Infection Control & Blood Borne Pathogen Training
Hepatitis B
Causes 200 to 300 deaths each year in health care workers. A vaccine to protect health care workers from hepatitis B is available at your physicians’ office or local health department. The vaccine is highly recommended for all health care providers who have routine or occasional contact with the blood or body fluids of clients. Hepatitis B is passed from person to person by exposure to blood and some body fluids.
HIV
HIV has infected some heath care workers on the job. Most got infected so by a “sharps injury” such as a needle stick. Others got infected with HIV by getting blood splashed on their chapped skin or in their eyes, noses or mouths. The risk of getting infected while working in the personal assistance setting is low but not zero. For example, the risk of infection by an accidental needle stick with an HIV contaminated needle is about three to four chances out of 1000. However, the risk of coming down with AIDS and dying is high if you get infected with HIV. A health care worked infected with a blood borne pathogen may pass it on to his or her partner by sexual contact.
Cytomegalovirus (CMV)
May not have any signs of illness. This virus may be passed from person to person by exposure to infected saliva and urine. If a pregnant woman becomes infected with CMV, it may cause damage to the fetus (unborn child).
Tuberculosis
Tuberculosis (TB) is a disease which usually affects the lungs. It is spread from person to person through the airborne route when a person who has active disease coughs, sneezes or speaks.
TB is caused by a bacterium called Mycobacterium Tuberculosis. If not treated properly TB can be fatal. Symptoms of TB include feeling of weakness, weight loss, fever, night sweats, chest pain, and coughing up blood.
To prevent the spread of TB, HCW’s caring for patients with TB need use appropriate respiratory protection (N95 particulate respirator). Transmission of TB has been associated with close contact of infectious patients by HCW’s during cough-inducing procedures, like a bronchoscopy.
Not everyone infected with TB becomes sick. There are 2 different TB related conditions; latent TB and active TB disease. People with latent TB have the TB germs in their bodies but are not sick because the germs are not active. They do not have symptoms of TB and cannot spread the germs to others although they may develop TB in the future. People with active TB are sick from the germs that are active. They usually have symptoms of TB and are capable of spreading the germs to others. People with active TB can be prescribed medication to help treat the disease.
TB can be treated with medication. People taking medication for TB need to take the medication exactly as they are instructed. People who do not take the medication as prescribed or who stop the medication too soon may become sick again, and the germs that are still present in them may become resistant to the medication and more difficult to treat.
People who are most likely to get sick from TB are; people with HIV, people who inject illegal drugs, babies/young children, the elderly, people who were not treated correctly for TB in the past, and people with certain chronic medical conditions.
Patients with suspected or confirmed TB need to be placed in private rooms with negative airflow or HEPA filter units, on Airborne Precautions, and with the door closed.
The CDC has changed the requirements if a Health Care Worker (HCW) is exposed to TB. They now require a Tuberculin Skin Test (TST) be placed once exposure is confirmed and then again in 8-12 weeks. Having a “current” TST does not exclude a HCW from this requirement.
MRSA
MRSA is “Methicillin-Resistant Staph Aureus” infection. It is an infection that is resistant to antibiotic treatment. Usually, clients acquire this infection while in the hospital. Client who are elderly or who are immuno-compromised are most susceptible to this infection.
Contact-Droplet Isolation: gown, gloves, and mask are required for all health care providers. The client may have been instructed to wear a mask, but it is not required.
Schedule MRSA clients for the last appointment of the day.
All clothing that comes in contact during the visit to be washed in HOT water and dried on the HOT setting.
All gowns, gloves and masks worn during the treatment are to be separately bagged in a garbage bag and immediately placed in a bio hazard bag or separate trash bag.
Often, we do not know that a client has one of these diseases. Many times a client does not look sick. However, if you are exposed, you can still get one of these diseases. You can protect yourself from exposure by following special precautions know as UNIVERSAL PRECAUTIONS.
WHAT IS EXPOSURE?
Significant exposure to blood or body fluids is defined as:
Injury with a contaminated sharp object (e.g., needle sticks, scalpel cuts)
Spills or splashes of blood or body fluids into non-intact skin (e.g., cuts, hangnails, dermatitis, abrasions, chapped skin) or into a mucous membrane (i.e., mouth, nose, eyes)
Blood exposure covering a large area of apparently intact skin.
EXAMPLES OF EXPOSURE:
Getting blood or body fluids in cuts or in breaks in your skin, or in skin sores or on large areas of skin.
Getting blood or body fluids in your eyes, mouth, or nose.
Getting cut or stabbed with any needles or sharp instruments which were used on a client.
