Blood Borne PathogensBlood Borne Pathogens

Becky Walch, R.N.Becky Walch, R.N.Micheel Valdez, L.V.N.Micheel Valdez, L.V.N.Micheel Valdez, L.V.N. Micheel Valdez, L.V.N.

Examples of Blood Borne Pathogens

Hepatitis BHepatitis BHepatitis CHepatitis CHepatitis CHepatitis COther HepatitisOther HepatitisHIVHIV

Hepatitis

Hepatitis means Hepatitis means inflammation of the inflammation of the liver. Hepatitis is a liver. Hepatitis is a serious disease that serious disease that affects the liver andaffects the liver andaffects the liver and affects the liver and can cause long term can cause long term damage. damage. da age.da age.Portal hypertension D/T Portal hypertension D/T hepatocellular carcinoma 2hepatocellular carcinoma 2°° to to Hep B.Hep B.Hep B.Hep B.

Chronic hepatitis

Chronic hepatitis can Chronic hepatitis can lead to scarring of the lead to scarring of the liver (cirrhosis), liver liver (cirrhosis), liver failure, and may lead failure, and may lead to liver cancerto liver cancerto liver cancer.to liver cancer.

Signs of viral hepatitisAsymptomaticAsymptomaticLow grade feverLow grade feverMuscle achesMuscle achesTirednessTirednessLoss of appetiteLoss of appetiteLoss of appetiteLoss of appetiteNausea/vomiting/diarrheaNausea/vomiting/diarrheaDark urine, pale BMDark urine, pale BMDark urine, pale BMDark urine, pale BMPain in stomachPain in stomachJaundiceJaundice

Jaundice of sclera

Viral Hepatitis OverviewViral Hepatitis OverviewViral Hepatitis - OverviewViral Hepatitis - OverviewType of HepatitisType of Hepatitis

AA BB CC DD EErce of feces blood/ blood/ blood/ feces

Type of HepatitisType of Hepatitis

urce ofs

feces blood/blood-derived

body fluids

blood/Blood-derivedbody fluids

blood/Blood-derivedbody fluids

feces

ute of fecal oral PercutaneousPercutaneousPercutaneous fecal oralute ofnsmission

fecal-oral Percutaneouspermucosal

Percutaneouspermucosal

Percutaneouspermucosal

fecal-oral

ronicti

no yes yes yes noction

vention pre/post-exposure

i i ti

pre/post-exposure

i i ti

blood donorscreening;i k b h i

pre/post-exposure

i i ti

ensure safedrinking

timmunization immunization risk behaviormodification

immunization;risk behavior

water

timates of Acute and Chronic Diseasetimates of Acute and Chronic Diseased f Vi l H titi U it d St td f Vi l H titi U it d St t

timates of Acute and Chronic Diseasetimates of Acute and Chronic Diseased f Vi l H titi U it d St td f Vi l H titi U it d St turden for Viral Hepatitis, United Statesurden for Viral Hepatitis, United Statesurden for Viral Hepatitis, United Statesurden for Viral Hepatitis, United States

HAVHAVHAVHAV HBVHBVHBVHBV HCVHCVHCVHCV HDVHDVHDVHDVHAVHAVHAVHAV HBVHBVHBVHBV HCVHCVHCVHCV HDVHDVHDVHDVute infections1000)/year* 125-200 140-320 35-180 6-13

minant aths/year 100 150 ? 35

ronicections

0 1-1.25 million

3.5million 70,000

ronic liver diseaseronic liver disease aths/year 0 5,000 8-10,000 1,000

ange based on estimated annual incidence, 1984-1994.g

What is Hepatitis B (HBV)?

HBV is a virus that causes acute and sometimes HBV is a virus that causes acute and sometimes chronic inflammation of the liver causing liver chronic inflammation of the liver causing liver damage that can lead to cirrhosis, cancer, and damage that can lead to cirrhosis, cancer, and death.death.HBV i f ti ith l d t l tHBV i f ti ith l d t l tHBV infections may either lead to complete HBV infections may either lead to complete recovery with lifelong immunity (acute illness) or recovery with lifelong immunity (acute illness) or it may result in a lifelong infectionit may result in a lifelong infectionit may result in a lifelong infection.it may result in a lifelong infection.Chronic illness is defined as illness that is not Chronic illness is defined as illness that is not resolved within (6) monthsresolved within (6) monthsresolved within (6) months.resolved within (6) months.

Who is at risk?

Persons whose sex partner has chronic hepatitis.Persons whose sex partner has chronic hepatitis.People who live with someone who has chronic People who live with someone who has chronic hepatitis.hepatitis.Persons recently diagnosed with an STD.Persons recently diagnosed with an STD.Persons with multiple sex partners.Persons with multiple sex partners.IV drug users.IV drug users.People whose jobs expose them to human blood.People whose jobs expose them to human blood.

