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BLOOD BORNE PATHOGENS hepatitis

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					BLOOD BORNE PATHOGENS UPDATE
ALLIANCE CARE
September 2007


What are Blood Borne Pathogens?

Blood borne pathogens are viruses, bacteria and other pathogens or microorganisms that
can be present in the bloodstream. Some blood borne pathogens carry diseases that can be
deadly. The most common blood borne pathogens that you are at the greatest risk of
contracting as a health care worker are
               HIV or AIDS
               Hepatitis C
               Hepatitis B

Pathogens, bacteria and viruses are present every day, everywhere. Most pathogens will
not make us ill or cause slight illnesses from which we will soon recover. There are
bacteria on every surface that we come in contact with except sterilized items. The best
way to protect yourself is frequent hand washing. We need to protect ourselves from
blood borne viruses that can cause diseases that can be deadly if contracted. Two other
Blood borne micro-organisms that cause disease in humans are syphilis and malaria both
of which are curable.

HIV- Human Immunodeficiency Virus and AIDS
         HIV attacks the immune system and causes it to break down and stop working.
The affected person does not die from an HIV infection, but HIV multiplies thousands of
times in the blood and lowers the T-cells or immune cells so the person becomes
susceptible to an opportunistic infection. HIV progressively destroys the body’s ability to
fight off certain bacteria, viruses, fungi, parasites and other microbes. The most advanced
stage of HIV infection is called AIDS or Acquired Immune Deficiency Syndrome. There
are treatments to improve the AIDS victims symptoms, there is no cure and AIDS is a
fatal disease. There are about 1 million people in the USA infected with AIDS and up to
25% are unaware that they are infected. AIDS is the leading killer of African American
males 25-44 years of age. African American women and children are at great risk for
contracting the disease, 2/3 of all cases in women and children are African American’s.
The risk for health care workers working with HIV/ AID’s patients is below 1 % if
universal precautions are maintained
               Transmission of HIV/ AIDS

                      1. anal, vaginal or oral sex
                      2. sharing needles with an infected person
                      3. infections transmitted by the mother to an infant during birth

       HIV and AIDS are not transmitted by casual contact, toilet seats, door
       knobs, dishes and drinking glasses, food, pets, mosquitoes or a hug.

               Early symptoms of HIV infection 1-2 months after infection

                      1.   lethargy (weakness) – increased sleeping
                      2.   fever
                      3.   headache
                      4.   swollen glands

               Symptoms of HIV infection appearing months to years before advancing
               to AIDS

                      1.   lack of energy
                      2.   unintended weight loss
                      3.   fevers and sweats
                      4.   persistent yeast infections (oral or vaginal)
                      5.   skin rashes, flakey skin
                      6.   pelvic inflammatory disease resistant to treatment
                      7.   short term memory loss

               Stages of AIDS
                      1. Infection- may have flu like symptoms or no symptoms at all
                      2. Compromised immune system- swollen lymph glands or small
                          infections or illnesses that take advantage of the weakened
                          immune system
                      3. The body becomes completely unable to fight off life
                          threatening infections and disease.

Hepatitis C-
       There is no vaccine for Hepatitis C. The rate of infection with Hepatitis C has
dropped dramatically from an average of 240,000 new cases per year in the 1980’s to
26,000 new cases in 2004. The drop is due to education and screening of the blood
supply. 80% of infected persons do not have noticeable symptoms until they develop
serious illness. Since most infected people do not have symptoms they are often not
diagnosed until have advanced disease, sometimes they are diagnosed during routine
blood tests or when they donate blood. People may be infected for up to 30 years while
having no symptoms, HCV is slowly damaging their livers during this time. Children
who are infected at birth have a 75-85% chance of developing chronic infections. There
is NO VACCINE for hepatitis C. Those at greatest risk for HCV include people who
have had a blood transfusion prior to 1990, IV drug users who share needles, household
members and sexual partners and medical personnel who are exposed to infected blood
and body fluids. There is not a cure for HCV but antiviral medications and treatments are
available that can be helpful for some patients.

       Transmission of Hepatitis C-

              1.   blood from an infected person enters the body of an uninfected person
              2.   sharing needles
              3.   can be spread by sex in rare instances
              4.   an infected mother to her baby during the birth process

       Hepatitis C is not spread by sneezing or coughing, casual kissing or hugging,
       dishes and glassware, breastfeeding

       Signs and symptoms of HCV

              Usually begin at 7 weeks after infection but can range from 2 – 24 weeks
              but many people exhibit NO symptoms.

