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Slide 1: Bloodborne Pathogen Training for School Staff
December 1991- Occupational Safety & Health Administration (OSHA) in the U.S. Department of Labor issued regulations regarding bloodborne pathogen (BBP) occupational exposure to reduce risk for workers. In Ohio, public employees are subject to Public Employee Risk Reduction Program (PERRP). PERRP regulations are consistent with OSHA regulations.
BBP training must be provided to identified staff:
1.   At no cost.
2.   During working hours.
3.   Annually.
Additional training must be offered if there is a modification or addition of tasks that affect the occupational exposure of the staff member.
Training materials must be appropriate to the educational and literacy level, as well as the language, of the employees.
Training records must:
1.   Include dates of training sessions.
2.   Include the contents of training sessions.
3.   Include the names of qualified persons conducting training.
4.   Include the names and job titles of all attending training sessions.
5.   Be maintained for three years from date of training. Reference: http://www.osha-slc.gov/OshStd_data/1910_1030.html

Slide 2: Note

Dear School Nurse,
The purpose of this resource is to assist you as you inform your school district staff about bloodborne pathogens.
You will find notes on each slide with additional information for you to review before making your presentation. The notes are provided as background information for you; you do not need to read all of the notes during a presentation.
This presentation has been created on Microsoft PowerPoint. Nurses are encouraged to customize the content at their discretion. For example, you may wish to insert slides with specific information about your school district policy. You will need to save the presentation to your hard drive in order to make any changes.
It is best to include demonstrations (such as proper glove removal) in the presentation in order to enhance the learning of the audience members.
We hope that you find this resource helpful!

Ohio Department of Health, School and Adolescent Health
August 2006

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Slide 3: Training Objectives

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OSHA regulations describe the content to be covered in BBP training.
The material covered in this PowerPoint presentation satisfies the majority of the requirements.
For compliance, you should supplement this presentation with information specific to your district, as found below in requirements numbers 1, 4 and 10.
BBP training must include:
1.   Accessible copy and explanation of the regulatory text.

2.   Explanation of the epidemiology and symptoms of bloodborne disease.
3.   Explanation of modes of transmission of BBP.
4.   Explanation of employer’s exposure control plan, including employee access to written copy.
5.   Explanation of methods to identify tasks involving exposure to blood or other potentially infectious material (OPIM).
6.   Explanation of use and limitations of engineering controls, work practices and personal protective equipment (PPE).
7.   Information on types, proper use, location, removal, handling, decontamination and disposal of PPE.
8.   Information on hepatitis B vaccination.
9.   Information on actions when exposed to blood or OPIM.

this determination as each situation is unique

Slide 4: Why do I need this training?
Important: Because all exposure plans are site specific, please refer to your district plan frequently during this presentation.

The school district administration is required to identify staff whose job duties put them at risk of exposure to blood or OPIM. Administration may ask for the assistance of the nurse concerning this determination. Each district must assess risks to each employee in making this determination, as each situation is unique.

Reference: http://www.osha-slc.gov/OshStd_data/1910_1030.html

Slide 5: Regulatory Authority
BBP standards prescribe safeguards to protect workers against the health hazards from exposure to blood and OPIM, and to reduce their risk from this exposure. Implementing this standard can significantly reduce the risk of workers contracting HIV, hepatitis C, hepatitis B or other bloodborne diseases.

Reference: http://perrp.com.state.oh.us/w3/webpo2.nsf?Opendatabase

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Slide 6: What are Bloodborne Pathogens?
BBP include:
1.   Hepatitis B Virus (HBV).
2.   Hepatitis C Virus (HCV).
3.   Hepatitis D Virus (HDV).
4.   Hepatitis G Virus (HGV).
5.   Human Immunodeficiency Virus (HIV).
6.   Cytomegalovirus (CMV).
7.   Parvovirus B19, Erythema Infectiosum (EI).

