BBP Online 2017

Bloodborne Pathogens& HIPAA

Bloodborne Pathogens

OSHA Bloodborne Pathogen Standard

• OSHA mandates training annually for all employees who have the potential to be exposed to blood and other potentially infectious materials (OPIM) in the workplace.

• OSHA Bloodborne pathogens regulation went into effect on March 6th, 1992.

Persons covered under this standard

• All employees who may reasonably expect to be exposed to blood and OPIM that may contain pathogens.

• Anyone whose job involves handling or possibly being exposed to blood, blood products, or OPIM.

What are OPIM?Any body fluids , including:

• Saliva• Semen• Vaginal Secretions• Breast Milk• Amniotic Fluid• Cerebral spinal

fluid

• Synovial Fluid • Pleural Fluid• Peritoneal Fluid• Pericardial Fluid• Any body fluid that

visibly is contaminated with blood, such as vomit or urine.

PathogensPathogen: any disease-producing agent, especially a virus, bacterium, or other microorganism.

Examples: HIV, hepatitis B (HBV) and C (HCV), influenza (flu), tuberculosis (TB), meningitis, etc.

Exposure to pathogens• Persons do not have to come into

direct contact with others who have a disease to be exposed.

• Pathogens can be spread through exposure to blood or OPIM that is infected.

How are pathogens spread?• Spilled blood or body fluids• Clinical specimens• Biohazardous Trash• Blood or body-fluid soaked laundry• Sharps (needles, scalpels, etc.)• Aerosolized particles (cough or

sneeze)

Common Pathogens Encountered by EMS Personnel

• Bloodborne Pathogens– HIV– Hepatitis B– Hepatitis C

• Airborne Pathogens– Tuberculosis– Influenza–Meningitis– Pneumonia

Human Immunodeficiency Virus(HIV and AIDS)


Description: HIV damages cells essential for immune function and results in AIDS. People with AIDS are more susceptible to opportunistic infections.

Symptoms: many people with HIV have no symptoms. HIV may take up to 10 years or more to develop into AIDS. Symptoms of AIDS include:

• Loss of appetite• Weight loss• Skin rashes• Swollen lymph nodes• Diarrhea • Fatigue• Night sweats • Inability to fight off infection


How detected: HIV can be detected only through blood tests. The results are usually positive 12 weeks after exposure. A confirmation test is recommended six months after exposure.

How Transmitted: • Through an infected person’s body fluids (blood, semen,

vaginal secretions, breast milk, OPIM if blood is present)• Sexual activity• Needle stick or puncture wounds• Exposure through mucous membranes

Cure / Vaccine: NONE


HIV is not transmitted through:• Casual contact• Sharing a drinking glass, meal, or fork• Kissing, hugging or touching• Sneezes or coughs• Sharing a phone or bathroom• Through mosquitoes, fleas, ticks or

other blood sucking vermin

Hepatitis B Virus (HBV)Description: viral infection that attacks the liver and can cause both acute and chronic disease.

Symptoms: most people do not experience symptoms during the acute infection phase. However, some people have acute illness that lasts several weeks including:• Jaundice• Dark urine• Extreme fatigue• Nausea• Vomiting• Abdominal pain

Hepatitis B Virus (HBV)How Detected: HBV can be detected through blood tests. The incubation period can be up to 12 weeks.How Transmitted: • Through an infected person’s body fluids (blood, semen, vaginal

secretions, breast milk, OPIM if blood is present)• Sexual activity• Needle stick or puncture wounds• Exposure through mucous membranes• Transmitted to child by mother at birthAt room temperature HBV may survive outside the body for several days.Cure / Vaccine: There is no cure, however Hepatitis B vaccination is available in a series of three injections over the course of several weeks.

Hepatitis B Virus (HBV)Hepatitis B is NOT Transmitted through:• Casual contact• Sharing a drinking glass, meal or fork• Kissing, hugging or touching• Sneezes or coughs• Fecal matter• Food or water

Hepatitis C Virus (HCV)Description: A viral infection that attacks the liver and can cause both acute and chronic disease. HCV is usually more chronic than HBV.Symptoms: most people do not experience symptoms during the acute infection phase. However, some people have acute illness that lasts several weeks including:• Jaundice• Dark urine• Extreme fatigue• Nausea• Vomiting• Abdominal pain

Hepatitis C Virus (HCV)How Detected: HCV can be detected through blood tests. Incubation period can be up to 12 weeks.How Transmitted:• Through an infected person’s body fluids (blood, semen, vaginal

secretions, breast milk, OPIM if blood is present)• Sexual activity• Needle stick or puncture wounds• Exposure through mucous membranes• Transmitted to child by mother at birth

At room temperature HCV may survive outside the body for several days.