              1.   loss of appetite
              2.   stomach pain
              3.   jaundice (yellowing of the skin and whites of the eyes)
              4.   flu like symptoms
              5.   nausea
              6.   tiredness
              7.   dark urine

              Infections may result in being a chronic carrier while undiagnosed HCV is
              damaging the liver for years. Other problems are liver cancer, cirrhosis,
              liver failure and death. HCV is the number one cause for the need for liver
              transplants. Persons at risk for Hepatitis C are also at risk for Hepatitis B
Hepatitis B-
        Hepatitis B commonly known as serum hepatitis causes very serious liver
damage, if it is not treated it will result in death for most victims. Hepatitis B (HBV) is
THE MAJOR INFECTIOUS BLOOD BORNE HAZZARD to health care workers.
HBV is extremely infectious, the exposure to very small amounts of HBV positive blood
can result in infection. In the 80’s the CDC reported 450,000 new infections annually, in
1999 the new infection rate dropped dramatically to 80,000 new cases the rate dropped
again in 2004 to 60,000 new cases a year.. This is due to education and the hepatitis
vaccination being available. The greatest decline is in children and teens due to routine
vaccination programs. The percentage of health care workers being infected is below 1%
again due to Vaccination against HBV

       Transmission of Hepatitis B

               1. blood form an infected person entering the body of an uninfected
                  person
               2. unprotected sex
               3. sharing needles
               4. from an infected mother to her baby during the birth process

       You cannot get Hepatitis B from sneezing or coughing, casual
       kissing, hugging, dishes and glassware or breastfeeding

       Signs and symptoms of HBV
              1. loss of appetite
              2. stomach pain
              3. jaundice (yellowing of the skin and whites of the eyes)
              4. flu like symptoms that can last for months
              5. fatigue and tiredness
              6. nausea and vomiting
              7. joint pain

       Symptoms can appear 1-9 months after infection. The person may become a
       chronic carrier without noticeable symptoms but can infect others, this is true in
       about 30% of the cases. Untreated the disease can progress to liver cancer or
       cirrhosis and ultimately death. Of children infected at birth 90% will develop
       chronic infection.
      HBV vaccination is your best protection against HBV, the vaccination is a 3 step
      process with 3 injections over a 6 month period. The vaccination is safe and
      effective and even recommended by the Academy of Pediatrics for infants and
      children.

      Persons at risk for Hepatitis B are also at risk for HIV/ AID’s and Hepatitis C

Transmission of Blood Borne Pathogens-

       Blood Borne pathogens are most commonly spread through contact with blood
and body fluids containing blood which may or not be visible.

      Other body fluids which may contain blood borne pathogens:
             1. semen
             2. vaginal secretions
             3. cerebrospinal fluid 9fluid around the brain and spinal column)
             4. pericardial fluid (fluid around the heart)
             5. synovial fluid (fluid around joints)
             6. pleural fluids ( fluid between the linings of the lungs)
             7. peritoneal fluid (fluid in the abdomen)
             8. amniotic fluid ( fluid surrounding a baby in the uterus)
             9. saliva (especially during dental procedures)
             10. any body fluid contaminated with blood
             11. any body fluid where you are unsure of contamination
             12. any body tissue

      Common modes of transmission of blood borne pathogens
              1. sexual contact
              2. sharing of hypodermic needles
              3. mother to child during childbirth
              4. accidental puncture wounds with contaminated needles
              5. contact with body fluids between broken or damaged skin
              6. contact with mucous membranes- splash accidents into eyes and
                  mouth
      Blood borne viruses can live in the blood from minutes to hours, never assume
      dried blood is pathogen free. Always use gloves to clean up any body fluid or
      waste spill and wash your hands thoroughly after discarding gloves. Do not make
      the assumption that the elderly do not have blood borne pathogens. Anyone can
      be infected and universal precautions are the same for everyone you care for.
      Blood borne pathogens are not transmitted through coughing or sneezing,
      touching an infected person or hugging them. Glasses and hearing aids will not
      transmit blood borne pathogens.
Clean up of spills
        In a residents home bleach should be used on the spill, it is then no longer
considered contaminated and does not require labeling or special containers for
disposal. Some body fluids like stool and urine may be flushed in the toilet. If you
are in a facility like a nursing home or assisted living home, ask the staff for
assistance every facility has their own procedure for disposing of medical waste.
Always use gloves when handling body fluids and wash you hands before and
after using gloves.

