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Bloodborne PathogensAnnual Refresher Training
PRIDE 2014
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What Are We Going To Do ...
Talk about any changes in BBP info during the last 12
months
Look at local infectious disease numbers
A quick review on basic disease information
Review information specific to Loudoun County
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National Disease Numbers 2010
AIDS – 36,870 Hepatitis B – 3,405 Hepatitis C – 782 Syphilis – 44,828 TB – 11,182 WNV- 524 Lyme – 22,561
Measles cases – 74 Mumps – 1,991 Pertussis (whooping cough) – 16,858
Other Key Diseases
August 19, 2010
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Virginia Numbers
2011 AIDS 1108 HIV 577 TB 221 Syphilis 717 Hepatitis B 667 West Nile Virus 9 Lyme Disease 1023
2012 (as of 9/1/12) AIDS 415 HIV 769 TB 112 Syphilis 489 Hepatitis B 351 West Nile Virus 9 Lyme Disease 454
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Loudoun Numbers
2011 AIDS 13 HIV 23 TB 12 Syphilis 4 Hepatitis B 64 West Nile Virus 0 Lyme Disease 261
2012 (as of 9/1/12) AIDS 9 HIV 18 TB 7 Syphilis 9 Hepatitis B 46 West Nile Virus 0 Lyme Disease 125
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Infection Control Concepts
All diseases are infectious, but not all
diseases are communicable.
So what are we concerned with?
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Virulence
Mode of Entry
Host Resistance
Organism
Dose
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What is the incubation phase?
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What constitutes an exposure?
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Body Fluids That Pose A Risk
Primary Risk Blood Semen Vaginal Secretions
Secondary Risk Synovial Fluid Pericardial Fluid Pleural Fluid Amniotic Fluid Cerebrospinal Fluid Any other body fluid
containing visible blood
“O.P.I.M.”
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Tears, sweat, urine, stool, vomitus, nasal secretions, and sputum do not pose a risk unless they contain visible blood!
Human Bites & Exposure
If a patient bites you and draws blood… You have not had
an exposure. The patient has had the exposure, to your blood!
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What constitutes an exposure?
NOT AN EXPOSURE
Blood on intact skin Vomit on your face Urine on your skin Patient coughs in the
ambulance.
AN EXPOSURE
Blood on broken skin Vomit (with visible blood
in it) in your eyes Blood coughed in eyes
and/or mouth while suctioning
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Disease specific information
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Tuberculosis (TB)
Airborne bacteria transmitted by droplet contact
Not highly communicable...requires prolonged “close
quarters” contact
“Incubation” = 4-12 weeks
Findings = persistent cough > 3 weeks AND swollen
glands, significant weight loss
Annual testing recommended
2009 lowest case number since 1953 11,540 cases
Largest 1 year decrease since 1993
Five states carry over 52% of the total number of cases: Florida, Texas, New York, California, Illinois
Tuberculosis
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TB Testing
The Tuberculin Skin Test (used to be called the PPD) is no longer used by LCFR for annual testing of career staff.
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TB Blood Test Guidelines
QuantiFERON (QFT-Gold) Blood test for latent TB infection Used for screening healthcare
workers/military personnel/correctional staff
No need to return for readings Can be used with personnel who had
previous positive TST tests
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Tuberculosis
If you are transporting a patient who is actively coughing and is high risk for TB: Place a mask on the patient – an NRB is
adequate.
Would it be effective to place an N-95 on the patient?
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MRSA
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MRSA
Methicillin-resistant staphaureus (MRSA)
Most associated with healthcare settings. CDC report from 2010 shows that there has been a significant decline in MRSA since 2005.
Most frequent among people with weakened immune systems, the elderly, children.
24MRSA pimples in a person with a suppressed immune system
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MRSA
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MRSA
Clusters among athletes, military recruits, children, prisoners
May live on surfaces contaminated with body fluids containing MRSA
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Primary Means of Transmission
Skin-to-skin contact Crowded conditions Poor hygiene Sharing of personal items
Treatment
Incision & Drainage for soft tissue infections
No antibiotics
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Hepatitis B
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Hepatitis B (HBV)
Virus that attacks the liver
Very virulent
Direct or indirect contact
“Window” = 45 days “Incubation” = up to 6 months
Early Findings = flu-like illness (communicable)
Late Findings = yellow skin/eyes, dark urine, liver
enlargement (non-communicable)
No cure...vaccine (Recombivax) is available
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Hepatitis B Vaccine
Reminder
Offers protection via “immunologic memory”
There is NO formal requirement or recommendation
for a booster
Titer 1-2 months after completion of vaccine series
is required- OSHA enforcing
CDC, 1992,1997, June 29, 2001
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Hepatitis C
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Hepatitis C Cases
The acute incidence continues to decline
Additional data shows an increased risk with
tattoos and body piercing.
