BLOODBORNE PATHOGENS
INFECTION CONTROL
STAFF TRAINING
5-2017
INFECTION CONTROL
TABLE OF CONTENTS
Introduction ………………………………………………….3
I. OSHA Overview ……………………………………………………….. 3
II. Bloodborne Pathogen Standard ………………………………………. 3
III. Epidemiology & Bloodborne Pathogens ……………………………… 4
Hepatitis Viruses
Human Immunodeficiency Virus
IV. Implementation of Universal Precautions ……………………………. 6
V. Engineering and Work Control Practices …………………………..... 6
1. Engineering Controls
2.Work Practice Controls
3. Standard Precautions
4. Hazardous Waste Management
VI. Exposure Control Plan ………………………………………………….14
VII. Personal Protective Equipment (PPE) …………………………………14
Selecting PPE
Avoiding Contamination
Decontaminating & Disposing of PPE
VIII. What to do if a Contamination Incident Occurs ……………………. 15
IX. What to do if an Exposure Incident Occurs ………………………… 15
Reporting exposure incidents
Medical Evaluation and Follow-up
Written Opinion
Confidentiality
X. Hepatitis B Vaccination ………………………………………….……17
Vaccination Program
What if I’m Exposed
XI. Labeling ……………………………………………………………..….18
XII. Airborne and Droplet-Transmitted diseases………………………….19
Tuberculosis
Seasonal Influenza
XIII. Medical Record Keeping …………………………………...………… 20
INFECTION CONTROL
INTRODUCTION
The R.N. Director of Health Services is the designated Exposure Control Officer and is responsible for the overall management and support of the Infection Control and Bloodborne Pathogen Compliance Program. To assist the Exposure Control Officer, we have created an Exposure Control Committee. This committee consists of key administrative personnel, Program Coordinators and Group Home Managers.
Training and education is coordinated by the nurse(s) and he/she is responsible for providing information and training to all employees who have the potential for exposure to bloodborne pathogens.
I. OSHA OVERVIEW
OSHA (Occupational Safety and Health Administration), feels that certain procedures are necessary and appropriate to provide adequate protection to employees exposed to blood and other potentially infectious materials (OPIM). Having a well informed and educated staff is extremely important when attempting to eliminate, or minimize our staff’s exposure to bloodborne pathogens. Our staff receives full training when hired, and will receive the required re-training at least annually. All new employees, as well as employees changing job functions, will be given additional training that their new position requires at the time of their new assignment.
II. BLOODBORNE PATHOGENS STANDARD
OSHA has issued a regulation called the Occupational Exposure to Bloodborne Pathogens Standard. The BBP Standard is maintained in the Health Services Office area, and in the policy manual located in each group home. To reduce the health risk to workers whose duties involve exposure to blood or other potentially infectious materials, OSHA promulgated the Bloodborne Pathogens (BBP) standard. The provisions of the standard were based on the Agency’s determination that a combination of engineering and work practice controls, personal protective equipment, training, medical surveillance, hepatitis B vaccination, signs and labels, and other requirements would minimize the risk of disease transmission. Contained in this manual are discussions of bloodborne pathogens, their transmission and symptoms, engineering and work practice controls, personal protective equipment, actions to take in case of an exposure incident, hazard labeling, record keeping, vaccinations for Hepatitis B., and other areas important to the worker. This Standard applies to all occupational exposure to blood or other potentially infectious materials (OPIM) regardless of the occupation involved. Occupational exposure is defined as reasonable anticipated skin, eye, mucous membrane or parenteral contact with blood or OPIM that may result from the performance of an employee’s duties. Parenteral means any break in the skin or mucous membrane – an example is a human bite.
The term “reasonably anticipated” includes the potential for exposure, as well as actual exposure. Employees who are designated as responsible for rendering, or expected to render First Aid or medical assistance as part of their job duties, are covered by this Standard.
III. EPIDEMIOLOGY AND BLOODBORNE PATHOGENS:
Epidemiology is the study of those diseases which spread rapidly throughout a population. Bloodborne Pathogens are infectious micro-organisms in human blood that can cause disease in humans. Health care workers are at risk for exposure to bloodborne pathogens such as hepatitis B (HBV), hepatitis C (HCV), and human immunodeficiency virus (HIV). These pathogens can be transmitted when there is a needlestick, human bite, and when infectious blood and body fluids come in contact with mucous membranes and non-intact skin. Infected individuals are also capable of transmitting the pathogens to others. A discussion of the most significant BBP, Hepatitis B Virus (HBV), Hepatitis C Virus (HCV), and Human Immunodeficiency Virus (HIV) follows:
1. HEPATITIS B virus(HBV):
Hepatitis B virus can cause acute and chronic liver disease that leads to liver failure and death.
