Unit 3 - Work Safety and Infection Control
Management of Occupational Exposure to HIV/HBV/HCV
An occupational exposure is defined as a percutaneous injury(e.g., a needlestick or cut with a sharp object) or contact of mucous membrane or non-intact skin (e.g., exposed skin that is chapped, abraded, or afflicted with dermatitis) with blood, tissue, or other potentially infectious materials.
Disinfectant/Chemical Germicides
Chemical germicides and disinfectants used at recommended dilutions must be used to decontaminate environmental surfaces. Consult the Environmental Protection Agency (EPA) lists of registered sterilants, tuberculocidal disinfectants, and antimicrobials with HIV/HBV efficacy claims for verification that the disinfectant used is appropriate.
Bite or Scratch Wounds
Exposure to saliva is not considered substantial unless there is visible contamination with blood or the saliva emanates from a dental procedure. Wash the area with soap and water, and cover with a sterile dressing as appropriate. All bites should be evaluated by a health care professional. Note: For human bites, the clinical evaluation must include the possibility that both the person bitten and the person who inflicted the bite were exposed to bloodborne pathogens
Personal Protective Equipment (PPE)
Gloves, masks, protective eyewear and chin-length plastic face shields are examples of personal protective equipment (PPE). PPE shall be provided by the company owner/owners. Employees must wear appropriate PPE in all instances where they will or may come into contact with blood or OPIM. This includes, but is not limited to dentistry, phlebotomy or processing of any bodily fluid specimen, and postmortem (after death)procedures.
Hand Hygiene
It is advisable to keep fingernails short, and to wear a minimum of jewelry. Additional information on hand hygiene a can be found in the CDC Guideline for Hand Hygiene in Healthcare Settings, 2002.
Post-Exposure Management
Post-Exposure medical evaluation must be : Provided according to Federal Regulations The employer is also responsible for arranging source individual testing Made immediately available Kept confidential Provided at no cost to the employee
Source testing
WAC 296-823-16010 requires the employer to arrange to test the "source individual" - someone whose blood or OPIM an employee was exposited to - for HIV, HBV and HCV as soon as feasible after getting their consent. If the employer does not get consent the employer must document such and informs the employee.
The Risks of Infection from an Occupational Exposure Depend on the Following:
Whether the exposure was from a hollow-bore needle or other sharp instrument; Was exposure on non-intact skin or mucus membranes (such as the eyes, nose, and/or mouth); What was the amount of blood that was involved and the amount of virus present in the source's blood.
Regulated Waste Disposal
All regulated waste must be placed in closeable, leak proof containers or bags that are color-coded (red bagged) or labeled as required by WAC 296-823-14060 to prevent leakage during handling, storage and transport. Disposal of waste shall be in accordance with federal, state and local regulations.
Cleaning Body Fluid Spills on Vinyl Floors
Any broken glass should be swept up using a broom and dustpan, (never bare hands!) empty the dustpan in a well-marked plastic bag or heavy-duty container. The body fluid spill may be pretreated with full-strength liquid disinfectant or detergent. Next, wipe up the body fluid spill with either a mop and hot, soapy water, or appropriate gloves and paper towels. Dispose of the paper towels in the plastic bag. Use a good disinfectant (e.g., household bleach 5.25% mixed fresh with water 1:10) to disinfect the area that the spill occurred. If a mop was used for the cleaning, soak it in a bucket of hot water and disinfectant for the recommended time. Empty the mop bucket water in the toilet, rather than a sink. Sponges and mops used to clean up body fluid spills should not be rinsed out in the kitchen sink, or in a location where food is prepared.
Exposure Control Plan to Limit Exposure is Mandated by WISHA/OSHA
1. A written "exposure determination" that includes those job classifications and positions in which employees have the potential for occupational exposures. 2. The procedure for evaluating the circumstances surrounding exposure incidents, including maintenance of a "Sharps Injury Log." 3. The infection control system used in your workplace 4. Documentation of consideration and implementation of appropriate, commercially available safer medical devices designed to eliminate or minimize occupational exposure. 5. The ECP must be updated on at least an annual basis and whenever changes occur that effect occupational exposure.
The Employer must supply:
A copy of WAC 296-823-160 A description of the job duties the exposed employee was performing when exposed Documentation of the routes of exposure and circumstances under which exposure occurred Results of the source person's blood testing, if available All medical records that you are responsible to maintain, including vaccination status, relevant to the appropriate treatment of the employee.