Getting cut on the broken glass that was used to hold blood, body fluids, or human tissue (glass tubes, blood collection tubes, bottles, jars, etc.)
WHAT IS NOT EXPOSURE?
Handling food trays or furniture.
Handling assistive devices or wheelchairs with clients.
Using public bathrooms or telephones.
Personal contacts with clients such as shaking hands, giving information, touching intact skin as when bathing intact skin or giving a back rub.
Doing clerical or administrative duties for a client.
UNIVERSAL PRECAUTIONS:
GOOD HAND WASHING IS A MUST. THIS IS TO BE DONE BEFORE, DURING, AND AFTER CLIENT VISITS USING ANTIBACTERIAL SOAP AND HOT WATER FOR AT LEAST 30 SECONDS.
1. You must wear gloves if you touch blood, body fluids, mucous membranes or human tissue of any client. To touch a client’s skin that is broken or cut, wear gloves. Gloves must be worn when cleaning and debriding a surgical incision or open wound, while performing any EMG/NCV diagnostic testing procedure, or suctioning a client. You must wear gloves when performing any vascular access procedures – such as venipuncture. You must wear gloves when touching any surface or object which is reasonably anticipated to be contaminated even if not visibly contaminated, such as the outside of client specimens. Always change gloves when they are torn. Always change gloves after contact with each client. Always remove contaminated gloves before touching clean items such as door knobs, light switches, etc. Always wash hands immediately after taking off gloves. Do not wash or disinfect surgical or examination gloves for reuse. Do not use non-intact or discolored gloves. Gloves are available at your local branch office at no charge to employees. It is your responsibility to ensure that you have a box of gloves with you during scheduled client services. Not having or utilizing gloves during scheduled client service could result in disciplinary action.
2. When mucous membranes (i.e., mouth, nose, or eyes) come in contact with blood or body fluids, you must flush (irrigate) them with large amounts of water. If you have blood or a body fluid splashed into a skin cut, skin puncture or skin lesion, first wash the area with soap and water for at least 10 seconds, then put 70% isopropyl alcohol on the area. You must report any exposure that occurs either as a part of your job or through an emergency outside the scope of your job to management as soon as possible. Follow the same procedures used for incident reporting.
3. Do not eat, drink, apply cosmetics, lip balm or handle contact lenses in work areas where there is a potential for occupational exposure to blood or body fluid contaminated surfaces or objects.
4. Wear fluid resistant gowns or plastic aprons if soiling of clothes with blood or body fluids is likely.
5. You must wear a mask and eye protection or a face shield if spraying, splashing, or splatter to your face is possible. Minimal facial protection would consist of a surgical mask and eye glasses with solid side shields. Eyeglasses without solid side shields are never acceptable for the purpose of protection.
6. All personal protective equipment (gloves, masks, eye protection, and fluid resistant gowns or aprons) shall be removed immediately upon leaving the work area and placed in a designated container for washing or disposal. If contaminated, personal protection equipment should be removed immediately or as soon as feasible. If a pullover item is contaminated, remove it in a way that contamination of head or face does not occur. If this is not feasible, then pullover item should be cut off with scissors.
7. CPR masks are essential when performing mouth-to-mouth resuscitation, and are available at the clinic. Gloves, CPR masks, and proper hand washing are essential.
8. Handle anything sharp with care to prevent accidental cuts or punctures. Do not recap, bend or break used disposable needles. Discard all sharp items immediately by placing them in a puncture-resistant needle box or a puncture-resistant contaminated materials container (CMC). Broken glassware that may be contaminated shall not be picked up directly with the hands. Use a mechanical device such as brush and dustpan, tongs or forceps. Remove vacutainer needles only from clean vacutainer holders. Use the needle removal device to do this. Do not remove needles from visibly bloody vacutainer holders. Discard both holders and needles if they are visibly bloody. Needle boxes and CMCs should be closed when nearly full. They should never be allowed to become overfilled. They should also never be placed above eye level.
9. Clean blood or body fluid spills promptly. Wear gloves and use a freshly made dilution of one part chlorine bleach to 9 parts of water to clean a spill. Place paper towels over spill. Flood the spill area with bleach dilution. Leave on for 10 minutes. Discard the paper towels in a contaminated materials container.
10. All client specimens may be contaminated on the outside of the container and must be handled with gloves. Place them inside plastic bags before sending them to a laboratory. Be careful not to contaminate the outside of the plastic bad by handling it with potentially contaminated gloves. If the container is enclosed in a clean dry plastic bad, gloves need not be used for handling the bag. Do not send soiled containers to a laboratory.
11. Do not place food or drink in refrigerators, freezers, cabinets or other areas where any client specimens are placed.
