Bloodborne Pathogens

1
Bloodborne Pathogens

• Jill Cranmore
• Director, Human Resources
• Danville Area Community College
• 2000 E. Main St.
• Danville, IL 61834
• 217-443-8756
• schlecht_at_dacc.edu

2
Bloodborne Pathogens

• Occupational exposures to bloodborne and other
  pathogens and consequent infection can occur not
  only as the result of accidents, but also during
  the performance of routine work activities.
  Therefore, it makes good sense to plan your work
  with regard to the basic principles of biosafety.

3
Bloodborne Pathogens

• Part I
• The Infectious Disease Process

4
Bloodborne Pathogens

• Microorganisms include the following
• classifications
• Bacteria
• Viruses
• Fungi
• Algae
• Yeasts
• Protozoa
• These microorganisms are too small to be seen by
  the unaided human
• eye.
• They are found in the soil, in the water,
• and on plants and animals. In fact,
  billions
• are found in humans on the skin and in
• both the nasal and intestinal tracts.

5
Bloodborne Pathogens

• Although most microorganisms live in
• harmony with the human body, somecalled
• pathogenscan infect the body and cause
• disease. Infectious diseases range from mild
• illnesses, such as a cold, to fatal illnesses,
• such as AIDS.

6
Bloodborne Pathogens

• We occasionally come into contact with people or
  animals that are infected and thus expose
  ourselves to the pathogens of their diseases. In
  fact, our environment is such that everyday we
  live with some risk of exposure to diseases.

7
Bloodborne Pathogens

• Some individuals, because of the work they
• do, are at risk for occupationally acquired
• infection. For this reason, DACC has
• developed training and procedures to help
• minimize your health risks.
• This training program will cover
• the infectious disease process
• potential exposure risks to employees
• work practices that will minimize your risk of
  exposure to pathogenic microorganisms
• Let's start by exploring the infectious disease
  process.

8
Bloodborne Pathogens

• The infectious disease process is defined as the
  interaction between the pathogenic microorganism,
  the environment, and the host. The process may
  be thought of as a circular chain with six links.
  

The following story illustrates the chain
9
Bloodborne Pathogens

• The chain begins with the
• existence of a specific
• pathogenic microorganism.
• The second link is the
• reservoir, an environment
• where the pathogen can
• survive.

10
Bloodborne Pathogens

• The third link is the
• means of escape
• from the reservoir.
• The fourth link is the
• mode of transmission
• from the reservoir to
• the host.

11
Bloodborne Pathogens

• The fifth link is the means
• of entry into the host.
• And the last link is the
• host's susceptibility to
• the pathogenic
• microorganism.

12
Bloodborne Pathogens

• For an infectious disease to occur, each link in
  the chain must be connected.

13
Bloodborne Pathogens

• If even one link of the chain is missing, it
  interrupts the process, and no infection will
  occur. Here the chain is broken at the point of
  host susceptibility.

14
Bloodborne Pathogens

• Here the mode of
• transmission breaks
• the chain of infection.
• Before looking at the infectious disease process
  for several different illnesses, see if you can
  correctly answer the following question

15
Bloodborne Pathogens

• The chain of infection illustrates?
• A. Contact with a pathogen means
• you will become fatally ill.
• B. Every link in the chain must
• be broken to prevent infection.
• C. You can prevent infection by
• interrupting the process anywhere
• in the chain.
• D. All microorganisms are hazardous
• to your health.
• And the answer is

16
Bloodborne Pathogens

• C. You can prevent infection by
• interrupting the process anywhere
• in the chain.

17
Bloodborne Pathogens

• Hepatitis B Virus (HBV)
• The microorganism known as Hepatitis B Virus
  (HBV)
• causes an inflammation of the liver. This can
  result in
• illnesses such as chronic hepatitis, cirrhosis of
  the liver, and
• liver cancer. Because the virus is present in
  the blood or
• body fluids of a person with the Hepatitis B
  Virus, it is termed
• a bloodborne pathogen. Hepatitis B Virus is a
  serious health
• concern for any employee whose work
  responsibilities bring
• them in contact with blood or body fluids.