Exposure to needle sticks-
      OSHA DEFINES AN EXPOSURE INCIDENT AS: A SPECIFIC EYE,
MOUTH, OTHER MUCOUS MEMBRANE, NON INTACT SKIN,
PARENTERAL (PIERCING MUCOUS MEMBRANES OR THE SKIN
BARRIER THROUGH SUCH EVENTS AS NEEDLE STICKS, BITES, CUTS
AND ABRASIONS) CONTACT WITH BLOOD OR OTHER POTENTIALLY
INFECTIOUS MATERIALS THAT RESULT FROM THE PERFORMANCE
OF AN EMPLOYEES DUTIES

        You should not be handling client needles. All needles or sharps should be
placed by the client into a strong plastic container for disposal. Sharps should
never be placed directly into the trash can, if there is an issue at a clients home
with needle disposal call and speak to the nurse who will visit and teach the client
about proper disposal. Always carry trash away from your body do not place your
hands or feet into trash can or bag. Be aware of loose needles lying around a
diabetic’s home and NEVER, NEVER, NEVER recap a needle. If you are
accidentally stuck with a dirty needle or otherwise exposed to blood borne
pathogens, wash the area under a steady stream of water and use soap. DO NOT
PANIC- call the office and follow up testing and care will be set up for you. It is
important to receive follow up care as soon as possible some treatments must be
started within 24 hours of infection. Call the office or on call as soon as an
incident occurs to arrange an immediate evaluation.

       Safety tips to prevent exposure
               1. never pick up broken glass with your hands
               2. never recap a needle throw it into a sharps container or hard
                   plastic bottle
               3. never reuse any sharps or needles
               4. report all injuries ASAP
               5. carry trash away from your body
               6. do not put feet or hands into a trash bag or can
Hand washing and Alcohol based hand cleaners – Hands should be washed
with soap and water for at least 15 seconds or as long as it takes to sing Happy
Birthday- Hands are washed before and after client contact, before and after food
preparation, after using the restroom, before and after using gloves, or whenever
they are soiled. Alcohol based hand cleaners can be used instead of hand
washing,. if you feel the build up or hand cleaner on your hands or your hands are
visibly soiled they must be washed with soap and water. When using hand
cleaners rub your hands briskly until the cleaner is dry.

Engineering and Work Practice Controls

       Engineering controls are equipment or devices designed to reduce injury
from exposure to blood borne pathogens. Examples are

               1.   gloves
               2.   self sheathing needles
               3.   needle disposal containers
               4.   gowns
               5.   CPR barrier masks
               6.   eye shields

      Work practice controls are procedures that you will follow to prevent
exposure to blood borne pathogens. Examples are

               1. hand washing
               2. wearing PPE
               3. not handling used needles
               4. not recapping needles
               5. proper clean up of body fluid spills
               6. protecting yourself from splash injuries during oral care,
                  emptying foley catheters etc
               7. isolation signs
               8. warning labels or signs


PPE – personal protective equipment
            1. gloves- should be worn when dealing with feces, sputum,
                urine, sweat, tears, vomit, nasal or oral secretions, vaginal
                secretions or blood or open wounds.
              2. mask/ goggles/ face shield- should be worn if there is a
                 potential for splashing into your eyes, nose mouth or any other
                 mucous membrane
              3. You should always carry a CPR mask if you are trained in CPR
                 for your protection against disease


****ALWAYS WASH YOUR HANDS BEFORE AND AFTER USING PPE******

    *** ALWAYS USE PPE WHEN YOU ARE IN CONTACT WITH BODY
    FLUIDS- ALWAYS HAVE A BARRIER BETWEEN YOU AND MOIST
    OR WET SUBSTANCES ORIGIANTING FROM ANOTHER
    PERSON********

    **FOOD DRINK AND SMOKING—NEVER EAT, DRINK. SMOKE,
    HANDLE CONTACT LENSES, APPLY COSMETICS OR LIPSTICK
    UNTIL YOUR ARE AWAY FROM INFECTIOUS MATERIALS AND
    HAVE THROUGHLY WASHED YOUR HANDS WITH SOAP AND
    WATER

				
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Description: BLOOD BORNE PATHOGENS hepatitis