Bloodborne Pathogens

Why is it uncommon for the US to have hep A?

In the United States, chlorination of water kills Hepatitis A virus that enters the water supply.

Complications of Hepatitis B

Liver Cancer Cirrhosis Chronic liver disease Death

What is the Tx for Hep B?

acute infection : supportive chronic - antiviral meds, medical evaluation, and monitoring

Bloodborne Pathogens of Most Concern in the Workplace (3)

1. Human Immunodeficiency Virus (HIV) 2. Hepatitis B & C Virus (HBV) (HCV) 3. Viral Hemorrhagic Fever (Level 4: Ebola and Marburg virus)

Purpose of the Standard

1. Safe work environment 2. Increase awareness 3. Teach personal protection 4. Improve work conditions 5. Reduce risks

What is the highest risk for HIV transmission? Second highest risk?

1. anal sex 2. vaginal sex HIV is spread mainly by having unprotected sex with an infected person

What 3 things should close follow-up for exposed personnel provide?

1. counseling 2. baseline and follow-up HIV testing 3. monitoring for drug toxicity

Anti-HCV antibody can usually be detected within

12 weeks of exposure

Bloodborne Pathogens Standard

1991 ALL occupational exposure to blood + other potentially infectious material (OPIM)

A person infected with Hepatitis B will usually have a positive test for the HBV surface antigen within ___weeks from the start of symptoms

2-6 weeks

New recommendation-PEP medication regimens should contain _____ (or more) antiretroviral drugs for all occupational exposures to HIV

3

Vaccine available for long-term prevention of HAV infection in persons ____of age and older

1 year

Engineering and Work Practice Controls

1) Avoiding actions which may splash, spray, splatter, or create droplets 2) Never pipette or suction infectious materials by mouth 3) Always using appropriate personal protective equipment 4) Using approved sharps containers whenever necessary 5) Disposing of glass, etc. in puncture resistant containers 6) Using needleless systems, if possible 7) Never eating, drinking, smoking, applying cosmetics or lip balm, or handling contact lenses where blood or other potentially infectious materials are present 8) Decontaminating all surfaces, tools, and equipment that come in contact with blood or potentially infectious materials as soon as possible

Risk Groups for HCV

1) Multiple sex partners or dx of STD 2) homosexual men 3) Sex contacts of infected persons 4) Injection drug users 5) Household contacts of chronically infected persons 6) Infants born to infected mothers 7) Health care and public safety workers 8) Hemodialysis patients

Vaccination, Post-Exposure Follow-up

1) Report the incident immediately 2) Inform supervisor 3) Go to clinic/medical services provider 4) Confidential medical evaluation ----Route of exposure -----Circumstances of the incident ------Source known 5) Important to start drug therapy within *2 hours* Testing of victim/source only with consent (baseline blood stored for 90 days)

Compliance: Fluorescent orange-red Labels must include universal biohazard symbol and the term "Biohazard" Where-ever BBP or OPIM are stored...Secured with: string, tape, wire, adhesive what are the exceptions:

1) clinical use blood products 2) blood samples in containers 3) blood drawing tubes

Ideally vaccination should have been done prior to training/working and tested _____after completion of vaccine series

1-2 months

Do the majority of HBV infected people become carriers or recover?

Approximately 85% of infected persons will recover in 6-8 weeks The other 15 % become chronic carriers of the disease and can transmit it to others

is very hardy and can survive in dried blood for many days.

Hepatitis B virus

Hep that is not efficiently transmitted sexually

Hepatitis C

most common chronic bloodborne infection in the United States Approximately 2.7 million persons have chronic ___infection

Hepatitis C

leading cause of chronic liver disease in the U.S.

Hepatitis C Virus

number one indication for liver transplantation in the U.S

Hepatitis C Virus

____ needles are the cause of injury in 68.5% of cases of contamination

Hollow-bore

"Retractable Technology"

Injection goes in, needle jumps into the barrel so you don't have to worry if its stuck

How long does it take for a blood test, to be positive after exposure to hepatitis B virus?

On the average of 4 weeks (range 1-9 weeks) after exposure to the virus.

How do you get hepatitis A?

Oral-Fecal Route Spread when a person ingests fecal matter from contact with objects, food, or drinks contaminated by the feces, or stool, of an infected person

what is recommended when occupational exposures to HIV occur?

PEP postexposure prophylaxis or post-exposure prevention (PEP) is any preventive medical treatment started immediately after exposure to a pathogen (such as a disease-causing virus), in order to prevent infection by the pathogen and the development of disease.

PEP medication regimens should be started and continued for how long? When should follow up occur?

PEP medication regimens should be started as soon as possible after occupational exposure to HIV, and they should be continued for a *4-week* duration Follow-up appointments should begin within 72 hours of an HIV exposure 4th generation Ab = 4-6 months

HCV TREATMENT

Peginterferon alfa 2a or 2b & Ribaviran the mainstay until 2013 achieve SVR (sustained virologic reaction) in 50%-80% of patients after 24-48 weeks of treatment In late 2013 the FDA approved two new direct acting antiviral drugs, Sofosbuvir (Sovaldi™) and Simeprevir (Olysio™) to treat chronic HCV infection achieve SVR in 80%-95% of patients after 12-24 weeks of treatment

What is the treatment for Hepatitis A?

