Embedded Files
what is a bloodborne pathogen?
what is a bloodborne pathogen?
A bloodborne pathogen is an infectious microorganism (like a virus or bacteria) carried in human blood that can cause disease in a person. This includes diseases such as HIV/AIDS, Hep B, Hep C, and Syphilis, to name a few. Remember from earlier: You never know what diseases anyone else's blood may carry. Sometimes those individuals don't even know. ALWAYS treat blood specimens as if they are contaminated with a disease. Properly protect yourself from exposure by using proper protective equipment and following safety protocol.
We are going to learn a little more about some of the most common bloodborne pathogens to emphasize the importance of safety, especially as a phlebotomist where you will be at high risk for exposure. OSHA specifically addresses HBV and HIV in their Bloodborne Pathogen Standard.
Hepatitis b (HBV)
Hepatitis b (HBV)
What is HBV?
There are many different hepatitis diseases. "Hep-" means liver and "-itis" mean inflammation, therefore, hepatitis is inflammation of the liver. Hepatitis B Disease is caused by the Hepatitis B Virus. It can be a short-term (acute, lasts less than 6 months) or long term disease (chronic, lasts more thaN 6 months). If it becomes chronic it can also be life-threatening with health issues like cirrhosis or liver cancer. Cirrhosis when scarring occurs on the liver and the liver tissue hardens. This can cause liver failure.
How is it transmitted?
HBV is transmitted percutaneously (puncture through the skin) or through mucosal contact with infectious blood or bodily fluids like semen and saliva.
Activities that may lead to the transmission include:
Sex with an infected partner
Sharing needles, syringes, or drug preparation equipment
Birth to an infected mother
Contact with blood or an open sores from an infected person
Exposure to dirty needle sticks or sharp instruments
Sharing items with an infected person that can break the skin or mucous membranes (Razors, toothbrushes, glucose monitor equipment, etc.)
HBV is NOT spread by sharing food or water, sharing eating utensils, breastfeeding, hugging, kissing, hand holding, coughing, sneezing, sharing baths or showers or swimming pools and hot tubs. If a blood spill were to occur during one of these activities, proper clean up and prevention should be taken.
How long does it survive outside of the body?
HBV will survive outside of the body, even in dried blood and remain infectious for at least 7 days.
Who is at risk of HBV Infection?
Infants born to infected mothers
Sex partners of infected people
Men who have sex with men
People who inject drugs
Household contacts or sexual partners of known people with chronic HBV infection
Health-care and public-safety workers at risk for occupational exposure to blood or blood-contaminated body fluids (YOU!)
Hemodialysis patients
What are the signs and symptoms of infection?
Not all people with acute HBV infection have symptoms. The presence of signs and symptoms varies by age. Most children <5 years of age and newly infected immunosuppressed adults are generally asymptomatic, whereas 30%–50% of people age ≥5 years have signs and symptoms. When present, signs and symptoms of acute HBV infections can include
fever
fatigue
loss of appetite
nausea
vomiting
abdominal pain
dark urine
clay-colored stool
joint pain
jaundice
These symptoms can last several weeks, even up to 6 months in acute patients. This disease is more severe among adults >60 years old.
Most people with chronic HBV infection are asymptomatic and have no evidence of liver disease or injury. However, some people who develop chronic hepatitis will experience jaundice (yellowing of the skin and eyes), darkened urine, cirrhosis, and/or hepatocellular carcinoma ( liver cancer).
What is the incubation period?
If symptoms occur, they begin an average of 90 days (range: 60–150 days) after exposure to HBV.
How is it treated?
Patients with acute HBV are provided supportive treatments depending on their symptoms. Chronic patients may be able to receive antiviral medication if they are available and will receive regular monitoring in an attempt to prevent liver damage or cancer. Although recovery is possible, there is no known cure for this disease.
