbirth
• Scene and equipment cleanup

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Risk Assessment And Management The Risk

• Tasks and activities that may involve exposure to
  potentially infectious material
• Consider ALL body substances as potentially
  infectious
• Diseased persons may have NO symptoms

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Items To Understand (Each Discussed Later)

• Modes of exposure and transmission
• Epidemiology and symptoms
• Exposure control plan
• Universal precautions
• Engineering controls
• Work practices

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Items To Understand (Continued) (Each Discussed
Later)

• Exposure control plan (cont.)
• Personal protection equipment
• Selection
• Types
• Decontamination
• Handling
• Disposal
• Reporting exposures

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Modes Of Exposure and Transmission

• Percutaneous (through the skin)
• Stick by needle or other sharps
• Splash on rash, sore, cut, or scratched skin
• Mucocutaneous (through a mucous membrane)
• Splash into eyes, nose, or mouth
• Sexual contact

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Modes Of Exposure and Transmission Chain Of
Infection

• Infectious agent (virus, bacteria)
• Reservoir (infected person)
• Means of exit (cut, burn, weeping rash)
• Mode of transmission (cleat, screw driver,
  needle)
• Means of entry (puncture wound, rash)
• Susceptible host (YOU)

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Epidemiology and symptoms Hepatitis B and
Hepatitis C

• Inflammation of the liver
• Millions of carriers in U.S.
• Carriers are infectious and may
• develop serious liver diseases
• Cirrhosis (scarring of liver)
• Liver cancer
• Most persons recover

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Hepatitis B (The Virus)

• Incubation period long 45 to 160 days
• Fatality rate about 1.4
• Spread mostly via blood, vaginal fluids, semen,
  saliva from a bite

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Hepatitis B (The Virus)

• Chance of infection after a stick
• 6 to 30
• Survival outside the body
• 7 days or longer
• Vaccine available

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Hepatitis BDiagnosis and Treatment

• Diagnosis
• Clinical signs and symptoms
• Laboratory tests
• Treatment
• Supportive (fluids, nourishment)
• Prevention
• Interrupt chain of infection
• Immunization

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Epidemiology and symptoms Human Immunodeficiency
Virus

• Disease AIDS (Acquired Immunodeficiency
  Syndrome)
• Incidence Over 1 million persons infected in
  U.S.
• Infection rate increasing (fewer dying)
• Spread mostly via blood, semen, and vaginal
  secretions

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Human Immunodeficiency Virus

• Chance of infection after stick less than 1
• Survival of virus outside body short time
• Vaccine not available

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Acquired Immunodeficiency Syndrome (AIDS)

• Onset usually insidious- may not develop for 10
  years after infected with HIV
• May be prevented by immediate prophylaxis
  (treatment)

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AIDSSigns and Symptoms

• Non-specific (mono-like illness)
• Swollen lymph glands
• Chronic diarrhea
• Weight loss
• Fever
• Tuberculosis suggestive

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AIDSDiagnosis

• Clinical findings
• Blood tests

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AIDSTreatment

• Drug treatment immediately after exposure may
  prevent development of AIDS
•  
• Death now no longer inevitable

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AIDSPrevention

• Interrupt chain of infection
• Immediate prophylaxis
•  

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 Exposure Control Plan Methods Of Compliance

• Prevent contact with blood or other potentially
  infectious materials (Universal precautions)
• ALL body fluids should be considered potentially
  infectious

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Exposure Control Plan Engineering Controls

• Devices which prevent contact
• Gloves
• Other personal protection equipment
• Isolation and containment supplies
• Handwashing facilities
• Sharps containers
• Medical waste containers

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Exposure Control Plan Work Practices

• Wash hands (even after using gloves)
• Do not bend, break, or recap needles (sharps)
• Do not eat, drink, smoke, apply cosmetics or lip
  balm, or handle contact lenses
• Avoid causing splashes or splatters
• Properly handle contaminated materials

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Exposure Control Plan Personal Protection
Equipment

• Gloves
• Gowns or laboratory coats
• Face shields or masks
• Eye protection
• Mouthpieces, pocket masks
• Resuscitation bags
• Other ventilation devices

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Exposure Control Plan Personal Protection
Equipment (cont.)

