[4] occupational risks (bloodborne pathogens) Flashcards

Question

Sporadic CJD (2)

Answer 1

* the disease appears even though the person has **no known risk factors** for the disease. * This is by far the **most common type of CJD** and accounts for at least 85 percent of cases.

Answer 2

* the person may have a **family history** of the disease and test positive for a genetic mutation associated with CJD

Answer 3

* the disease is **transmitted by exposure to brain or nervous system tissue**, usually through certain **medical procedures** (e.g. injection of pituitary gland hormone from an infected source, cornea or skin transplants from people who had CJD)

Answer 4

Cannibalism has also been implicated as a transmission mechanism for abnormal prions, causing the disease known as **Kuru**. * This was primarily found among **women and children** of the **Fore people in Papua New Guinea**, where a cultural practice involved consuming the bodies of deceased tribe members. Women and children were most affected because they often left the less desirable parts including the **brain**, which contains **prion proteins**.

Answer 5

* **Prions** are not deactivated by **routine surgical sterilization** nor by **alcohol** or common **disinfectants**. * The only effective way to prevent further transmission is to **dispose of contaminated instruments**, often by **burying them**. ## Footnote NOTE: A type of CJD called **variant CJD (or vCJD)** can be acquired by **eating meat from cattle affected by a disease** similar to CJD called **bovine spongiform encephalopathy (BSE)** or, commonly, **“mad cow” disease**

Answer 6

Cause: * Creutzfeldt-Jakob disease is caused by **abnormal proteins called prions** that are not killed by standard methods for sterilizing surgical equipment. Consequences: * Those affected lose the ability to think and to move properly and suffer from memory loss. It is always **fatal, usually within one year of onset of illness.** * As prions build up in cells, the **brain slowly shrinks**, and the tissue fills with holes until it resembles a sponge.

Answer 7

* Occurs when a person is infected by the **human T-lymphotropic virus type 1**, causing **adult T-cell leukemia/lymphoma** * MOT: blood transfusions, sexual contact and sharing needles (esp for IV drug users); mother to child. ## Footnote * If a person has HTLV-1, the **lymphocyte nucleus appears lobulated**, resembling a **flower** rather than a single whole nucleus. * Observing this under a microscope can **indicate the possibility** of adult T-cell leukaemia or lymphoma

Answer 8

* Formerly known as **Ebola hemorrhagic fever**, a rare but severe, often fatal illness in humans * Transmitted to people from wild animals and spreads in the human population through human-to-human transmission. * **Fruit bats** are the **natural hosts** of the Ebola virus. It is introduced to humans through **close contact with the blood, secretions, organs, or bodily fluids of an infected bat**. * The virus then spreads **human-to-human through direct contact with broken skin** or mucous membranes, exposure to blood, body fluids, or contaminated objects from a person sick with or deceased from Ebola. ## Footnote Symptoms of EVD can be sudden and include: * Fever, fatigue, muscle pain, headache, sore throat * Vomiting, diarrhea, rash/appearance of rash, impaired kidney and liver function, internal and external bleeding

Answer 9

Risk of Exposure in the Healthcare setting is high because, most of the time, we are dealing with specimens from patients. There is a high likelihood of acquiring bloodborne pathogens particularly for: * Medical Technologists * Nurses and Physicians

Answer 10

* Main source: **Human Blood**, its components, and products made from it (It is important to protect oneself by practicing standard laboratory guidelines and by wearing PPE) ## Footnote **Other Potentially infectious materials (OPIM)** * Human body fluids * Any unfixed tissue or organ from human * Cultures, culture mediums, or other solutions * Experimental animal blood, tissues, or organs infected with HIV or HBV

Answer 11

occurs through: * **Direct Contact** - when an infected specimen (blood or body fluid) from one person is transferred directly to another * **Indirect Contact** - when a person touches an object or surface that is contaminated * **Respiratory Transmission** - when a person inhales respiratory droplets from an infected person through coughing or sneezing * **Vector-borne Transmission** - when a person’s skin is penetrated by a bite from an infected organism, especially insects such as mosquitoes and ticks ## Footnote We have a lot of modes of transmission, such as: * Contact with another person’s blood or bodily fluids that may contain blood * Accidental injury by contaminated sharps or needles or the needlestick injury * Contact with open cuts, nicks, and abrasions * Contract of blood with mucous membrane in the eyes, mouth, nose, and ears which can serve as a portal of entry for our bloodborne pathogens. * Industrial accidents * Administering first aid * Post accident clean-up * Janitorial or maintenance work