Rate in US – 1.3%
3.2 million people in U.S. have chronic HCV
infection
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Hepatitis C- Transmission
Blood
IV drug use
Mother to infant
Intranasal cocaine use
Sexual Contact
Multiple partners
High-risk sexual practices
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Hepatitis C - HCW Infection
There is no recommendation for the routine
screening of healthcare workers
Hepatitis C is not efficiently transmitted
occupationally
• AJIC, 1999, Vol.. 27 (1):54-55• CDC, 1998, CDC, 6/29/01
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HIV/AIDS
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Human Immunodeficiency Virus (HIV)
Virus that attacks the immune system
Low virulence
“Window” = 1-12 weeks...”Incubation” = up to 10 years
Early Findings = none to mild flu-like symptoms
Late Findings = varied, depending on infections
produced by ineffective immune system
No cure...No vaccine
1978 – December, 2006 57* documented cases
0 in fire/EMSpersonnel 49 were sharps related exposures
No new reported cases since 2000
Occupational Infection-HIV
CDC, 2008(CDC), NIOSH
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Rapid HIV Tests Rapid HIV Testing currently available
OraQuick Reveal Uni-Gold Multispot Clearview
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If source patient is negative with rapid testing = no further testing of health-care worker
Use of rapid testing will prevent staff from being placed on toxic drugs for even a short period of time
Testing Issues - Post Exposure
• CDC, May , 1998, CDC June 29, 2001, September 2005 41
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Flu
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Influenza (Flu)
Airborne virus transmitted by droplet contact
Respiratory tract infection caused by the influenza virus.
Fever, cough, sore throat, runny nose, muscle aches,
extreme fatigue are common. (Clear in 1 to 2 weeks)
20,000 deaths nationwide and more than 100,000
hospitalizations, annually.
The elderly and people with chronic health problems are
much more likely to be seriously affected
Flu Vaccine - Annual
“Direct patient care”
All healthcare workers
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CDC Flu Vaccine Program
Employers must offer
Employers must pay
Employees who decline - sign a declination form
CDC, February 24, 2006/2008/2009, NFPA 1581
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FluMist – Nasal Spray
For healthy persons 2- 49 years old Does not need to be
stored frozen Do not take if
pregnant – live virus vaccine
No thimerosal Is egg based Cost reduced No work restriction
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‘Swine’ flu is not expected to be a big component of this year’s flu season.
If you had the H1N1 vaccine, it is still protective. No booster is necessary.
H1N1 Flu Virus
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Fever Sore throat Cough Nausea Vomiting Diarrhea
Flu Signs/Symptoms
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Adult Shortness of breath Chest pain/pressure Dizziness Confusion Persistent vomiting
Pediatric Respiratory distress Bluish skin color Irritability Fever with rash Low fluid intake Not waking or
interacting
Severe Signs/Symptoms
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Place a surgical mask on patient If that isn’t possible, place a surgical mask
on yourself Good handwashing Use good airflow in vehicle
If a patient is suspected of having the flu
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Flu virus survives on hard surfaces for about 2 hours Routine cleaning is important
EquipmentSurfaces in vehicle
Survival on Surfaces
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Clostridium difficile‘C- diff’
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Anaerobic spore-forming bacillus
Clostridium difficile associated disease (CDAD) Hospital-acquired Related to antibiotic treatment
C- diff
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Surpassing MRSA as the major hospital acquired illness
215,000 infections annually 12,000 deaths Cost $1.6 billion
Incidence Rate – Hospital
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263,000 cases each year 16,500 deaths annually Cost $2.2 billion
Incidence Rate – Long Term Care
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Alcohol handwash is not 100% effective Soap & water is more effective and should be
used when available
Handwashing & C-diff
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Disease prevention guidelines
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Routine Immunizations
HBV Vaccine MMR Tdap Chickenpox Vaccine Flu Vaccine
CDC, 1997, OSHA,1999,2005
CDC Statement
Health-care personnel place themselves and their patientsat risk if they are not protected against measles.
