Fermilab Fire Department Excellence Through Training January 2009

Fermilab Fire Department Excellence Through Training January 2009

Bloodborne Pathogens Awareness

Objectives 1 of 2 • Identify the laws relating to Bloodborne Pathogens (BBP) • Identify the definition of BBP • Identify local procedures for BBP and exposures to BBP • Identify precautions and PPE relating to BBP

Objectives 2 of 2 • Identify Facts and Characteristics of BBP • Identify Methods BBP can be spread • Identify high risk behaviors/practices associated with BBP

OSHA 1910. 1030 Occupational Exposure to Bloodborne Pathogens (Mandated Federal Law) Adopted by reference in Illinois (IDOL)

“Bloodborne Pathogens” Defined. . . Pathogenic microorganisms that are present in human blood and can cause disease in humans.

“Bloodborne Pathogens” Examples. . . Human Immunodeficiency (HIV) Hepatitis B (HBV) Hepatitis C (HCV)

“Regulated Waste” Defined. . . • Liquid or semi-liquid blood or other potentially infectious materials; • Contaminated items that would release blood or other potentially infectious materials in a liquid or semi-liquid state if compressed; • Contaminated sharps; • Pathological and microbiological wastes containing blood or other potentially infectious materials (OPIM).

“Other Potentially Infectious Materials” Defined. . . (1) The following human body fluids: semen, vaginal secretions, cerebrospinal fluid, synovial fluid, pleural fluid, pericardial fluid, peritoneal fluid, amniotic fluid, saliva in dental procedures, any body fluid that is visibly contaminated with blood, and all body fluids in situations where it is difficult or impossible to differentiate between body fluids;

OSHA 1910. 1030 Effective March 6, 1992 Applies to ALL Employers With Employees “Reasonably Anticipated”to Have Occupational Exposure to Blood and Other Potentially Infectious Materials

Requirements of OSHA 1910. 1030 • • Exposure determination Exposure control plan Annual awareness training Implementation of engineering and work practice controls

Requirements of OSHA 1910. 1030 • Proper labeling of blood or other potentially infectious materials • Free HBV vaccinations • Free medical evaluations for incidents of exposure

Persons who may be exposed. . . • • • Firefighter / EMTs Firefighter / Paramedics Fire Lieutenants Fire Chiefs Day Care Workers Medical Department

Tasks involving potential exposure. . . • • • Rescue / Extrication Fire Suppression BLS / ALS procedures (EMS) Handling of deceased persons Disinfecting / Decontaminating procedures

FERMILAB Exposure Control Plan • • • Engineering & work practices Hepatitis B Vaccination Post-exposure evaluation & follow-up Bio-hazard labeling Record keeping Information & training

AIDS Acquired Immunodeficiency Syndrome Caused by HIV Human Immunodeficiency Virus

HIV • • • Outcome of infection with the virus varies: Some have no symptoms. Some have less severe symptoms than those with AIDS results from destruction of the immune system which allows diseases to threaten life or health.

How Widespread Is HIV ? Worldwide • CDC estimates that 33. 6 million people worldwide are living with HIV / AIDS. (32. 4 million adults) 2008 • Approx. 5. 6 million new HIV infections were reported in 2006. More than 15, 000 infections each day. • One in every 100 adults aged 15 to 49 is HIVinfected.

How Widespread Is HIV ? United States • CDC estimates that 650, 000 to 900, 000 US residents are currently living with HIV infection, of whom more than 200, 000 are unaware of their infection. • Approx. 43, 000 new HIV infections were reported in 2006 • 711, 344 cases of AIDS have been officially reported to the CDC as of June 30, 2005

You Cannot “Catch” HIV: • • Through the air Through casual, everyday contact – (sharing bathrooms, kitchens, etc. ) • Through nonsexual social situations • Through insects or mosquitoes • Through urine, feces, nasal secretions, sputum, vomitus, saliva, sweat or tears from an infected person

What Personal Behaviors/Practices Put You at Risk ? • Sexual contact with an infected person • Sharing infected needles • Infected woman to her child at birth • Blood transfusion* *The blood supply is thoroughly screened so that the risk of infection from transfusion is extremely small.