Transmission:
• HBV is transmitted through exposure to an infected person’s blood and other body fluids or tissues
• HBV can survive for seven days on environmental surfaces and can cause infection; all blood spills, including dried blood, should be cleaned with 1:10 bleach solution
Symptoms:
• Presence of signs and symptoms with an acute infection occur 90 days after exposure and vary by age; 30 to 50 percent of people age 5 or older have initial signs and symptoms, whereas most children under 5 years old and newly infected immunocompromised adults are asymptomatic.
• When symptoms do appear, they include fever, jaundice, fatigue, abdominal pain, nausea, vomiting, loss of appetite, joint pain, dark urine, and clay-colored bowel movements (these symptoms last for several weeks and can continue for up to six months).
Prevention and treatment:
• Get vaccinated (Hepatitis B series is offered at Keystone at no cost to you); HBV vaccination is proven to be effective in preventing HBV transmission
• Health care workers should follow safe practices to prevent work-related exposures
• Early treatment (preferably within 24 hours) after exposure can effectively prevent infection
• For acute infection, no medication available and treatment is supportive
• For chronic infection, there are several antiviral medications that are available
2. HEPATITIS C virus(HCV):
Hepatitis C is the most common chronic bloodborne infection in the United States. Like HBV, it can cause liver disease that leads to liver failure and death. It is the leading cause for liver transplants.
Transmission:
• HCV is transmitted through exposure to an infected person’s blood and other body fluids or tissues
Symptoms:
• Only 20 to 30 percent of people who are newly infected with HCV develop mild symptoms such as fatigue, abdominal pain, joint pain, fever, dark urine, nausea, vomiting, poor appetite, clay-colored stool, and jaundice
• The time period from exposure to symptom onset (incubation period) is 4-12 weeks
• Most people with chronic HCV infection are asymptomatic for decades (during that time, the virus actively damages liver function)
Prevention and treatment:
• There is no vaccine to prevent HCV
• The best way for healthcare workers to prevent getting Hepatitis C is to follow safe practices to prevent work related exposures
• Combination therapy with Interferon and Ribavirin has been the only treatment for chronic hepatitis C until late 2013 when FDA approved antivirals, Sofosbuvir and Simeprevir which are successful in reducing HCV replication
3. HUMAN IMMUNODEFICIENCY VIRUS(HIV):
HIV is the virus that causes acquired immunodeficiency syndrome (AIDS) – a disease that attacks and destroys a person’s immune system that is needed to fight diseases.
Transmission:
• HIV is transmitted through exposure to an infected person’s blood and other body fluids or tissues
• The most common modes of transmission include: anal or vaginal sex with an infected person; sharing drug injection equipment with a person infected with HIV; and from an infected mother to her child during pregnancy, birth, or breastfeeding
• Other modes of transmission include: needlestick; bllod transfusions, blood products, or organ and tissue transplant (very uncommon due to testing of blood supply in the United States); unsanitary dental or medical practices; eating food prechewed by a person infected with HIV; human bite; blood or body fluid exposure to open skin or mucous membranes; deep kissing; and tattoing or body piercing
• HIV is not transmitted by air, water, insects,(including mosquitoes), saliva, tears, sweat, shaking hands, sharing dishes, or closed-mouth, “social” kissing
Symptoms:
• Some people develop flu-like symptoms that last a week or two within a few weeks of being infected with the HIV virus, and others will have no symptoms at all (people with HIV infection may appear and feel healthy for several years)
• If untreated, early HIV infection can lead to cardiovascular disease, kidney disease, liver disease, and cancers and their associated symptoms; if left untreated, HIV infection will eventually lead to the disease AIDS (symptoms of AIDS will be associated with the disease and cancers that occur from having a destroyed immune system)
Prevention and treatment:
• Health care workers should follow safe practices to prevent work-related exposures
• There is no vaccine to prevent HIV infection
• There is no cure for HIV infection
• There are benefits to early treatment of HIV infection; medications to treat HIV infection can limit or slow down the destruction of the immune system, improve the health of people living with HIV, and reduce their ability to transmit the virus
• Early treatment allows a person with HIV infection to live a longer, healthier life even decades before they develop AIDS
IV. IMPLEMENTATION OF UNIVERSAL PRECAUTIONS
Universal Precautions (UP) means treating all human blood and certain human bodily fluids as if they are known to be infectious for HIV, HBV, and other bloodborne pathogens. The following fluids are the most prevalent in our work environment:
• Semen
• Saliva
Other fluids:
• Vaginal secretions
• Cerebrospinal fluid
• Synovial fluid
• Pleural fluid
• Pericardial fluid
• Peritoneal fluid
• Amniotic fluid
V. ENGINEERING AND WORK PRACTICE CONTROLS
These are controls that isolate or remove the Bloodborne pathogen hazard from the work place and are the primary methods used to prevent occupational transmission of HIV, HCV and HBV.