Cure / Vaccine : NONE

Hepatitis C Virus (HCV)Hepatitis B is NOT Transmitted through:• Casual contact• Sharing a drinking glass, meal or fork• Kissing, hugging or touching• Sneezes or coughs• Fecal matter• Food or water

InfluenzaDescription: viral infection that infects the respiratory tract.

Symptoms:• Cough• Running or stuffy nose• Muscle pain• Stiffness• Fatigue• Headache• Sore throat• Shaking / chills• Fever• Dehydration• Difficulty breathing

InfluenzaHow Detected: diagnosis based on symptoms and/or Rapid influenza diagnostic test (RIDT)

How Transmitted: virus enters the body via mucous membranes (eye, nose, mouth). Most often contracted via airborne droplets or by hand to eye / hand to nose / hand to mouth contact.• Hands (after touching contaminated objects)• Air (in the vicinity of coughing or sneezing)• Contaminated objects (steering wheels, stretcher, used linen)Influenza may survive outside the body for several days.

Cure / Vaccine: no cure, but a vaccine is available. The yearly vaccine only protects against the three strains of the flu expected for that season. Does not always protect against Swine Flue strains and variants.

Tuberculosis (TB)Description: bacterial infection that often infects the lungs.Symptoms: many people with TB infection have no symptoms.

Those who have TB disease (active) will experience:• Weight loss• Fever• Night sweats• WeaknessIn the lung infection can cause:• Coughing• Chest pain• Production of sputum• Coughing up blood

Tuberculosis (TB)How Detected: ppd, blood tests, and chest X-ray (if you have been exposed, you will always test positive on a ppd)People can be infected (no symptoms / not contagious) meaning they have the bacterial antibodies present. A person with active TB is said to have TB disease (symptomatic / contagious)

How Transmitted: aerosolized particles from the cough or sneeze of an infected person.

Cure / Vaccine: TB has no vaccine, but TB disease is curable with antibiotics. Those with TB infection may develop the disease again in the future.

Tuberculosis (TB)How TB is NOT Transmitted:• Clothing• Drinking glass• Eating utensils• Shaking hands• Toilet• Other surfaces

Exposure PreventionExposure Prevention – the means by which you can isolate yourself from pathogens, and protect yourself from exposure.

Exposure: when a specific eye, mouth, other mucous membrane, non-intact skin, or parenteral (piercing mucous membranes or skin) contact with blood or OPIM that results from the performance of an employee’s duties.

Engineering ControlsEngineering Controls – Are controls that isolate or remove the bloodborne pathogen hazard from the workplace.• Sharps disposal containers• Self – sheathing needles• Needleless IV systems• Handwashing• Eye wash stations• Biohazard labels

Sharps ContainersMust be present for safe disposal of used sharps. Containers must be:• Puncture resistant• Leak-proof on sides and bottom• Clearly labeled with orange/red

biohazard warning label• Closable and sealable for shipping or

transport

Handwashing / Eye-washing stations• Handwashing stations must be

supplied whenever possible.–Waterless antiseptic hand

cleanser may be provided when handwashing is not possible.

• Eye-wash stations must be provided whenever possible.– Any equipment or fixture which

allows for flushing of eyes with water for at least 20 minutes.

Work Practice ControlsWork Practice Controls – are controls that reduce the likelihood of exposure by altering the manner in which a task is performed.• Use of personal protective equipment (PPE)• Handwashing• Decontamination and sterilization of equipment /

areas• Safely handling sharps• Correctly disposing of wastes• Safely handling laundry• Work area restrictions

Personal Protective Equipment (PPE)Personal Protective Equipment – is specialized clothing or equipment worn by an employee for protection against a hazard.General work clothes (uniforms, pants, shirts, or blouses) not intended to function as protection against a hazard are not considered to be personal protective equipment.The following are considered PPE:• Gloves• Tyvek suits / aprons• Eye shields and goggles• Face masks / face shields

Personal Protective Equipment(PPE) (cont.)

