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Bloodborne Bloodborne PathogensPathogens Exposure Control PlanExposure Control Plan

Training ProgramTraining Program

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Bloodborne pathogen exposure can occur in the Bloodborne pathogen exposure can occur in the school setting or work environment. Exposure to school setting or work environment. Exposure to blood is the most frequent source of transmission of blood is the most frequent source of transmission of the Hepatitis B virus, Hepatitis C virus and Human the Hepatitis B virus, Hepatitis C virus and Human Immunodeficiency virus (HIV) in the work place. Immunodeficiency virus (HIV) in the work place.

Our objectives are to:Our objectives are to:

Educate employees about these diseases.Educate employees about these diseases. Train you how to protect yourself.Train you how to protect yourself. Continue the safety and good health of our Continue the safety and good health of our

personnel.personnel. Fulfill the law…Fulfill the law…

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Title 29 Code of Federal Title 29 Code of Federal Regulation, Article 1910.1030, Regulation, Article 1910.1030, Occupational Safety and Health Occupational Safety and Health Administration (OSHA), Administration (OSHA), Bloodborne Pathogens Standard Bloodborne Pathogens Standard as specified in Health and Safety as specified in Health and Safety Code, Article 81.304 mandates a Code, Article 81.304 mandates a program be developed to minimize program be developed to minimize employees exposure to employees exposure to

bloodborne pathogensbloodborne pathogens..

4CDC,2004

Hepatitis B (HBV)Hepatitis B (HBV) Causes serious liver disease, cirrhosis, and cancer Causes serious liver disease, cirrhosis, and cancer Jaundice (yellowing of eyes and skin due to toxins Jaundice (yellowing of eyes and skin due to toxins

in the blood)in the blood) Fatigue, abdominal pain, loss of appetite Fatigue, abdominal pain, loss of appetite 50% have no symptoms at all50% have no symptoms at all Most people infected recover and clear the Most people infected recover and clear the

infection. infection. 10% become chronically infected.10% become chronically infected. Poses greatest risk of transmissionPoses greatest risk of transmission Can live on a hard surface up to a weekCan live on a hard surface up to a week Can be prevented by a vaccination!!Can be prevented by a vaccination!!

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HepatitisHepatitis B ContinuedB Continued Each year 5,000 people die from chronic liver Each year 5,000 people die from chronic liver

disease and liver cancer caused by HBV.disease and liver cancer caused by HBV. According to the Centers for Disease Control and According to the Centers for Disease Control and

Prevention (CDC), 1.25 million people are Prevention (CDC), 1.25 million people are chronicallychronically infected with HBV. infected with HBV.

Risk for infection from a known carrier from single Risk for infection from a known carrier from single needle stick or cut is 6 – 30 %.needle stick or cut is 6 – 30 %.

Post exposure treatment should begin preferably Post exposure treatment should begin preferably within 24hrs, no later than 7 days.within 24hrs, no later than 7 days.

Treatment begins with vaccine immediately and or Treatment begins with vaccine immediately and or Hepatitis B Immune Globulin, (HBIG).Hepatitis B Immune Globulin, (HBIG).

Region 3 of CDC, Dallas, Denton and Tarrant Region 3 of CDC, Dallas, Denton and Tarrant Counties, 462 people died of viral hepatitis (all Counties, 462 people died of viral hepatitis (all types) in 2002. The greatest death rate was in the types) in 2002. The greatest death rate was in the 45-49 age group.45-49 age group.

Reference: Public Health Regions in Texas

6CDC, 2004

HBV VaccineHBV VaccineThe HBV vaccine is a three shot The HBV vaccine is a three shot series completed over 4-6 months.series completed over 4-6 months.

The second dose must be one The second dose must be one month from the first and at least month from the first and at least two months from the third dose.two months from the third dose.

The first and third doses must The first and third doses must have at least four months between have at least four months between them. Most clinicians prefer six.them. Most clinicians prefer six.

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Control Plan,2001

““At Risk” EmployeesAt Risk” Employees

School nurseSchool nurseClinic aide, Unlicensed Diabetic Care AssistantClinic aide, Unlicensed Diabetic Care AssistantPrincipal designees who cover clinic when nurse is Principal designees who cover clinic when nurse is out.out.Athletic trainerAthletic trainerCoachesCoachesSpecial Ed Teachers and AssistantsSpecial Ed Teachers and AssistantsSpecial Ed Bus DriverSpecial Ed Bus DriverSpecial Ed Bus MonitorSpecial Ed Bus MonitorPrincipal, Assistant Principal, Admin. Intern, Dean of Principal, Assistant Principal, Admin. Intern, Dean of InstructionInstructionSchool resource officerSchool resource officerPE teachersPE teachersSelected maintenance personnel-plumber/custodianSelected maintenance personnel-plumber/custodian

8Bloodborne Pathogens Exposure

Control Plan, 2001

HBV Vaccine Continued…HBV Vaccine Continued…

Most people who get the Hepatitis B vaccine Most people who get the Hepatitis B vaccine have no problems with it. Others complain have no problems with it. Others complain of soreness at injection site and/or mild to of soreness at injection site and/or mild to moderate fever lasting a day or two.moderate fever lasting a day or two.