18
Bloodborne Pathogens

• Human Immunodeficiency Virus (HIV)
• The Human Immunodeficiency Virus (HIV) is another
  
• bloodborne pathogen. This life-threatening virus
  
• compromises the body's immune system. Early
  symptoms
• may be similar to those of the flu. During later
  stages of the
• disease, the body is incapable of warding off
  other infections
• which frequently prove fatal.

19
Bloodborne Pathogens

• Penetration into the Bloodstream
• Bloodborne pathogens are transmitted when an
  individual comes in
• contact with an infected person's blood or body
  fluids. However, contact
• alone does not mean infection will result.
  Pathogens must enter the
• bloodstream to cause infection. In the
  workplace, an employee may be
• exposed to HBV or HIV when infected blood or body
  fluid is
• allowed to enter the body by means of
  penetration.
• This can occur through
• a needle stick
• a cut or break in the skin
• contact with mucous membranes
• such as those of the eye, nose,
• and mouth

20
Bloodborne Pathogens

• Preventive Measures
• To interrupt the chain of infection for HBV or
  HIV, use the following
• preventive measures
• Wash your hands to remove infectious
• organisms before they can enter the body.
• Wear gloves as a barrier when handling
• blood and other body fluids.
• Wear face protection when work tasks
• include the potential for spraying
• or splattering of body substances.

21
Bloodborne Pathogens

• Use caution when handling needles or
• other sharp objects. They can penetrate
• the skin and create entries for pathogens.
• The safest way to handle contaminated
• needles or other sharp objects is to place
• them directly into a labeled sharps
• container without recapping. This practice
• minimizes your risk of a needle stick. If
• your work requires you to recap needles,
• you will want to learn a special one-handed
  technique.
• Finally, receive an HBV vaccination to decrease
  your susceptibility to the
• disease. Presently, no vaccine for HIV is
  available.

22
Bloodborne Pathogens

• Preventing infection from bloodborne pathogens
  involves?
• A. Vaccination against HIV.
• B. Preventing blood or body
• fluids from contacting your
• skin or mucous membranes.
• C. Washing your hands before beginning work.
• D. Wearing gloves as a barrier against
• needle sticks.
• The answer is

23
Bloodborne Pathogens

• B. Preventing blood or body fluids from
• contacting your skin or mucous membranes.

24
Bloodborne Pathogens

• Mycobacterium (tuberculosis)
• Another group of pathogens known as
• Mycobacterium cause the chronic lung
• disease tuberculosis (TB). Although
• human beings are the main reservoirs,
• other primates, cattle, and swine can also
• be reservoirs. TB is transmitted
• primarily through the air. A person with
• an active case of TB discharges the
  microorganisms by coughing or
• sneezing.
• Inhalation Exposure occurs when others breathe
  the contaminated air.
• Once inhaled, the pathogen may lodge in lung
  tissue and produce
• lesions.

25
Bloodborne Pathogens

• Preventive Measures
• How then can employees protect themselves from
  airborne diseases such
• as TB?
• If necessary, and risk factors for TB are
• present, wear respiratory protection.
• Screen yourself for exposure to TB by
  receiving a TB skin test.

26
Bloodborne Pathogens

• TB is an airborne disease?
• A. Transmitted by plants.
• That used to be a health concern,
• but is not relevant in the workplace any longer.
  
• C. Prevented by wearing a respiratory mask to
  prevent inhaling contaminated air.
• Prevented by holding your breath.
• The answer is

27
Bloodborne Pathogens

• C. Prevented by wearing a respiratory mask to
  prevent inhaling contaminated air.

28
Bloodborne Pathogens

• Salmonella
• The next disease, salmonellas, is caused by a
  group of bacteria called
• salmonella. The most common manifestation of
  this disease is acute
• gastroenteritis or intestinal inflammation. Both
  animals and humans are
• reservoirs for the salmonella organism. Diseased
  animals and humans
• discharge large numbers of salmonella in their
  feces.

29
Bloodborne Pathogens

• Ingestion
• Infection results from ingesting (i.e., through
  the mouth) salmonella
• organisms. Employees may be exposed to these
  organisms when
• handling soiled diapers and linens, working with
  animals, or cleaning and maintaining restrooms.