• PPE is to be provided at no cost to the employee

• Training on how to properly use equipment is to be provided to employees

• PPE must be cleaned, repaired, or replaced as needed

Medical Exam Gloves• Normal exam gloves are non-latex• P2 (Heavy gloves) are latex• Sterile gloves are latex

• Make sure gloves are intact– If not, replace glove– Do not attempt to repair gloves with tape, etc.– Petroleum based hand lotions can weaken

gloves, do not use them!

Removal and Disposal of Gloves

• Remove contaminated gloves carefully without touching any part of the outside of the glove.

• Dispose of gloves in a container clearly marked for biohazardous wastes.

Other PPE• Tyvek suits – protect clothing

(available in different thicknesses and materials)

• Goggles, Eye Shields, Safety glasses with side shields, and face shields: protect eyes from exposure to blood / OPIM– Do personal eyewear (sunglasses /

prescription glasses) count as PPE for eye protection?

–NO! They do not have side shields.

Handwashing Guidelines• Immediately wash any exposed skin,

ideally with antibacterial soap• Be gentle with any scabs or sores• Wash all surfaces including the back

of the hands, wrists, between the fingers and under the fingernails

• Wash hands immediately after removing gloves or other PPE

Waterless Handwashing• Antiseptic towelettes and waterless

antibacterial handwashing liquid can be used when soap and running water are not available.

• After a potential exposure a thorough scrubbing with soap and water is still recommended as soon as possible.

Decontamination / Sterilization

• Clean and sterilize all reusable equipment after use.

• Clean and disinfect working surfaces such as bench seats, shelves, floors, and ambulance floors, walls, and ceilings.– Use 10% bleach solution or acceptable pre-mixed

commercial solutions– Clean surfaces as they become contaminated– Clean surfaces after any spill of blood or OPIM

• Ideally, ambulances should be decontaminated after every call.

Decontamination / Sterilization

Handling Sharps• Sharps containers must be placed in

easily accessible areas where sharps are used

• Contaminated sharps must be placed into sharps containers immediately or as soon as possible after use

• Contaminated sharps shall not be bent, re-capped, sheared, or broken, and sharps should not be disassembled prior to disposal

Regulated Waste• Liquid or semi-liquid blood or OPIM• Contaminated items which would release blood or

OPIM in a liquid or semi-liquid state if compressed• Items with dried blood or OPIM that could be

spread by handling• Contaminated sharps• Pathological or microbiological waste containing

blood or OPIM• Waste should be placed into an appropriate

receptacle container such as a red bag or clearly labeled sharps container.

Safely Handling Laundry• Uniforms, clothing and cloth supplies

should be kept free from contamination when possible.

• Laundry contaminated by blood or OPIM shall be placed in a labeled hazardous materials bag.– DO NOT TAKE CONTAMINATED LAUNDRY

HOME, you can wash it at the Wash Tub on South Park Ave., and they will bill Big Tree VFC

Safely Handling Laundry (cont.)

Anyone handling contaminated laundry must be trained to handle bloodborne pathogens

Universal PrecautionsAll blood and OPIM is treated as if it were infected with HIV, HBV, and other bloodborne pathogens.

Dealing With ExposureIf blood or OPIM splashes in your eyes or other mucous membranes:• Flush area with running water for twenty minutes• Wash any exposed area well with antibacterial

soap• Gently treat any scabs or sores• IMMEDIATELY report the exposure to 9-3 or (in the

absence of a 9-3) the chief• Save any potentially contaminated objects for

testing purposes• Seek medical care

Post-ExposureTreatment and medical care depend on:• The type of exposure• Substance involved• Route of transmission• Severity of the exposureA confidential exposure report will be placed in the employee's personnel file.

Bloodborne Questions?

HIPAA & PHI

HIPAA• In 1996 the Health Insurance

Portability and Accountability Act was passed by the federal government.

• It’s aim, among other things, was to force health care providers to protect the privacy of patient health information (PHI).

Covered Entity• An organization or business which is

bound by HIPAA regulations is called a “Covered Entity”

• Big Tree VFC is a “Covered Entity”

What is PHI?“Health information means any information, whether oral or recorded in any form or medium, that-• (A) is created or received by a health care

provider, health plan, public health authority, employer, life insurer, school or university, or health care clearinghouse; and

• (B) relates to the past, present, or future physical or mental health or condition of any individual, the provision of health care to an individual, or the past, present, or future payment for the provision of health care to an individual.”