• Must be readily accessible
• Kits
• Gloves
• In personal flotation device (PFD)
• In film canister in PFD
• Hypoallergenic gloves available if allergic to
  latex

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Exposure Control Plan Personal Protection
Equipment (cont.)

• Cleaning, laundering, and disposing (hospital)
• Replace
• If defective (inspect regularly)
• Immediately after use
• Different patient
• Disposable

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Exposure Control Plan Housekeeping

• Maintain worksite in clean and sanitary condition
• Determine implement cleaning schedule
• Determine method of decontamination
• 110 dilution household bleach (sodium
  hypochlorite)

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Exposure Control Plan Housekeeping (Cont.)

• Clean all equipment surfaces after
  contamination occurs (deck, cleats, chafing gear,
  survival equipment)
• Use personal protective equipment
• Inspect bins, pails, cans, similar receptacles
  never insert hands
• Broken glassware (use mechanical means)

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Exposure Control Plan Laundry

• Handle contaminated laundry as little as possible
  using universal precautions
• Bag contaminated laundry place in appropriate
  container
• Labeled biohazard
• Color coded
• Fluorescent orange
• Orange-red

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Exposure Control Plan Laundry (Cont.)

• Laundry (per local protocol)
• Approved laundry facility
• Use CDCP or manufacturers recommendations
• Detergent
• 71 degrees Celsius (170 degrees Fahrenheit) 25
  minutes

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If Not Adequately Equipped

• Leave the area
•  
• Notify controlling authority

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If Contaminated Or Punctured

• Decontaminate
• Wash
• Document circumstances
• Route of exposure
• Source
• Intensity
• Duration of exposure

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If Contaminated Or Punctured

• Notify
• Operational commander
• Medical personnel immediately

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Personal Protection Equipment - Donning

• (See Appendix for technique)
• Gloves - Used alone when
• minimal risk of exposure exists

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Personal Protection Equipment - Donning

• (See Appendix for technique)
• Extensive protection when greater
• risk of exposure exists
• Mask and eye
• protection
• Gown
• Shoe covers
• Gloves

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Personal Protection Equipment

• Make Sure Contaminated Apparel Does Not Come
  Into Contact With Clothing or Skin

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Personal Protection Equipment

• Do not cross contaminate
• Use different gloves and other PPE when treating
  another patient

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Personal Protection Equipment - Removal

• Carefully
• (See Appendix for technique)
• Shoe covers
• Gown /gloves
• Gloves
• Head cover
• Mask and eye shield

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Biohazard Waste Bag

• Able to be closed
• Leakproof
• Labeled and/or color coded
• Do not contaminate outside of bag
• Secure opening by knotting

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Personal Protection Equipment - Disposal

• State regulations
• Civilian emergency medical responders
• Local hospital

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Hand Washing

• After ANY contact (even if gloves have been worn)
• Lather with soap
• Vigorous rubbing of all surfaces
• 15 seconds minimum

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Hand Washing (Cont.)

• Antiseptic towelette
• Wipe all surfaces
• Dispose of in trash
• Wash when facilities available

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Reports

• Radio
• Written
• Medical information
• Exposure
• Extent
• Duration
• Breakdown in protection
• Care rendered

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Post-exposure

• Evaluation and follow-up if ANY exposure
• Prophylaxis DO NOT DELAY

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Summary

• Are you trained?
• Are you equipped?
• If no
• Notify station
• Do not become a victim

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Summary (Cont.)