Answer 12

* when there are: -- Needlestick injuries (accidental punctures from Sharps like needles and broken glass) -- Cuts from other contaminated sharps -- Contact of mucous membrane or broken skin with contaminated blood or OPIM * anytime there is blood to blood contact with infected blood or body fluid there is a slight potential for transmission * Unbroken skin forms an impervious barrier against bloodborne pathogens. Therefore, if you have cuts or abrasions on your hand, cover it with plaster or bandaid before gloving prior to phlebotomy ## Footnote Infected blood can enter your system through: * Open sores * Cuts * Abrasions * Acne * Any sort of damaged or broken skin such as sunborn or blisters

Answer 13

* refers to people who have direct or indirect contact with patients, involved in accidents, cleans up an area where surgery was conducted * CDC estimates 5.6 million workers in healthcare and related occupations are at risk * All occupational exposure to blood or OPIM places workers at risk * Data from the National Surveillance System for Healthcare workers show that nurses sustained the highest number of percutaneous injuries, as they have the largest workforce in hospitals * Injuries most often occur after use and before disposal of a sharp device, during use of a sharp device on a patient, and during or after disposal of a sharp device * Most needlestick injuries involve hollow-bore needles. ## Footnote Occupations at risk: * First aid responders * Housekeeping personnel in some industries * Nurses and other healthcare personnel

Answer 14

* A written plan to eliminate or minimize occupational exposure. * ECP a mandated written document that: 1) Identifies sources of exposure 2) Communicates information to employees 3) Provides methods of compliance 4) Records training/vaccinations/incidents ➢ All of these steps are important to prevent healthcare workers from acquiring bloodborne pathogens or acquiring the infection caused by the bloodborne pathogens. ➢ There is a need to review and update the plan annually/yearly: ○ Whenever a new or modified task or procedure affects occupational exposure. ○ When there is a new revised employee position with occupational exposure.

Answer 15

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

Answer 16

* There is a need to identify job classifications with occupational exposure to blood or other potentially infectious materials. * There is also a need to review tasks and procedures for occupational exposure potential. * Reevaluate when new processes or procedures are being introduced.

Answer 17

* There should be methods of compliance to avoid exposure risks to bloodborne pathogens. * Also look into HIV and HIV research laboratories and production facilities. * Hepatitis vaccination and post exposure evaluation and follow up. * Communication of hazards to employees.

Answer 18

* As much as possible if accidents occur and it involves exposure to bloodborne pathogens, **the institutions should be able to evaluate or look into what could have been the lapses that they missed that lead to healthcare workers being exposed to bloodborne pathogens** or acquiring the infections.

Answer 19

● Potential exposure determination ● Safe work practices ● Changes in technology that reduce/eliminate exposure ● Decontaminating equipment ● Selecting and using PPE ● Handling biohazard waste ● Labels and signs ● Training requirements ● Recordkeeping requirements ● Annual review and update ## Footnote * ECP must also set forth the schedule forimplementing other provisions of OSHA’s blood borne pathogen standard and specify the procedure for evaluating circumstances surrounding exposure incidents. * The control plan is important -- it helps you protect your workers from exposure to blood and other potentially infectious materials -- by protecting your workers you also control exposure incident costs. * The control plan is considered as a living document -- it is the source of information for answering bloodborne pathogen related questions -- to help ensure exposure control activities are in place. * If exposure to blood and other potentially infectious materials are reasonably anticipated you are required by the OSHA Bloodborne Pathogen Standard to develop an exposure control plan.