How is HBV transmitted?

HBV is transmitted primarily through HBV is transmitted primarily through contact with infected blood and body fluids.contact with infected blood and body fluids.

unprotected sex with an infected person,unprotected sex with an infected person,mother to newborn during childbirth,mother to newborn during childbirth,ggsharing needles,sharing needles,accidental needle sticks, andaccidental needle sticks, andaccidental needle sticks, andaccidental needle sticks, andcontact with infected fluids through contact with infected fluids through broken skin or mucous membranes.broken skin or mucous membranes.broken skin or mucous membranes.broken skin or mucous membranes.

Concentration of Hepatitis B Virus Concentration of Hepatitis B Virus Concentration of Hepatitis B Virus Concentration of Hepatitis B Virus in Various Body Fluidsin Various Body Fluidsin Various Body Fluidsin Various Body Fluids

High ModerateLow/Not

Detectableg

blood semen urineserum vaginal fluid fecesserum vaginal fluid feces

wound exudates saliva sweattearstears

breast milk

Prevention

Practice safe sex.Practice safe sex.No IV drug usage.No IV drug usage.No IV drug usage.No IV drug usage.Use PPE for clean up.Use PPE for clean up.N h t thb hN h t thb hNever share your razor or toothbrush.Never share your razor or toothbrush.Get vaccinated.Get vaccinated.

Hepatitis B VaccineThe vaccine will The vaccine will impart immunity in impart immunity in over 95% of over 95% of over 95% of over 95% of individuals who individuals who receive it, no vaccine receive it, no vaccine i 100% ff ti i 100% ff ti is 100% effective. is 100% effective. Thus, adhering to Thus, adhering to standard precautions standard precautions standard precautions standard precautions is also fundamentally is also fundamentally important.important.

Hepatitis B VaccineHepatitis B Vaccine

The vaccine is given in three The vaccine is given in three stagesstages::

1.1. The initial injectionThe initial injection1.1. The initial injectionThe initial injection2.2. A second injection one month laterA second injection one month later3.3. A third injection 6 months after the A third injection 6 months after the

first injectionfirst injectionfirst injectionfirst injectionAll three injections are necessary to All three injections are necessary to ensure immunity. There is no ensure immunity. There is no evidence that the vaccine has ever evidence that the vaccine has ever caused Hepatitis B, and the incidence caused Hepatitis B, and the incidence of side effects is low.of side effects is low.

Hepatitis C

Hepatitis C is spread by direct contact with Hepatitis C is spread by direct contact with hepatitis Chepatitis C--infected blood. For example, if infected blood. For example, if pp p ,p ,infected blood came into contact with an infected blood came into contact with an open sore or a cut in your hands, you may open sore or a cut in your hands, you may p y y yp y y ybecome infected. Hepatitis C is not spread become infected. Hepatitis C is not spread by casual contact. by casual contact. yyThere is no vaccine to protect against Hep There is no vaccine to protect against Hep C.C.C.C.

Who should get tested forWho should get tested for Hepatitis C?

Persons who have used injection drugs not Persons who have used injection drugs not prescribed by a doctor, even once prescribed by a doctor, even once P h i d bl d b f 1992P h i d bl d b f 1992Persons who received blood before 1992Persons who received blood before 1992Persons who have received an organ transplant Persons who have received an organ transplant before 1992before 1992before 1992before 1992Persons who have received longPersons who have received long--term term hemodialysishemodialysisyyPersons who were treated for clotting problems Persons who were treated for clotting problems with a blood product made before 1987 with a blood product made before 1987 (h hili )(h hili )(hemophiliacs)(hemophiliacs)

Who should get tested forWho should get tested for Hepatitis C?

Persons who have signs and symptoms of liver Persons who have signs and symptoms of liver disease (e.g., abnormal liver enzyme tests)disease (e.g., abnormal liver enzyme tests)Healthcare workers after accidental exposure to Healthcare workers after accidental exposure to blood (e.g., needle sticks or splash to the eye)blood (e.g., needle sticks or splash to the eye)Cocaine use, sharing straws.Cocaine use, sharing straws.Children born to hepatitis C virusChildren born to hepatitis C virus--positive women.positive women.Long term house hold contacts and sex partners of Long term house hold contacts and sex partners of Hep C.Hep C.

What is the treatment forWhat is the treatment for Hepatitis C?

There is no vaccine for hepatitis C. There is no vaccine for hepatitis C. Antiviral drugs, such as interferon usedAntiviral drugs, such as interferon usedAntiviral drugs, such as interferon used Antiviral drugs, such as interferon used alone or in combination with ribavirin, are alone or in combination with ribavirin, are approved for treatment. Some infectionsapproved for treatment. Some infectionsapproved for treatment. Some infections approved for treatment. Some infections respond better to treatment than others. respond better to treatment than others. Overall, treatment works well in 30Overall, treatment works well in 30--5050Overall, treatment works well in 30Overall, treatment works well in 30 50 50 percent of those who complete antiviral percent of those who complete antiviral treatment.treatment.treatment. treatment.