1. ENGINEERING CONTROLS
The term “Engineering Controls” includes all control measures that isolate or remove a hazard from the workplace, encompassing not only sharps with engineered sharps injury protections and needleless systems but also other medical devices designed to reduce the risk of percutaneous exposure to bloodborne pathogens. Engineeering controls must be examined and maintained, or replaced, on a scheduled basis. The following Engineering controls are used throughout our homes:
(1) Handwashing facilities which are readily accessible to all
employees who have the potential for exposure
2) Containers for contaminated sharps that are:
Puncture resistant
Color-coded or labeled with a biohazard warning label
Leak-proof on sides and bottom
3) Specimen containers which are:
Leak-proof
Color-coded or labeled with a biohazard warning label
Puncture-resistant, when necessary
4) Containers to store regulated waste must be closeable and
Suitable to contain the contents and prevent leakage of fluids.
They must be labeled or color-coded to ensure that employees are aware of potential hazards. Biohazard labeled trash cans with removable hard plastic liners are in each group home.
5) Small red biohazard bags are kept on top of biohazard cans
2. WORK PRACTICE CONTROLS:
Work practice controls are the controls that reduce the likelihood of exposure by altering the manner in which a task is performed.
a) Hand Hygiene:
Health care workers’ hands are the number one source for the spread of germs to clients.
Key hand hygiene practices for health care workers include:
• Decontaminating hands with an antiseptic agent
• Preventing nails from transmitting germs
• Keeping skin on hands intact and not irritated
• Appropriately using gloves
i. Hand Decontamination:
The use of an alcohol-based waterless hand gel or foam (an antiseptic agent) to decontaminate hands is the most effective way for health care workers to reduce client infections and infection-related deaths.
An alternative way to decontaminate hands is with an approved antimicrobial soap and water. Alcohol-based waterless hand gels and antimicrobial soaps used to decontaminate hands have ingredients that kill germs on the hands. Plain soap and water will not kill (decontaminate) germs on hands. Plain soap and water only remove most germs when soap is used with a lot of friction (rubbing hands together really hard). This is why using approved antiseptic agent such as alcohol-based waterless hand gel to decontaminate hands is so important.
Below are the times you must decontaminate your hands:
o Before having any direct contact with clients
o Before applying and after removing gloves or other personal protective equipment
o Between contact with the environment and a client
o After unplanned, unprotected contact with blood, body fluids, excretions, mucous membranes, and non-intact skin
ii. Glove use:
Hands must be decontaminated before applying and after removing gloves.
Gloves are never a substitute for hand decontamination; they need to be changed every time you must decontaminate your hands.
iii. Nail care:
Artificial nails and extenders store more bacteria than natural nails, and are not permitted for staff who provide direct client care. All nails must be ¼ inch or less in length.
iv. Hand care:
Your hands should not be dry or cracked. Dry, cracked hands can become infected and prevent the proper use of antiseptic agents to decontaminate hands.
Lotion, provided by your office upon your request, should be used for hands that are dry or to prevent hands from becoming dry.
Notify your manager immediately if you have an injury to your hands that prevents you from decontaminating them (such as cuts, sutures, burns).
Alcohol-based waterless hand gel or foam use:
Procedure for hand gel use:
• Make sure your hands are dry and free of visible dirt or contaminates
• Apply a dime-sized amount of gel or more, per manufacturer’s instructions, to the palm of your hand
• Rub your hands together, making sure all surfaces are covered until your hands are dry; an adequate amount will usually take 15 to 20 seconds to dry on your hands.
Alcohol-based waterless hand gel or foam facts:
• Can use without water
• Does not remove visible dirt or contaminates from hands
• Can only effectively kill germs when there is no visible dirt or contaminates on the hands
What are the situations when hands are most likely contaminated?
• You touched or think you touched any body fluid or contaminated surface without glove protection
• You used the restroom
How are dirt and contaminates removed from hands?
Dirt and contaminates, such as blood and body fluids, can be removed from hands by creating friction when washing hands with an antimicrobial or plain soap and water. If hands are washed with plain soap and water to remove dirt and contaminates, hands should be dried and then decontaminated with alcohol-based waterless gel or foam.
Caution: Alcohol content in the gel or foam is flammable when hands are not fully allowed to dry and can cause burns. Wash your hands with soap and water before cooking on an open flame such as a gas stove or grill.
It is also recommended that you wash your hands with soap and water before eating and preparing food.