12. A provider should report to the manager if you have a draining skin cut or sore. You must report before you take care of clients or touch client care equipment. If there is a question about a provider’s ability to safely care for clients, they should be cleared through management first. Cover any non-draining lesions with waterproof dressing before entering the home environment.
13. Laundry visibly soiled with blood or body fluids must be handled with gloves. All laundry must be placed in a fluid proof plastic bag. Do not place laundry in a red bag. If the outside of the bag is visibly soiled with blood or body fluids, the bag must be placed inside another bag. If personal clothing becomes contaminated with blood or other potentially infectious material, it cannot be taken home until it is laundered or disinfected.
14. To get rid of large quantities of blood or body fluids, carefully pour them down a toilet. The drain connects to a sewer system. If splash or splatter is likely, you must wear protection for your eyes and a mask or a face shield. You must also protect your cloths – wear a fluid resistant gown or apron.
15. ANY MATERIALS OR ITEMS VISIBLY CONTAMINATED WITH BLOOD, BODY FLUIDS OR HUMAN TISSUE MUST BE PUT INTO A CONTAMINATED MATERIALS CONTAINER (CMC). If one is not available you should use a plastic trash bag from the client residence.
16. The following policies and documents are available for your review at the office. A copy of any or all of the following policies or documents is available to you upon request.
Occupational Exposure Training Policy
Hepatitis B Vaccine for Employees Policy
Blood borne Pathogens Exposure Control Plan Policy
Provision of Personal Protective Equipment Policy
CPL 2-2.60 - “Exposure Control Plan for OSHA Personnel with Occupational Exposure to Blood borne Pathogens.”
Federal Register, “Blood borne Pathogens Regulatory Text”, OSHA Standard 1910.1030
Care of Equipment
You are responsible for equipment used in performing your work. Any damage or failure of this equipment is to be reported to your supervisor immediately. Equipment or supplies are to be used for clients of Promise Senior Solutions. Personal assistance aides and all field staff have the potential to transmit insects and infectious microorganisms from household to household. Medical supplies and equipment are to be stored, handled, and transported in a way to minimize this risk. Likewise, medical supplies/equipment in the client’s home are to be stored and handled without compromising integrity. Promise Senior Solutions is not responsible for loss or damage to your personal property. Valuable personal items such as purses and all other valuables should not be left in areas where theft might occur.
PURPOSE
To promote cleanliness of medical supplies and equipment in the personal assistance aide’s and field staff’s car. To prevent transmission of insects or infectious organisms
PROCEDURE
Personal assistance aides and field staff who travel by car are to keep a large plastic or cardboard container in a designated clean area of the car, preferably the trunk.
The aide bag, extra staff uniform, and medical supplies and equipment are to be kept in this container.
Supplies and equipment are to be stored in the car container in a neat and orderly fashion. Do not leave temperature-sensitive equipment in the car overnight or for long periods.
Equipment Cleaning
PURPOSE
To prevent the spread of infectious organisms. To maintain clean equipment when providing client care
EQUIPMENT
Personal care agency-approved disinfectants
Liquid soap and water
Antiseptic wipes
Utility gloves and an impermeable plastic trash bag
PROCEDURE
Don utility gloves to protect hands.
For initial clean up, wash all equipment with soap and water.
After washing equipment with soap and water, disinfect, rinse, and dry.
Disinfection methods in the home will vary. The item to be disinfected will primarily determine the disinfectant that is to be used. Bleach corrodes metal but is cited as an all-purpose disinfectant for blood and body substance spills.
Seal disposable supplies used to clean equipment in a leak-proof impermeable plastic trash bag separate from the family trash; secure and place in the family trash. Otherwise discard disposable items according to Standard Precautions.
Stethoscope
Routinely clean the bell/diaphragm of the stethoscope with a disinfectant spray, or, using a rotary motion, with an antiseptic wipe each visit.
Glucose Meters
Follow specific manufacturer’s recommendations for cleaning.
Thermometers
Use an antiseptic wipe to clean glass thermometers; otherwise follow the manufacturer’s recommendations.
Soap and water are effective for cleaning equipment such as nasal cannulas, masks, tubing, the cap and mouthpiece of cartridge inhalers, humidifiers, and surfaces of most respiratory therapy equipment. Home respiratory equipment may also be soaked in a white vinegar/water (1 cup: 3 cups) solution for 20 minutes, thoroughly rinsed with warm running water, and allowed to air dry. Cleaning should be done daily or at least 2 to 3 times per week. Cleaning of respiratory equipment is also recommended after each intermittent positive pressure breathing (IPPB) or aerosol treatment. After being cleaned, humidifiers should be refilled with fresh distilled water to prevent bacterial growth.
