Staff Training:

Universal Precautions

And Bloodborne Pathogens

There are 29 slides of material required for the quiz.

Supplemental information can be found on slides after the quiz.

Objectives

Provide a basic understanding of:

1. Blood borne pathogens
2. Common modes of transmission
3. Methods to prevent transmission
4. Identify appropriate actions to reduce risk of exposure
5. Describe how to respond if an exposure or injury occurs

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Blood borne pathogens in the school setting

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Required by Occupational Safety and Health Administration (29 CFR 1910.1030)

• Applies to employees in all industries who may be exposed to blood or other potentially infectious materials (OPIM)

What are Bloodborne Pathogens?

Microorganisms such as viruses or bacteria that are present in human blood and can cause diseases in humans

• Hepatitis B virus (HBV)
• Hepatitis C virus (HCV)
• Human Immunodeficiency Virus (HIV)

Types of exposure

DIRECT: touching body fluids from an infected person

INDIRECT: touching objects that have touched body fluids of an infected person

VECTOR: obtaining a bite from an infected animal or person

AIRBORNE: breathing in droplets when infected persons cough or sneeze

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How are infections spread?

1. Airborne or respiratory route
2. Direct contact
3. Fecal-oral route
4. Blood contact route

What are standard precautions?

Standard precautions are basic procedures that protect against infectious diseases transferred by DIRECT contact through blood and body fluids.

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Why are standard precautions needed?

Standard precautions reduce the risk of spreading germs (bacteria and viruses) that can cause infection, even when those spreading the micro-organisms do not appear to be ill.

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Air-borne or respiratory route

Germs are spread by droplets through:

• Nose
• Mouth
• Sinuses
• Throat
• Lungs
• Contaminated tissues

Examples: TB, colds, flu, strep throat, chicken pox, measles

How you can help reduce the spread

• Handwashing
• Teach children sneeze/cough etiquette: use a tissue or your sleeve; dispose of tissue properly
• Cover your cough, handwashing posters in classrooms, bathrooms, public
• spaces

Direct contact route

Germs are spread by directly touching an infected area or body fluid:

• Saliva
• Mucous
• Eye drainage
• Pus or discharge from a sore

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Examples: conjunctivitis, impetigo, strep throat, MRSA, chicken pox, meningitis

How you can help reduce the spread

• Draining or open sores should be covered with a dressing or Band-Aid until they scab over
• Wear gloves with contact with wound, cut or scrape
• Chicken pox is highly communicative illness, see school nurse for protocol

Fecal-Oral route

Germs are transferred from stool to host by:

• Hands
• Food
• Mouthed toys
• Toilet
• Diapers

Examples: Hand, foot & mouth disease, Rotavirus, Hepatitis A, Shigella, Salmonella, Giardia, meningitis

How you can help reduce the spread

• Wash hands before meals, preparing or serving food and after using the bathroom
• HFM is spread by more than one route - airborne-respiratory, direct contact and fecal-oral route

Hepatitis A

• Spread fecal-oral route
• A viral infection causing liver inflammation
• An acute, usually self limiting illness

Outbreaks of HAV in schools have been associated with contaminated home prepared snacks that were served to everyone in class. Any treat or snack brought from home for the class should be commercially prepared, and ideally they should be individually wrapped. Please check with your school nurse for protocol for food served in school.

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How you can help reduce the spread

• Wash your hands especially after diapering or taking children to the bathroom
• Wash children’s hands and yours before eating or preparing food
• Clean and sanitize surfaces (with bleach solutions) in all areas

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Infectious diseases spread through casual contact

Examples of Infectious diseases:

Chickenpox, Conjunctivitis, Flu, Impetigo Staph Infections (MRSA VRSA)

Examples of casual contact:

• Hugs or handshakes

• Using the telephone or drinking fountain

• Using the toilet

• Sitting next to someone

• Touching tears or sweat

How are blood borne infections spread?

• Bleeding injuries
• Bloody nose
• Biting
• Open draining sore
• Loose tooth (with bleeding)
• Changing band-aids or dressing
• Any task involving visible blood
• Performing CPR

Outbreaks and communication with families:

The school nurse notifies parents/guardians for the following conditions

Meningitis

Pertussis

Invasive infections

Chickenpox virus

Head lice, scabies, and ringworm

Infections of GI tract with diarrhea and HVA

HIB

Parvovirus B19 or fifth disease

TB

Two or more affected unrelated persons affiliated with the facility with a vaccine preventable disease

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Exposure Control Plan

Methods that reduce the chance of exposure

• Universal/standard precautions
• Hand washing
• Engineering controls (sharps containers)
• Post-exposure follow-up

Universal precautions

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Treat ALL human blood and bodily fluids as if it’s infectious

Best practices: protect yourself and others

• Wear disposable gloves on clean hands, masks are not required
• Absorb as much of the spill as you can with paper towels; put the contaminated towels in a plastic bag with a secure tie
• Clean contaminated surfaces with soap solution ¼ cup detergent to 1 gallon water and rinse with clean water
• Sanitize the clean surface by wetting the entire surface with a spray application of freshly mixed ¼-3/4 cup bleach to 1 gallon water or 1-3T of bleach to 1 quart of water
• Leave on surface for at least 2 minutes

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Best practices: protect yourself and others

• Dispose of all soiled items in plastic bags with secure ties
• Soiled clothing should be placed in a plastic bag and sent home with child
• If floors, rugs, carpets are contaminated, additional cleaning by shampooing or steam cleaning may be necessary
• Mops used to clean up body fluids should be cleaned, rinsed with a disinfecting solution and wrung out and hung up to dry

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Handwashing

Handwashing is the single most effective way to prevent the spread of infectious disease.