30
Bloodborne Pathogens

• Preventive Measures
• You can guard against salmonella exposure by
  incorporating the
• following practices into your daily routine
• As a first line defense against ingesting
• microorganisms, don't put anything in
• your mouth while at work.
• Wear gloves when your hands will
  likely come in contact with
  contaminated materials.

31
Bloodborne Pathogens

• Wipe counters with a disinfectant after
• performing tasks with materials that
• may be contaminated.
• And, thoroughly wash your hands after
• handling potentially contaminated items.
• Even microscopic amounts of fecal matter
• may contain millions of salmonella
• organisms.

32
Bloodborne Pathogens

• Preventing ingestion of salmonella
• organisms involves?
• A. Not washing your hands if they look clean.
• B. Wearing gloves, washing hands, and
  disinfecting work
• surfaces.
• C. Not eating right after work.
• Putting only your own pencils and pens in your
  mouth.
• The answer is

33
Bloodborne Pathogens

• B. Wearing gloves, washing hands, and
  disinfecting work surfaces.

34
Bloodborne Pathogens

• In summary, the infectious disease process
  typically consists of three
• routes of entry
• PENETRATION into the bloodstream, exemplified by
  HBV and HIV
• INHALATION of airborne organisms, illustrated by
  TB and
• INGESTION of organisms, demonstrated by
  salmonella.
• As seen in the examples, occupational exposures
  and consequent
• infection can occur not only as the result of
  accidents but also during the
• performance of routine work activities.
  Therefore, it makes good sense to
• plan your work with regard to the basic
  principles of biosafety.

35
Bloodborne Pathogens

• The best strategy to decrease your risk of
  infection is to?
• A. Enhance your susceptibility
• through proper nutrition.
• B. Not worry about things you
• cannot see.
• C. Rely on vaccination.
• D. Break the chain of infection by using several
  preventive
• measures.
• The answer is

36
Bloodborne Pathogens

• D. Break the chain of infection by using several
  preventive measures.

37
Bloodborne Pathogens

• AT RISK employees continue!
• At risk employee groups include, but are not
  limited to
• Athletic Trainers and Coaches
• Building Services Attendants
• Child Development Center staff
• First Aid / CPR Instructor
• Groundskeeper
• Instructors of Invasive Labs
• Maintenance Mechanics
• Nursing and C. N. A. staff
• Science Lab staff

38
Bloodborne Pathogens

• Part II
• Exposure Control Strategies

39
Bloodborne Pathogens

• The next part of this program will cover exposure
  control strategies that
• include the use of
• universal precautions
• immunization
• good personal work habits
• containment
• personal protective equipment
• decontamination
• emergency procedures for
• accidental exposures

40
Bloodborne Pathogens

• Universal Precautions
• Universal precautions are work practices
• that reduce your risk of exposure to
• pathogens found in blood and body fluids,
• particularly HBV and HIV. A government
• regulation referred to as the "Bloodborne
• Pathogen Rule" requires that employees
• with a risk of occupational exposure receive
  training in universal
• precautions and other safety measures. At-risk
  employees are those
• individuals whose work responsibilities could
  potentially bring them in
• contact with blood and body fluids.

41
Bloodborne Pathogens

• Preventing Accidental Exposures
• Most occupational exposures to bloodborne
  pathogens occur accidentally from
• needle sticks
• injuries from sharp objects
• splashes to the eyes, nose, and mouth
• contact with broken skin
• The following universal precautions are aimed at
  preventing these exposures
• Eliminate the use of needles and sharp
  instruments whenever possible. Choose safer
  alternatives for your work tasks.
• When use of needles and sharps is required, place
  used items directly into a sharps container
  located within easy reach. Remember that
  recapping should be avoided, because it increases
  your risk of needle stick injuries.
• Use only labeled, leak-proof, puncture-resistant
  sharps containers to help avoid accidental
  exposure of co-workers and waste handlers down
  the line.

