OSHA's TB, Bloodborne Pathogens
Office of Environmental Health and Safety

OSHA's TB, Bloodborne Pathogens and Biomedical Waste Training CBL

Approximate Duration: 30 minutes 

For questions on this subject, please contact:

Sandra Chen-Walta

Environmental Health and Safety

Cell:305-608-7801

Available 24/7 - 365 days for questions on the contents of this CBL.

Office:305-243-3400

Navigating the Module

This section will introduce you to the course layout and terminology. The first part will show you how to use this course. In order to view this course, you must allow pop-ups. Usually, clicking on the yellow message bar that appears on the top of your screen is enough to allow pop-ups.

The Opening Page

sample.gif Each lesson will be divided into pages. On the right side of the page a sidebar may appear (see the area in blue). A table of contents can be displayed to show all of the pages for a lesson (see the area in red). Page navigation (moving from one page to any other) is accomplished by pointing to the Page Navigation bar (see the area in green) and clicking on a page number. When you point to a page number, you will see the title for the page.

Pop-Up Text - Within the lesson you will notice some of the text is boldfaced. This will indicate that there is additional information hidden behind the text. You will be able to display the hidden text by pointing to the boldface text. At the end of this sentence, there is an example of a Pop-Up Text window that is displayed by pointing to the boldface word WHY. When the pointer is moved off the boldface text the Pop-Up disappears. You can try this by pointing to the boldface word "why" in this paragraph.

Sidebars - The sidebars are located on the right side of the window. Here you can learn more about a specific topic or link to additional resources.

Activities & Quiz Questions - At different points within the lesson, you will go over quiz questions and activities. These questions will be used to reinforce a topic or concept. The question types could be True/False, Multiple Choice, Multiple Answer, Matching or Short Answer. After answering each question, click on the Check Answer button. Notice the cumulative score is kept for all of the questions for a particular lesson.

Tuberculosis Awareness Training

Because you will be working at the Medical Campus and/or exposed to TB in the workplace, you are required to complete this training. This section covers the following topics:

 

This section will take approximately 10 minutes to complete

 


What is Tuberculosis (TB)?

4d.jpg TB is an Infectious disease cause by the bacterium, Mycobacterium tuberculosis.

When a person inhales the TB germ, the germ can reside in the lungs or it can move to other parts of the body such as the brain, liver, kidney, the lymph nodes, and the spine.

Policies

- Policies are in place to eliminate or minimize occupational exposure to TB and to protect you. The TB Infection Control Policy for the University is located at www.miami.edu/ehs

 

TB Occurrence

 

 

Drug Resistant TB

 

2a.png Drug resistant Tuberculosis does not respond to the usual anti-tubercular drug therapies. Resistance develops due to poor medication adherence or inadequate treatment prescribed by the healthcare provider. The more drugs a person is resistant to, the more difficult it is to treat that person.

Contributing factors for TB infection and TB disease include:

 

TB Transmission

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The TB germ is spread by airborne particles, "droplet nuclei," which may be generated when a person with TB disease coughs, sneezes, speaks, or sings. The TB germ is also spread if it becomes aerosolized during medical and laboratory procedures and autopsies. The person inhales the mycobacterium and becomes infected. The person may remain with latent TB infection or go on to develop active TB disease.

Environmental factors that enhance transmission

Miami-Dade County

Tuberculosis is a reportable disease in Miami-Dade County. The state of Florida has ranked for many years in the top states with the highest number of cases of TB in the United States.

 

TB Infection Vs. Active TB

3x.jpg Tuberculosis infection is not the same as active TB. Of those infected with TB (latent TB infection), approximately 10% will progress to active TB (infectious TB).

Latent TB Infection

 

Active TB (Infectious)

If you develop active pulmonary or laryngeal TB, you may have the signs and symptoms of TB. Signs and symptoms of active TB include:

If you have active TB, you are infectious and should seek medical care immediately. Active TB cases must be reported to the Miami Dade County Health Department. Hospitalized persons with active disease are placed in isolation rooms. Isolation rooms are rooms with negative air pressure. This keeps air from flowing out of the room and into adjacent rooms or areas. Persons entering isolation rooms are required to wear a N 95 respirator.

 

Respiratory Protection

When to wear Respiratory Protection (N-95 Respirator). Use respiratory protection when caring for patients with suspected or confirmed TB.

High-Risk Activities

This is characterized by the potential to generate airborne secretions. These procedures include cough inducing or aerosol-generating procedures:

 

 

What To Do?

Clinics/Receptionists/Outpatient settings

 

 

Isolation Practices

4b.jpg Educate patients and family regarding:

When entering TB patients' rooms:

Discontinuation of TB isolation:

Discontinue isolation only when diagnosis of TB is ruled out or the patient is:

Appropriate post-discharge arrangements should be coordinated with the health department.

 

 

TB Screening

TB screening is done at the Employee Health Office upon employment and periodically. TB screening is an effort to protect workers from the spread of TB disease. A two-step TB testing will be administered at the time of employment. The frequency of future TB screening during employment will depend on the employee's TB risk category in the workplace.