Hepatitis B Vaccination
There is a Hepatitis B Vaccination available. OSHA requires all healthcare workers who will be exposed to blood or bodily fluids to receive the Hep B vaccination series OR sign a declination form. This is a series of 3 shots and it must occur within 10 days of employment. The series slowly builds up immunity to Hepatitis B. The vaccination is made from yeast cultures and you are not in danger of contracting the disease from getting the shots. Once you have received the series, you do not need to get it again. Booster shots are available and may in some instances be recommended (such as an outbreak of Hep B in your area). The vaccination should be offered at no cost to those who have routine exposure to bloodborne pathogens (doctors, nurses, first responders, phlebotomists, etc.). Your employer is required by law to provide the Hepatitis B vaccination, but you are not required to accept the offer and have the right to decline.
If you are exposed, you may request a Hep B vaccine. It is safe to receive post exposure. It is exceptionally effective at preventing disease if received immediately after exposure. There are blood tests that can also be done to test you for HBV post exposure and recommended for monitoring contraction of the disease. Remember it can take anywhere from 1-9 months before seeing any symptoms.
You can find out more information about HBV at https://www.cdc.gov/hepatitis/hbv/hbvfaq.htm#overview. Questions on the test for this Phlebotomy Course will be from the course text and not additional information you may research. But there is a lot more you can learn about each disease if you are interested.
Source: CDC, National Notifiable Diseases Surveillance System.
Human Immunodeficiency Virus (HIV)
Human Immunodeficiency Virus (HIV)
What is HIV?
HIV is the Human Immunodeficiency Virus and it attacks the body's immune system. If not treated, it can lead to AIDS (Acquired Immunodeficiency Syndrome). HIV in humans came from a type of chimpanzee in Central Africa. The version of the virus in the chimp is called SIV or Simian Immunodeficiency Virus. It was probably passed to humans when they hunted the chimpanzees for meat and came in contact with infected blood. This may have occurred as far back as the last 1800's and it has slowly spread across Africa and into other parts of the world. As far as we know, the virus has existed in the United States since at least the mid to late 1970's.
How is it transmitted?
You can only get HIV by coming into direct contact with certain body fluids from a person infected with HIV. These fluids are:
Blood
Semen and pre-seminal fluid
Rectal fluids
Vaginal fluids
Breast milk
For transmission to occur, the HIV in these fluids must get into the bloodstream of the exposed person through a mucous membrane (rectum, vagina, mouth, or tip of the penis). It can also be transmitted from bodily fluids to open cuts or sores; or by direct injection.
How long does it survive outside of the body?
Not long, a few hours at most. One study showed it surviving up to 6 days in dried room temperature blood, but the concentration of living virus was low to negligible. Fresh blood or infectious bodily fluids are a much higher risk. The virus does not survive in water, so swimming pools or hot tubs are not a high risk activity.
What are the signs and symptoms of infection?
Symptoms of HIV will occur within 2-4 weeks after infection. Some people will have flu-like symptoms such as:
Fever
Chills
Rash
Night sweats
Muscle aches
Sore throat
Fatigue
Swollen lymph nodes
Mouth ulcers
Some people remain asymptomatic. But no symptoms does not mean you don't have HIV. And having these symptoms doesn't mean you have HIV, other illnesses have similar symptoms. If you are exposed or wonder about infection, there is a blood test you can do to know for sure.
Stages of HIV
Stage 1: Acute HIV Infection
At this stage the person infected will have a large amount of the virus in their bloodstream and are very contagious. Some people at this stage have flu-like symptoms. This is the body's natural response to infections. Other people may not have symptoms at this stage and may or may not later. If you think you have been exposed, get medical attention and get tested to know for sure.
Stage 2: Chronic HIV Infection
At this stage of infection the bloodstream has low levels of virus but the virus is still active. This stage is also known as asymptomatic HIV or clinical latency. So people aren't always sick during this phase. Without medications it may last a decade or longer and yes, this infected person is still contagious and can transmit the disease. A person in Stage 2 moves to Stage 3 when the viral load or amount of HIV in the bloodstream increases and a cell level called CD4 goes down. CD4 cells are a type of white blood cell and essential to the immune system. As the virus level increases, symptoms will appear making the patient ill.