What is PHI? (cont.)“Individually identifiable health information is information that is a subset of health information collected from an individual, and:• (1) Is created or received by a health care provider, health

plan, employer, or health care clearinghouse; and• (2) Relates to the past, present, or future physical or

mental health or condition of an individual; the provision of health care to an individual; or the past, present, or future payment for the provision of health care to an individual; and

• (i) That identifies the individual; or• (ii) With respect to which there is a reasonable basis to

believe the information can be used to identify the individual.”

To simplify, PHI is:Any information that can identify or potentially identify a patient and/or pertains to the patients past, present or future health status.

For us this is:Name ,DOB, SS#, history, meds, chief complaint, etc.

Restricted Use and Disclosure of PHI

• Patients can ask that health information not be shared with certain people, groups, or companies.

• In cases like this the EMT in charge of the patient needs to make 9-3 and/or 9 aware of this request as soon as possible without compromising patient care or safety.

• For Example, a patient may ask that there information not be shared or made known to a certain member.

When is it okay to release PHI?

• Generally patients must give a “covered entity” WRITTEN consent to release any PHI

• There are a few ways some PHI may be released without written consent:– A patients name may be used in a radio

transmission if a crew is having difficulty locating said patient. For example – there are no room numbers on an apartment list, but there are resident names. Dispatch can radio the name of the patient to the crew.


– An EMS crew may report the condition of a patient to an immediate family member (spouse, child, grandchild, or health care proxy)

– If the patient is a victim of a crime, EMS may tell law enforcement about the patient’s injuries and condition. If the patient is NOT a victim of a crime but agrees to speak to police about their condition, this is not a PHI violation because the patient is speaking to police, not the EMS crew.


– An EMS crew may report patient injuries to law enforcement if the patient is possibly wanted in relation to a crime.

– When EMS is delivering a report to a hospital or receiving medical facility. This is to preserve the continuity of care, providers NEED to pass on pertinent medical information and history and treatments given. EMS can disclose PHI to a triage nurse or doctor at a receiving facility.

– EMS also has the right to open and review patient records when being transferred from a facility.


–When EMS is reporting suspected abuse that is covered under Mandated Reporting;• Child abuse/ neglect

– 50 years following the date of death of the individual

When is it NOT permissible to disclose PHI?

Posting it on Social Media• EMS providers may not post details

about runs on any electronic medium. This is true even when a patient name is not used. If there is enough information for someone to identify the patient (for example the nature of the injury, the time and location of an incident, etc.) the provider will be in violation.


Discussions with colleagues/friends• Just as with electronic mediums, discussing

patient encounters with colleagues who were not part of the patient care team (face to face, or in writing) is a definite no-no.

• This applies also to conversations outside of work with the provider’s friends or family.KEEP IN MIND: YOU NEVER KNOW WHO

KNOWS WHOM!


Statements to news media• EMS providers may not provide any

information about the nature or severity of a patient’s illness or injuries.

• EMS providers may not verify the identity of a patient being treated EVEN IF the media agency claims to already know the identity of the patient.

• “NO COMMENT” and/or “PLEASE SEE THE PIO/CHIEF” are always rules of thumb!


Sharing patient status or information with neighbors

• EMS providers may not disclose any patient information to a patient’s neighbor, friends, or other persons who are not involved in the treatment of said patient.

• If a concerned neighbor or friend wants to know about the patient, let the patient tell them.

Allowing other people to access your PCR

• PCRs are confidential. • PCRs and other hard copy PHI (med lists, etc.)

should be secured in a receptacle designed to protect against unauthorized access.

• EMS providers may not allow others to see their PCRs, however, there are some exceptions:– When the member in question is on the call with you– When a EMTs number are on that PCR– For training/learning/QA&QI purposes with patient

info redacted.

Why is HIPAA Important?• Individuals and agencies who violate

HIPAA privacy can be fined and individuals can even serve jail time if found guilty of violating these statutes.

• It’s just the right thing to do – we are patient advocates and should be protecting the privacy of our patients.

HIPAA breach notification• In the event that PHI is accidently or

deliberately disclosed in violation of HIPAA regulations, the covered entity is required to report the breach immediately.

