CNA TRAINING COURSE: BLOODBORNE PATHOGENS

 What are Bloodborne Pathogens?

Microorganisms such as viruses, bacteria, or parasites that can enter the human blood stream causing diseases.

Examples of Bloodborne Pathogens:

Common examples include hepatitis B, hepatitis C, and HIV (human immunodeficiency virus)

How do they enter the bloodstream?

These microorganisms may be transmitted when mucous membranes or non-intact skin (cuts, abrasions, burns) are exposed to human blood or body fluids. Other modes of transmission include blood splashes, handling contaminated items, needle sticks or cuts from contaminated sharps.

What are Hepatitis Viruses?

Hepatitis is inflammation (pain and swelling) of the liver. Viruses that cause inflammation of the liver are called Hepatitis viruses.

What is Hepatitis?

Hepatitis means inflammation, redness, swelling, and soreness of the liver.

Hepatitis B Virus (HBV):

Hepatitis B is a contagious virus that causes inflammation of the liver.

How is Hepatitis B spread?

HBV is transmitted by sharing needles, razors, and toothbrushes. Body fluids, saliva, and semen that are exchanged during sexual interactions cause transmission. HBV is also transmitted from mother to infant during her pregnancy.

 Who is at risk for Hepatitis B?

• Intravenous drug users
• Sexual contact with partner infected with Hepatitis B
• Living with someone with chronic Hepatitis B
• Having oral-anal sexual contact with someone who has hepatitis B
• Traveling to a country with high rates of Hepatitis B
• Health-care and public safety workers who have contact with blood or body fluids or blood-contaminated products
• Hemodialysis patients
• Birth of a child to a Hepatitis B infected mother

What are the symptoms of Hepatitis B?

Most of the people newly infected with Hepatitis B do not show any symptoms. Most common symptoms if present include:

• Fever
• Fatigue
• Jaundice (yellowing of the skin and/or eyes)
• Nausea and Vomiting
• Abdominal pain
• Dark urine
• Clay-colored bowel movements
• Loss of appetite

·         How long do Hepatitis B symptoms last?

·         Symptoms may begin as early as 60 days or up to 150 days after exposure to HBV. Ninety-five percent of the adults recover completely from HBV and do not become chronically infected. In contrast, 90% of infants and 35% of children under the age of 5 years old will remain chronically (life long) ill with HBV.

·            What is the difference between acute and chronic HBV infection?

·         If a person was infected with hepatitis B for the first time, it is called acute hepatitis. Usually acute (short-term) hepatitis lasts for 6 weeks or less. Chronic (long-term) HBV infection occurs in minority of the adults who were infected with HBV. In contrast, the majority of the infants exposed to HBV will have chronic (long term) HBV. Chronic infection may last 6 months or more.

·         What happens in chronic HBV infection?

·         15-25% of the people with chronic HBV develop cirrhosis (liver damage), liver failure, or liver cancer.

·          How is it treated?

·         There are no special treatments for acute hepatitis B infection.

·         For chronic infection, many antiviral drugs are available.

How can you prevent Hepatitis B?

• Avoid sharing of needles, toothbrushes, and razors.
• Protected sex (use of condom)
• Universal protection for health-care and public safety workers
• Vaccines are also available for prevention of hepatitis B infection.

Who should be vaccinated against Hepatitis B?

• All children at birth
• Those traveling to countries with high rates of hepatitis B
• Sexual partners of people infected with the Hepatitis B virus
• People who use injection or non-injection illegal drugs
• People with end-stage kidney disease
• Health-care and public safety workers
• People with chronic liver disease
• People who are being treated with clotting-factor concentrates

·         What is Hepatitis C Virus?
Hepatitis C is a contagious virus that causes inflammation of the liver.

H      How is it transmitted?
Hepatitis C is transmitted by needle stick injury, blood, blood products, sharing needles,razors, and toothbrushes, sexual contact with Hepatitis C infected person and birth to an infected Hepatitis C mother.

What is the risk of acquiring a Hepatitis C after a needle stick contaminated with Hepatitis C blood?
HCV infection is about 1.8%.

What are the signs and symptoms of HCV?
Most of the people newly infected with Hepatitis C do not show any symptoms. Most common symptoms if present include:

• Fever
• Fatigue
• Jaundice (yellowing of the skin and/or eyes)
• Nausea and Vomiting
• Abdominal pain
• Dark urine
• Clay-colored bowel movements
• Loss of appetite

What is the difference between Acute and Chronic Hepatitis C?
If a person was infected with Hepatitis C for the first time it is called acute hepatitis. Usually acute hepatitis lasts for 6weeks or less. Approximately 15-25% of patients infected will clear the infection without treatment. The majority of Chronic HCV infections occur in adults who were infected with HCV. About 75-85% of patients will continue to have chronic (long-term) infection.

What happens to chronic Hepatitis C patients?
The majority (70-85%) of the infected people will develop chronic (long-term) infection. 60-70% of them will have chronic liver disease . 5-20% of patients will develop chronic liver disease. 1-5% will die because of the complications of Hepatitis C.

Is there Hepatitis C vaccination?
There is no vaccine for Hepatitis C.

How do you prevent Hepatitis C?

• Avoid sharing needles, toothbrushes, and razors
• Protected sex (use of condom)
• Universal protection for health-care and public safety workers

·         What is Human Immunodeficiency virus (HIV)?

·         Human Immunodeficiency virus (HIV) is the virus that causes AIDS.

·        What is AIDS?