Reporting the Exposure
After cleaning the exposed area, report the exposure to the department or individual at your workplace that is responsible for managing exposure. Obtain medical evaluation as soon as possible. Discuss with a healthcare professional the extent of the exposure, treatment, follow-up care, personal prevention measures, the need for a tetanus shot and other care. Your employer is required to provide an appropriate post exposure management referral at no cost to you. Note: HIV and hepatitis infection are notifiable conditions under WAC 246-101. To see the WAC click on the link below:
Hand Hygiene: Hand hygiene (soap and water washing or use of a waterless alcohol based hand rub) must be performed
After removal of gloves and/or other protective equipment. Immediately after hand contact with blood or other infectious materials. It is also recommended that hand hygiene be performed before leaving Patient care facilities. Upon leaving the work area. Before and after patient contact and after using restroom soap and water hand washing must be performed whenever hands are visibly contaminated or there is a reasonable likelihood of contamination.
Hepatitis B Vaccination
All employees with occupational exposure to blood or OPIM must be offered Hepatitis B Vaccination after receiving required training and within 10 days of initial assignment. The vaccine must be provided free of charge. Serologic testing after vaccination (to ensure that the shots were effective) is recommended for all persons with ongoing exposure to sharp medical devices.
Blood and Other Potentially Infectious Materials (OPIM)
Body Fluids that carry infection Bodily fluids that have been recognized as linked to the transmission of HIV, HBV and HCV, and to which Standard Precautions and Universal Precautions apply are: blood, blood products, semen, vaginal secretions, cerebrospinal fluid, synovial (joint) fluid, pleural (lung)fluid, peritoneal (gut) fluid, pericardial (heart) fluid, amniotic (fluid surrounding the fetus) fluid, saliva in dental procedures, and specimens with concentrated HIV, HBV and HCV viruses. Body fluids such as urine, feces, and vomitus are not considered OPIM unless visibly contaminated by blood. Laundry can be a source of infection, handle it carefully!
Personal Activities and Food and Drink
Eating, drinking, smoking, applying cosmetics or lip balm, and handling contact lenses are prohibited in work areas that carry occupational exposure. Food and drink must not be stored in refrigerators, freezers or cabinets where blood or OPIM are stored, or in other areas.
Exposure to Urine, Vomit, or Feces
Exposure to urine, feces, vomit or sputum is not considered a potential bloodborne pathogens exposure unless the fluid is visibly contaminated with blood. Follow your employer's procedures for cleaning these fluids.
Treatment after a Potential Exposure
FOLLOW THE PROTOCOL OF YOUR EMPLOYER. As soon as safely possible, wash the affected area(s) with soap and water. Application of antiseptics should not be a substitute for washing. It is recommended that any potentially contaminated clothing be removed as soon as possible. It is also recommended that you familiarize yourself with existing protocols and the location of emergency eyewash or showers and other stations within your facility. If the exposure is to the eyes, nose or mouth, flush thoroughly with water, saline or sterile irrigates. The risk of contracting HIV through this type of exposure is estimated to be 0.09%.
Bloodborne Pathogens Training is also Mandatory to Prevent Exposure
New Employees - All new employees or employees being transferred into jobs involving tasks or activities with potential exposure to blood/OPIM shall receive training prior to assignment to tasks Training - Include information on the hazards associated with blood/OPIM, the protective measures to be taken to minimize the risk of occupational exposure, and information on the appropriate actions to take if an exposure occurs. Retraining - Retraining is required annually, or when changes in procedures or tasks affecting occupational exposure occur. Questions - Employees must be provided access to a qualified trainer during the training session to ask and have answered questions as questions arise.
Safer Medical Devices
Safer medical devices and work practices shall be used in preference to personal protective equipment to minimize or eliminate employee exposure. There are now many safer medical devices available. Employers must include employees in ongoing evaluation of safer medical devices and implement these devices whenever feasible. Evaluation and implementation of these devices must be documented in the ECP. Safer medical device lists can be accessed through web sites maintained by the California Division of Occupational Safety and Health SHARP program, the National Association for the Primary Prevention of Sharps Injuries, and the International Health Care Worker Safety Center. Note: Reusable syringes which have loose needle hubs should be replaced. If the hub ends up coming off when the needle is being removed it could cause a needle stick injury when the employee tries to remove the dirty needle from the hub. For safety reasons purchase replacement syringes in which the hub does not screw on and off. Never reach into a sharps container to reclaim a needle hub.
