Bloodborne Pathogens (Review)

You will find in this section, the information needed to prepare for the Home Health Aide In-Service exam. You can view, download and print for better preparation.

BLOODBORNE PATHOGENS

Why Is It Important to Protect Yourself From Contact With Blood and Body Fluids?

Though they can't be seen, there are hundreds of tiny organisms living in blood and other body fluids that can cause disease in humans. These are called "bloodborne pathogens."

Some of these organisms are harmless and can be handled easily by the body's immune system, but others can cause severe illness, such as hepatitis or AIDS.

Bloodborne Diseases: HIV/AIDS, Hepatitis B, Hepatitis C

Bloodborne pathogens include the hepatitis B virus (HBV), the hepatitis C virus (HCV), the human immunodeficiency virus (HIV) that causes autoimmune deficiency syndrome (AIDS) and others.

These pathogens are transmitted through contact with infected body fluids such as blood, semen and vaginal secretions. Exposures occur (a) when the skin is punctured by a contaminated needle, razor or other sharp item or (b) when broken skin or mucous membranes are splashed with blood or body fluid.

Fortunately, most exposures do not result in infections.

Standard precautions are designed to prevent transmission of HIV, HBV and HCV. Standard precautions must be observed in all situations where there is potential for contact with blood or other potentially infectious body fluids.

Standard precautions apply to:

Blood

Semen

Vaginal secretions

Saliva

Cerebrospinal fluid

Synovial fluid

Pleural fluid

Peritoneal fluid

Pericardial fluid

Amniotic fluid

Feces

Nasal secretions

Sputum

Sweat

Tears

Urine

Vomitus

Treat all human blood and body fluids as if they are infectious. Remember who you are protecting - YOURSELF!

Hand hygiene

The CDC has made the following recommendations for hand hygiene for health care providers that should be followed when providing patient care:

A. When hands are visibly dirty or contaminated with proteinaceous material or are visibly soiled with blood or other body fluids, wash hands with either a nonantimicrobial soap and water or an antimicrobial soap and water.

B. If hands are not visibly soiled, use an alcohol-based hand rub for routinely decontaminating hands in all other clinical situations described in items OR wash hands with an antimicrobial soap.

C. Hands should be cleansed before having direct contact with patients.

D. Hands should be cleansed before donning sterile gloves when inserting a central intravascular catheter.

E. Hands should be cleansed before inserting indwelling urinary catheters, peripheral vascular catheters, or other invasive devices that do not require a surgical procedure.

F. Hands should be cleansed after contact with a patient's intact skin (e.g., when taking a pulse or blood pressure, and lifting a patient).

G. Hands should be cleansed after contact with body fluids or excretions, mucous membranes, nonintact skin, and wound dressings if hands are not visibly soiled.

H. Hands should be cleansed if moving from a contaminated-body site to a clean-body site during patient care.

I. Hands should be cleansed after contact with inanimate objects (including medical equipment) in the immediate vicinity of the patient.

J. Hands should be cleansed after removing gloves.

K. Before eating and after using a restroom, wash hands with a non-antimicrobial soap and water or with an antimicrobial soap and water.

L. Antimicrobial-impregnated wipes (i.e., towelettes) may be considered as an alternative to washing hands with non-antimicrobial soap and water. Because they are not as effective as alcohol-based hand rubs or washing hands with an antimicrobial soap and water for reducing bacterial counts on the hands of healthcare workers they are not a substitute for using an alcohol-based hand rub or antimicrobial soap.

M. Wash hands with non-antimicrobial soap and water or with antimicrobial soap and water if exposure to Bacillus anthracis is suspected or proven. The physical action of washing and rinsing hands under such circumstances is recommended because alcohols, chlorhexidine, iodophors, and other antiseptic agents have poor activity against spores.

NOTE: Non-alcohol based hand rubs are not recommended for cleansing of hands in the healthcare setting.

Hand-hygiene technique

A. When decontaminating hands with an alcohol-based hand rub, apply product to palm of one hand and rub hands together, covering all surfaces of hands and fingers, until hands are dry. Follow the manufacturer's recommendations regarding the volume of product to use.

B. When washing hands with soap and water, wet hands first with water, apply an amount of product recommended by the manufacturer to hands, and rub hands together vigorously for at least 15 seconds, covering all surfaces of the hands and fingers. Rinse hands with water and dry thoroughly with a disposable towel. Use towel to turn off the faucet. Avoid using hot water, because repeated exposure to hot water may increase the risk of dermatitis.

C. Liquid, bar, leaflet or powdered forms of plain soap are acceptable when washing hands with a non-antimicrobial soap and water. When bar soap is used, soap racks that facilitate drainage and small bars of soap should be used.

D. Multiple-use cloth towels of the hanging or roll type are not recommended for use in health-care settings.

Additional aspects of hand hygiene:

A. Do not wear artificial fingernails or extenders when having direct contact with patients at high risk for infection.

B. Keep natural nails tips less than 1/4-inch long.

Standard precaution 2: Gloves

A. Wear gloves when contact with blood or other potentially infectious materials, mucous membranes, and non-intact skin could occur.