In accordance with current recommendations, health-care personnel
should have documented evidence of measles immunity¶¶ readily available at their work location (3).
If this documentation is not available when measles is introduced,
major costs and disruptions to health-care operations
can result from the need to exclude potentially infected
staff members and rapidly ensure immunity for others (6).
CDC, May 1, 2008
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Mumps
In order to be considered immune: History of physician diagnosis OR Receipt of at least 1 dose of mumps
vaccine OR Positive mumps IgG
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Mumps Vaccine - Update
2 doses needed for coverage
1 dose = 80% protection
Vaccine cannot be used post-exposure
CDC, 2006
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Mumps Exposure
Within 3 feet of infected person
No surgical mask used
Measles – Virginia 2008
8 EMS personnel exposed No documentation of immunity available
Personnel needed an average of 36 hours off duty for testing
Cost- $14,400.00
Vaccination prevents influenza regardless of antiviral resistance –
get vaccinated
CDC, Dr. Fiore
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Reduce the Risks of Disease Transmission through….
PREVENTION
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The Prevention ProgramIncludes…
Education on Infection Control Encouraging good hygiene practices Eat a healthy diet Proper cleaning & disinfection of athletic equipment Proper handling of blood and OPIM
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By altering one component of the triangle, one or more of the other components may be changed
Environment – Surfaces, Equipment, Personnel who come to work with infections
Causal Agent - Herpes, HOST: Recruits, Staph Infections EMTs,
MRSA Firefighters, Officers
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Host(Personnel)
Healthy Habits Diet rich in green, yellow, and
orange vegetables can bolster natural immunity.
Drinking 8 to 10 glasses of water a day can help flush disease causing organisms from the body.
Regular exercise.
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Alter the Environment
Hygiene Practices Keep cuts & scrapes clean and covered Do not share personal items
Towels, soap, razors, tweezers, sports equipment, ball caps, linen etc.
Shower after PT or strenuous activities Hand Hygiene
Wash your hands Soap and water is best Waterless hand sanitizer if soap & water is not available Antibacterial soap is not recommended
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Cleaning of equipment
All Chemical Germicides and Bleach Solutions (1 part bleach to 100 parts water)
MIX Appropriately USE Appropriately READ and FOLLOW LABELS
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Infection Control
BSI – aka Standard Precautions
Good handwashing
NRB or Surgical mask on the patient
Protective eyewear
N-95 respirator for care provider
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Prevention for HCW’s
Handwashing -
After touching blood/body
fluids/contaminated objects After glove removal Provide 15 sec. of friction
DO NOT squeeze the site to express
blood
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Hand Hygiene Guidelines
No antibacterial soap
Alcohol based foam
or gel
No artificial nails or
extensions
• CDC, October,2002
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Glove Use - Reminder
Practical and feasible-
Gloves must be used when there is reasonable
anticipation of contact with contaminated
surfaces or when performing vascular access
procedures, direct contact with patient mucous
membranes or non- intact skin
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Prevention for HCW’s
Mask Use - Eye
Protection
For procedures that
may generate
splash/splatter of
blood/body fluids
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Mask Clarification
Surgical mask
Filters what goes out
Respirator
Filters what comes in
Never put a respirator on a patient
Needle safe Devices
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Genie™ safety Lancets Filter Straws
Baxter Multi-dose vial adapters
Micro Pin Blunt cannula
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Loudoun County Infection Control Officers
Designated Infection Control Officer – Deputy Chief Jose Salazar
Back up Infection Control Officers – Battalion Chief Tim Menzenwerth Captain James Cooper Captain Micah Kiger Captain Mike Mahoney Captain Daniel Neal
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When an exposure happens!
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When an exposure happens!
Don’t Panic…did you really get exposed?
Clean the site with soap and water as soon as
possible.
Immediately call LCFR – ECC and have the
Infection Control Officer notified
Notify the receiving health care facility of the
exposure.
Do not provide your personal insurance information
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When an exposure happens!
The ICO will discuss your report with you and provide
you with additional instructions.
Follow-up procedures may be required.
All information pertaining to your exposure incident will
be keep confidential.
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When an Exposure Occurs
If the source patient is identified and tested, there is no
need to draw bloods on employee.
If source patient tests are positive, then follow up will be
done.