BBP most commonly encountered in the school environment are HBV, HCV and HIV. Reference: http://www.cdc.gov/ncidod/diseases/hepatitis/b/

Slide 7: Hepatitis B Virus (HBV)
HBV may lead to acute hepatitis, chronic active hepatitis, cirrhosis, liver cancer, liver failure and death. Symptoms appear two to six months after exposure
(so immunization immediately after exposure may prevent infection). The most common transmission route in the U.S. is sexual contact. Transmission does not appear to occur by tears, sweat, urine, stool or droplet.
CDC recommends vaccination against HBV for:
1.   All babies.
2.   Sexually active adolescents or those who inject drugs.
3.   People exposed to blood at work.
4.   People engaging in tattooing or body piercing. Reference: http://www.cdc.gov/ncidod/diseases/hepatitis/b/

Slide 8: HBV Symptoms
Thirty percent of people with HBV have no signs or symptoms. Children are less likely to exhibit
signs and symptoms than adults. There is no specific treatment for HBV.

Other symptoms of HBV:
1.   Fatigue.
2.   Joint pain.
3.   Appetite loss.
4.   Nausea and vomiting.
5.   Itching all over the body.

The highest rate of HBV occurs in 20 to 49-year-olds because of lifestyle choices. Reference: http://www.cdc.gov/ncidod/diseases/hepatitis/b/

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Slide 9: Hepatitis B Vaccine
The vaccine is only effective for HBV (does not include hep. A or hep. C). A nurse needs a prescription from a health care provider to administer vaccine.

School districts are required to offer the vaccine, but staff are not required to accept the vaccination.
1.   Vaccine must be made available within 10 working days of assignment to job at risk of exposure.
2.   Any employee who declines the vaccine must sign a declination statement.
3.   An employee who chooses not to have the vaccination at the initial offering may request the vaccination at a later date.
4.   Employees are not required to participate in antibody prescreening program to receive vaccination series.
5.   If routine boosters are later recommended by the US Public Health Service, the employer shall provide it to employees.

Reference: http://www.osha-slc.gov/OshStd_data/1910_1030.html

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Slide 10: Hepatitis C Virus (HCV)
Long term effects of HCV:
1.   Chronic infection in 55-85 percent.
2.   Chronic liver disease in 70 percent.
3.   Cirrhosis.
4.   Liver cancer.
5.   One to five percent infected may die of liver disease.
6.   Leading cause of liver transplant. Most HCV infections are due to illegal drug use.
Reference: http://www.cdc.gov/ncidod/diseases/hepatitis/c/fact.htm

Slide 11: HCV Symptoms
Eighty percent of those infected with HCV have no signs or symptoms. The incubation period for HCV is two to six months.
Highest incidence of HCV is in 20-29 age group.

Reference: http://www.cdc.gov/ncidod/diseases/hepatitis/c/fact.htm

Slide 12: Human Immunodeficiency Virus (HIV)
Casual, person-to-person contact does not transmit HIV. It is not transmitted through insects,
air or water. Contact with saliva, sweat, urine, feces or tears has never been found to transmit HIV. Transmission through blood transfusions is rare.

HIV is fragile and does not survive well in the environment.

HIV typically enters the blood stream through lining in vagina, vulva, penis, rectum or mouth during intimate sexual contact.

HIV may be transmitted through sharing needles; droplets of contaminated blood remain in syringe or needle and are injected into bloodstream.

Babies of HIV-infected mothers may be infected during pregnancy, delivery or breastfeeding.

To diagnose, blood is tested for high levels of HIV antibodies which may not be present in traceable quantities until up to six months after diagnosis.

Recent improvements in treatment have improved the quality of life and longevity of those with HIV. There remains no cure or vaccine for HIV.

Slide 13: Symptoms of HIV
Twenty-five percent of those in the U.S. with HIV are unaware of their infection status.

Flu-like symptoms may occur within one to two months after exposure. Additional symptoms include: fever, headache, tiredness, enlarged lymph nodes. People are very infectious at this time.

Other symptoms that may be noted later: lack of energy, weight loss, frequent fevers and sweats, persistent yeast infections, skin rashes or flaky skin, short-term memory loss and pelvic inflammatory disease that does not respond to treatment. Some people develop severe herpes infections or shingles. Infected children may grow slowly or experience frequent illnesses.

AIDS is the most advanced stage of HIV infection.

Those exposed to HIV should be tested in six weeks to 12 months so that treatment can start. Testing can be done anonymously.

Reference: http://www.niaid.nih.gov/factsheets/hivinf.htm

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Slide 14: Transmission: How BBP Enter Your Body
Example of #1: If a staff member punctures their skin with a sharp item (glass, knife) that is contaminated with blood, this could provide a possible opportunity for a BBP to enter the body.