How long after you are exposed to the hepatitis C virus should

you be tested?you be tested?If you are exposed to HCV, have a baseline If you are exposed to HCV, have a baseline y p ,y p ,blood test done immediately. Second, get blood test done immediately. Second, get retested after 6 months. It can take up to 6 retested after 6 months. It can take up to 6 ppmonths before antibodies appear. months before antibodies appear.

H titi D E d GHepatitis D,E, and GHepatitis D (Delta) is a virus that causes inflammation of Hepatitis D (Delta) is a virus that causes inflammation of p ( )p ( )the liver. Unlike the other hepatitis viruses, HDV cannot the liver. Unlike the other hepatitis viruses, HDV cannot sustain an infection without the help of HBV. sustain an infection without the help of HBV. H titi E i i l di th t i fl ti fH titi E i i l di th t i fl ti fHepatitis E is a viral disease that causes inflammation of Hepatitis E is a viral disease that causes inflammation of the liver. HEV does not cause chronic disease and in the the liver. HEV does not cause chronic disease and in the United States, HEV is rarely found. United States, HEV is rarely found. HGV is a virus that causes chronic inflammation of the HGV is a virus that causes chronic inflammation of the liver. As this virus is very rare, very little is known. As it liver. As this virus is very rare, very little is known. As it appears to be associated with individuals who have anappears to be associated with individuals who have anappears to be associated with individuals who have an appears to be associated with individuals who have an HCV infection, it is thought to be spread in much the same HCV infection, it is thought to be spread in much the same manner as HCV. manner as HCV.

H.I.V. and A.I.D.S.

H.I.V. H.I.V. ––Human Immunodeficiency VirusHuman Immunodeficiency VirusA.I.D.S.A.I.D.S.-- Acquired ImmunodeficiencyAcquired ImmunodeficiencyA.I.D.S.A.I.D.S. Acquired Immunodeficiency Acquired Immunodeficiency SyndromeSyndromeHeterosexual people ages 18Heterosexual people ages 18 25 are at25 are atHeterosexual people ages 18Heterosexual people ages 18--25 are at 25 are at increasing risk for H.I.V.increasing risk for H.I.V.P l ll h t f b tP l ll h t f b tPeople usually have no symptoms for aboutPeople usually have no symptoms for about10 years. (attacks immune system) 10 years. (attacks immune system)

Symptoms Prevention andSymptoms, Prevention and Treatment

People can have no symptoms. They are People can have no symptoms. They are usually diagnosed when they get an usually diagnosed when they get an y g y gy g y ginfection that can easily be treated.infection that can easily be treated.Education, universal precautions, no needleEducation, universal precautions, no needleEducation, universal precautions, no needle Education, universal precautions, no needle sharing, and safe sex sharing, and safe sex Medications for life experimental drugsMedications for life experimental drugsMedications for life, experimental drugs, Medications for life, experimental drugs, holistic therapy, comfort care.holistic therapy, comfort care.

Transmission

Needle stick or sharps injuryNeedle stick or sharps injuryNose, mouth, or eye contactNose, mouth, or eye contactNose, mouth, or eye contactNose, mouth, or eye contactMucous membrane and non intact skin Mucous membrane and non intact skin exposureexposureexposureexposureBlood or other potentially infectious Blood or other potentially infectious

t i l ( t h d t d bit )t i l ( t h d t d bit )materials (scratched, cuts, wounds, or bites)materials (scratched, cuts, wounds, or bites)

Risk of infection after a needle stick

HIV is 0.3%.HIV is 0.3%.Hepatitis C is 3%.Hepatitis C is 3%.Hepatitis C is 3%.Hepatitis C is 3%.Hepatitis B is 30%.Hepatitis B is 30%.

Prevention

Exposure control planExposure control planStandard PrecautionsStandard PrecautionsStandard PrecautionsStandard PrecautionsEngineering controls: sharps containers, self Engineering controls: sharps containers, self sheathing needlessheathing needlessheathing needles.sheathing needles.Work place practices: prompt sharps Work place practices: prompt sharps di l i dldi l i dldisposal, no recapping needles.disposal, no recapping needles.Personal protective equipmentPersonal protective equipment

Standard Precautions

Treat every patient as if they are infected Treat every patient as if they are infected with a blood borne pathogen.with a blood borne pathogen.p gp gTreat all blood and body fluids as Treat all blood and body fluids as infectious.infectious.infectious.infectious.Use personal protective equipment (PPE).Use personal protective equipment (PPE).W h h d f tlW h h d f tlWash hands frequentlyWash hands frequently

PPE

PPE = personal protective equipmentPPE = personal protective equipmentGlovesGlovesGlovesGlovesEye protectionEye protectionGGGownsGowns

PPE

The best proven The best proven effective PPE attire.effective PPE attire.Recommended by the Recommended by the Knights of the Round Knights of the Round T blT blTable.Table.