B. Remove gloves after caring for a patient. Do not wear the same pair of gloves for the care of more than one patient, and do not wash gloves between uses with different patients.

C. Change gloves during patient care if moving from a contaminated body site to a clean body site.

Standard precaution 3: Protective barriers

Protective barriers, including gloves, reduce the risk of your skin or mucous membranes being exposed to potentially infective blood and body fluids. You should wear the appropriate barriers for the work you are doing.

Employers must provide suitable personal protective equipment (PPE) in the right sizes. Protective equipment includes gloves, gowns, masks, eye protection, face shields, mouthpieces, resuscitation devices and other things. Hypoallergenic gloves, glove liners, powderless gloves or other alternatives must be available for those who are allergic to the regular gloves.

The equipment you need depends on your work. When splashing of blood or body fluids is likely, wear the following PPE in addition to gloves:

Mask if your face could be splashed with blood or body fluids

Eye protection if your eyes could be splashed with blood or body fluids

Gown if your clothing or skin could be splashed

Standard precaution 4: Proper disposal of sharp items

A "sharp" is any object that can penetrate the skin, such as needles, scalpels, broken glass, broken capillary tubes and exposed ends of wires. A sharp is contaminated if it has been in contact with blood, body fluids or body tissues.

Contaminated sharps must be disposed of properly. Follow your agency's policies.

Be careful to prevent injuries from needlesticks and other sharp instruments after procedures, when cleaning used instruments and when disposing of used needles. Do not recap or manipulate needles.

It's best to use needleless injection systems or needles with injury protection. If you must use a regular needle, remember:

*Do not recap needles. If it is absolutely necessary to recap a needle, use one hand to slide the needle into a cap lying on a flat surface.

Do not hold the cap in your other hand while recapping.

Tips

Use thick rubber household gloves to protect your hands during housekeeping chores or instrument cleaning involving potential blood contact.

Treat all linen soiled with blood or body secretions as potentially infectious.

Surfaces that have been contaminated with blood or body fluids should be cleaned with a disinfectant according to your organization's policies.

If an Exposure Occurs

Immediately following an exposure to blood or body fluids:

Wash needlesticks and cuts with soap and water.

Flush splashes to the nose, mouth or skin with water.

Irrigate eyes with clean water, saline or sterile irrigants.

Report the exposure at once. Treatment may be recommended, and it should be started as soon as possible. See a medical professional.

Discuss the possible risks and the need for treatment with the person managing your exposure.

Remember that mandatory testing of a patient is not legal. Patients who might be the source of an infection must give consent to be tested.

Workers' Rights

The Occupational Safety and Health Administration (OSHA) is a federal agency that guarantees rights to a safe workplace. Under OSHA's rules, workers who might be exposed to contaminated blood or body fluids have specific rights.

Employers must train workers that might be exposed to blood or body fluids about the hazards and how to protect themselves. This training must occur during working hours at no cost to employees, at orientation and annually thereafter.

Standard precautions must be practiced at all times. Punctureproof and leakproof containers must be provided for disposal of sharp items. There must be a system for reporting exposures to blood or body fluids.

Employers must provide free hepatitis B vaccination, free protective equipment and free immediate medical evaluation and follow-up for anyone exposed to blood or body fluids. Employees must receive confidential treatment, and their medical records must be protected.

Effective June 2021, OSHA also requires that employers provide employees with paid leave as needed to receive vaccination for COVID-19, as well as other the implementation of other safety workplace safety measures for COVID-19 prevention.

Workers' responsibilities

Always use standard precautions.

Actively participate in evaluating safer equipment and encouraging your organization to purchase safer equipment. Be open to new products or practices that could prevent exposure and protect workers and patients.

Be immunized against hepatitis B, getting the series of three injections.

Report all exposures immediately after cleaning and disinfecting the exposed skin or mucous membranes.

Comply with postexposure recommendations of your organization.

Support other workers who have been exposed. HIV-infected workers who continue working deserve support and confidentiality.

Know your own HIV/HBV/HCV status. If you are positive for any of these viruses, you do not pose a risk for patients if you don't do invasive procedures.

Participate in social distancing, mask-wearing, and other COVID-19 prevention measures as needed.

Specific Exposure Risks and Treatments

Human immunodeficiency virus

HIV is the virus that causes AIDS.

Risk of infection after exposure:

Needlestick is the most common cause of work-related infection.

Risk factors include the amount of blood or fluid, the puncture depth and the disease stage of the infected person.

The average risk of HIV infection after a needlestick or cut exposure is 1 in 300. The risk after exposure of the eye, nose, skin or mouth to positive blood is less than 1 in 1,000. If the skin is damaged, the risk may be higher.

Treatment after exposure:

There is no vaccine against HIV.

Postexposure treatment is not always recommended. A physician or exposure expert should advise you.

Drugs used to prevent infection may have serious side effects.

Perform HIV antibody testing for at least six months after exposure.

Hepatitis B virus

Risk of infection after exposure:

Hepatitis B vaccine prevents this disease. Persons who have received the vaccine and developed immunity are at virtually no risk for infection. A series of three injections are required, given initially, then one to two months later, then four to six months after the first injection.