Answer 20

* It must be written specifically for the facility * It must be reviewed and updated at least yearly ➢ This is to reflect changes such as new worker positions or technology used to reduce exposure to blood or other bodily fluids. * It must be readily available to all workers ➢ Must not be kept in cabinets or filing cabinets for safekeeping. ➢ The purpose of having a control plan is to make sure that all healthcare workers exposed to blood and other body fluids can access the material in the event that there are accidents or accidental exposure to samples containing bloodborne pathogens.

Answer 21

* The key to not being able to acquire infections caused by blood borne pathogens lies in controlling the exposures. * Observe universal precautions, such as: -- Treating all blood and bodily fluids as if they are contaminated -- Proper cleanup and decontamination (especially after handling or processing samples that are suspected to have blood borne pathogens) * Employees are to observe universal precautions to prevent contact with blood or OPIM under circumstances in which differentiation between body fluid types is difficult or impossible, all body fluids shall be considered potentially infectious materials. ## Footnote We have to treat all blood and OPIM with appropriate precautions such as: * the use of gloves, masks, and gowns, if blood or OPIM is anticipated. * Use of engineering controls or work practice controls to limit exposure.

Answer 22

* Engineering and work practice controls * Hand hygiene * PPE examples * Employer's responsibilities * PPE Selection * Required PPE training * Housekeeping * Clean-up and decontamination * Regulated waste disposal * Laundry * Training * Hepatitis B vaccination

Answer 23

1) Safer medical devices 2) Sharps disposal containers * We have this rule not to recap needles after using, but in some situations wherein we cannot help but recap, we should but it should be done carefully

Answer 24

Should be practiced before and after procedure

Answer 25

○ Masks ○ Aprons/Smocks/Gowns ○ Face shields ○ Mouthpieces ○ Safety glasses ○ CPR pocket masks ## Footnote According to the hierarchy of controls, PPE is the least effective effective but most commonly implemented risk mitigation control

Answer 26

○ Perform hazard assessment ■ He/she should pinpoint areas wherein there is risk of being exposed to bloodborne pathogens ○ Identify and provide appropriate PPE to employee at no cost ○ Train employees on use and care ○ Maintain/replace PPE ○ Review, update, evaluate PPE program ## Footnote ○ Employers must provide PPEs to their employees when engineering, work practice, and administrative controls do not provide sufficient protection and ensure its proper use.

Answer 27

* Safe design and construction * Fit comfortably

Answer 28

○ When it is necessary ○ What kind is necessary ○ Proper donning, adjusting, wearing, doffing ○ Limitations ○ Proper care, maintenance, useful life, disposal

Answer 29

Written schedule for cleaning for cleaning and decontamination ○ All equipment, environmental, and working surfaces shall be cleaned and decontaminated after contact with blood after contact with blood, or other potentially infectious materials ○ Some equipment, if grossly contaminated, must be cleaned with soap and water solution prior to decontamination, as some antimicrobial products will not work in the presence of blood which interferes with the sterilization process ○ Protective covering such as plastic wrap or aluminum foil shall be removed or replaced as soon as possible when they become over-decontaminated or at the end of a work shift if they may have become contaminated during the shift ○ All bins, pails, cans, and similar receptacles intended for reuse which have reasonable likelihood of being contaminated with blood or other potentially infectious material shall be inspected and decontaminated on a regularly scheduled basis and cleaned and decontaminated immediately or as soon as feasible upon visible contamination. ## Footnote ○ Picking up broken glass ■ Not picked up by hands ■ Mechanical means only, such as a brush and dust pan, tongs, or forceps ■ Sharp objects can be a source of bloodborne pathogens especially if visibly contaminated with blood

Answer 30

Clean-up and decontamination for housekeeping personnel tasked to do cleanup and decontamination: ○ Wear protective gloves ○ Use appropriate disinfectant ○ Clean and disinfect contaminated equipment and work surfaces ○ Thoroughly wash up immediately after exposure ○ Properly dispose of contaminated PPE, towels, rags, etc. ## Footnote ○ OSHA also mandates that the disposal of the infectious waste in accordance with federal, state, or local regulations and that the surface is left wet with disinfectant for 30 seconds for HIV 1 and 10 minutes Hepatitis B virus.