Exposure incident (definition): specific eye, mouth, other mucous membrane, non-intact skin,
or parenteral contact with blood or OPIM that results from the performance of an employee’s duties.

Parenteral-piercing mucous membranes or the skin barrier through such events as needlesticks, human bites, cuts and abrasions.

It is important that the staff understand an exposure incident must include
1) blood and/or OPIM AND 2) an entrance into the body.

Other Potentially Infectious Material (OPIM) includes:
1.	Human bodily fluids such as: semen, vaginal secretions, cerebrospinal fluid, synovial fluid, pleural fluid, saliva, pleural fluid, pericardial fluid, peritoneal fluid, amniotic fluid,
any body fluid visibly contaminated by blood and fluids where it is difficult to differentiate between fluids.
2.	Any unfixed human organ or tissue, whether the source is living or dead.
3.	Cultures or cells containing HIV or HBV, or specimens from experimental animals infected with HIV or HBV.

BBP can also enter via non-sterile technique when tattooing or body piercing, sharing needles, sexual intercourse and rarely by direct blood transfusion.

Reference: http://www.osha-slc.gov/OshStd_data/1910_1030.html

committee

Slide 15: Exposure Control Plan
Site specific: Copy and hand out district’s/school’s Exposure Control Plan. Go over the site-
specific plan with the trainees, including the above suggested material. An Exposure Control Plan must be written and contain:
1.   Exposure determination.
2.   Procedure for evaluation of an exposure incident.
3.   Plan to ensure a copy is accessible to all employees.
4.   Plan to review and update annually, which shall reflect:
a. Changes in technology.
b. Consideration of more effective and safer methods and products.
c. That non-managerial employees were solicited to be on the review committee.

Go over general criteria in plan including:
1.   Engineering controls.
2.   Work-practice controls.
3.   Housekeeping.
4.   Personal protective equipment (PPE).
5.   Infectious waste.
6.   Vaccinations.
7.   What to do/where to go in case of an exposure incident.

Reference:	slc gov/OshStd data/1910 1030 html

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Slide 16: Exposure at Work
These are some examples of specific jobs and tasks in the schools that may expose staff members to BBP. This list is not exhaustive. For example, if your building has health occupation teachers, they might be included in this list.

Other job tasks and actions that may present more risk of exposure to BBP:
1.   Breaking up fights.
2.   Assisting with nose bleeds.
3.   Working with combative students including those who bite and break the skin.
4.   Rendering first aid and other instances involving blood.
5.   Swallowing therapy.

Slide 17: Work Practice Controls
Work-practice controls: controls that reduce the likelihood of exposure to BBP by altering the
manner in which a task is performed. This may include use of PPE, handwashing, use of disinfectants and proper waste disposal.

Reference: http://www.osha-slc.gov/OshStd_data/1910_1030.html

Slide 18: Universal Precautions
The use of either standard precautions or universal precautions terminology are acceptable.

Universal/Standard Precautions
1.   Reduce the risk of transmission of microorganisms from both recognized and unrecognized sources of infection.
2.   Universal Precautions describes an approach to infection control that assumes all human blood and OPIM are treated as if known to be infectious for BBP.

Remember:
Everyone has something you don’t want… you universally treat everyone the same.

Reference: http://www.osha-slc.gov/OshStd_data/1910_1030.html

controls due to increased risks

Slide 19: Universal Precautions
Although exposure to body fluids other than blood is unlikely in the school, the following body
fluids are also to be treated as being infectious: semen and vaginal secretions, amniotic fluid
and cerebrospinal fluid.

Good infection control practices encourage wearing gloves when involved in some activities such as diapering or cleaning restrooms. Gloves should be worn, not because of potential exposure to BBP, but because of potential exposure to other disease-causing organisms.

Health occupation teachers/vocational health programs may require addition work practice controls due to increased risks.

Reference: http://www.osha-slc.gov/OshStd_data/1910_1030.html

Slide 20: Hand Washing
Employers should provide hand washing facilities that are appropriately stocked and readily accessible to employees.

Hands should always be washed after the removal of gloves and after exposure to blood and OPIM.