Handwashing: hands and other skin surfaces (or mucous membrane areas) should be washed immediately and thoroughly if contaminated with blood, saliva, or other bodily fluids to which universal precautions apply, or potentially contaminated articles. Hands should always be washed after gloves (utility or disposable), are removed, even if the gloves appear to be intact. Hands should also be washed when:
• Coming on duty
• Going off duty
• Hands are obviously soiled
• Between assisting residents
• After touching any dirty/contaminated areas
• Before and after use of toilet
• After blowing or wiping the nose
• Before and after eating
• Before, after handling food or assisting with kitchen
Duties
Handwashing should be completed using the appropriate Facilities, such as utility or rest room sinks. Liquid soap dispensers and disposable towels are provided in all kitchen and bathroom areas. If hands are washed with plain soap and water to remove dirt and contaminates, hands should be dried and then decontaminated with alcohol-based waterless gel or foam.
Procedure for washing hands with antimicrobial or plain soap and water:
• Turn on running water to warm temperature; avoid hot water, which can damage skin
• Wet hands and wrists thoroughly, holding hands downward over the sink
• Apply soap to wet skin
• Rub hands together in a circular motion to create friction for a minimum of 30 seconds; be sure to clean between fingers and around and under fingernails
• Rinse hands and wrists under running water so soap flows downward toward fingertips until all soap is removed
• Dry wrists and hands thoroughly with a paper towel
• Turn off water using a paper towel to cover faucet handle
• If using plain soap and water, decontaminate hands with alcohol-based waterless hand gel prior to client contact
b) Eye and mouth protection: when assisting or providing a
Resident with daily oral hygiene, you must wear gloves and stand to the side of, or behind the resident. This practice will prevent any possible splattering of any potentially infectious material to your eyes and mouth.
c) Personal toiletry items: must be kept separate and may not
be shared. This includes manual or electric razors, towels, washcloths, toothbrushes, water piks, clippers or any item which may be blood contaminated. Toothbrushes are to be air dried and replaced every three months or earlier if needed.
d) Sharps: any object that can penetrate the skin including, but not limited to needles, broken glass, and dental wires. Never pick up contaminated broken glass by hand, even with gloves. Always use a dust pan and broom. Needles should be disposed of in the specifically designated container used by the nurse. When full, this container is forwarded to a licensed “medical waste carrier” for disposal. Contaminated needles and other contaminated sharps are not bent, recapped or removed unless it can be demonstrated that there is no feasible alternative; and/or the action is required by specific medical procedures.
In the two situations above, the recapping or needle removal is accomplished through the use of a medical device or a one-handed technique. Careful handling of sharps can prevent injury and reduce the risk of infection. By following these work practices, employees can decrease their chances of contracting bloodborne illnesses.
e) Decontamination: Disinfection techniques must be adequate to prevent the spread of the virus. Employees must decontaminate working surfaces and equipment with an appropriate disinfectant after completing procedures involving exposure to blood. A commercial disinfectant or a labeled solution of 1:10 bleach should be used to wipe down possibly contaminated areas such as bathroom sinks, toilets, showers, bathtubs, counter tops, etc. The solution is maintained in a secured closet.
Staff who are assigned the regular responsibility of cleaning bathrooms are instructed to wear gloves. Reusable utility gloves are available, as well as disposable gloves. Staff who use utility reusable gloves are responsible for the maintenance and cleaning of those gloves.
A germicidal solution (i.e. Citrus II) is used for re-sanitizing areas of articles contaminated with blood or blood products, where it is not appropriate to use a bleach solution. (Examples: carpet, clothing, furniture, non color-fast materials, etc.) Employees must clean:
• When surfaces become obviously contaminated
• After any spill of blood or other potentially infectious materials
• At the end of the work shift if contamination might have occurred
Bleach or solutions containing bleach may not be poured directly onto a spill, as chlorine gas may be released. Clean first, then disinfect. Rigid daily cleaning of all possibly contaminated areas must occur. Sponges and cloths used for washing dishes may not be used to wipe up spills.
Procedures for wiping up small spills of blood or bodily fluids:
• The employee shall wear well-fitting disposable gloves.
• The employee shall wipe the spill as soon as possible with a disposable rag.
• The rag shall be disposed of in a plastic bag and placed in a designated trash can.
• The spill shall be bagged in the room in which the spill occurs.
• The employee shall remove the gloves and dispose of them in the designated trash can.
• The employee shall wash his/her hands for at least 15 seconds.
f) Laundry: Those individuals doing the laundry must wear gloves when handling soiled linen and hold them away from your clothing. Contaminated bed linens should be placed in a plastic bag, transported to the washing machine, and washed as soon as possible with hot water, one cup of bleach (if fabric can tolerate contact with chlorine bleach) and laundry detergent. Bed linens, underwear, and white socks should be routinely washed with bleach regardless if blood is present or not. Do not use bleach on non color-fast items. Routine laundry need not be done separately for those with HBV. However, universal precautions must be followed for any items soiled with blood or other bodily fluids. If such items are apparent, they are to be double-bagged, clearly marked, and placed in appropriately marked containers in the laundry room. The linens/clothing should then be washed with a solution of 1 cup bleach per machine of hot water. After these items are laundered, the washing machine should also be cleansed with a bleach solution of I cup bleach per machine of hot water. Blankets and sheets should be laundered at least once a week. Laundry must be sorted in the laundry rooms; never in common living areas of the apartment.