• It is unlawful to hide or cover-up any confirmed or potential breach.

• If you feel that a HIPAA breach has occurred, report the situation to any Chief or EMS officer immediately!

Civil HIPAA breach penaltiesHIPAA Violation Minimum Penalty Maximum Penalty

Unknowing

$100 per violation, with an annual maximum of $25,000 for repeat violations (Note: maximum that can be imposed by State Attorneys General regardless of the type of violation)

$50,000 per violation, with an annual maximum of $1.5 million

Reasonable Cause $1,000 per violation, with an annual maximum of $100,000 for repeat violations


Willful neglect but violation is corrected within the required time period

$10,000 per violation, with an annual maximum of $250,000 for repeat violations


Willful neglect and is not corrected within required time period



Criminal HIPAA breach penalties• Criminal violations of HIPAA are handled by the DOJ. As

with the HIPAA civil penalties, there are different levels of severity for criminal violations.

• Covered entities and specified individuals, as explained below, who "knowingly" obtain or disclose individually identifiable health information, in violation of the Administrative Simplification Regulations, face a fine of up to $50,000, as well as imprisonment up to 1 year.

• Offenses committed under false pretenses allow penalties to be increased to a $100,000 fine, with up to 5 years in prison.

• Finally, offenses committed with the intent to sell, transfer or use individually identifiable health information for commercial advantage, personal gain or malicious harm permit fines of $250,000 and imprisonment up to 10 years.

Lets see what we have learned

Scenario 1After a call your writing your PCR in length. It was a bad call, and you know that it is going to go to court. After your done writing it you take a picture with your cellphone, which is passcode protected, so you won’t forget the details of it.

NO, its not okay, there are requirements for electronic storage of PHI. Even though the device is passcode protected, it may need more security like encryption and other measures. Generally most personally owned devices don’t meet HIPAA requirements for PHI.

Scenario 2You wrote a PCR and wrote a couple things in wrong spots and crossed out a lot of other items. You decide that you are going to re-write it. After re-writing it you destroy the old PCR by ripping it up into little pieces.This is not considered a secure way to dispose of PHI, some one may be able to easily put it back together. You must shred the PCR to prevent someone from possibly being able to tape it together.

Scenario 3You are in a hospital common area with 2 other members whom are discussing a EMS call you were not on from the other night. There are no patients or other personnel around.Because you were not on the EMS call, you do not know the patient involved. During the conversation, they mention the patients name and that he was diagnosed as being schizophrenic.

What should you do?A. Advise the members to please stop discussing the

call and patient while you are with them. Remind them that they should not be discussing PHI or other confidential information with you or with others who are not authorized to have it.

B. Since you are from the same agency, tell the other members that they can continue their discussion, but should be quieter since other people might overhear what they are saying.

C. Continue what you're doing and don’t say anything.D. Since the same thing can happen on other calls, ask

for more information as it can be a great learning experience.

ReasoningThe correct option is A. When discussing PHI or other confidential information with others (in person or on the phone), this information should be shared with only those people who are authorized to receive the information and have a “need to know” status.

Scenario 4You find a portion of a patients record left on the glass of a copy machine in a public area of the hall. No one else is around.What should you do?A. Call the patient and notify them that their PHI

was left out in the open.B. Shred the document.C. Leave it by the copier. The person who left it

will most likely come back.D. Secure the document by putting it in a folder

or envelope and report it to a chief.

ReasoningThe correct option is D. Securing the document prevents further unintentional disclosure, and a chief can make sure the incident is properly documented. Be sure to cover the information appropriately at all times while delivering it.

Scenario 5While you are leaving a patient at the hospital, a doctor is talking quietly to another patient in another hospital bed in the same room. You, your patient, and your patients family overhear parts of the conversation.What should you do?A. Nothing.B. Speak to the doctor after you both leave the room,

reminding him of his patients right to privacy.C. Speak loudly while you are in the room so that your

patient and there visitors cannot overhear the conversation.

D. Interrupt the doctor to remind him of his patients protection under privacy laws.

ReasoningThe correct option is A. “Incidental” disclosures are allowed, so as long as the Covered Entity takes reasonable measures to keep the disclosure to the minimum necessary.

HIPAA and/or PHI Questions?

The END

Recruiting & HR

BBP Online 2017