( 3) Risk of Exposure

high

high

The risk of exposure in the healthcare setting is ____ because most of the time we are always dealing with specimens coming from patients.

1. Blood

2. Other potentially infectious materials (OPIM)

What is the two contaminated sources?

Blood (human blood, human blood components, and products made from human blood)

What is the main source of contaminated sources?

• Human body fluids

• Any unfixed tissue or organ from humans

• Cultures, culture mediums, or other solutions

• Experimental animal blood, tissues, or organs infected with HIV or HBV

What are the other potentially infectious materials (OPIM)

standard guidelines of processing specimens and also by wearing PPE

Since we are constantly exposed to these sources when working in healthcare, it is also important to remember that we need to protect ourselves by practicing the _________ and _______.

• Direct contact
• Indirect contact
• Respiratory transmission
• Vector-borne transmission

Spread of bloodborne pathogens occurs through:

Direct contact

Wherein infected blood or body fluids from one person is transferred directly to another.

Indirect contact

Wherein a person touches an object that may contain the blood or body fluid of an infected person.

Respiratory transmission

The person inhales respiratory droplets from an infected person through coughing or sneezing.

Vector-borne transmission

Wherein a person's skin is penetrated by a bite from an organism that carries the disease (e.g. mosquitos and ticks).

• Contact with another person’s blood or bodily fluids that may contain blood

• Accidental injury by contaminated sharps or needles or the needlestick injury

• Contact with open cuts, nicks, and abrasions

• Contract of blood with mucous membrane in the eyes, mouth, nose, and ears which can serve as a portal of entry for our bloodborne pathogens.

• Industrial accidents

• Administering first aid

• Post accident clean-up

• Janitorial or maintenance work

We have a lot of modes of transmission, such as:

• Needlestick injuries
• Cuts from other contaminated
sharps
• Contact of mucous membrane or
broken skin with contaminated blood or OPIM

How exposure occurs:

a slight potential for transmission

Anytime there is blood-to-blood contact with infected blood or body fluid, there is________.

•Open sores
•Cuts
•Abrasions
•Acne
•Any sort of damaged or broken skin such as sunburn or
blisters

Unbroken skin forms an impervious barrier against bloodborne pathogens. However, infected blood can enter your system through:

With nurses (44) , physicians (28), and technicians(15) accounting for most of the incident.

Figure 1: What healthcare workers that are mostly exposed to blood or body fluids?

With inpatient facilities (40) (medical or surgical wards, and intensive care units, as well as operating rooms (25) ) account for the majority of the exposure sites.

Figure 2: What work locations that are mostly exposed to blood or body fluids?

◦ First aid responders
◦ Housekeeping personnel in some industries
◦ Nurses and other healthcare personnel

Occupations at risk:

5.6 million

CDC estimates _________ workers in healthcare and related occupations are at risk

risk

All occupational exposure to blood or OPIM places workers at ______.

National Surveillance System for Healthcare Workers

Data from the _________________________ show that nurses sustain the highest number of percutaneous injuries.

majority of injuries happen at in-patient units

Although sharp injuries happen everywhere, data also shows that the ___________ particularly in medical floors, ICUs, operating rooms; after use and before disposal of sharp devices; during use; during or after disposal of sharp devices.

1. Identifies sources of exposure
2. Communicates information to
employees
3. Provides methods of compliance
4. Records training/vaccinations/incidents

ECP a mandated written document that:

1. Whenever new or modified tasks or procedures affect occupational exposures.

2. When there is a new or revised employee position with occupational exposure.

When an ECP is established, there is also a need to review and update the plan annually or:

• it helps you protect your workers from exposure to blood and other potentially infectious materials

• By protecting the workers, you also control exposure incident costs

Why ECP is important?

• Exposure determination
• Schedule and method of implementation
• Procedure for evaluation of exposure incidents

Required elements of Exposure Control Plan include:

• Potential exposure determination
• Safe work practices
• Changes in technology that reduce/eliminate exposure
• Decontaminating equipment
• Selecting and using PPE
• Handling biohazard waste
• Labels and signs
• Training requirements
• Recordkeeping requirements
• Annual review and update

The ECP must include:

▪ It must be written specifically for the facility
▪ It must be reviewed and updated at least yearly
▪ It must be readily available to all workers

ECP must meet OSHA’s criteria:

• Treating all blood and bodily fluids as if they are contaminated
• Proper cleanup and decontamination

Observe universal precautions, such as:

1.Safer medical devices
2.Sharps disposal container
3. Hand Hygiene

Engineering and work practice controls:

PPE

One of the risk mitigation controls. According to the hierarchy of controls, this is the least effective but the most commonly implemented risk mitigation control.