42
Bloodborne Pathogens

• Wear personal protective equipment such as
  gloves, face shields, eyewear with side shields,
  and gowns to prevent contact with blood and body
  fluids. Properly decontaminate or dispose of
  this equipment after use.
• Wash your hands routinely, even after removing
  gloves. Gloves may have minute holes through
  which fluids can pass.

43
Bloodborne Pathogens

• Immunization
• Finally, decrease your susceptibility to
  infection by being immunized.
• Recommended Vaccines
• HBV for potential exposure to
• blood or body fluids
• Measles, Rubella, Diphtheria,
• Poliomyelitis, and Tetanus for
• anyone who has not been
• vaccinated in childhood
• Tetanus and Rabies for work with animals
• Other vaccines for foreign travel and research
  with pathogens

44
Bloodborne Pathogens

• The HBV vaccine is offered free of charge
• to all employees who may be occupationally
• exposed to blood or other body fluids. The
• vaccine is effective in more than 90 of
• healthy people who receive the series of
• injections. It is administered intramuscularly
• in three doses within a six-month period. The
  most common side effect
• of vaccination is soreness at the injection site.
  
• If you decide against vaccination, you will
• be required to sign a declination form.
  However, you will remain eligible for
  vaccination if you desire it at a later
  time.

45
Bloodborne Pathogens

• Following universal precautions means you should?
• A. Handle every sample as if it
• is infectious.
• B. Use protective equipment
• only when you think the
• sample is from a patient with HBV.
• C. Think about washing your hands and do so when
  you have time.
• Use needles and blades whenever possible.
• The answer is

46
Bloodborne Pathogens

• A. Handle every sample as if it is infectious.

47
Bloodborne Pathogens

• Good Personal Work Habits
• Hand Washing
• Conscientious hand washing is an essential part
  of your daily regimen. Hands routinely come into
  contact with items and materials that may be
  contaminated with pathogens.
• Hands also unconsciously touch the eyes, nose,
  and mouth numerous times throughout the day.
  These body areas are potential portals of entry
  for infectious organisms. Because of these
  factors, it is extremely important to wash your
  hands frequently.
• Wash hands immediately if you contact potentially
  contaminated material.
• Wash them after
• handling infectious waste, even if it is properly
  contained
• removal of gloves
• using the restroom
• And finally, wash your hands before going on
  breaks and before leaving work at the end of the
  day.

48
Bloodborne Pathogens

• Proper hand washing involves the following steps
  
• Wet both hands and wrists. Lather well using
• two squirts of soap or hand washing solution.
• Spread the lather to the back of the hands and
• wrists. Clean between the fingers. Washing
  time
• should be at least 10 seconds.
• Rinse hands and wrists well to remove all soap.
• Dry hands completely. Turn off the water using
• disposable towels when the faucet has handles.
• This prevents recontamination of the hands.

49
Bloodborne Pathogens

• Many personal activities increase the risk of
• exposure to pathogens transmitted by hand and
• mouth. Therefore, the following activities are
• discouraged in your work area
• smoking (prohibited)
• eating or drinking
• food storage
• application of cosmetics or
• contact lens

50
Bloodborne Pathogens

• Hand washing is an important work habit because?
• A. It is easy for everyone to remember.
• B. After you wash your hands, you can
• eat lunch in the lab.
• C. It removes pathogens that you may not know are
  on your
• hands.
• One thorough cleansing lasts all day.
• The answer is

51
Bloodborne Pathogens

• C. It removes pathogens that you may not know are
  on your hands.

52
Bloodborne Pathogens

• Containment
• Another approach to preventing exposure
• to pathogens is to ensure containment of
• potentially infectious materials, that is, to
• prevent the contamination of other items
• whenever possible.
• An action as simple as opening a container can
  create a hazard by
• splashing or spraying material onto your hands
  and work area.
• Procedures that can result in the
  generation of droplets include pipetting,
  vortex mixing of unsealed containers, and
  decanting liquids.

53
Bloodborne Pathogens

• Careful, thoughtful manipulation of potentially
• infectious materials is the key to avoiding
• splashes, spills, and the production of droplets.
  