Unless blood is evident, no special procedures need to be observed for the disposal of feces, soiled diapers, bedding, etc. However, strict observances of good sanitary practices and laundering methods should be employed.
If the resident is responsible for changing and laundering their own bed linens, they should simply remove the bed linens and carry them directly to the clothes washer or to the appropriately marked container in the laundry room. If the resident does not change or launder their own linens, a designated trained staff person will be responsible for this duty. Laundry receptacles should be lined with plastic bags, which should be replaced daily or as needed.
g) Eating, Drinking, Hygiene: Do not eat, drink, apply cosmetics, or handle contact lenses in areas of potential occupational exposure, such as the bathroom. Food and drink must not be stored in areas where infectious materials may be present. This includes freezers, refrigerators, shelves, cabinets, countertops, etc.
3. STANDARD PRECAUTIONS
Use standard precautions for care of all clients. Standard precautions are designed to reduce the risk of transmission of both recognized and unrecognized sources of infection. Blood and body fluids (except sweat) from all clients are considered potentially infectious for Hepatitis B Virus (HBV), Hepatitis C Virus (HCV), Human Immunodeficiency Virus (HIV) and all other infectious diseases.
Key practices related to standard precautions;
• Strictly adhering to hand hygiene practices, including proper hand decontamination technique
• Wearing gloves when performing procedure that may require contact with blood, body fluids, secretions (except sweat), excretions, non-intact skin (including dermatitis, cuts abrasions, chafing, and acne), and mucous membranes, or any item that is soiled or contaminated with these substances.
• Handling soiled dressings, equipment, and linen in a manner to prevent exposure or transfer of organisms
• Safe handling of sharp instruments
• Following respiratory hygiene and cough etiquette: cover your cough or sneeze with a tissue, or cough and sneeze into your sleeve; dispose used tissues immediately in waste basket; perform hand hygiene after each sneeze or cough
• Protective coverings: plastic bags must line each garbage receptacle and be replaced each time the garbage is emptied.
• Stethoscopes and otoscopes should be cleaned with 70% alcohol solution after each used to prevent cross infection.
4. HAZARDOUS WASTE MANAGEMENT:
Hazardous waste is any solid, liquid or gaseous material that can cause substantial harm to our health and the environment it is improperly stored, treated, transported, or disposed of. It is the responsibility of every employee to know how to safely identify, handle, and properly dispose of hazardous waste.;
Waste generated in the homes can be identified as general, medical or chemotherapy waste.
General waste includes items that are not contaminated with blood or other potentially infectious materials and is not considered a hazardous waste. General waste includes:
• Wrappers from dressings
• Paper towels used to dry hands
• PPE that is not soiled
• Removed dressings that do not have blood or other infectious materials on them
• Incontinence briefs or pads without solid material. Sanitary pads should be bagged in a small plastic bag or waxed coated paper bag before discarding into a plastic lined trash container
• IV tubing not used to administer blood or blood products
Medical waste is identified as contaminated items that can potentially transmit disease. Medical waste is a hazardous waste and includes:
• Blood and blood products (such as whole blood, serum, plasma, blood components, and products made from human blood)
• Body fluids, except sweat (such as, secretions and excretions, saliva, semen, vaginal secretions, urine and feces, lymph, cerebrospinal, synovial and pleural fluids, peritoneal, pericardial and amniotic fluids)
• Used sharps such as contaminated objects that can penetrate, puncture or lacerate the skin, like hard plastic and glass, either broken or whole, lancets, needles and pipettes)
• Other biohazardous waste such as non-liquid human tissue and body parts, used supersaturated, absorbent materials that have the potential to drip or splash blood or body fluids, disposable medical devices that retain visible blood adhering to inner surfaces after use and rinsing and microbiological agents and germicidal solutions that were used to clean contaminated areas.
Chemotherapy waste is all material used in chemotherapy, including the chemotherapy medications and the equipments and materials used to administer them.
Handling and disposing of hazardous waste:
• Recognize and use the universally recognized hazardous waste symbol
• When you see this symbol with or without the words bioharzard, you know there is hazardous waste
• The labels should be in orange-red or a fluorescent orange color
Biohazard waste containers must be closed before removal to prevent the contents from spilling. If the outside of a container becomes contaminated, it must be placed within a second suitable container.