Serious allergic reaction is very rare.Serious allergic reaction is very rare.

However, If you have ever had a serious or However, If you have ever had a serious or life-threatening reaction to baker’s yeast or life-threatening reaction to baker’s yeast or a previous dose of Hepatitis B you should a previous dose of Hepatitis B you should not get the vaccine.not get the vaccine.

9CDC, 2004

Hepatitis C (HCV)Hepatitis C (HCV) Causes serious liver diseaseCauses serious liver disease Symptoms are similar to HBVSymptoms are similar to HBV 85% of people with HCV have chronic 85% of people with HCV have chronic

infections.infections. About 3 million people are About 3 million people are

chronically infected in the U.S.chronically infected in the U.S. 75% have no symptoms for more 75% have no symptoms for more

than 20 years while serious liver than 20 years while serious liver damage may be occurring. damage may be occurring.

10CDC, 2004

HCV continuedHCV continued Leading cause for liver transplantsLeading cause for liver transplants Up to 10,000 people die annually from Up to 10,000 people die annually from

HCV related liver disease.HCV related liver disease.

Can be transmitted during tattooing and Can be transmitted during tattooing and body piercingbody piercing

Risk for transmission from a needle stick Risk for transmission from a needle stick or cut from a known carrier is 1.8%.or cut from a known carrier is 1.8%.

No vaccine, no cure No vaccine, no cure

Antiviral drugs have been effective in Antiviral drugs have been effective in treatment.treatment.

11CDC, 2004

HIVHIV The clinical picture of a person with HIV The clinical picture of a person with HIV

differs from person to person.differs from person to person.

The body’s immune system loses the The body’s immune system loses the ability to fight off infection.ability to fight off infection.

900,000 are infected in the US according 900,000 are infected in the US according to the CDC.to the CDC.

Persons are living longer with the disease Persons are living longer with the disease due to many anti-viral drugs but many due to many anti-viral drugs but many strains are showing resistance.strains are showing resistance.

However, there is However, there is no cureno cure and and no vaccineno vaccine..

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HIV/AIDS Cases and People Living with AIDS in Public Health Region 3

Health Region 3, 2005 and 200612,691

People Living with HIV/AIDS in Texas, in 200658,993

Texas Department of Health 2008

(CDC,2004) 13

HIV continuedHIV continued

Risk for infection from a known carrier from a Risk for infection from a known carrier from a needle stick or cut is 0.3% or 1 in 300.needle stick or cut is 0.3% or 1 in 300.

Treatment from a known exposure should start Treatment from a known exposure should start within hours. A 4 week regime of a combination within hours. A 4 week regime of a combination of antiviral drugs are recommended by the CDC.of antiviral drugs are recommended by the CDC.

14CDC, 2004

How are the Viruses How are the Viruses Spread?Spread?

The viruses are spread through The viruses are spread through contact with:contact with:

1. Blood1. Blood

2. Semen2. Semen

3. Vaginal Secretions3. Vaginal Secretions

4. Other Bodily Fluids4. Other Bodily Fluids

15CDC, 2004

TransmissionTransmission

NeedlesNeedles

IntercourseIntercourse

Mom to unborn child during or after Mom to unborn child during or after deliverydelivery

Blood or other bodily fluid splashes Blood or other bodily fluid splashes to un-intact skin or the mucous to un-intact skin or the mucous membranes of the eyes, nose or membranes of the eyes, nose or mouth.mouth.

16CDC, 2004

Standard PrecautionsStandard Precautions

Standard Precautions simply Standard Precautions simply states that all blood and bodily states that all blood and bodily fluids (except sweat) are fluids (except sweat) are considered to be infected with a considered to be infected with a bloodborne pathogen.bloodborne pathogen.

Therefore, you must assume Therefore, you must assume everyone’s blood is infected and everyone’s blood is infected and protect yourself.protect yourself.

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ProtectionProtection

Follow Standard Precautions.Follow Standard Precautions.

Get immunized against HBVGet immunized against HBV

Wear Personal Protective Equipment Wear Personal Protective Equipment to prevent exposure.to prevent exposure.

If able, allow the person whose blood If able, allow the person whose blood is exposed to clean it up.is exposed to clean it up.

18CDC, 2004

Think First!!Think First!! In the event of a possible body fluid In the event of a possible body fluid

exposure always exposure always glove firstglove first. .

Cover any cuts or abrasions with a band Cover any cuts or abrasions with a band aid or other appropriate material.aid or other appropriate material.

Never reuse glovesNever reuse gloves

Remove them appropriately (see Remove them appropriately (see demonstration)demonstration)

Wash your hands after removingWash your hands after removing

19CDC, 2004

What is an exposureWhat is an exposure??

An exposure occurs when another An exposure occurs when another individual’s blood or bodily fluids individual’s blood or bodily fluids comes in contact with your un-comes in contact with your un-intact skin or mucous membranes.intact skin or mucous membranes.