Specimens
Specimens of blood or OPIM must be placed in a closeable, labeled or color-coded leak proof container prior to being stored or transported.
Occupational Exposure to Bloodborne Pathogens
The following requirements are mandated by Washington Administrative Code (WAC)296-823, Occupational Exposure to Bloodborne Pathogens. They are enforced by the Department of Labor and Industries Division of Occupational Safety and Health (DOSH). Please check with your agencies to make sure you are in compliance with there requirements of this rule. Failure to comply may result in citations or penalties. This is a brief summary, and is not meant to provide direction on compliance with WAC 296-823. The federal Occupational Safety and Health Administration's compliance directive on occupational exposure to bloodborne pathogens, CPL 2-2.69, may be referenced for additional direction. For more information or assistance, contact an L&I consultant in your area. Check the blue government section of the phone book for the office nearest you, or call L&I's 24-hour toll-free line 1-800-4-BE-SAFE. For Internet access, go to www.lni.wa.gov. While HBV and HIV are specifically identified in the standard, "Bloodborne Pathogens" include any human pathogen present in human blood or other potentially infectious materials (OPIM). Bloodborne pathogens may also include HCV, Hepatitis D, malaria, syphilis, babesiosis, brucellosis, leptospirosis, arboviral infections, relapsing fever, Creutzfeldt-Jakob disease, adult T-cell leukemia/lymphoma (caused by HTLV-I), HTLV-I associated myelopathy, disease associated with HTLV-II, and viral hemorrhagic fever. According to the CDC, HCV infection is the most common chronic bloodborne infection in the United States. HCV is a viral infection of the liver transmitted primarily by exposure to blood.
Risk of HIV Transmission
The risk of HIV infection to a health care worker through a needle-stick is less than 1 percent. Approximately 1 in 300 exposures through a needle or sharp instrument result in infection. The risks of HIV infection though splashes of blood to the eyes, nose or mouth is even smaller - approximately 1 in 1,000. There have been no reports of HIV transmission from blood contact with intact skin. There is a theoretical risk of blood contact to an area of skin that is damaged, or from a large area of skin covered in blood for a long period of time. Through December 2002, the CDC reports 57 documented cases and 139 possible cases of occupational exposure to HIV since reporting started in 1985.
Risk of Hepatitis B and C Transmission
The risk of getting HBV from a needle-stick is 22-31% if the source person tests hepatitis B surface antigen (HBsAg) and Hepatitis B e antigen (HBeAg) positive. If the source person is HBsAg positive and HBeAg negative one has a 1-6% risk of getting HBV unless the person exposed has been vaccinated. The risk of getting HCV from a needle-stick is 1.8%. The risk of getting HBV or HCV from a blood splash to the eyes, nose or mouth is possible but believed to be very small. Since 1999 about 800 health care workers a year are reported to be infected with HBV following occupational exposure. There are no exact estimates on how many health care workers contract HCV from an occupational exposure, but the risk is considered low.
Clean and Sanitary Conditions
The work area is to be maintained in a clean and sanitary condition. The employer is required to determine and implement a written schedule for cleaning and disinfection based on the location within the facility, type of surface to be cleaned, type of soil present and tasks or procedures being performed. All equipment, environmental and working surfaces must be properly cleaned and disinfected after contact with blood or OPIM. Contaminated broken glassware must be removed using mechanical means, like a brush and dustpan or vacuum cleaner.
Infection Control Systems
Universal precautions - A system designed to prevent transmission of bloodborne pathogens in health care and other settings. Under universal precautions, blood/OPIM of all patients should always be considered potentially infectious for HIV and other pathogens. Standard Precautions - Is a newer system that considers all body fluids, except sweat, should be considered to be potentially infectious.
Blood and Other Potentially Infectious Materials (OPIM) (continue), Cleaning Dental/Medical Traps should be Considered potentially an exposure risk
Wastewater (sewage) has not been implicated in the transmission of HIV, HBV, and HCV and is not considered to be either OPIM or regulated waste. However, plumbers working in health care facilities or who are exposed to sewage originating directly from health care facilities carry a theoretical risk of occupational exposure to bloodborne pathogens. Employers should consider this risk when preparing their written "exposure determination". Plumbers or wastewater workers working elsewhere are probably not at risk for exposure to bloodborne pathogens. Wastewater contains many other health hazards and workers should use appropriate personal protective equipment and maintain personal hygiene standards when working.
