Infection Control - Quick Review: Bloodborne Pathogens & Standard Precautions

Bloodborne Pathogens Standard (29 CFR 1910.1030)

• Purpose: protect workers from occupational exposure to bloodborne pathogens.
• Key pathogens: HBV, HIV (examples).
• Applies Universal Precautions; includes exposure control plan, engineering/work practice controls, PPE, training.
• Post-exposure follow-up and PEP policies.

HIV (Human Immunodeficiency Virus) Overview

• Infectious virus that can lead to AIDS; targets T4 lymphocytes (CD4).
• AIDS = HIV Stage 3.
• Lifecycle (essential steps):
  • $1$ Attach/entry to CD4 cell via $gp120$ and $gp41$.
  • $2$ Reverse transcription of HIV RNA to DNA.
  • $3$ Integration of HIV DNA into host genome (Integrase).
  • $4$ Transcription/translation of viral proteins.
  • $5$ Assembly and budding of new virions.
  • $6$ Protease-mediated maturation of new HIV.
• Transmission: blood, sexual contact, perinatal.
• Not transmitted by casual contact.

HIV Incidence, Prevalence & Mortality (US, 2021)

• Prevalence: $1.2\times 10^6$ living with HIV in the US.
• Incidence (new infections in 2021): $36{,}136$.
• HIV-related deaths (2021): $19{,}624$ (deaths from any cause).

HIV Dormancy & Antibodies

• Dormancy: approx. $7{-}10$ years with ongoing infectivity.
• Antibodies present, confirm infection but do not eradicate infection.
• HIV stage 3 refers to AIDS-related illnesses.

Acute HIV Symptoms

• Common: fever, chills, night sweats, sore throat, fatigue, swollen neck lymph nodes, muscle/joint pains.
• Many patients experience no symptoms.

HIV Stage 3 (AIDS) & Opportunistic Illnesses

• Examples: Pneumocystis carinii pneumonia, Kaposi’s sarcoma, TB.

HIV Transmission & Non-Transmission

• Transmission routes: blood, sexual contact, perinatal.
• Not transmitted by casual contact (hugging, saliva, coughing, sneezing).

HIV Vulnerability & Inactivation

• Virus dies quickly outside the body.
• Bleach disinfection: $1{:}10$ (1:10) solution effective.
• Soap and water remove/flush virus from hands.

HBV – Hepatitis B Virus

• Hepatitis = liver inflammation; can be chronic or acute carriers.
• Chronic carriers: estimated $5.8\times 10^5$ to $1.17\times 10^6$ in the US.
• Acute cases estimated in 2020: $1.4\times 10^4$.
• HBV can survive on environmental surfaces for up to $7$ days.

HBV Transmission & Risks

• Transmission routes similar to HIV; not spread by breastfeeding, coughing, sneezing.
• Inanimate objects can play a role in transmission.

HBV Symptoms

• Early: muscle pain, joint pain, fever, nausea.
• Tell-tale: jaundice, dark urine (choluria).
• Incubation: $30{-}180$ days.

HBV Immunization

• Schedule: 1st dose, 2nd dose 1 month later, 3rd dose 5 months after #2.

Occupational Exposure to BBP

• Majority via percutaneous exposure.
• Higher risk with: $7{-}10$ deep injury? (interpretation) • deep injury; visible blood on device; device previously in vein/artery; source patient in end-stage disease.

Post-Exposure Prophylaxis (PEP)

• Start ASAP after exposure; continue for $4$ weeks.
• Regimen: $3+$ antiretroviral medications.
• Follow-up HIV testing: immediately, at $6$ weeks, $12$ weeks, and $6$ months.
• Emphasize personal protection: "Don’t wait for someone to protect you…PROTECT YOURSELF!"

Prevention of Exposure (BBP Standard)

• Purpose: protect workers from occupational exposure to BBP.
• Consists of:
  • Employer responsibilities
  • Preventing needle-stick injuries
  • Communication about biohazards
  • Exposure response plan
  • Worker education
  • Universal Precautions (for all patients)
• Designed to protect you!