• Wash hands before eating
• Wash hands after any contact with blood, body fluids or soiled objects, using the toilet, assisting with personal hygiene

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Hand washing technique

• Approach the sink standing away so to prevent clothing from being contaminated.

• Turn on the water, wet hands

• Apply soap (rinse bar soap off before returning to dish)

• Wash for 20 seconds using rotary motion, interlacing fingers, fingernails, wrist

• Rinse allowing the water to flow off of the fingertips

• Dry hands well

• Turn off running water using a paper towel.

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Alcohol-based hand sanitizer/gels

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Waterless antibacterial hand sanitizers are convenient for use when water and hand washing is not available. However, they are for bacteria prevention only.

• Apply about ½ teaspoon of product onto the palm of your hand
• Rub your hands together
• Rub the product over all surfaces of hands and fingers until hands are dry

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Warm water and soap is the best, gels are better than not washing at all.

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Gloves

• Wear during possible exposure with potentially infectious materials
• Check gloves before use
• Remove contaminated gloves before leaving work area (roll down starting at cuff to finger tips)
• Wash hands after removing gloves
• NEVER reuse disposable gloves
• Types of gloves include vinyl, latex, neoprene or utility gloves

Disposing of Sharps

• Discard all contaminated sharps in designated container

Signs and Labels

Biohazard sign: warns that container holds blood or other potentially infectious materials

Waste such as bloody tissues can be disposed of in plastic-lined trash cans (and do not need biohazard sign)

Clean up and decontamination

Some commercial solutions will effectively disinfect surfaces and equipment

• Look for “tuberculocidal agent that kills hepatitis B virus”
• Store cleaners according to label instructions

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Household chlorine bleach

• Solution must be made fresh every 24 hours
• Use a 10% bleach solution

Housekeeping: spill clean-up

• Use PPE & Universal precautions (apply gloves)
• Cover spill or area with paper towels or rags
• Apply a 10% bleach solution or approved disinfectant over towels or rags
• Let solution sit for appropriate time
• Bleach solution = 15 minutes
• Follow label on other products
• Place materials in appropriate container
• Arrange for pick-up and disposal

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Additional Information

History

In the 1980s the Centers for Disease Control and Prevention (CDC) established guidelines for the care of patients with communicable diseases. These guidelines were intended to reduce the spread of infection to health care providers, (doctors and nurses) and to other patients in the health care setting. The guidelines were then termed "universal precautions." They were designed to prevent transmission of blood-borne germs such as the hepatitis B virus and they targeted the proper handling of body fluids such as vomit, urine, feces, blood, and wound drainage.

The recommendations have been expanded and we now refer to these precautions as Standard Precautions. This new term, Standard Precautions, recognizes that any body fluid may hold contagious germs, not just blood. Although the precautions are still primarily designed to prevent the spread of disease carried by blood or other body fluids, they are also excellent measures to prevent the spread of infectious disease in group settings.

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Over the years, there have been outbreaks of diseases around the world. Three examples of outbreaks that have affected the U.S. include the 1981 outbreak of HIV, the 2014 outbreak of Ebola, and, most recently, the 2016 outbreak of the Zika virus. All three are examples of diseases that can spread through contact with infected blood or other bodily fluids.

The CDC estimates that 5.6 million workers in the healthcare industry and related occupations are at risk of occupational exposure to bloodborne pathogens, including human immunodeficiency virus (HIV), hepatitis B virus (HBV), hepatitis C virus (HCV), and others. All occupational exposure to blood or other potentially infectious materials (OPIM) places workers at risk for infection from bloodborne pathogens.

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Save for later: Exposure Control Plan

Required elements of Exposure Control plan include:

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

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Hepatitis B

• A viral infection causing inflammation of the liver that can lead to serious illness, lifelong infections, liver disease and liver cancer

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• Over 12 million Americans are infected (1 in 20)

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• Most infectious blood borne hazard

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• Most people recover fully, but some carry the virus for a lifetime

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• Vaccination for HBV is available and effective

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Hepatitis B symptoms

Possible symptoms of Hepatitis B:

• Flu-like symptoms (fever, fatigue, loss of appetite, aches and pains, nausea and vomiting)
• Abdomen pain
• Skin and whites of eyes turn yellow (jaundice)
• Dark urine
• Clay colored stools

Some people have no symptoms at all!

How is Hepatitis B transmitted?

• Blood or body fluids containing blood
• Sharing any equipment to inject drugs
• Sexual contact
• Tattooing or body piercing
• Contact with open sores
• Children born to infected mothers
• Although the virus can be found in saliva, the amount of the virus is so low that spread is very unlikely.
• HBV virus can remain contagious on surfaces for 7 days or more.