How Can You Prevent HIV Transmission in Your Personal Life? Refrain from: • Vaginal or oral sex with someone who uses IV drugs • Sex with someone you don’t know well • Sex with someone who has multiple sex partners • Sex without a condom - with an infected person • Sharing IV drug needles

Occupational Acquired HIV Infection & AIDS Of the 427, 795 infected adults reported to the CDC where the type of job was known, 21, 760 were health care workers. Of those, 74% have died.

Occupational Acquired HIV Infection & AIDS There has only been one documented case of patients being infected by a health care worker in the United States. This involved HIV transmission from one infected Dentist to six patients.

Protect yourself from HIV on the job by avoiding contact with blood and potentially infectious body fluids that can transmit the virus

Blood The single most prominent source of HIV in the occupational setting

The risk of HIV infection through contact with feces, nasal secretions, saliva, sputum, sweat, tears, urine and vomitus is extremely low or nonexistent.

Workers May Be Exposed Through: • Needle stick – 47 of the 55 reported health care workers who seroconverted to HIV after exposure were exposed through punctures / cuts. • Mucous membranes of the eyes, nose or mouth • Broken or non-intact skin

Risk of HIV Infection: • Needle stick: 0. 3% following needle stick contaminated with blood from a known infected person. • Chapped / broken skin or mucous membranes: less, but not definitively known

HIV Antibodies • Antibodies to HIV in an infected person’s blood can be detected by a test. • Persons usually develop antibodies within 6 to 12 weeks after becoming infected.

How Can You Protect Yourself? • Use Body Substance Isolation (BSI) procedures & equipment. • No preventative vaccine exists at the present time.

What Is Hepatitis B? • Caused by the Hepatitis B Virus (HBV). • Damages the liver, causing symptoms that range from mild or unapparent to severe or fatal. • 25% of infected individuals develop acute hepatitis. • 6% to 10% become HBV carriers. Carriers can develop liver disease and are infectious to others.

Hepatitis B. . . • 12, 000 health care workers become infected through occupational exposure each year. • 500 -600 infected health-care workers are hospitalized each year. • 200 -300 infected health-care workers die each year with associated diseases.

What Personal Behaviors Put You at Risk for HBV Infection ? • Sexual contact with an infected person • Sharing drug needles and syringes with infected person • Since blood supply is screened for HBV, the chance of being infected through transfusion is extremely small.

What Occupational Exposures Put a Worker at Risk for HBV Infection ? Contact with blood or potentially infectious body fluids through: • Needle stick • Broken or non-intact skin • Mucous membranes of eyes, nose and mouth Saliva injected through a human bite can also transmit HBV.

Body Substance Isolation (BSI) The same BSI equipment & procedures that will protect against exposure to HIV will protect the worker against HBV.

Blood tests are available to detect antibodies for HBV in an infected person.

Vaccines provide protection against HBV infection (90% protection for 7 or more years) Vaccines are 70% to 80% effective when given within 1 week of exposure

Personal Protective Equipment Gloves • • Disposables protect against blood and fluids Normally provide no protection against sharps Must be changed if soiled or torn Must be changed between handling of different people

Personal Protective Equipment Masks, Eyewear & Gowns • Not necessary unless blood or other potentially infectious fluids are or could be present • Masks & eyewear should be worn together if splashes are anticipated • Gowns or aprons are worn to avoid soaking of clothes

There are no reported cases of HBV or HIV transmission from mouth-to-mouth resuscitation.

Because other diseases can be transmitted this way, protective devices should be used: bag-valve-mask devices pocket masks mechanical resuscitators

How Can You Protect Yourself Against HIV & HBV ? • If you perform tasks that put you in contact with blood, or other potentially infectious body fluids, you should be vaccinated against HBV. • Practice BSI if blood or other potentially infectious fluids are present. • Have PPE readily available.

HIV cannot live in a dry environment for more than a few hours HBV can live in a dry environment for at least 7 days Once the virus is dead - it’s dead. You cannot “reactivate” it by adding water.

