Bloodborne Pathogens; Infection Control and Safety: Bloodborne Pathogens; Infection Control and Safety UCSF Department of Hospital Epidemiology and Infection Control Anthony Kakis, DPM,CIC Welcome!!!


Infection Control Questions?Call us 353-4343http://infectioncontrol.ucsfmedicalcenter.org: Infection Control Questions? Call us 353-4343 http://infectioncontrol.ucsfmedicalcenter.org What do we do? Education Surveillance Consultation Policies and Procedures Special Studies Liaison with local and state Public Health Dept. Exposure follow-up


Bloodborne Pathogen  History : Bloodborne Pathogen History The AIDS epidemic triggered development of standards and policies to protect HCWs and patients from transmission of bloodborne pathogens Bloodborne Pathogen (BBP) Standard Universal/ BSI Precautions


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1. Standard Precautions (SP)2. Transmission Based Precautions SP USED ON ALL PATIENTS: 1. Standard Precautions (SP) 2. Transmission Based Precautions SP USED ON ALL PATIENTS Combines the features of Universal Precautions and Body Substance Isolation Use when chance of contact with: Blood, and body fluids except sweat, broken skin, mucous membranes Features of SP include..... Hand hygiene; before, between, & after patient contact


Hand Hygiene: Hand Hygiene Study at Duke (The Lancet) found only 17% of physicians in the ICU washed hands appropriately Research published in The Annals of IM (1999) found that busy ICU staff had the lowest rate of handwashing compliance UCSF Hand hygiene compliance in 2004; MDs 30%-50%; RNs 75%-90% Use of alcohol based gel has shown to increase handwashing compliance - It is available in all patient care areas.


Hand Hygiene: Hand Hygiene Current CDC guidelines recommend alcohol gel as primary hand hygiene agent. If hands are visibly soiled use water and soap. If you are performing an invasive procedure use either alcohol gel or an anti-microbial soap/agent.


Slide9: Complying with hand hygiene policy…..


Indications for Hand Hygiene Handwashing/Hand Antisepsis : Indications for Hand Hygiene Handwashing/Hand Antisepsis Before having direct contact with patients. Before donning gloves. After removing gloves or other personal protective equipment. After contact with body substances or articles/surfaces contaminated. After contact with patient’s intact skin (e.g. taking a pulse, blood pressure or lifting a patient). Before preparing/eating food (don’t use alcohol) After personal contact that may contaminate hands (e.g., covering sneeze, using bathroom).


Personal Protective Equipment PPE are Barriers you Wear: Personal Protective Equipment PPE are Barriers you Wear Device or clothing for protection against blood, body fluids, chemicals, and fumes. Type of PPE based on the anticipated risk of exposure. Not to be worn in hallway. NOT a substitute for hand hygiene!


What type of PPE do you use?: What type of PPE do you use?


Gloves must be worn for:: Gloves must be worn for: anticipated contact with moist body substances, mucous membranes, tissue, and non-intact skin of all patients; contact with surfaces and articles visibly soiled/contaminated by body substances; performing venipuncture or other vascular access procedures (IV starts, phlebotomy blood draws, Injections); handling specimens when contamination of hands is anticipated.


Gloves Use…: Gloves Use… Don gloves at bedside, immediately prior to task. Replace torn or otherwise damaged gloves Remove & discard gloves after each task involving body substance contact. Gloves should not be worn: away from the bedside or lab bench, at the nursing station, to handle charts, clean linen, clean equipment or patient care supplies, or in hallways or elevators.


Glove Use…: Glove Use… Perform handwashing or hand antisepsis (per above indications) as soon as possible after glove removal, or removal of other PPE Caution: Gloves do not provide protection from needlesticks or other puncture wounds caused by sharp objects. Use extreme caution when handling needles, scalpels, etc.


Additional Glove Information:: Additional Glove Information: Sterile gloves - when aseptic technique required. Hypoallergenic and powder-free gloves are available for individuals who are allergic to powder (request through manager).


Additional Glove Information:: Additional Glove Information: Unsterile gloves: Vinyl and latex gloves are equally effective in preventing contact with microbes. Vinyl gloves are used for activities that require application of non-sterile gloves; used for protection during routine patient care tasks where contact with blood and body fluids is intermittent (e.g. venipuncture) Nitrile Gloves are used for contact with chemotherapy agents, handling hazardous drugs or chemicals, or prolonged contact with body fluids where the wearer may not have the opportunity to change gloves frequently (e.g. some laboratory tasks)..


What’s wrong with this picture?: What’s wrong with this picture?


Believe it or not........48 year old morbidly obese female is admitted to your unit, with chills, rash, a productive cough and in respiratory distress. Endotracheal intubation is ordered. Because of patient’s size, 15 staff assist in positioning the patient or the procedure. All staff wear gloves, and most wash their hands. Sixty hours later 9 staff who assisted in the procedure complain of sore throat, fever, and general malaise. The patient’s respiratory, blood, and wound cultures obtained on admission are positive for Group A Streptococcus. : Believe it or not........ 48 year old morbidly obese female is admitted to your unit, with chills, rash, a productive cough and in respiratory distress. Endotracheal intubation is ordered. Because of patient’s size, 15 staff assist in positioning the patient or the procedure. All staff wear gloves, and most wash their hands. Sixty hours later 9 staff who assisted in the procedure complain of sore throat, fever, and general malaise. The patient’s respiratory, blood, and wound cultures obtained on admission are positive for Group A Streptococcus.