People with Hepatitis A usually improve without treatment

What are the causes of hepatitis ?

excessive alcohol use illicit drug use prescription + OTC interactions viral infections (mono)

Hep A presentation

jaundice cirrhosis

How can you kill/prevent Hep B?

Bleach Sterilization Formalin

how is Hep B transmitted?

is transmitted primarily through blood to blood contact

Bloodborne Pathogens

a microorganism that is carried, replicated and/or transmitted in blood or blood products and is capable of causing disease

what is the #1 OTC drug that's metabolized through the liver

Acetaminophen (tylenol)

Revisions to Standards

Additional definitions New Exposure Control Plan requirements Input non-managerial employees Sharps injury log

Signs posted at all work area entrances

Biohazard symbol Infectious agent Entry requirements Name & telephone # of responsible person

Needleless Systems New Definition

Device that does not use a needle for: 1) Collection of bodily fluids 2) Administration of medication/fluids 3) Any other procedure with potential percutaneous exposure to a contaminated sharp

procedures that are established to minimize or eliminate personal contact with bloodborne pathogens

Engineering and Work Practice Controls

Inspection Items

Exposure Control Plan --Jobs --Tasks --Compliance Methods Engineering Controls --Workplace Practices --PPE HBV Vaccination/Post-Exposure Follow-up Records Management --Medical --Sharps Injury Log --Training

T or F alcohol swabs can kill Hep B

F

T or F Records including dates of Hepatitis B vaccinations and related information as well as medical evaluations and reports must be maintained for the duration of employment

F *plus 30 years and must be kept confidential Includes: Name & social security number Vaccination status Examination results

T or F Expert consultation is recommended for only severe occupational exposures to HIV

F Expert consultation is recommended for any occupational exposures to HIV

T or F Using antiseptics or squeezing the wound will reduce the risk of transmission of a bloodborne pathogen

F No scientific evidence found Using a caustic agent such as bleach is not recommended

The 30% of HCV people who do have symptoms feel like they have the_____

Flu

dark urine clay-colored stools jaundice abdominal pain joint pain N/V, loss of appetite, fatigue, fever

HBV

75-85% of patients become chronic carriers of this Hepatitis

Hep C

This Hep can live on dried surfaces for up to one week

Hepatitis B

This Hep vaccine given in a series of 3 shots. 1) Day 0 2) 1 month later 3) 5 months later up to 95% effective and is effective for up to 15 years

Hepatitis B

6-30% chance of infection from a puncture wound (contaminated needle) occurs in this Hepatitis.

Hepatitis B & C Virus

Up to 30% of infected individuals can become carriers without having symptoms in this Hepatitis

Hepatitis B & C Virus

What is more infectious...Hep B and C or HIV?

Hepatitis B & C Virus is 100 times more infectious than HIV

How long can HCV live outside the body and transmit infection?

Recent studies suggest that HCV may survive on environmental surfaces at room temperature at least 16 hours, but no longer than 4 days.

Must be placed in closeable, leak-proof containers built to contain all contents during handling, storing, transporting or shipping and be appropriately labeled or color-coded

Regulated Waste

Bloodborne Pathogens: Other Potentially Infectious Materials

Semen Vaginal secretions Spinal, pleural, peritoneal, pericardial, amniotic, and synovial fluids Saliva from dental procedures Any body fluid visibly contaminated with blood

When should you start Hepatitis B immune globulin (HBIG) alone or in combination with vaccine (if not previously vaccinated?

Start, preferably within 24 hr, but no later than 7 days.

T or F All human blood and other potentially infectious body fluids must be treated as infectious

T

T or F Once the needle is used, the hinge should be clicked into place using a tabletop-- NOT the other hand.

T

T or F Red bags or containers may be substituted for labels

T

Two Specific Criteria for Infection to Occur

The blood/body fluid must be infected AND The virus must enter the body - exposure incident

T or F Hepatitis A appears only as an acute or newly occurring infection. It does not become chronic

True

T or F Meeting the Bloodborne Pathogen Standard is not optional

True. Purpose is to protect employees from health hazards associated with bloodborne pathogens

Sharps Injury Log

Type and brand of device involved Department or area of incident Description of incident

Engineering/Work Practices Control Decontamination Procedures:

Use a freshly prepared bleach solution diluted 1:10 with water or other EPA registered tuberculocidal disinfectant Wear gloves and other personal protective equipment, as necessary Cover the spill with paper towels or rags, gently pouring the disinfectant over the towels, and let it set at least 10 minutes Assure that all areas of blood/OPIM are in contact with the disinfectant Dispose of decontaminated material in the normal trash Decontaminate mops and other reusable equipment after use

What Are Fluids NOT Considered a Risk for BBP?

Vomit Feces Urine Sweat Nasal discharges Saliva (non dental) Tears *But all become a risk if contaminated with blood

Is the Hep B vaccine safe for pregnant women or for women who are breast feeding?

Yes.