Engineering Practices & Control

Universal Precautions • Consider everything contagious • Personal Protective Equipment (PPE) – MUST be provided free of charge • PPE is carried on all EMS apparatus • Fire fighting gear offers little or no protection

Contaminated Equipment • If possible, use as much disposable equipment as possible. • Reusable equipment should be decontaminated with a germicidal solution as soon as possible / practical. • Consider patient’s clothing / belongings as contaminated if soiled.

Needles & Sharps Disposal • Needles should not be recapped or manipulated by hand. • Disposable blades and other sharps should be placed in a puncture-resistant container. • Puncture-resistant containers should be readily available at all times. • Scissors, glass, lancets should be considered.

Hand Washing • Wash hands upon arrival at hospital or returning to quarters. • Use utility or designated sink -- not the food preparation area. • Wash thoroughly with soap & water or germicidal cleanser. • Antiseptic hand cleaners should be available for special situations.

Cleaning & Decontaminating Spills of Blood: • Wear gloves and clean with disposable towels. Place soiled linens in a red plastic bag. • Wear eye & face protection if splashing is a possibility. • Wear shoe covers if amount of blood is great.

Cleaning & Decontaminating Spills of Blood: • Decontaminate with tuberculocidal solution or 10: 1 solution of bleach. Wipe area with clean towels and let air dry. • Waste/unused cleaning solution should only be poured down sanitary drains. Sinks shall be disinfected after use. • Remove contaminated items, shoe coverings, etc. and place in a red plastic bag for proper disposal. Remove gloves last. Wash hands after removing gloves.

Laundry • Handle soiled items as little as possible. • If possible, remove soiled linens at place of use and place in red plastic bags that prevent leakage.

Labeling

Record Keeping Records MUST BE kept for the duration of employment plus 30 years.

Exposure Reporting Exposures MUST BE reported as soon as possible so the postexposure documentation can be completed and the postexposure evaluation procedures initiated.

What is a Significant Exposure? Refers to an exposure which carries the potential for transmission of HIV (AIDS Virus).

“Significantly Exposed” means. . . Sustained a contact which carries a potential for a transmission of HIV, by one or more of the following: 1) Transmission, into a body orifice or onto mucous membrane of blood; semen; vaginal secretions; cerebrospinal, synovial, pleural, peritoneal, pericardial or amniotic fluid; or other body fluid that is visibly contaminated with blood.

Guidelines & Procedures 1. Pre-hospital providers should have on record their past medical history • Tetanus • Hepatitis B Vaccination

Guidelines & Procedures 2. Each ambulance should have a hand washing product and surface cleaner available at all times. • Most EPA approved germicidals OK • 10% bleach may be substituted but some equipment could be bleach sensitive.

Guidelines & Procedures 3. Hand Washing should be done before & after contact with patient 4. Gloves should be worn when there is any risk with bodily fluids 5. Masks, gowns and protective eyewear should be worn when there is any risk of splattering or spraying of infectious material

Guidelines & Procedures 10. Soiled clothing – linens should be placed into leak proof bag, sealed and transported to ER. Rescuer clothing laundered ASAP. 11. Sharps should be handled with extreme caution. DO NOT RECAP, BEND or CUT USED NEEDLES. Use appropriate puncture resistant containers.

Guidelines & Procedures 12. Where possible, disposable equipment should be used on all patients. Where not possible equipment should be cleaned immediately with a commercial disinfectant or bleach solution. 13. CPR should use appropriate protection, avoid mouth-to-mouth, clean & disinfect if not disposable.

Guidelines & Procedures 14. Exposure to blood or body substance, should: • • • Fill out “Exposure form” Verbal report Evaluation by ED within one hour Follow-up determined by ED in accordance with Policy Provider reports incident to Employer

Guidelines & Procedures 15. Exposure to eyes should necessitate immediate irrigation & evaluation by Fermilab Office or ED if off hours. 16. Exposure to skin should necessitate washing with warm soap & water or commercial agent, & seek evaluation by Fermilab Medical Office or ED if off hours.

THE FERMILAB EXPOSURE CONTROL PLAN FESHM CHAPTER #5072

The End