Select the right answer: Select the right answer Staff adequately protected themselves by using gloves and washing hands. Lack of handwashing with antimicrobial soap probably related to the exposure Proper adherence to Standard Precautions not followed; should use face shield with mask during procedures that likely cause aerosolization of fluid and generate droplets Standard Precautions; only used for serious infections


Bio-hazardous Waste: Bio-hazardous Waste Any item contaminated with liquid blood must be placed in the biohazard waste Bin Sharps containers - used and unused sharps PPE, dressings, empty Foleys, etc. that do not have liquid blood may go into regular trash


BBP Premises: BBP Premises Bloodborne infection defined as an infection caused by any pathogen present in blood or other body fluids transmissible via the parenteral, mucosal, or non-intact skin route. Exposure is defined as an incident in which individual is exposed to blood or blood-contaminated body fluid of another individual by the parenteral, mucosal, or non-intact skin route. Invasive procedures; procedures in which the integrity of the skin, mucous membrane, or tissue is interrupted by needles or other devices, and potential for bleeding exists.      D.  Healthcare personnel are entitled to privacy and not obligated to disclose            their bloodborne infection status to patients, colleagues, or            administrators (See Section III C 3 of this policy).      E.  Patients have a right to know that healthcare workers are not required to            have testing for bloodborne infections (See Section III C 3 of this policy).


Management of HCW Exposure to Blood/Body Substances: Management of HCW Exposure to Blood/Body Substances Guidelines for the prevention of transmission of infection to personnel and patients the IC Manual, Section 3; these guidelines minimize potential for Health Care Worker (HCW) exposure to blood and other body substances.


HEPATITIS B VACCINE : HEPATITIS B VACCINE Vaccine offered/Potential exposure All Medical Center HCWs whose jobs involve tasks with potential exposure to bloodborne pathogens shall be offered the vaccine series within 10 working days of beginning their assignment. 


HEPATITIS B VACCINE: HEPATITIS B VACCINE Non–vaccinated - approximate risk of acquiring Hepatitis B, C, or HIV from a single needlestick or exposure; (varies depending on viral load of source patient) Hepatitis B: 6%-30% or 1/7 Hepatitis C: 1.8% - 3% or 1/35 HIV: .3% or 1/300


Management of HCW Exposure to Blood/Body Substances: Management of HCW Exposure to Blood/Body Substances Following exposure to blood/body fluids (except seat) the HCW should immediately Clean/decontaminate the site. Wash wounds and contaminated skin with soap and water;


Management of HCW Exposure to Blood/Body Substances: Management of HCW Exposure to Blood/Body Substances Rinse mouth, eyes with copious amounts of saline or tap water. Do not wash skin with bleach. Remove contract lens if splashed in eye. Contacts need to be removed immediately and decontaminated prior to replacement. Soft lenses may need special decontamination.


Management of HCW Exposure to Blood/Body Substances: Management of HCW Exposure to Blood/Body Substances The Needlestick/Exposure Hotline offers confidential screening of exposures and recommends treatment in some cases, when the source of the exposure is known to have a BBP and or the exposure is of a high risk nature. The hotline is monitored 24/7/365.


Management of HCW Exposure to Blood/Body Substances: Management of HCW Exposure to Blood/Body Substances HCWs should report exposures to Hotline as soon as possible to insure timely assessment of the exposure, and to facilitate source patient testing. Also notify supervisor/manager


Management of HCW Exposure to Blood/Body Substances: Management of HCW Exposure to Blood/Body Substances HCWs are responsible for initially contacting the Exposure Hotline pager at 719-3898 to report any needlesticks, lacerations, splashes or human bites which expose them to blood.


Management of HCW Exposure to Blood/Body Substances: Management of HCW Exposure to Blood/Body Substances After reporting the exposure to the Hotline the HCW will need to contact the Employee Health Program at (885-7580) to arrange for follow-up assessment of their Hepatitis HIV and hepatitis B, C will also be assessed. HIV testing will only be done with the HCWs expressed written consent.


Management of HCW Exposure to Blood/Body Substances: Management of HCW Exposure to Blood/Body Substances Source patients will be contacted by Employee Health and with written consent will be tested for HIV and hepatitis B and C. Exposed HCWs should not initiate source patient testing. If a source patient is discharged before the Employee Exposure clinician can see them in person, the Hotline responder may request that blood sample be sent to the lab and held for Employee Health.


BBP; HCW Status : BBP; HCW Status Healthcare personnel are entitled to privacy and not obligated to disclose their bloodborne infection status to patients, colleagues, or administrators. Patients have a right to know that healthcare workers are not required to have testing for bloodborne infections. (See Section 7.6 of IC Manual)


BBP: BBP UCSF recognizes that minimizing the possibility of transmission of bloodborne pathogens from infected providers to their patients is of paramount concern.  The risks of transmitting bloodborne infections, including hepatitis B & C virus and HIV, from infected workers to patients during the performance of invasive procedures or other patient care activities, the UCSF Medical Staff and Medical Center conclude that enforcing a high standard of infection control applicable to all healthcare personnel is the best strategy for protecting patients from accidental exposure.


Slide40: http://www.ucsfmedicalcenter.org/matserv/ Safety Devices… ask and be informed as to what safety devices are available. Lear more at the below website:


Bloodborne Pathogens: Bloodborne Pathogens For more info on the Bloodborne Pathogen Standard refer to below website: http://manuals.ucsfmedicalcenter.org/EOC/2004ECBloodbornePathogens.pdf


Slide42: Airborne AFB Airborne Droplet Contact Transmission Based Precautions


Prevent Transmission: Break the chain of infection -Stay home when ill - unexplained skin rash S home when you are sick Set an example Prevent Transmission


Infection Control: Infection Control It’s in your hands…….


wishing everyone a peaceful day..: wishing everyone a peaceful day..