Workers should be tested one to two months after the vaccination series to make sure the vaccination has provided immunity.

For the unvaccinated person, the risk from a single needlestick or cut exposure ranges from 6% to 30%, depending on the level of virus in the infected person's blood. A higher concentration of virus makes it more likely that someone exposed to that blood will become infected.

Treatment after exposure:

Everyone with a chance of exposure to blood or body fluids should receive hepatitis B vaccine, preferably during training, unless it is contraindicated because of allergies, pregnancy or potential pregnancy.

Hepatitis B immune globulin (HBIG) effectively prevents HBV infection after exposure. Recommendations for postexposure management of HBV may include HBIG and/or hepatitis B vaccine. The decision to begin treatment is based on several factors, such as whether the:

*Source person is positive for hepatitis B

*Worker has been vaccinated

*Vaccine provided immunity

Hepatitis C virus

Infection with HCV carries a great potential for chronic liver disease and can lead to liver failure, liver transplants and liver cancer.

Risk of infection after exposure:

HCV is a growing problem.

The risk for infection after a needlestick or cut exposure to HCV-infected blood is approximately 1.8%.

The risk after a blood splash is unknown but is believed to be very small; however, HCV infection for such an exposure has been reported.

Treatment after exposure:

There is no vaccine against hepatitis C and no treatment after an exposure that will prevent infection.

HBIG is not recommended.

Following recommended infection control practices is vital.

There are several tests that should be performed in the weeks after an exposure and for four to six months afterward. Confer with a physician or an exposure specialist.

COVID-19

COVID-19 is a dangerous disease caused by a virus discovered in December 2019 in Wuhan, China. It is very contagious and has quickly spread around the world. COVID-19 spreads when an infected person breathes out droplets and very small particles that contain the virus. These droplets and particles can be breathed in by other people or land on their eyes, noses, or mouth. In some circumstances, they may contaminate surfaces they touch.

Risks of infection after exposure:

COVID-19 is a highly infectious virus with multiple variants that spreads quickly through populations.

Individuals who suffer from any immune condition, pulmonary condition, and other comorbid conditions are at higher risk for more serious infection and potential mortality due to COVID-19.

Infection with COVID-19 can result in severe pulmonary conditions including viral pneumonia, organ dysfunction, sepsis, respiratory failure, and long term effects in some individuals.

Some individuals may experience no symptoms due to immune response or prior vaccination.

Treatment after exposure:

Vaccinated individuals or those who are asymptomatic may require no treatment.

Individuals who are symptomatic or with known positive tests should be quarantined to prevent the spread of infection as recommended by CDC guidelines.

Individuals experiencing severe pulmonary or other symptoms may require hospitalization for the treatment of symptoms.

Additional Precautions for Infection Control

If you know or suspect that a patient has a disease that is spread in one of the following ways, use the following extra precautions in addition to standard precautions.

Airborne germs can travel long distances through the air and are breathed in by people. Examples of diseases caused by airborne germs are COVID-19, TB, chickenpox and shingles. Precautions include the following:

Wear a mask. If the patient has, or might have, TB, wear a special respiratory mask (ask your supervisor).

A regular mask will not protect you.

Remind the patient to cover nose and mouth when coughing or sneezing.

Treat the patient's used tissues or handkerchiefs as infected material.

When treating patients who are known to have COVID-19, always wear a mask, assure that the patient is wearing a mask, and advise all household members to do the same. Follow CDC guidelines for in- home care of COVID-19 positive persons.

Contact germs can cause the spread of disease by touch. Examples of diseases caused by contact germs are pink eye, scabies, wound infections and methicillin-resistant Staphylococcus aureus. Precautions include the following:

Wear gloves.

Treat bed linens, clothes and wound dressings as infected material.

Wear a gown if the patient has drainage, has diarrhea or is incontinent.

Use a disinfectant to clean stethoscopes, blood pressure cuffs or other equipment.

Droplet germs can travel short distances through the air, usually not more than 3 feet. Sneezing, coughing and talking can spread these germs. Examples of diseases caused by droplet germs are flu and pneumonia.

Precautions include the following:

Wear a mask when working close to the patient (within 3 feet).

FIGURE 4.1 | CENTERS FOR DISEASE CONTROL AND PREVENTION TWO-TIERED SYSTEM TO CONTROL DISEASE TRANSMISSION

Everyone is a possible source of bloodborne infection.

Protect yourself!

TIER 2:

Transmission based precautions

Based on Type of Disease and How It Is Transmitted:

1. Airborne

2. Contact

3. Droplet

TIER 1:

Standard Precautions

Use Precautions at All Times, With All Patients, to Prevent Transmission of Bloodborne Diseases:

1. Frequent, thorough handwashing.

2. Wear gloves when you touch blood or body fluids.

3. When splashing of blood or body fluids is likely, wear the following, depending on the situation:

a. Masks

b. Eye protection

c. Disposable gowns

4. Safe use and disposal of sharp items. Do not recap needles at any time.

Source: Essential In-Services for Home Health, 2023 p. 39-49