VI. EXPOSURE CONTROL PLAN: A written exposure control plan is necessary for the safety and health of our staff. In an effort to minimize the incidence of illness and injury experienced by our employees, we have instituted a BLOODBORNE PATHOGENS EXPOSURE CONTROL PLAN. The purpose of this plan is to protect our staff from the health hazards associated with bloodborne pathogens and to provide appropriate treatment and counseling should an employee be exposed.
The Exposure Control Plan (ECP) is placed in the Procedures Manual and is available to staff at any time. Copies of the manual are maintained by the nurse, and copies are available in each Group Home.
VIII. PERSONAL PROTECTIVE EQUIPMENT (PPE):
Staff who have direct exposure to blood and other potentially infectious materials on their jobs, are at risk of contracting bloodborne infections from HBV, HCV and HIV and other pathogens. Wearing proper PPE can greatly reduce potential exposure to all bloodborne infections.
Wear PPE when in contact, or anticipate contact, with:
• Blood
• Body fluids (except sweat)
• Secretions
• Excretions
• Non-intact skin
• Anything soiled or contaminated with these substances
A. Selecting PPE;
1) Wear gloves to protect hands:
• When performing procedures that may require contact with blood, body fluids, non-intact skin, mucous membranes, or any item that is soiled or contaminated with these substances;
o Obtaining a specimen
o Providing or assisting with oral hygiene
o Assisting with toileting, or washing the rectal and genital areas
o Changing dressings
o Giving an enema/suppository
o Doing treatment
o The care giver has cuts, “open wounds”, lesions or weeping dermatitis on his/her hands
Latex/poly gloves must be discarded after assisting individual residents with any of the above. They may not be washed or reused in order to assist another resident in any of the above.
2) CPR disposable mouth shields are available at the following locations:
• 1st Aid Kit/cabinet in each apartment/home
• In each vehicle
• Portable 1st Aid Kits used for outings, etc.
How do you obtain PPE?
• PPE is provided to you at no cost to you
• We ensure that there is a continued supply of PPE. You can stop in the office to pick up items yourself
• You should never run out of PPE. If you notice the supply is low, stop in to pick up what you need
B. Avoiding contamination: the key is that blood or other infectious
materials must not reach an employee’s work clothes, street clothes, skin, eyes, mouth, or other mucous membranes under normal conditions for the duration of exposure.
• Follow hand hygiene procedures
• Use standard precautions (appropriately select, apply, and remove PPE)
• Use transmission-based precautions
• Use engineered needle safety devices
• Identify and safely handle hazardous materials
• Identify and report any unsafe situation (client who is aggressive, needles that are not disposed of properly)
C. Decontamination and Disposing of PPE: staff must remove PPE
before leaving the work area or when PPE becomes contaminated.
IX: WHAT TO DO IF A CONTAMINATION INCIDENT OCCURS: If con-
tamination involving blood or other potentially infectious materials
occurs, the following actions are recommended:
• Notify pertinent individuals of the hazard
• Have a person monitor the spill area and follow appropriate maintenance procedures
X: WHAT TO DO IF AN OCCUPATIONAL EXPOSURE INCIDENT
OCCURS:
An exposure incident is specific eye, mouth, other mucous membrane, non-intact skin, or parenteral contact with blood or other potentially infectious materials that results from the performance of an employee’s duties;
• Immediately wash the exposed area with soap and water, or flush affected mucous membranes (eyes or mouth) with water or normal saline
• After washing the exposed area, contact the office or in-charge person and report the incident
• Promptly go to an occupational health physician for a medical evaluation or the emergency room if after hours or on the weekend
1. Reporting Exposure Incidents: staff should immediately report exposure incidents to the in-charge person, and a written Exposure Incident is completed. This allows for timely medical evaluation and follow-up by a health care professional. Exposure Incidents Forms are maintained in designated binders in each apartment/home and with the nurse.
2. Post Exposure Medical Evaluation and Follow-up: Medical evaluation and treatment is provided to employees who experience an exposure incident. The first step is to test the blood of the exposed employee. Any employee who wants to participate in the medical evaluation program must agree to have blood drawn. However, the employee has the option to give the blood sample but refuse permission for HIV testing at that time. Repeat HIV and HBV testing will be done at the treating physician’s discretion.
The health care provider will counsel the employee based on the test results. If the source individual was HBV positive, or in a high risk category, the exposed employee may be given Hepatitis B Immune Globulin and vaccination, as necessary. If there is no information on the source individual or the test is negative, and the employee has not been vaccinated or does not have immunity based on his or her test, he or she may receive the vaccine. Further, the health care provider will discuss any other findings from the tests.
The standard requires that the employer makes the Hepatitis B vaccine available, at no cost to the employee. This requirement is in addition to post exposure testing and treatment responsibilities.