Answer 31

Refers to the following categories of waste which requires special handling: ■ Liquid or semi-liquid blood/other potentially infectious material ■ Items contaminated with blood/ other potentially infectious material and which would release these substances in a liquid or semi-liquid state if compressed ■ Items that are caked with dry blood and are capable of releasing these materials when handling ■ Contaminated sharps ■ Pathological and microbiological waste containing blood or other potentially infectious materials ○ It is the employer’s responsibility to determine the existence of regulated waste ■ Not based on the actual volume of blood but on the potential to release blood when compacted on a waste container ■ If OSHA determines that sufficient evidence of regulated waste exists either through observation or based on employee interviews, citations may be issued if the employer does not comply with the provisions on the standard of regulated waste ○ Dispose of regulated waste in closable, leak-proof red or biohazard labeled bags or containers in accordance with the proper color coding of waste in the healthcare system ■ Closed before removal to prevent spillage/ protrusion of contents during handling, storage, transport, or shopping ■ If outside contamination of the regulated waste container occurs, it shall be placed in a second container. ○ Dispose of contaminated sharps in closable, puncture-resistant, leak- proof (red)

Answer 32

○ Laundry which has been soiled with blood or other potentially infectious materials or may contain sharps ○ Handled as little as possible ○ Contaminated laundry must be bagged or contained at the location where it was used. ○ Shall not be rinsed or sorted in the location of use ## Footnote Requirements for handling ■ Placing and transporting laundry in bags or containers labeled or color coded ■ If contaminated laundry is wet and presents a reasonable likelihood of soaked through or leakage from the bag or container, the laundry shall be placed in bags or containers which prevents soaked through or leakage of fluids to the exterior ■ The employer shall ensure that employees in contact with contaminated laundry wear appropriate PPE to prevent contraction of any bloodborne pathogen that may be presen

Answer 33

**Who** ■ All employees with occupational exposure to blood or other potentially infectious material (OPIM) ■ Employees who are trained in first aid and CPR ■ Part time employees are covered and should be trained during company time ○ No cost; during working hours **When** ■ Initial assignment ■ Annually; or with new/modified tasks

Answer 34

○ Offered to all potentially exposed employees ○ Provided at no cost to employees (within 10 days to employees with occupational exposure) ○ Employer doesn’t have to make the vaccination available to employees who have previously received the vaccination series/ who are already immune as their antibody tests reveal/ for whom receiving the vaccine is contraindicated for medical reasons ○ must be made available within 10 working days of initial assignment after appropriate training has been completed ■ If employee declines the vaccination, the employer must ensure that the employee signs a hepatitis B vaccination declination ■ Employees have the right to refuse the hepatitis B vaccination and any post exposure evaluation and follow-up. However, the employee needs to be properly informed of the benefits of the vaccination and post exposure evaluation through training ■ The employee has the right to take the vaccination at a later date as he/she so chooses. The employer must make the vaccination available by then. ■ The employer must ensure that the Hepa B vaccination and any post exposure evaluation and follow up is of no cost to the employee. ## Footnote ○ Declination form No vaccinations for: ■ Hepatitis C ■ HIV

Answer 35

* Exposure incident * Immediate actions * Confidential medical evaluation and follow-up

Answer 36

○ Specific eye, mouth, or other mucous membrane ○ non-intact skin ○ parenteral contact with blood or OPIM that results from the performance of an employee’s duties

Answer 37

○ Wash exposed area, such as needlesticks and cuts, with soap and water ○ Flush splashes to nose, mouth, or skin with water ○ Irrigate eyes with water and saline or sterile irrigants ## Footnote ○ No scientific evidence shows that using antiseptics or squeezing the wound will reduce the risk of transmission of a bloodborne pathogen ○ Using a caustic agent such as bleach is not recommended ○ Report the incident to the person responsible for managing exposures, usually the infection control unit of the hospital ○ Prompt reporting is essential because in some cases, post exposure treatment may be recommended and must be started as soon as possible. ○ We have to discuss the possible risk of acquiring HBV, HCV, and HIV, and the need of post exposure treatment, with the provider managing your exposure ○ You should have already received Hepatitis B vaccine