If you contract a bloodborne If you contract a bloodborne pathogen disease, you risk pathogen disease, you risk spreading the disease to your spreading the disease to your family.family.

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2001

LatexLatex

Be sure and notify your school nurse Be sure and notify your school nurse if you are allergic to latex.if you are allergic to latex.

The school can provide you with vinyl The school can provide you with vinyl gloves.gloves.

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HANDWASHINGHANDWASHING The Number #1 Protective activity from all The Number #1 Protective activity from all

bacteria and viruses is thorough hand bacteria and viruses is thorough hand washing.washing.

Use soap and running water Use soap and running water Wash vigorously for 10-15 secondsWash vigorously for 10-15 seconds Wash under jewelry, front and backs of Wash under jewelry, front and backs of

hands.hands. Rinse hands thoroughly.Rinse hands thoroughly. Dry hands with a clean paper towel.Dry hands with a clean paper towel. Turn off water with another paper towel.Turn off water with another paper towel. Only use antimicrobial soap when indicated Only use antimicrobial soap when indicated

because it removes the skins natural because it removes the skins natural defenses.defenses.

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Control Plan,2001

Good HousekeepingGood HousekeepingIt’s everyone’s It’s everyone’s responsibilityresponsibility

1. Clean and decontaminate surfaces with 1. Clean and decontaminate surfaces with disinfectant after exposure to possible disinfectant after exposure to possible infectious fluids. Disinfect changing infectious fluids. Disinfect changing tables after each use.tables after each use.

2. Use broom and dust pan to pick up 2. Use broom and dust pan to pick up broken glass or call custodial staff.broken glass or call custodial staff.

3. Place all contaminated sharps in a sharp’s 3. Place all contaminated sharps in a sharp’s container (Nurse’s Office).container (Nurse’s Office).

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Control Plan,2001

Housekeeping Cont.Housekeeping Cont. 4. All material used for clean-up should be 4. All material used for clean-up should be

double bagged.double bagged.

5. Regularly inspect and disinfect pails, beds, 5. Regularly inspect and disinfect pails, beds, bends, etc… that may likely be infected.bends, etc… that may likely be infected.

6. Toys will be disinfected daily with a non-6. Toys will be disinfected daily with a non-toxic hospital grade disinfectant.toxic hospital grade disinfectant.

7. Laundry contaminated with body fluids 7. Laundry contaminated with body fluids should be washed with commercial laundry should be washed with commercial laundry soap and bleach in 160 degrees for at least soap and bleach in 160 degrees for at least 25 minutes. Dry on the hottest setting.25 minutes. Dry on the hottest setting.

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Control Plan, 2001

Points to RememberPoints to Remember

Never eat, drink, smoke or apply Never eat, drink, smoke or apply make-up or contacts where exposure make-up or contacts where exposure is likely.is likely.

Clean all blood and bodily spills Clean all blood and bodily spills quickly quickly (Notify your (Notify your custodian).custodian).

Wear gloves to carry soiled clothing, Wear gloves to carry soiled clothing, blankets, etc… and carry them away blankets, etc… and carry them away from your body.from your body.

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Control Plan, 2001

Continued…Continued…

Never attempt to compact the trash Never attempt to compact the trash with your hands or feet. Pull the bag with your hands or feet. Pull the bag up from the sides and gently shake up from the sides and gently shake the trash down.the trash down.

DOUBLE BAG any trash that is DOUBLE BAG any trash that is saturated with blood or other bodily saturated with blood or other bodily fluids.fluids.

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Personal Protective Personal Protective Equipment (PPE’s)Equipment (PPE’s)

GlovesGloves GownsGownsLab coatsLab coats EyewearEyewearMasksMasks MouthpiecesMouthpiecesRespirator bagsRespirator bags

*All PPE’s must fit, be worn *All PPE’s must fit, be worn correctly and may not be correctly and may not be damaged.damaged.

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Control Plan,2001

What do I do if I am What do I do if I am Exposed?Exposed?

1.1. DO NOT PANIC!DO NOT PANIC!2.2. Wash hands immediately or flush eyes with Wash hands immediately or flush eyes with

large amounts of water (Do not use caustic large amounts of water (Do not use caustic materials to clean eyes).materials to clean eyes).

3.3. Report to the Nurse on your campus to fill Report to the Nurse on your campus to fill out an exposure report. If nurse is not out an exposure report. If nurse is not available report to the principal’s office or available report to the principal’s office or secretary.secretary.

4.4. Remember exposure does not always lead Remember exposure does not always lead to infection. A large dose of the virus must to infection. A large dose of the virus must enter bloodstream and overcome body’s enter bloodstream and overcome body’s natural defenses first.natural defenses first.

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Exposure Occurs

Contact school nurse, health services coordinator or supervisor

Source Individual consents toor refuses testing

Exposed employee consents to or refuses testing (signs form)

Health Care Provider provides: (Concentra)Testing Possible Vaccine Counseling Recommendation for follow-up

School District talks to exposed employee to be sure follow-up Information was received.

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