Reference: http://www.osha-slc.gov/OshStd_data/1910_1030.html

Slide 21: Hand Washing Technique
If hand washing facilities are not available, employers must provide employees with antiseptic hand cleaner such as alcohol-based hand sanitizers. When hand sanitizers are used, hands should then be washed with soap and running water as soon as possible.

References:
http://www.osha-slc.gov/OshStd_data/1910_1030.html

http://www.co.la- crosse.wi.us/Health/Environmental/docs/HandWash.htm

Slide 22: Alcohol-based Hand Sanitizers
Waterless, alcohol-based hand sanitizers are recommended for use for hand hygiene when soap and water are not available.

The alcohol content must be 60-95 percent to be effective.
Hands that are visibly soiled or contaminated should be washed with soap and water. Alcohol-based hand sanitizers strip the outer layer of oil on the skin which destroys
microorganisms on the skin surface. Regrowth of bacteria occurs slowly after use.

Alcohol based hand sanitizers should be applied according to manufacturer’s directions.

References:
http://www.osha-slc.gov/OshStd_data/1910_1030.html http://www.cdc.gov/od/oc/media/pressrel/fs021025.htm http://www.cdc.gov/cleanhands/ http://www.cdc.gov/ncidod/EID/vol12no03/05-0955.htm

Slide 23: Personal Protective Equipment (PPE)
General work clothing is not intended to function as protection against a hazard and is not considered PPE. PPE should keep blood and OPIM from reaching the employee’s work clothing, skin or mucous membranes under normal conditions.

All contaminated PPE must be removed and properly disposed of when leaving the area of exposure.

Reference: http://www.osha-slc.gov/OshStd_data/1910_1030.html

Slide 24: Personal Protective Equipment (PPE) in the School
The employer must ensure that all employees use appropriate PPE.

PPE in the school setting may include gloves, gowns, lab coats, face shields, masks, eye protection and resuscitation masks.

Gowns, aprons and gloves should be used when there is risk of exposure due to splashes, sprays and splatters.

Reference: http://www.osha-slc.gov/OshStd_data/1910_1030.html

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Slide 25: PPE Guidelines: Gloves
If a staff member has allergic sensitivity to latex or powder, hypoallergenic gloves must be provided by the district.

Types of situations when gloves should be worn include:
1.   Diapering, toileting, changing menstrual pads or catheterization.
2.   Wound care or dressing changes.
3.   Oral care, including toothbrushing and cleaning oral and nasal secretions.
4.   Blood glucose monitoring.
5.   Clean up of emesis, ostomy bag change or suctioning.
6.   Application of topical medications.
7.   Cleaning blood spills.
8.   Emptying trash or contaminated laundry.
9.   Sweeping up or handling sharps containers or other regulated waste. Reference: http://www.osha-slc.gov/OshStd_data/1910_1030.html

Slide 26: Glove Removal Demonstration
This is an important technique that should be demonstrated by the nurse.

Gloves should be removed properly to avoid exposure to BBP. Contaminated gloves should be disposed of properly. Hands should be washed after gloves are removed.

Procedure:
Step 1--Grasp outside edge near wrist.
Step 2--Peel away from hand turning glove inside-out.
Step 3--Hold in opposite gloved hand. Slide ungloved finger under the wrist of the remaining glove; be careful not to touch the outside of the glove.
Step 4--Peel off from inside, creating a bag for both gloves.
Step 5--Discard gloves. Hands should be washed after gloves are removed.

References:
http://www.osha-slc.gov/OshStd_data/1910_1030.html http://research.dfci.harvard.edu/ehs/PPE/glove%20procedure%20document.pdf

Slide 27: Disposing of Sharps
Sharps--Anything that can puncture your skin is considered a sharp. This might include needles, broken glass, power tools, razor blades and sharp equipment, etc.

Broken glassware should not be picked up directly with the hands. Describe the types of containers and locations in your building. Ohio EPA—Ohio Environmental Protection Agency.
Sharps notes:
1.   Contaminated needles should not be recapped or bent.
2.   Sharps containers must be:
a. Puncture resistant. b. Closeable.
c. Labeled or color coded. d. Leak proof.
f. Kept in a secure place away from student access.
3. Be careful not to overfill sharps containers to prevent injury. Reference: http://www.osha-slc.gov/OshStd_data/1910_1030.html

Slide 28: Signs and Labels
Warning labels must be affixed to containers of regulated waste. Labels should be fluorescent orange or orange-red with contrasting color writing. Red bags may be substituted for labels.