• If yes
• Respond
• Monitor the situation
• Inform station of all activities
• Record all that transpires
• Activate appropriate resources

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Reference

• COMDTINST M6220.8
• Prevention of Bloodborne
• Pathogen transmission
•  

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Appendix

• Techniques for Donning and Removing Personal
  Protection Equipment

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Personal Protection Equipment Donning and
Removal

• The following slides describe techniques for
  donning and removing BBP Personal Protection
  Equipment.

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Personal Protection Equipment - Donning

• Gloves
• (Used alone when minimal risk of exposure exists)
• Remove jewelry
• Insert hands
• Pull upward from cuff
• Pull glove over garment cuff

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Personal Protection Equipment - Donning

• The following directions are for donning the
  contents of a complete Personal Protection
  Equipment kit when a high risk of exposure exists.

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Personal Protection Equipment - Donning

• Mask and Eye Protection
• Open mask/visor by gripping top and bottom and
  opening pleated area
• Place ear loops over each ear
• Pull bottom of mask under chin
• Bend nosepiece to conform over nose

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Personal Protection Equipment Donning (cont.)

• Mask and Eye Protection

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Personal Protection Equipment - Donning

• Gown
• Slide arms into gown
• Tie strings in shoelace bow

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Personal Protection Equipment - Donning

• Shoe Covers
• Insert entire shoe until covered and snug
• Be very careful to avoid slipping

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Personal Protection Equipment - Donning

• Gloves
• Remove jewelry
• Insert hand
• Pull glove upward
• from cuff
• Pull glove over garment cuff

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Personal Protection Equipment - Removal

• The following slides describe the techniques for
  removing BBP Personal Protection Equipment

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Personal Protection Equipment - Removal

• Gloves (When used alone)
• With right hand, grasp
• left glove 2 inches below
• cuff
• Partially remove left glove
• by inverting it until only
• prior inside is visible

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Personal Protection Equipment Removal (cont.)

• Gloves (When used alone)
• With partially gloved left hand, grasp right
  glove 2 inches
• below the cuff edge
• Partially invert right
• glove until only fingers
• are visible

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Personal Protection Equipment Removal (cont.)

• Gloves (When used alone, cont.)
• With fingers of right hand,
• hold and remove left glove,
• encasing it in right glove
• Grasp inside of right glove
• with fingers of left hand
• and remove right glove

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Personal Protection Equipment Removal (cont.)

• Gloves (When used alone)

Dispose of gloves in biohazard waste bag
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Personal Protection Equipment - Removal

• (When a complete PPE kit has been used)
• Remove Carefully
• Deposit each component in biohazard waste bag
• First Shoe Covers

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Personal Protection Equipment Removal (cont.)

• Gown/Gloves
• With right hand, firmly grasp left wrist area of
  glove and gown

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Personal Protection Equipment Removal (cont.)

• Gown/Gloves (Cont.)
• Withdraw left hand
• Slide left arm out of gown
• Untie tie-strings
• with left hand

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Personal Protection Equipment - Removal (cont.)

• Gown/Gloves (Cont.)
• With left hand, grasp inside of right shoulder
  of gown and remove, turning right sleeve inside
  out to wrist

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Personal Protection Equipment - Removal (cont.)

• Gown/Gloves (Cont.)
• With left hand, grasp inside right wrist
• area of glove and gown and remove
• right hand

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Personal Protection Equipment - Removal (cont.)

• Gown/Gloves (Cont.)
• Roll gown carefully, touching only clean, inside
  surface
• Deposit in biohazard bag

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Personal Protection Equipment - Removal

• Mask and Eye Protection
• Remove after all other clothing
• Grasp earloops or untie strings with both hands

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Personal Protection Equipment - Removal (cont.)

• Mask and Eye Protection (cont.)
• Deposit in biohazard bag

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Personal Protection Equipment

• Make sure contaminated apparel does not come into
  contact with clothing or skin
• Dispose of properly

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Bloodborne Pathogen Awareness And Prevention

• Edition 14 January 2003