• Using safety devices and equipment appropriate
• to the task also helps to minimize the release of
  
• pathogens into your work environment.
• Centrifuge containers prevent splattering of
  materials if the sample container is
  damaged during centrifugation. You will
  avoid the need for extensive environmental
  cleanup by containing the spill within a
  secondary container.

54
Bloodborne Pathogens

• When your work involves manipulations of
• potentially infectious materials, be certain
  equipment is functioning properly and is
  designed to keep the materials contained.
• If you must carry potentially infectious
• materials to another area, place the primary
• containers in a leak-proof container to
• prevent a spill during transport.

55
Bloodborne Pathogens

• Personal Protective Equipment
• Now let's turn our attention to the use of
  personal protective equipment barriers you wear
  to prevent contact with infectious materials.
• DACC provides lab coats, gowns, gloves, caps,
  shoe covers, and respiratory and eye protection,
  as needed. Choosing the appropriate form of
  protection depends on work tasks and situations
  you might encounter.

56
Bloodborne Pathogens

• As mentioned earlier, gloves prevent direct
• contamination of the hands and are especially
• necessary to block entry of pathogens if the
• skin is broken. Remember, you must wash your
• hands after removing gloves.
• Properly fitted face masks offer protection
  against inhalation of airborne pathogens.
  Put on a mask before entering an area
  where there is a risk of respiratory
  exposure.

57
Bloodborne Pathogens

• During work activities where splashes to
  the face might occur, wear both a mask and
  eye protection or a face shield to prevent
  contact with infectious organisms.
• If you work with blood or other potentially
  infectious materials, you must wear
  protective garments designed to prevent
  these materials from soaking through to
  your clothing or skin. Garments such as
  gowns, lab coats, aprons, and coveralls
  offer such protection.

58
Bloodborne Pathogens

• All personal protective clothing and
• equipment must be removed before
• leaving the work area so as not to
• accidentally expose others. When
• removing garments, grasp the clean
• side, peel off the article, and fold the
• contaminated side inward.
• Place contaminated items in a
• designated container.

59
Bloodborne Pathogens

• Personal protective equipment must be?
• A. Designed to allow pathogens to contact your
  skin.
• B. Removed when leaving the work area and going
  to the cafeteria for lunch.
• C. The same for all tasks.
• Stylish and flattering.
• The answer is

60
Bloodborne Pathogens

• B. Removed when leaving the work area and going
  to the cafeteria for lunch.

61
Bloodborne Pathogens

• Decontamination
• The next portion of this program will examine
  various decontamination
• procedures used to destroy pathogens on items and
  materials that
• become contaminated during regular work
  activities.

62
Bloodborne Pathogens

• Waste items that have been properly
  decontaminated may be discarded
• in the regular trash.

63
Bloodborne Pathogens

• One particular means of decontamination is with
  the use of chemical
• disinfectants. Choosing the type and
  concentration of a disinfectant
• depends on its effectiveness against specific
  pathogens. Soak
• contaminated items in a suitable chemical
  disinfectant to render them
• safe for further handling. Items may then be
  washed, and if needed,
• sterilized.

64
Bloodborne Pathogens

• An important practice aimed at preventing
  transmission of pathogens is routine use of
  chemical disinfectants for wiping work
  surfaces. Wipe your work area with an
  appropriate disinfectant before starting
  work, between projects, immediately after a
  spill, and at the end of the work shift.
• Use a disinfectant to wipe equipment that
  cannot be autoclaved or soaked. This is
  especially important if the equipment is sent
  elsewhere to be recalibrated or repaired.
• If parts of the equipment cannot be
  disinfected, the equipment must be packaged
  and labeled to ensure that others will handle
  it with caution.

65
Bloodborne Pathogens

• The fluorescent orange or red biohazard
• emblem is used to communicate a risk of
• exposure to pathogens.
• Biohazard labels must be affixed on
  refrigerators, freezers, and any other
  containers used for storage or transport of
  potentially infectious materials.

66
Bloodborne Pathogens

• The biohazard label on a waste bag or use
  of a red bag signify that items inside pose
  an exposure risk. These containers require
  careful handling until they can be
  decontaminated by methods such as
  autoclaving or incineration.
• To handle an infectious waste bag, grasp
• and lift the bag by its top. If an infectious
• waste bag develops a leak or a tear, contact
• your supervisor immediately.