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Loudoun County, Virginia www.loudoun.gov
Management and Financial Services, Human Resources / Benefits 1 Harrison St., SE, 4th Floor, MS #41A Leesburg, VA 20177-7000 Telephone (703) 777-0517 Fax (571) 258-3212
Employee’s Report of Injury (Must Be Handwritten) Instructions-Employee: Please complete this report and return to your supervisor. Supervisor: Review incident with employee and then enter the required information onto the Employer’s Accident Report. Send both original injury reports to the Workers’ Comp dept. within 48 hours.
Name (First, Middle, Last) _______________________________________________________________________ Address__________________________________ City_________________________ State______ Zip_________ Phone No. ____________________ Date of Birth _________________ Social Security No. ___________________ Job Title _____________________ Department _____________________________________________________ Injury Date ___________________ Time of Injury __________ Overtime Yes/No Last Day Worked___________ Date Supervisor Notified___________________ Date Returned to Work __________________________________ What was the injury or illness? State exact part of the body affected and what the injury or illness was. Injury________________________________________________________________________________________ Body Part______________________ Specific Area_______________________ Please Circle: Left Right N/A What were you doing just before the incident occurred? Describe the activity, as well as the tools, equipment or material you were using. Be Specific. Example: “Arresting subject.” ____________________________________________________________________________________________ ____________________________________________________________________________________________ How did the injury/illness occur? Example: “While arresting subject, fell to the ground and landed on arm.” ____________________________________________________________________________________________ ____________________________________________________________________________________________ Where did the incident happen? __________________________________________________ What can be done to prevent future occurrence? ____________________________________________________________________________________________ Where did you go for medical treatment? ______________________________________N/A I certify that the information in this Work-Related Injury Report is true and accurate to the best of my knowledge. I understand that the County will rely upon this form in evaluating my claim. I further understand that this document may be presented or used in support of or against a claim for payment under the County’s policy of workers’ compensation insurance. I understand falsification of any information on or about this injury report form or the alleged injury, and the assertion of a false workers’ compensation claim, are violations of Virginia’s Criminal laws, may result in a fine and imprisonment and/or termination of my employment.
Employee Signature___________________________________________________ Date _____________________ Supervisor Signature___________________________________________________Date_____________________
Employee’s report of
injury
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Employer’s Accident Report (formerly: Employer’s First Report of Accident)
The boxes
Reason for filing
VWC file number
Virginia Workers’ Compensation Commission 1000 DMV Drive Richmond, VA 23220
to the right are for the
Insurer code or PEO Ref. No. 90267
Insurer location 760
See instructions on the reverse of this form use of the insurer
Insurer claim number
Employer
1. Name of employer (trading as or doing business as, if applicable)
County of Loudoun, VA 2. Federal Tax Identification Number
54-0948306 3. Employer’s Case No. (if applicable)
4. Mailing address
P.O. Box 7000, 1 Harrison Street., SE Leesburg, Virginia 20177
5. Location (if different from mailing address)
6. Parent corporation /Policy Named Insured (if applicable) or PEO name
Loudoun County Government 7. Nature of business
County Government/Volunteer Fire & Rescue 8. Name and Address of Insurer or self-insurer for this claim
Wells Fargo Disability Management 9. Policy number
10. Effective date
Time and Place of Accident
11. City or county where accident occurred Loudoun County
12. Date of injury
13. Hour of injury a.m. p.m.
14. Date of incapacity
15. Hour of incapacity
13a. Time began work a.m. p. m.
16. Was employee paid in full of day of injury?
Yes No
17. Was employee paid in full for day incapacity began?
Yes No 18. Date injury or illness reported
19. Person to whom reported
20. Name of other witness
21. If fatal, give date of death
Employee
22. Name of employee (Last, First, Middle)
23. Phone Number
24. Sex Male Female
25. Address
26. Date of Birth
27. Marital Status
Single Divorced
28. Social Security Number
Married Widowed
29. Occupation at time of injury or illness (SOC code, if applicable)
30. Is worker covered by PEO policy?
Yes No
31. Number of dependent
children 32. How long in current job?
33. Date of Hire
34. Was employee paid on a piece work or hourly basis? Piece work Hourly
35. Hours worked
per day
36. Days worked
per week
37. Value of perquisites per week
Food/Meals Lodging Tips Other 38. Wages per hour $
39. Earnings per week (inc. overtime) $
$ $ $ $
Nature and Cause of Accident
40. Machine, tool, or object causing injury or illness
41. Specify part of machine, etc.
42. Describe fully how injury or illness occurred 43. Describe nature of injury or illness, including arts of body affected
43a. Overnight inpatient hospitalization?