Other
Soiled bedpans and bedside commodes should be cleaned with soap and water and then disinfected.
Instruments may be boiled on the stove for 15 minutes in a clean pan or metal tray and then stored in the aide bag.
Always read the label on the disinfectant and follow directions. Remember, disinfectants are designed for inanimate objects and may damage the skin; use with caution and instruct the family to store out of reach of children.
Use disinfectants in a well-ventilated room. If possible, totally submerge contaminated articles in the disinfecting solution for the required time-period.
If disinfection of contaminated equipment is not possible in the client’s home, seal in an impermeable plastic trash bag and transport to the personal assistance agency for disinfection. Never place soiled or contaminated equipment in the aide bag.
Whenever possible, use disposable equipment/supplies for home care clients.
Personal Care Bag Technique
PURPOSE
To prevent contamination of the aide bag. To prevent cross-contamination and spread of infectious organisms
EQUIPMENT
Aide bag with impermeable lining
Paper towels
Fresh newspapers or other suitable barrier
Leak-proof and puncture-proof container for bag storage in the car
Liquid soap (bar soap can be a haven for bacteria) (Note: antiseptic hand cleanser may be used instead of liquid soap) and an impermeable plastic trash bag.
PROCEDURE
Observe the principles of Standard Precautions at all times. The inside of the aide bag should be regarded and maintained as a clean area.
Transport the aide bag in the car on top of a supply of fresh newspapers. In addition, the bag should be stored in a clean area of the car, preferably in a plastic or cardboard container designated for such use.
Once in the client’s home, select the cleanest and most convenient work area and spread the newspaper.
Place the bag on the newspaper.
Prepare a receptacle (impermeable plastic trash bag for disposable items).
Open the aide bag and remove items needed to wash hands (hand washing supplies should be kept at the top of the bag). Close the bag. Use the aide bag as few times as possible.
Wash and dry hands according to the procedure for Hand washing.
Return to the aide bag, open it again, and remove necessary items for the visit. Apply personal protective equipment as needed. Keep the bag closed during the visit. Leave all plastic containers in the bag. If additional equipment or supplies are needed from the bag during the home visit, the hand washing procedure must be repeated.
Discard disposable personal protective equipment in an impermeable plastic trash bag. To discard a disposable gown or plastic apron, remove the apron by folding the exposed side inward.
After providing care, clean all equipment with soap and water or a personal assistance agency-approved disinfectant before returning it to the bag. Return unused clean supplies to the aide bag after care is given. Contaminated equipment or equipment that cannot be cleaned in the client’s home may be transported for disinfection to the personal assistance agency in an impermeable sealed plastic bag placed on the floor of the car. Never place used needles, soiled equipment, or dressings in the aide bag.
Wash hands. Discard any remaining items according to Standard Precautions. Return cleaning supplies (e.g., liquid soap) to the aide bag.
Close the aide bag and fasten. When leaving the client’s home, pick up the bag and place the newspaper that was underneath it in the family trash. When traveling, store the aide bag in a clean place.
The aide bag should be cleaned and restocked weekly.
The following should be considered when selecting work areas in the client’s home:
a. Adequate work space (preferably a clean surface)
b. Protection of the family’s property
c. Protection of the aide bag (place in a safe place area from children and/or pets)
d. Convenience of water
Reporting and Managing an Exposure Incident
PURPOSE
To report an exposure incident. To prevent infectious disease or staff injury. To acquire personal assistance agency support services for possible staff exposure to infectious disease.
PROCEDURE
1. When an exposure incident occurs in the workplace, the following guidelines will be followed:
a. Eyes. If an exposure to the eye or mucous membrane occurs, immediately flush the area with clean water for at least 5 minutes.
b. Cuts. If an exposure occurs in a cut, open sore or lesion, abrasion, or damaged cuticle, wash the area with soap and water as soon as possible. Apply first aid.
c. Puncture wound. If exposure occurs by sharps, wash the area with soap and water as soon as possible. Apply first aid.
d. Clothing. Immediately clean all contaminated clothing with a 10% bleach solution. Change clothes as soon as possible. Carry an extra uniform in the car.
2. Report the exposure incident to your supervisor within 1 hour of occurrence & complete a Exposer Incident Report. The report must be completed within 24 hours of the Exposure Incident.
3. Follow OSHA recommendations for testing, counseling, and seeking appropriate medical assistance.
4. No further client contact should be made by the exposed personal assistance aide and field staff until approval is given by the Administrator.
5. Clean and replace any equipment used during the procedure. Discard any disposable items according to Standard Precautions.
Consider a tetanus prophylaxis for cuts and deep wound punctures; consult with a physician as needed.