There are specific guidelines for interpreting the results of the TB skin test. The TB skin test is read in 48-72 hours. If the employee does not return after 72 hours for the TB reading, the test will be repeated.

Two-Step Testing

An initial TB skin test is done and the employee returns in 2 weeks for a second test. The two-step testing is done because of the "Booster Phenomenon."

Two-step testing will NOT be performed if you have:

 

The Booster Phenomenon

The ability to react to the TB skin test wanes over a period of time. A person may have a negative TST even though they have the TB infection. Therefore the initial test that is done upon hire may be negative but a subsequent test is positive. This positive test, once hired, may be misinterpreted as a new conversion.

The Centers for Disease Control and Prevention (CDC) describes the booster phenomenon as a phenomenon in which people (especially older adults) who are skin tested many years after becoming infected with M. tuberculosis may have a negative reaction to an initial TST, followed by a positive reaction to a TST given up to a year later; this happens because the first TST boosts the immune response. Two-step testing is used in TB testing programs to tell the difference between boosted reactions and reactions caused by recent infection.

 

BCG Vaccine (Bacillus Calmette-Guerin Vaccine)

Many people from various parts of the world are vaccinated with this TB vaccine. Many people have a noticeable scar on their upper arm. This vaccine is not used in the United States for the prevention of TB because its efficacy is questioned. The vaccine does not provide lifelong immunity to TB infection but it decreases progression from latent TB infection to active TB disease.  

If you were vaccinated with the BCG vaccine, it does not preclude you from receiving the TB skin test; ONLY if you have documented history of a positive skin test or an allergic reaction to the PPD.

A Positive Skin Test

If you receive a bill for the chest x-ray, please contact the Employee Health Office immediately.

 

TB Exposure

If you are exposed to TB in the Workplace

 

Record your answer, click on the "Check Answer" button after making your selection.

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Bloodborne Pathogens Outline

This computer-based learning (CBL) course outlines important aspects of exposure to bloodborne pathogens in the workplace. This exposure is a major concern to both workers and employers, and OSHA has a standard to address this concern. The Bloodborne Pathogens Rule requires both employers and workers to prevent the spread of bloodborne diseases.

Objectives

BIOHAZARD.jpg In this module, you will explore:

Workplace

Exposure to bloodborne pathogens in the workplace is a major concern to workers and employers. The Occupational Safety and Health Administration (OSHA) has a standard to address this concern. The Bloodborne Pathogens Rule requires both employers and workers to prevent the spread of bloodborne diseases

 What is a Bloodborne Pathogen?

After making your selection, click on the Check Answer button to record your selection.

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Exposure

ExposuretoBloodbornePathogenPic.jpg How are people exposed to bloodborne pathogens?

Some people (though not as many) have been infected from splashing blood or other body fluid:

Be sure to use caution when you come in contact with any bodily fluids/substances.

Bloodborne Diseases of Major Concern

Three bloodborne diseases of major concern to healthcare workers are:

Needle sticks from used needles or other sharps injuries are the primary means of transmission of these diseases to healthcare providers in the workplace.

Does Everyone Exposed to a Bloodborne Pathogen Become Infected?

Whether or not you become infected depends on:

Bloodborne Diseases

What Is HIV?

HIV is a viral infection of the immune system. This infection robs a person of the ability to fight off other disease-causing germs. HIV can be contracted by:

Bloodborne Diseases, Continued

physicians.jpg HIV cannot be spread by:

You cannot get HIV from donating blood. The risk of contracting HIV from a blood transfusion is extremely low. The blood supply is carefully tested.

What Happens if You Are Exposed to HIV?

glove_disposal.JPG If you are exposed to HIV through a needle stick or other sharps injury, your risk of contracting the disease is about 0.3%. The risk is less for blood splashes into mucous membranes or on broken or scraped skin.

Symptoms do not usually occur until several years after the infection. A person can infect others even though he does not look or feel sick. HIV is usually spread to others when the infected person does not yet know he has the disease.

 

Bloodborne Diseases

gloves.jpg What Is Hepatitis B?

Hepatitis B is a virus that affects the liver. Many people who are infected with the virus do not have symptoms. An infected person with no symptoms is still contagious.

Symptoms may include:

How Is Hepatitis B Contracted?

Hepatitis B can be contracted by:

What Happens If You Are Exposed to Hepatitis B?

inspection.jpg Of the people who show symptoms, most have a full recovery. Ten percent of people who contract the virus develop a chronic infection.

Chronic hepatitis B puts a person at a higher risk for:

There is a vaccine for hepatitis B, but medical treatment for this disease is still in the experimental stage. If you are exposed to hepatitis B through a needle stick or other sharps injury, your risk of contracting the disease is about 5 to 30% if you have not had a series of three vaccinations.

Bloodborne Diseases

What Is Hepatitis C?

manwomanmasked.jpg Hepatitis C (HCV) is a virus that is similar to hepatitis B.

How Is Hepatitis C Contracted?

If you are exposed to hepatitis C through a needle stick or other sharps injury, your risk of contracting the disease is about 3 to 10%. Blood transfusions were formerly a major means of transmission of hepatitis C, but that is no longer the case. Screening tests were put into place in the early 1990's.