If one of the staff is involved in an incident where exposure to bloodborne pathogens may have occurred, there are two things that are immediately focused on:
• Investigating the circumstances surrounding the exposure incident
• Making sure that employees receive medical consultations and treatment (if required) as expeditiously as possible.
The Executive Director or Designee investigates every exposure incident that occurs. This investigation is initiated within 24 hours after the incident occurs and involves gathering the following information:
• When the incident occurred
• Where the incident occurred
• What potentially infectious materials were involved in the incident
• Type of material (blood, etc.)
• Source of material
• Under what circumstances the incident occurred
• How the incident occurred
• Actions taken as a result of the incident
In case of exposure, Monday thru Friday (8-5), the employee is sent to the Worker’s Compensation Provider – after hours and on the weekends and holidays, the employee is sent to the nearest hospital emergency room.
3. Health Care Professional’s Written Opinion: after consultation, the healthcare professional provides the agency with a written opinion evaluating the exposed employee’s situation. We, in turn, furnish a copy of this opinion to the exposed employee. In keeping with this process, emphasis on confidentiality, the written opinion will contain only the following information:
• Whether Hepatitis B Vaccination is indicated for the employee
• Whether the employee has received the Hepatitis B Vaccination
• Confirmation that the employee has been informed of the results of the evaluation.
• Confirmation that the employee has been told about any medical conditions resulting from the exposure incident which require further evaluation or treatment.
5. All other findings or diagnoses will remain confidential and will not be included in the written report. Confidentiality means protecting information that any individual or institution has shared in a relationship of trust.
• There are federal and state laws to protect the privacy of those infected with HIV or AIDS
• Information that is protected includes: HIV testing, HIV results even if negative, HIV infection or HIV related illness or AIDS, HIV related conditions, medication specific to HIV disease, contacts of someone with HIV
• A client’s diagnosis of HIV is confidential and should only be shared with employees managing and caring for the client when it is necessary to know this information in order to provide care
• A client’s diagnosis of HIV is confidential and should never be shared with other family members or placed on documents where visitors can read them
XI. HEPATITIS B VACCINATION:
As an additional protection, Hepatitis B vaccination is provided to our residents and offered to all staff. This program is available, at no cost, to all employees who have potential for occupational exposure to bloodborne pathogens.
1. What does the vaccination involve: The Hepatitis B vaccination is a noninfectious, yeast-based vaccine given in three injections in the arm. It is prepared from recombinant yeast cultures, rather that human blood or plasma. Thus, there is no risk of contamination from other bloodborne pathogens nor is there any chance of developing HBV from the vaccine.
The second injection should be given one month after the first, and the third injection six months after the initial dose. More that 90 percent of those vaccinated will develop immunity to the Hepatitis B virus. To ensure immunity, it is important for individuals to receive all three injections. At this point it is unclear how long the immunity lasts, so booster shots may be required at some point in the future.
The vaccine causes no harm to those who are already immune or to those who may be HBV carriers. Employees may opt to have their blood tested for antibodies to determine the need for the vaccine. This screening is not a condition of receiving the vaccination, nor is the employer required to provided pre-screening.
Should an employee choose not to receive the vaccine, he/she will be asked to sign a waiver stating this. At a later date, should the employee decide to accept the vaccination, he/she may do so at no personal expense.
2. Side Effects: No serious side effects have been noted, however, it is possible that with expanded use, rare adverse reactions may become noted. In some instances, fatigue and/or soreness at the site has been documented. Fewer persons have complained of fever, joint pain, local reaction, rash, headache, or dizziness.
3. Who should not take the vaccine: You should not take the vaccine, (unless under the advice of your personal physician) if:
• You have an allergy to yeast
• You are pregnant or nursing
• You are planning to become pregnant within the next six months
• You have had a fever, gastric symptoms, respiratory symptoms, or the signs of illness in the last 48 hours
It is strongly advised, that you consult with your own physician prior to taking the vaccine. The exact duration of protection effects from the vaccine is unknown at the present. The need for booster doses is not yet defined.
If you terminate your employment before the completion of the vaccination series, it is the employee’s responsibility to contact his/her own medical provider to complete the series.
4. What if I am exposed but have not yet been vaccinated: if a worker experiences an exposure incident, such as blood splash in the eye, he or she must receive confidential medical evaluation from a licensed health care professional with appropriate follow-up. To the extend possible by law, the employer is to determine the source individual for HBV, HCV as well as HIV infectivity. The worker’s blood will also be screened if he or she agrees.
The health care professional is to provide treatment. This would include Hepatitis B vaccination. The health care professional must give a written opinion on whether or not vaccination is recommended and whether the employee received it. Only this information is reported to the employer. Employee medical records must remain confidential. HIV, HCV or HBV status must NOT be reported to the employer.