• Gloves

• Masks

• Aprons/Smocks/Gowns

• Face shields

• Mouthpieces

• Safety glasses

• CPR pocket masks

PPE examples:

• Perform hazard assessment
• Identify and provide appropriate PPE to employee at no cost
• Train employees on use and care
• Maintain/replace PPE
• Review, update, evaluate PPE program

Employer’s responsibilities:

• Safe design and construction

• Fit comfortably

PPE selection

◦ When it is necessary
◦ What kind is necessary
◦ Proper donning, adjusting, wearing, doffing
◦ Limitations
◦ Proper care, maintenance, useful life, disposal

Required PPE training

Written schedule for cleaning and decontamination

Housekeeping:

◦ Not picked up by hands
◦ Mechanical means only

Picking up broken glass

mechanical means

Broken glassware which may be contaminated must not be picked up directly with hands even if wearing gloves. Use __________________ such as a brush and dustpan, tongs, or forceps.

• Wear protective gloves
• Use appropriate disinfectant
• Clean and disinfect contaminated equipment and work surfaces
• Thoroughly wash up immediately after exposure
• Properly dispose of contaminated PPE, towels, rags, etc.

Clean-up and decontamination:

30 seconds for HIV-1 and 10 minutes for HBV

OSHA mandates that the disposal of the infectious waste is in accordance with federal state and local regulations, and that the surface is left wet with the disinfectant for ____________ and _________.

1. Liquid or semi-liquid blood or other potentially infectious materials (OPIM).

2. Items contaminated with blood or OPIM, and which would release these substances in a liquid or semi-liquid state if compressed.

3. Items that have dried blood, and are capable of releasing these materials during handling.

4. Contaminated sharps.

5. Pathological and microbiological wastes containing blood or OPIM.

The bloodborne pathogen standard, uses the term Regulated Waste to refer to the following categories of waste which requires special handling:

• Dispose of regulated waste in closable, leak-proof red or biohazard labeled bags or containers

• Dispose of contaminated sharps in closable, puncture-resistant, leak-proof (red)

Regulated waste disposal:

Contaminated laundry

________ means laundry that has been soiled with blood or OPIM, or may contain sharps.

Contaminated laundry

________must be bagged or contained at the location where it was used.

• Placing and transporting the laundry in bags or containers labeled or color coded.

• Whenever contaminated laundry is wet and presents a reasonable likelihood of soakthrough or leakage from the bag or container, the laundry shall be placed and transported in bags or containers which

  prevents soakthrough or leakage of the fluids to the exterior.

• The employers should ensure that employees who have contact with contaminated laundry wear protective gloves and other appropriate PPE to

  prevent the contraction of any bloodborne pathogen that may be present in the contaminated laundry.

Other requirements for handling contaminated laundry include:

• All employees with occupational exposure to blood or other potentially infectious material (OPIM)

• Employees who are trained in first aid and CPR

• No cost; during working hours

Training:
Who

• Initial assignment

• Annually; or with new/modified tasks

Training:
When

• Offered to all potentially exposed employees

• Provided at no cost to employees (within 10 days to employees with occupational exposure)

• Declination form

Hepatitis B vaccination:

• Hepatitis C
• HIV

No vaccinations for:

• have previously received the vaccination series

• who are already immune as their antibody test reveals

• employees who contraindicated for medical

  reasons

The employer does not have to make the HBV vaccination available to employees who:

Specific eye, mouth, or other mucous membrane, non-intact skin, parenteral contact with blood or OPIM that results from the performance of an employee’s duties.

Exposure incident:

• Wash exposed area with soap and water

• Flush splashes to nose, mouth, or skin with water

• Irrigate eyes with water and saline

Immediate actions

• Route(s) of exposure and circumstances

• Source individual

• Collect/test blood for HBV and HIV serological status

• Post exposure prophylaxis (when medically indicated)

• Counseling

• Evaluation

Confidential medical evaluation and follow-up: