Bloodborne Pathogen Awareness

And Prevention
(Part 1)

Bloodborne Pathogen
Awareness And Prevention
By

Richard C. Lavy, M.D.

Chief, Division Of Health And Safety
United States Coast Guard Auxiliary

Risk Assessment And

Management

Identify the hazard

Identify the mission task
Assess the risks
Identify the options
Evaluate the risk VS gain
Execute your decision
Monitor the situation

Risk Assessment And Management

The Hazard
A substance that may contain a
bloodborne pathogen
Blood
Semen
Vaginal secretions
Pus
Amniotic fluid

Risk Assessment And Management

The Mission

Report of the incident

Arrival on scene
Grossly bloody scene
Airway management
Emergency childbirth
Scene and equipment cleanup

Risk Assessment And Management

The Risk
Tasks and activities that may involve
exposure to potentially infectious
material
Consider ALL body substances as
potentially infectious
Diseased persons may have NO
symptoms

Items To Understand
(Each Discussed Later)

Modes of exposure and

transmission
Epidemiology and symptoms
Exposure control plan
Universal precautions
Engineering controls
Work practices

Items To Understand (Continued)

(Each Discussed Later)

Exposure control plan (cont.)

Personal

protection equipment
Selection
Types
Decontamination
Handling
Disposal
Reporting exposures

Modes Of Exposure and

Transmission
Percutaneous (through the skin)
Stick

by needle or other sharps

Splash on rash, sore, cut, or
scratched skin
Mucocutaneous (through a mucous
membrane)
Splash into eyes, nose, or mouth
Sexual contact

Modes Of Exposure and Transmission

Chain Of Infection
Infectious agent (virus, bacteria)
Reservoir (infected person)
Means of exit (cut, burn, weeping

rash)
Mode of transmission (cleat, screw
driver, needle)
Means of entry (puncture wound, rash)
Susceptible host (YOU)

Epidemiology and symptoms

Hepatitis B and Hepatitis C

Inflammation of the liver
Millions of carriers in U.S.
Carriers are infectious and may
develop serious liver diseases
Cirrhosis (scarring of liver)
Liver cancer
Most persons recover

Hepatitis B
(The Virus)

Incubation period long:

45 to 160

days
Fatality rate about 1.4%
Spread mostly via blood, vaginal
fluids, semen, saliva from a bite

Hepatitis B
(The Virus)

Chance of infection after a stick:

6% to 30%
Survival outside the body:
7 days or longer
Vaccine: available

Hepatitis B
Diagnosis and Treatment

Diagnosis
Clinical

signs and symptoms

Laboratory tests
Treatment
Supportive (fluids, nourishment)
Prevention
Interrupt chain of infection
Immunization

Epidemiology and symptoms

Human Immunodeficiency Virus

Disease:

AIDS (Acquired
Immunodeficiency Syndrome)
Incidence: Over 1 million persons
infected in U.S.
Infection rate: increasing (fewer dying)
Spread: mostly via blood, semen, and
vaginal secretions

Human Immunodeficiency
Virus

Chance of infection after stick:

less than 1%
Survival of virus outside body:
short time
Vaccine: not available

Acquired Immunodeficiency
Syndrome (AIDS)

Onset usually insidious- may not

develop for 10 years after infected
with HIV
May be prevented by immediate
prophylaxis (treatment)

AIDS
Signs and Symptoms

Non-specific (mono-like illness)

Swollen lymph glands
Chronic diarrhea
Weight loss
Fever
Tuberculosis suggestive

AIDS
Diagnosis

Clinical findings
Blood tests

AIDS
Treatment

Drug treatment immediately after

exposure may prevent
development of AIDS

Death now no longer inevitable

AIDS
Prevention

Interrupt chain of infection

Immediate prophylaxis

Exposure Control Plan

Methods Of Compliance

Prevent contact with blood or other

potentially infectious materials
(Universal precautions)
ALL body fluids should be
considered potentially infectious

Exposure Control Plan

Engineering Controls

Devices which prevent contact

Gloves
Other

personal protection equipment

Isolation and containment supplies
Handwashing facilities
Sharps containers
Medical waste containers

Exposure Control Plan

Work Practices

Wash hands (even after using gloves)

Do not bend, break, or recap needles

(sharps)
Do not eat, drink, smoke, apply
cosmetics or lip balm, or handle contact
lenses
Avoid causing splashes or splatters
Properly handle contaminated materials

Exposure Control Plan

Personal Protection Equipment

Gloves
Gowns or laboratory coats
Face shields or masks
Eye protection
Mouthpieces, pocket masks
Resuscitation bags
Other ventilation devices

Exposure Control Plan

Personal Protection Equipment (cont.)

Must be readily accessible

Kits
Gloves
In

personal flotation device (PFD)

In film canister in PFD
Hypoallergenic gloves available if
allergic to latex

Exposure Control Plan

Personal Protection Equipment (cont.)

Cleaning, laundering, and disposing

(hospital)
Replace
If defective (inspect regularly)
Immediately after use
Different patient
Disposable

Exposure Control Plan

Housekeeping
Maintain worksite in clean and sanitary
condition
Determine & implement cleaning
schedule
Determine method of decontamination
1:10 dilution household bleach
(sodium hypochlorite)

Exposure Control Plan

Housekeeping (Cont.)
Clean all equipment & surfaces after
contamination occurs (deck, cleats,
chafing gear, survival equipment)
Use personal protective equipment
Inspect bins, pails, cans, & similar
receptacles never insert hands
Broken glassware (use mechanical
means)

Exposure Control Plan

Laundry
Handle contaminated laundry as little

as possible using universal precautions

Bag contaminated laundry & place in
appropriate container
Labeled biohazard
Color coded
Fluorescent orange
Orange-red

Exposure Control Plan

Laundry (Cont.)
Laundry (per local protocol)
Approved

laundry facility
Use CDCP or manufacturers
recommendations
Detergent
71 degrees Celsius (170 degrees
Fahrenheit) 25 minutes

If Not Adequately Equipped

Leave the area

Notify controlling authority

If Contaminated Or Punctured
Decontaminate
Wash
Document circumstances
Route

of exposure
Source
Intensity
Duration of exposure

If Contaminated Or Punctured
Notify:
Operational commander
Medical personnel immediately

Personal Protection
Equipment - Donning
(See Appendix for technique)

Gloves - Used alone when

minimal risk of exposure exists

Personal Protection
Equipment - Donning
(See Appendix for technique)

Extensive protection when greater

risk of exposure exists
Mask and eye
protection
Gown
Shoe covers
Gloves

Personal Protection
Equipment
Make Sure Contaminated Apparel
Does Not Come Into Contact With
Clothing or Skin

Personal Protection
Equipment

Do not cross contaminate

Use different gloves and other PPE
when treating another patient

Personal Protection
Equipment - Removal
Carefully
(See Appendix for technique)

Shoe covers
Gown /gloves
Gloves
Head cover
Mask and eye shield

Biohazard Waste Bag

Able to be closed
Leakproof
Labeled and/or color coded
Do not contaminate outside of bag
Secure opening by knotting

Personal Protection
Equipment - Disposal

State regulations
Civilian emergency medical
responders
Local hospital

Hand Washing
After ANY contact (even if gloves
have been worn)
Lather with soap
Vigorous rubbing of all surfaces
15 seconds minimum

Hand Washing (Cont.)

Antiseptic towelette
Wipe all surfaces
Dispose of in trash
Wash when facilities available

Reports
Radio
Written
Medical information
Exposure
Extent
Duration

Breakdown in protection
Care rendered

Post-exposure

Evaluation and follow-up if ANY

exposure

Prophylaxis: DO NOT DELAY

Summary
Are you trained?
Are you equipped?
If no
Notify

station
Do not become a victim

Summary (Cont.)
If yes
Respond
Monitor

the situation
Inform station of all activities
Record all that transpires
Activate appropriate resources

Reference
COMDTINST M6220.8
Prevention of Bloodborne
Pathogen transmission

Bloodborne Pathogen
Awareness And Prevention
Proceed to (BBP-Part 2)
Edition: 12 June 2003