67
Bloodborne Pathogens

• Never discard needles, syringes, blades, or other
  
• sharp objects directly into waste bags because of
  
• the high puncture risk. Instead, place them in
  an
• approved, puncture-resistant, leak-proof sharps
• container that is labeled or color coded red by
  the
• supplier.
• Use the approved sharps container for all sharp
• items, even those free of pathogens. Never reach
  
• inside, and be sure to replace containers when
• about three-fourths full. Overfilling containers
  is
• hazardous.
• Contaminated laundry and linens should be placed
• in designated bags provided by DACC for safe
• collection and decontamination.

68
Bloodborne Pathogens

• A sharps container is?
• A. Safe to use when more than three-fourths full.
  
• B. Any rigid container you can find.
• C. Leak-proof, puncture-resistant, and
• properly labeled by the supplier.
• D. Optional for labs using
• uncontaminated sharps.
• The answer is

69
Bloodborne Pathogens

• C. Leak-proof, puncture-resistant, and
• properly labeled by the supplier.

70
Bloodborne Pathogens

• Accidental Exposures
• Earlier in the program, it was mentioned that
  most
• occupational exposures to pathogens occur
• accidentally from needle sticks, injuries from
  sharp
• instruments, splashes onto mucous membranes of
• the face, or contact with broken skin.
• If your skin is cut or punctured while
• handling potentially infectious materials
• encourage the wound to bleed
• flush with water
• apply antiseptic
• Then notify your supervisor, and immediately seek
  medical attention.

71
Bloodborne Pathogens

• If you receive a splash to the face or any other
  unprotected skin
• flush well at the nearest sink or
• eyewash fountain
• notify your supervisor
• seek medical attention

72
Bloodborne Pathogens

• DACC has developed a Bloodborne Pathogens
  Exposure Control Plan (available in the DACC
  Safety and Procedures Plan)
• that outlines how to report an exposure
  incident, where to
• go to receive an immediate medical evaluation,
  and what services are
• available for follow-up care. Review the
  Exposure Control Plan so
• that you know what to do in an emergency.

73
Bloodborne Pathogens

• If handled properly, accidental spills of
  potentially infectious materials
• onto environmental surfaces need not result in
  personal exposure.
• Employ the following cleanup procedure
• Immediately decontaminate the surface area
• Place paper towels over the spill
• Gently pour a disinfectant on the towels
• And allow the area to soak for about 10
• minutes before cleanup.
• If broken glass or other sharp equipment is
• involved, scoop up the material with a dust
• pan or cardboard to avoid the risk of injury.
• Place materials in a puncture-resistant
• container and then in a biohazard bag.

74
Bloodborne Pathogens

• Some spills require special cleanup techniques.
  If a spill of pathogenic
• material transmitted through inhalation occurs
• leave the room
• close the doors
• restrict access
• immediately call Campus Security
• (dial 888)
• Other accidental spills might involve the release
  of hazardous chemicals
• or materials along with pathogens. If such a
  situation occurs, be sure to
• report this additional information when you call
  Campus Security.

75
Bloodborne Pathogens

• Emergency situations such as needle sticks,
  spills, or
• splashes of infectious material?
• A. Don't happen in my building.
• B. Are of little concern if I have had
• a tetanus shot.
• C. Need not be reported until
• someone gets sick.
• D. Should be planned for in advance so the
  appropriate
• response can be initiated promptly.
• The answer is

76
Bloodborne Pathogens

• D. Should be planned for in advance so the
  appropriate response can be initiated promptly.

77
Bloodborne Pathogens

• This program has covered exposure control
  strategies that include the
• use of
• universal precautions
• vaccination
• good personal work habits
• containment
• personal protective equipment
• decontamination
• emergency procedures for accidental exposures

78
Bloodborne Pathogens

• If you have any questions or concerns, please
  contact your immediate supervisor or Jill
  Cranmore.
• Jill Cranmore can be reached at 217.443.8756 or
  jcranmore_at_dacc.edu