Yes No
43b. Treated in Emergency Room? Yes No
44. Physician (name and address)
45. Hospital (name and address)
46. Probable length of disability
47. Has employee returned to work? Yes No
If Yes
48. At what wage?
49. On what date?
50. EMPLOYER: prepared by (name, signature, title)
51. Date
52. Phone Number
53. INSURER: (name of processor)
54. Date
55. Phone number
56. THIRD PARTY ADMINISTRATOR (if applicable)
57. Address
58. Phone number
This report is required by the Virginia Workers’ Compensation Act Employer’s Accident Report VWC Form No. 3 (rev. 03/22/02)
Employer’s Accident
report to be filled out by supervisor
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Loudoun County, Virginia www.loudoun.gov
Management and Financial Services, Human Resources / Benefits 1 Harrison St., SE, 4th Floor, MS #41A Leesburg, VA 20177-7000 Telephone (703) 777-0517 Fax (571) 258-3212
Volunteer’s Report of Injury (Handwritten) Instructions-Volunteers: Please complete this report and return to your supervisor. Supervisor: Review incident with employee and then enter the required information onto the Employer’s Accident Report. Send both original injury reports to [email protected] within 48 hours.
Name (First, Middle, Last) _______________________________________________________________________ Address__________________________________ City_________________________ State______ Zip_________ Phone No. ____________________ Date of Birth _________________ Social Security No. ___________________ Job Title _____________________ Department _____________________________________________________ Injury Date ___________________ Time of Injury __________ Date Supervisor Notified___________________ Date Returned to Work __________________________________ What was the injury or illness? State exact part of the body affected and what the injury or illness was. Injury________________________________________________________________________________________ Body Part______________________ Specific Area_______________________ Please Circle: Left Right N/A What were you doing just before the incident occurred? Describe the activity, as well as the tools, equipment or material you were using. Be Specific. Example: “Arresting subject.” ____________________________________________________________________________________________ ____________________________________________________________________________________________ How did the injury/illness occur? Example: “While arresting subject, fell to the ground and landed on arm.” ____________________________________________________________________________________________ ____________________________________________________________________________________________ Where did the incident happen? __________________________________________________
What can be done to prevent future occurrence? ____________________________________________________________________________________________ Where did you go for medical treatment? ______________________________________N/A I certify that the information in this Work-Related Injury Report is true and accurate to the best of my knowledge. I understand that the County will rely upon this form in evaluating my claim. I further understand that this document may be presented or used in support of or against a claim for payment under the County’s policy of workers’ compensation insurance. I understand falsification of any information on or about this injury report form or the alleged injury, and the assertion of a false workers’ compensation claim, are violations of Virginia’s Criminal laws, may result in a fine and imprisonment and/or termination of my employment.
Volunteer’s Signature_________________________________________________ Date _____________________ Supervisor Signature__________________________________________________Date_____________________
Volunteer Report of
Injury
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Good Samaritan Exposure
Complete the “Good Samaritan Handout” at scene.
If unable to locate form, provide the Infection Control
Officer the following:
Good Samaritan’s name Contact information Unit # the patient was transported by Incident # and Patient # Name of facility patient was transported to
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COUNTY OF LOUDOUN
DEPARTMENT OF FIRE & RESCUE SERVICES
GOOD SAMARITAN EXPOSURE FORM
If you have received a person’s blood or body fluid into your eye, mouth, nose, or other mucous membrane, non-intact (an open area of your skin), or an object containing blood or body fluids pierced your skin, then you have receive an exposure.. The Virginia law on deemed consent states that if you have received an exposure (as defined above) to a person’s blood or other potentially infectious materials while rendering emergency assistance, you are entitled to have the person tested for HIV, Hepatitis B, and Hepatitis C and to receive the results of those tests. Call the Loudoun County Emergency Communication Center at (703) 777-0637 immediately, and advise them that you have received an exposure and are requesting the Designated Infection Control Officer to assist you. Please provider your name and the phone number where you can be reached at that time. The Designated Infection Control Officer will need the following information (Obtain from the fire-rescue member on the emergency scene):
Date and Time of event: ___________________ Agency and Unit # the patient was transported by: _________ Incident # ______________ Patient # (if more than one) _______ Name of the medical facility the source patient was transported to: _____________________________________
.
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What Questions do you have ?