PPE

GlovesGloves

Eye protectionEye protectionye p otect oye p otect o

Needle SafetyProperly dispose of Properly dispose of sharps in labeled sharps in labeled sharps containersharps containersharps container.sharps container.Do not recap needlesDo not recap needlesReplace sharpsReplace sharpsReplace sharps Replace sharps container when full.container when full.Sharps containers Sharps containers ppshould be easily should be easily accessible.accessible.

Hand washing is #1 defense.Before you eatBefore you eatBefore, during, and after Before, during, and after preparing foodpreparing foodpreparing foodpreparing foodAfter you use the restroomAfter you use the restroomAfter changing a diaperAfter changing a diaperAfter you cough or sneezeAfter you cough or sneezeAfter caring for someone After caring for someone sick or injuredsick or injuredsick or injuredsick or injuredAfter handling garbageAfter handling garbageAfter removing gloves After removing gloves (PPE)(PPE)(PPE)(PPE)

Hand washing procedure:

Blood cleanup procedure

Put on PPE gloves.Put on PPE gloves.Cover spill with absorbent paper towels.Cover spill with absorbent paper towels.p p pp p pClean by wiping from edge to middle (avoid Clean by wiping from edge to middle (avoid cuts from sharps).cuts from sharps).p )p )Clean spill area again with 10% bleach Clean spill area again with 10% bleach solution.solution.Rinse area with water.Rinse area with water.Let area air dry.Let area air dry.Let area air dry.Let area air dry.

Bloody noses, scrapes, and bruises

Put on PPE gloves.Put on PPE gloves.Cover or wipe injury Cover or wipe injury

ith tiith tiwith tissue or gauze.with tissue or gauze.Apply pressure.Apply pressure.Cl ith dCl ith dClean with soap and Clean with soap and water.water.Bandage injuryBandage injuryBandage injury.Bandage injury.Wash hands after Wash hands after removing gloves.removing gloves.

Work Place Practices / Reducing EExposure

Wash hands after removing gloves.Wash hands after removing gloves.Wash hands ASAP after contact w/ body fluids.Wash hands ASAP after contact w/ body fluids.Provide eye irrigation station.Provide eye irrigation station.Discard contaminated needles in sharps container.Discard contaminated needles in sharps container.ppDo not smoke, eat, drink, apply cosmetics or Do not smoke, eat, drink, apply cosmetics or contact lenses in an area of potential exposure.contact lenses in an area of potential exposure.Do not store food or drink in refrigerator where Do not store food or drink in refrigerator where blood or infectious materials are kept.blood or infectious materials are kept.

Work Place Practices / ReducingWork Place Practices / Reducing Exposure

Hep B vaccine must Hep B vaccine must be made available to be made available to all employees thatall employees thatall employees that all employees that have a risk for have a risk for exposure with in 10 exposure with in 10 days of initial days of initial assignment at no cost.assignment at no cost.E l hE l hEmployees who Employees who decline must sign a decline must sign a declination sheet.declination sheet.

What do you do if you are y yexposed to blood or body fluids?

Employer’s Exposure Incident PlanPlan

Wash your hands and any other potentially Wash your hands and any other potentially contaminated skin area immediately with soap andcontaminated skin area immediately with soap andcontaminated skin area immediately with soap and contaminated skin area immediately with soap and water.water.Use eye wash station for eyes and rinse 20 Use eye wash station for eyes and rinse 20 y yy yminutes with water only.minutes with water only.Immediately report incident to supervisor and Immediately report incident to supervisor and f ll t l (i id t t D i it b lif ll t l (i id t t D i it b lifollow protocol (incident reports, Dr visit, baseline follow protocol (incident reports, Dr visit, baseline labs, testing of source blood, post exposure labs, testing of source blood, post exposure prophylaxis)prophylaxis)p p y )p p y )All medical evaluations and follow up must be All medical evaluations and follow up must be made available at no cost to the employee.made available at no cost to the employee.

Follow-up checkup

Repeat testing needs to be done in one Repeat testing needs to be done in one month, three months, six months, and in one month, three months, six months, and in one , , ,, , ,year with your healthcare or workers year with your healthcare or workers compensation provider. (Check with your compensation provider. (Check with your p p ( yp p ( yemployers policy.)employers policy.)

Has this same exposure happened before and can we prevent thisbefore and can we prevent this from reoccurring in the future?g

Questions?Questions?