XII. LABELING:
Containers of regulated waste and other potentially infectious materials, and other containers used to store, transport blood or other potentially infectious materials must be labeled with fluorescent orange or orange-red biohazard warning labels. This warning label must contain the biohazard symbol and must have the word BIOHAZZARD on it.
XIII. AIRBORNE AND DROPLET-TRANSMITTED DISEASES:
• Transmission of most airborne and droplet germs occurs when an infected person coughs, sneezes, speaks or sings, releasing the infectious agent into the air. The germ is then moved through the air and may enter your respiratory system through your nose or mouth
• Some droplets fall onto environmental surfaces where they are picked up by a person’s hands. Contaminated hands can then transfer these germs to you or others and cause infection
• Airborne pathogens include tuberculosis, measles, chickenpox, smallpox and severe acute respiratory syndrome (SARS)
• Droplet-transmitted pathogens include influenza, respiratory syncytial virus (RSV), adenovirus, whooping cough, meningitis, pneumonia and streptococcal group A
• Tuberculosis continues to be on the rise and is a risk to health care workers
• Seasonal influenza is easily preventable through vaccination
a. Tuberculosis:
Tuberculosis (TB) is a disease that is spread from person to person by breathing in small respiratory droplets that are suspended in the air after an infected person releases the infectious droplets into the air when the cough, sneeze, speak or sing. It usually affects the lungs, although it may also spread to other body parts, such as the brain, kidneys and spine. Serious consequences, such as permanent body damage and death may result from this disease.
Symptoms:
• General symptoms include loss of appetite, unexplained weight loss, fever, night sweats, fatigue, chills, cough for three weeks, chest pain, and coughing up blood
• Additional symptoms depend on the part of the body affected
Transmission:
• Those sharing breathing space with an infected person are at an increased risk of TB contagion. This group includes family members, friends, coworkers and health care workers
• Those at the greatest risk od contacting TB are people who are homeless, individuals from foreign countries where there is uncontrolled TB epidemic, nursing home residents, prisoners, alcoholics, intravenous drug users and people living with diabetes, cancer or HIV
Screening for TB infection:
• TB infection is generally detected via a Tuberclin Skin Test (Mantoux test)
• All employees and clients are required to have a Tuberclin skin test upon admission or hire to Keystone, unless they have documentation of a previously positive Tuberculin Skin Test
• The Tuberclin Skin Test is offered free of charge to all new employees
• Employees with a documented history of a positive skin test and follow up will complete the symptom screening section of the TB screening tool upon hire.
• A small needle is inserted on the inside of the arm, just under the skin
• A health care professional (physician or nurse) must inspect the injection site within 48 to 72 hours of the test
• If there is a reaction from the skin test, there will be a hard raised bump with or without redness (the bump, not the redness is measured)
• A negative skin test usually means that the person has not been infected with the TB germ. However, there is minimal risk of a false negative result. This generally occurs with a person who has a weakened immune system or has recently been exposed to the TB disease (it can take between 2 to 10 weeks after exposure before a person tests positive)
• Although a positive skin reaction means that the person has been infected with the TB germ (Latent TB), it does not mean that the individual has active TB disease.
• Chest x‐ray or FDA approved tuberculosis blood test (QFT-G, QFT-GIT, or T-Spot) will be required for positive reactions.
b. Seasonal Influenza:
Influenza (flu) is a contagious respiratory viral disease.
Transmission:
• Influenza is spread in respiratory droplets through coughing and sneezing from person to person and when touching the mouth or nose after hands come in contact with areas contaminated with the virus
• The contagious period begins one day before symptoms occur and up to five days after symptoms begin
Symptoms:
• Include fever, headache, extreme tiredness, dry cough, sore throat, runny nose and muscle aches
• Complications include bacterial pneumonia, dehydration and worsening of chronic health conditions
Prevention:
• The best way to protect against the flu is to receive the influenza vaccine each fall
• Employees caring for a client with influenza should follow droplet precautions, which include:
➢ Wearing surgical mask when coming within three feet of the client
➢ Wearing gloves when in contact with any secretions or items contaminated with secretions like tissues and bed linens
➢ Adhering to excellent hand hygiene practices
CDC respiratory hygiene and cough practices to prevent the spread of influenza and other respiratory infections:
o Cover your nose and mouth with a tissue when coughing or sneezing
o If you do not have a tissue, sneeze or cough into your upper sleeve rather than your hands
o Dispose of used tissues is a waste basket immediately after use
o Perform hand hygiene after each sneeze or cough
XIV. MEDICAL RECORDKEEPING:
Medical records are maintained for all employees. According to OHSA guidelines, medical records are to be maintained for thirty years after the termination/resignation of the employee.
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