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How is Hepatitis C spread?

• Blood or body fluids containing blood
• Sharing any equipment to inject drugs
• Tattooing or body piercing
• Sexual exposure-can occur but less likely
• Infected during childbirth –this is rare

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Hepatitis C is NOT spread by

• Sneezing
• Hugging
• Kissing
• Coughing
• Food or water
• Sharing eating utensils or
• Drinking glasses or casual contact

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Hepatitis C

• Hepatitis C is the most common chronic bloodborne infection in the U.S.
• Approximately 3.2 million people infected in U.S.; most have no symptoms and don’t know they are infected until decades later when liver damage shows up in routine tests.
• No treatment or vaccine available
• People with Hepatitis C should be vaccinated against Hepatitis A and all children should be vaccinated against Hepatitis B
• Virus does not survive well out of the body

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Hepatitis C transmission

• Injection drug use
• Long term hemodialysis
• Blood transfusion or organ transplant before 1992
• Mother to baby
• Needle sticks
• Sexual exposure (rare)

Hepatitis C Symptoms

Symptoms are similar to Hepatitis B

• Pain on right side of abdomen
• Jaundice
• Fatigue
• Appetite loss
• Nausea
• Dark colored urine
• Pale stools

HIV/AIDS

Caused by a virus (HIV) that affects the body and in the most severe infections, progressively destroys the immune system, causing a condition called AIDS

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Estimated that more than 1.1 million people are living with HIV; close to 1 in 5 are unaware they are infected; once infected, human body cannot get rid of the HIV completely – infected for life

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HIV Transmission

• Contact of mucous membranes or openings in the skin with infected blood or body fluids that contain blood, semen, and cervical secretions.
• Sexual contact
• Contaminated needles or sharp instruments
• Women infected with HIV can pass the virus to their unborn child. As the virus can be transmitted through breastfeeding, breastfeeding is NOT recommended for infants of infected mothers
• Blood-to blood transmission when the infected blood enters the bloodstream by blood transfusion, breaks in the skin, mucous, or needle sticks

HIV Symptoms

A person with HIV may carry the virus for 10 years or more without developing symptoms.

• Flu-like symptoms
• Night sweats or fever
• Weight loss
• Fatigue
• Swollen glands

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HIV/AIDS in the school setting

HIV is not spread by the type of contact that occurs in child care and school settings, such as a typical classroom activities, or with surfaces touched by infected people. It is not spread through non-bloody saliva, tears, stool or urine.

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Potential Risk of Exposure

School nurses Caring for students/staff with illness/injury

Coaches/athletic trainers Caring for sports injuries

Custodians/Teachers Cleaning up bloody waster

Teachers/all staff Performing first aid

Risk of Exposure

Source: American Red Cross (2001) http://www.in.gov/isdh/files/BBP_American_Red_Cross_Fact_Sheet_xps(1).pdf

Spread of bloodborne pathogens - primarily through:

1. Direct contact – infected blood or body fluid (mucous) from one person is transferred directly to another person

2. Indirect contact – a person touches and object that contains the blood/body fluid of an infected person

3. Respiratory transmission – person inhales respiratory droplets from an infected person (through cough or sneeze)

4. Vector-borne transmission – person’s skin is penetrated by a bite (or other means) from an organism carrying the disease (mosquitoes, ticks, etc.)

Examples of Modes of Transmission:

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

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Accidental injury by contaminated sharps/needles

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Contact with open cuts, nicks and abrasions

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Contact with mucous membranes in eyes, mouth, nose and ears

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Industrial accident

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Administering first aid

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Post-accident cleanup

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Janitorial or maintenance work

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Engineering & Work Practice Controls

Engineering Controls

• Handwashing
• Biohazard waste bags

Work Practice Controls

• Personal protective equipment
• First Aid response
• Spill clean-up
• Waste disposal
• Exposure response

Personal protective equipment

Specialized clothing or equipment that provides protection against infectious material

• Gloves
• Gowns
• Eye protection
• Resuscitation devices

Housekeeping: Waste Disposal

• Use PPE when handling
• Leak-proof containers
• Proper labeling
• Labels
• Red bags or containers
• Drop off sites

Exposure Incident Response

• Contact with skin: wash exposed areas with antibacterial soap and running water
• Contact with eyes or mucous membranes: flush affected area with running water for at least 15 minutes
• Contact with clothing: remove contaminated clothing, wash underlying skin
• Report exposure to supervisor

Post-exposure evaluation

A specific incident that results in blood or other potentially infectious material entering the skin.

• Inform your supervisor
• Contact your school nurse

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Resources

Universal precautions fact sheet:

https://www.nd.gov/dpi/uploads/1234/UniversalPrecautionKits.pdf

OSHA BBP safety & health topics

https://www.osha.gov/SLTC/bloodbornepathogens/index.html

OSHA Model Plans and Programs

https://www.osha.gov/Publications/osha3186.pdf

Center for Disease Control and Prevention

https://www.cdc.gov/niosh/topics/bbp/

Swampscott public schools exposure plan

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