The chance of acquiring HCV by sexual transmission is less than or equal to 6%. Unlike hepatitis B, there is no vaccine to prevent the disease.

What Happens If You Develop Hepatitis C?

The hepatitis C virus causes chronic disease in about 85% of the people who contract it. Hepatitis C is a major cause of cirrhosis of the liver and liver cancer. While there is no cure for hepatitis C, the symptoms may be treated with antiviral drugs. Treatment usually leads to long-term improvement. Complications of hepatitis account for the majority of liver transplants in the United States.

After making your selection, click on the Check Answer button to record your selection.

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Exposure Control Plan

OSHA requires employers to develop an Exposure Control Plan. This plan provides protection for all hospital employees who might be exposed to bloodborne diseases. The plan is updated at least annually to include:

The plan is located at www.miami.edu/ehs

Note: For all exposures, please notify the Employee Health Office at pager: 305-750-0525

 

Precautions

Protecting Yourself -- It's Your Responsibility

You are responsible for understanding the risk of exposure to blood or other potentially infectious materials at your workplace. When working with blood or other potentially infectious materials:

Standard Precautions treats all blood and other potentially infectious materials as if they were known to be infected with bloodborne diseases. Standard Precautions protects the healthcare worker from bloodborne diseases.

Worker Vaccinations

physicians2.jpg OSHA requires that a Hepatitis B vaccine be available to all hospital employees who may be exposed to blood or other potentially infectious materials. The vaccine is:

You may elect not to take the vaccine at this time. You will be required to sign a waiver that you are declining the vaccination. The vaccine will be available later if you change your mind. Additional vaccinations are available for other diseases.

Personal Protective Equipment

N95.jpg Always use the required Personal Protective Equipment (PPE). This specialized clothing and equipment provides protection against contact with blood or other potentially infectious materials.

 By law, all hospital personnel entering a room with airborne precautions must wear a special fitted respirator. Regular masks do not adequately protect workers from tuberculosis. It is required to "Fit-test" the respirator to the one person for whom it is intended.

Workplace Practices

SharpsContainer.jpg Place regulated waste in:

Regulated waste includes:

Dispose of sharps in proper sharps containers. Never attempt:

Protect yourself by practicing personal hygiene and by washing your hands frequently. Wearing gloves does not replace hand washing.

Give feedback to your supervisor about how to improve engineering controls.

 

Minimize Risk

safety_glasses_small.jpg Minimize your risk of exposure by containing, removing, and disinfecting all blood or body fluid spills as quickly and effectively as possible. Wear gloves and other appropriate personal protective equipment (PPE).

In work areas where exposure is likely, do not:

Practice good housekeeping by observing established practices, schedules, and procedures for cleaning and disinfecting work areas at your facility. Follow recommended practices for handling contaminated clothing and laundry at your facility.

 

If You Are Exposed

Medical Follow Up and Evaluation

eyewash.jpg When you have contact with blood or other potentially infectious materials, immediately cleanse the area.

 

 

 

Post-Exposure Evaluation

The Post-Exposure Evaluation consists of four steps:

  1. Test the source patient immediately. You cannot restrain the patient to keep him from leaving the hospital.
  2. Offer the exposed person baseline testing.
  3. Offer the exposed person treatment as needed.
  4. Offer counseling.

The exposure is confidential. The exposed person is notified of diseases that the source patient might have had while the patient's identity is protected.

If You Are Exposed

Transmissible infections are a major concern among healthcare workers. This computer-based learning course introduces basic concepts of infection control including:

This course gives only a brief overview of infection control issues. For more information, talk with your Infection Control specialist. Remember that you are ultimately responsible for understanding the risk of exposure to blood or other potentially infectious materials at your workplace.

Infection Control Practices

Handwash.jpg Frequent hand washing is the foundation of infection control. This single action lowers the risk of transmitting microorganisms from one person or site to another.

When hands are visibly soiled, more time may be required.

After making your selection, click on the Check Answer button to record your selection.

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Infection Control Practices

Environmental control issues address:

Standard and Transmission-Based Precautions

There are two levels of precautions in hospitals: Standard Precautions and Transmission-Based Precautions. Transmission-Based Precautions combine Standard Precautions and Body Substance Isolation.

Transmission-Based Precautions

Transmission-Based Precautions apply to patients with documented or suspected infections or colonization that are highly transmissible. Transmission-Based Precautions include:

Please refer to your infection control policy and procedure manual for more information on contact, droplet and airborne precautions. They are used in addition to Standard Precautions.

Guidelines

Additional preventive measures include the use of:

Summary

Be familiar with key elements of the infection control program.

After making your selection, click on the Check Answer button to record your selection.

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Congratulations!

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You have finished reviewing this module! Please note that to successfully complete this course you must receive a passing score of 80% or above. We hope this Computer Based Learning course has been both informative and helpful. Feel free to review this course until you are confident about your knowledge of the material presented.

OSHA's Bloodborne Pathogens Standard and the University's policy require that you repeat this class in 12 months from today's date. Please make a note of this as your certificate will expire in 12 months.

Next Steps

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2. Click on the Email Score button