Employer Responsibilities (Engineering & Work Practice Controls)

• Engineering controls: design safety into tools/workspace.
• Work practice controls: PPE use, standard precautions; do not recap needles; gloves; hand hygiene.
• PPE provided free of charge; post-exposure plan communicated to employees.

Employer Responsibilities (Risk Categorization & Education)

• Categorize personnel by risk; provide annual education on standard precautions & BBP.
• Provide PPE in appropriate sizes, at no cost: gowns, gloves, masks, goggles, eye shields.
• PPE must be impermeable to liquids.

Defining Exposure

• Examples: needle-stick injury, cut or puncture; splash of blood/OPIM into mouth, nose, eyes, or mucous membranes; direct contact with large amounts of blood/fluids.

When Exposure Occurs – Immediate Actions

• Let area bleed freely; wash with antimicrobial soap.
• Alert supervisor and file incident report.
• Follow-up care: HIV & HBV testing with client consent; counseling; Hepatitis immunoglobulin or HIV prophylaxis as indicated; maintain confidentiality.

Universal Precautions vs Standard Precautions

• Treat all patients as infected; define fluids include: Blood, OPIM (semen, CSF, amniotic fluid, synovial, pleural, peritoneal, pericardial fluids, breast milk, vaginal secretions), unfixed tissue cultures, any body fluid with visible blood/OPIM.
• Purpose: cover all potential infectious exposures beyond BBP.

Standard Precautions Overview

• Applies to: Blood, all body fluids, excretions, secretions (except sweat), non-intact skin, mucous membranes.
• Core habit: WASH HANDS (10-second friction rub with soap).
• Follow: after touching blood/body fluids/secretions/excretions/contaminated items; after removing gloves; between patient contacts; on entering/leaving patient rooms.

Standard Precautions – Personal Protective Equipment (PPE) Rules

• Wear gloves when touching blood/body fluids/excretions/secretions/contaminated items.
• Put on clean gloves before touching mucous membranes or non-intact skin.
• Change gloves between tasks and after contamination or tearing; between patient contacts.
• Remove gloves and WASH HANDS immediately after removal.
• Wear mask, eye protection, or face shield when splashes/sprays are likely.

Standard Precautions – Gown & Equipment

• Gown: impermeable; worn when soiling/splashes likely; remove carefully; wash hands after removal; handle contaminated clothing without spreading contamination.
• Patient care equipment: handle carefully; dispose of single-use items properly; clean/process reusable equipment per policy.

Environmental Controls & Linen

• Follow routine cleaning/disinfection; HBV can persist for days.
• Linen handling: bag at origin; wear gloves; minimize handling; do not shake linens; close bag when ½–¾ full.

Sharps Safety

• Never recap needles unless using one-handed technique and only if absolutely necessary.
• Never bend, break, or remove a needle by hand.
• Dispose of all sharps in a sharps container; containers are color-coded, puncture-resistant, leak-proof, and sealable; replace when ½–¾ full.
• Use resuscitation devices (one-way valve mask) as alternatives to mouth-to-mouth.

Patient Placement & Specimens

• Use private rooms for clients who contaminate the environment or cannot assist in maintaining it.
• Label biohazardous waste; specimens collected in leak-proof, sealed, labeled containers.

Regulated Waste & Spill Cleanup

• Regulated waste includes liquids/semiliquids, items that release body fluids, heavily contaminated items, contaminated sharps.
• Spills: wear gloves; scoop up glass with dustpan; blot excess with absorbent material; place in biohazard/sharps containers as appropriate; disinfect with approved agent (e.g., $1{:}10$ bleach solution).

Reminder

• STANDARD PRECAUTIONS MUST BE OBSERVED WITH ALL PATIENTS, REGARDLESS OF AGE, GENDER, DIAGNOSIS, OR ISOLATION STATUS – ALWAYS.