Stage 3: Acquired Immunodeficiency Syndrome (AIDS)
This is the most severe stage of HIV infection. Those who take medication in Stage 2 may never move to Stage 3. In Stage 3, a person's immune system is so damaged that they have an increased risk of contracting severe illnesses. Their CD4 cell levels drop below 200 cells/mm. They have a high viral load and are very infectious. Without treatment, people with AIDS typically survive about 3 years.
How is it treated?
There is no cure for HIV/AIDS. There is an HIV medication called antiretroviral therapy (ART) that helps to control the HIV. Most people can get the virus under control within 6 months in attempt to prevent it from becoming AIDS.
HIV should be treated as soon as possible.
HIV Vaccination
Currently, no therapeutic HIV vaccines have been approved by the U.S. Food and Drug Administration (FDA), but research is underway.
You can find out more information about HIV at https://www.cdc.gov/hiv/basics/whatishiv.html. Questions on the test for this Phlebotomy Course will be from the course text and not additional information you may research. But there is a lot more you can learn about each disease if you are interested.
Watch this video.
Needlestick Safety and PRevention Act
Needlestick Safety and PRevention Act
On November 6, 2000 a law was passed in congress called the Needlestick Safety and Prevention Act. This act mandated that OSHA add safety provisions to the Bloodborne Pathogen Standard. It was recognized that numerous workers are occupationally exposed to bloodborne pathogens and that many have contracted fatal or serious viruses and diseases. In order to help prevent this OSHA was to add to the standard in these key areas:
Updating the Exposure Control Plan
New requirements for the evaluation and use of engineering controls (safety engineered sharps and needleless systems)
Annual employer considerations of safer medical devices and new technologies that reduce exposures
Non-managerial frontline employee feedback on the selection and use of these devices
The requirement to keep a sharps injury log in addition to the OSHA Recordkeeping requirements.
The sharps injury log must contain:
The type and brand of device involved in the incident
The department or work area where the exposure incident occurred
An explanation of how the incident occurred
Remember back to Module One when we learned about Quality Assurance and Control? This Act is a great example of that. It is an active way of attempting to prevent a problem and fix it to be better and controlled when problems occur. Each business and medical facility must meet the requirements of this law. Be sure to learn where the log is wherever you work/will work.
You can read the Needlestick Safety and Prevention Act at https://www.congress.gov/106/plaws/publ430/PLAW-106publ430.pdf if you would like to learn more.
What To do when exposed
What To do when exposed
In the next section we will review safety precautions that should always be taken in the workplace. Assuming you have taken these precautions and still are exposed to potentially infectious material, you should do the following:
Wash the exposed area with soap and running water. Use antibacterial soap if possible. If the exposed area is the eye or a mucous membrane (eyes, ears, mouth, nose) flush the area with running water for at least 15 minutes.
Report to your supervisor the incident as soon as possible.
Refer to the SDS (Safety Data Sheet). The SDS is a safety document required by OSHA that contains data about the physical properties of a particular hazardous substance. Information will include things such as toxicity, health effects, first aid, storage, proper disposal, protective equipment, and spill-handling procedures. Follow the procedure listed for the infectious material you were exposed to.
Fill out an exposure report form
The information documented on the exposure will be kept on record for the facility to meet OSHA standards. Your personal information will remain confidential.
Be sure to document the route of the exposure, the circumstances in which the exposure occurred, and who the source exposure was from (if possible). It is likely the dirty needle source is unknown. For example, if you stick yourself with a random needle from the sharps container, there is not a way to easily identify the original patient it was used on, or sometimes even which needle stuck you. There are always variables to document. Some situations may be prohibited by law to document. Consult your supervisor if you have questions and need help filling out your exposure form.
If it is possible to test the source's blood (the person whose potentially infectious material you were infected with) for HBV and HIV, this blood collection and test should be done as soon as possible. This may require having the patient come back in for the test since exposure can happen with them not present. If they are already known to be positive for a disease, they do not need to be tested. Your blood should also be collected as soon as possible and tested with your consent.
RETURN TO THE GOOGLE CLASSROOM AND DO THE PRACTICE WORKSHEET.
For more information and references on the reading material found in Section 9: Bloodborne Pathogens, click the link below. Test questions will be based on the reading in the sections and not from more information found in external references and website links.
Page updated
Google Sites
Report abuse