·         AIDS stands for acquired immunodeficiency syndrome. HIV infection causes suppression of the immune system (The immune system gives our bodies the ability to fight infections), which could lead to opportunistic infections and unusual types of cancer. AIDS may not develop for 8-10 years after the initial infection. AIDS is the final stage of HIV infection.

·  

·         How is HIV spread?

·         HIV is transmitted by having sex (anal, vaginal, or oral), blood (sharing needles and syringes), and blood products/body fluids (semen, saliva etc) of an HIV infected person. It is also transmitted from HIV infected mother to infant during her pregnancy or breast feeding.

Who is at risk for HIV?

• Drug or steroid users who share needles and syringes
• Unprotected sex (heterosexual and homosexual)
• Blood transfusion or clotting factor from 1978-1985
• Healthcare workers who got stuck with needles containing HIV-infected blood. A less frequently cause is after infected blood gets into an open cut or mucous membrane of the eyes or nose

What are the symptoms of HIV?

Most of the people newly infected with HIV do not show any symptoms for many years. Some people may get flu like symptoms for few weeks after becoming infected. Signs and symptoms may include:

• Fever
• Headache
• Sore throat
• Swollen lymph glands
• Rash

What are the symptoms of AIDS?

AIDS may develop over an 8-10 year period after the initial HIV infection. AIDS is the final stage of HIV infection, when the immune system has been severely damaged, which can lead to opportunistic infections and unusual types of cancers. Signs and symptoms may include:

• Night sweats
• Chills and fatigue
• Fever >100 F (38 C) for several weeks
• Dry cough and shortness of breath
• Chronic diarrhea
• Persistent white spots or unusual lesions on your tongue or in your mouth
• Headaches
• Weight loss

How long does the HIV infection last?

There is no cure for HIV infection. Usually HIV infection is a chronic condition.

How is it treated?

It is treated with multiple antiviral medications.

What is the risk of HIV infection to a health-care worker?

The average risk for HIV infection from all types of reported percutaneous exposure (needle stick) to HIV infected blood is 0.3 %.

How can you prevent HIV?

• Avoid sharing needles, toothbrushes, etc with an infected HIV person
• Protected sex (use of condom)
• Universal protection for health-care and public safety workers

·         Prevention of Bloodborne Diseases:

·         The Occupational Safety and Health Administration (OSHA) defined four principal strategies to prevent or reduce exposure to bloodborne pathogens:

·         1. Engineering controls

·         2. Work practice control

·         3. Personal Protective Equipment

·         4. Universal Precautions

1. Engineering controls:

Engineering controls refers to any object that comes between you and the potential infectious material.

Examples:

• Readily accessible hand washing facilities
• Eye stations
• Sharps containers
• Biohazard labels
• Self-sheathing needles or syringes with retractable needles
• Needleless IV systems

Biohazard Labels:

These labels should be attached to bags or containers containing potentially infectious materials. These labels must be fluorescent orange or orange-red with letters or symbols in contrasting color.

Labeling of Regulated Waste:

Regulated waste must be labeled on containers of regulated waste, contaminated sharps, on refrigerators and freezers that are used to store blood or other potentially infectious materials (OPIMs), and on containers used to store, dispose of, transport, or ship blood and OPIMs. Regulated waste containers must be labeled with biohazard label.

Needleless Systems and SESIP:

Sharps with Engineered Sharps Injury Protections (SESIP), i.e. needleless sharps or needleless systems are required to reduce the risk of an exposure incident.

Contaminated Sharps:

• Needles
• Scalpels
• Broken capillary tubes
• Dental wires

Contaminated needles or other contaminated sharps must not be bent or recapped. Needle removal or recapping needles must be accomplished through a one-handed technique or the use of a mechanical device. A sharps container must have a warning label affixed to it. Contaminated sharps must be discarded immediately or as soon as possible into an acceptable sharps container.

Reusable Sharps:

Reusable sharps, including pointed scissors must be decontaminated before reuse. Containers containing reusable sharps should be clearly labeled. Use forceps or tongs, to remove contaminated sharps from containers.

In Case of Injury:

If you are stuck by a needle containing blood or OPIMs, OSHA recommends the following:

• HIV test and counseling
• A test for HIV periodically for at least 6 months
• Practice "safe" sex
• Stop breastfeeding
• Get immediate evaluation of any illness

2. Work Practice Controls:

Work practice controls must be evaluated and updated regularly to ensure their effectiveness.

Hand washing:

Hand washing is the most important method in preventing transmission of foodborne or bloodborne pathogens. It is required that you wash your hands after removal of gloves and other PPE.

Cleaning Work surfaces:

The work areas that involve exposure or potential exposure to blood or OPIMs, along with potential contamination of surfaces, must be cleaned regularly. The cleaning must occur at least weekly or after completion of tasks or procedures or at the end of a shift if there is a possibility of contamination. You should use disposable towels to clean up the spill and then dispose of the towels in a biohazard-labeled bag. Use a dustpan and brush, cardboard, or tongs, to clean up any contaminated broken glass. Do not clean it up with your hands.

3. Personal Protective Equipments:

Personal protective equipments (PPE), is considered a special equipment clothing you wear for protection against hazards. PPE prevents blood or OPIMs from passing through to or contacting your clothes or your body. PPE includes:

• Gloves
• Gowns
• Aprons
• Face shields
• Masks
• Eye protection
• Laboratory coats

You must remove all PPE before leaving the work area.

4. Universal Precautions

Universal precaution means you should treat all human blood and body fluids as if they contain HIV, HBV, HCV, or other bloodborne pathogens.

Exposure control Plan:

Each employer should have an exposure control plan describing the guidelines for employees to follow when an exposure occurs.

PREPARED BY:

DR ITOBORE FRED