Waste such as bloody tissues should be disposed of properly in a plastic-lined trash can. It is not considered hazardous material, so it can be thrown away in the school Dumpster.

Reference: http://www.osha-slc.gov/OshStd_data/1910_1030.html

Slide 29: Cleaning Blood Spills
Staff using cleaning solutions should receive appropriate instruction for their use.

Contaminated surfaces should be cleaned and disinfected as soon as feasible

Slide 30: Cleaning Up and Decontamination
Discuss the products your school policy prescribes for cleaning blood spills; include where solutions can be found and any precautions on the product label.

Household chlorine bleach can be used with appropriate instructions/precautions.

Contaminated surfaces should be cleaned and disinfected as soon as feasible.

All bins, cans and pails shall be inspected and decontaminated on a regularly scheduled basis
or as soon as feasible after visible contamination.

Reference: http://www.osha-slc.gov/OshStd_data/1910_1030.html

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Slide 31: Cleaning Up a Blood Spill
Discuss equipment your building has to absorb spill. For example, a small spill can be absorbed with a paper towel.

Spills on carpet or rugs:
1.   Follow manufacturer’s directions for using industrial equipment for shampooing.
2.   Apply absorbent material and wait for it to dry.
3.   Sweep toward center of spill and dispose of in a plastic bag.
4.   Vacuum.
5.   Spray with white vinegar solution (1 ounce vinegar to 1 quart cool water).
6.   Blot area with paper towels.
7.   Rinse, disinfect and shampoo.
8.   Clean tools (such as the vacuum).

Reference: http://www.osha-slc.gov/OshStd_data/1910_1030.html

Slide 32: What is an Exposure Incident?
Refer to your school district’s Exposure Control Plan to identify staff to be contacted.
General procedures are:
1.   Incident should be reported as soon as possible for documentation of the event.
2.   An attempt should be made to identify the source individual. That person’s blood should be tested as soon as feasible and with appropriate consent to determine infection. This information should be provided to the exposed staff member.
3.   The exposed staff member should be directed to a health care provider for evaluation at the time of the exposure. Results should be reported to the school district.
4.   The exposed staff member shall receive appropriate testing, prophylaxis and counseling.

All health information should be kept confidential. Results of employee medical evaluation and follow-up must be kept confidential.

Reference: http://www.osha-slc.gov/OshStd_data/1910_1030.html

Slide 33: What to do if an Exposure Occurs
These are generally recommended instructions; it is important for the nurse to review your
district policy again here.

Reference: http://www.osha-slc.gov/OshStd_data/1910_1030.html

Slide 34: BBP Training
OSHA regulations require at least annual BBP training for all employees at risk of exposure. Additional training may be required if job duties change.

If the employee received BBP training in the past year, the next training must contain only provisions not included previously.

Reference: http://www.osha-slc.gov/OshStd_data/1910_1030.html

Slide 35: Questions
Use this slide for Q&A; also, reinforce resources for future questions.

Slide 36: References
Other references used in this presentation: http://www.cdc.gov/cleanhands/ http://www.cdc.gov/ncidod/diseases/hepatitis/b/ http://www.cdc.gov/ncidod/diseases/hepatitis/c/fact.htm http://www.cdc.gov/ncidod/EID/vol12no03/05-0955.htm http://www.cdc.gov/ncidod/hip/ppe/PPEslides6-29-04.pdf http://www.cdc.gov/od/oc/media/pressrel/fs021025.htm
http://www.co.la-crosse.wi.us/Health/Environmental/docs/HandWsh.htm http://www.health.state.mn.us/handhygiene/handrub.html http://www.niaid.nih.gov/factsheets/hivinf.htm http://research.dfci.harvard.edu/ehs/PPE/glove%20procedure%20document.pdf

Slide 37: Resources
1.		For review of your specific school plan, distribute or refer staff to Web site/manual.
2.		OSHA Standards – 29 CFR can be found online; standard requires that employers provide a written copy of 29 CFR 1910.1030 to employees.
3.	http://www.colostate.edu/Orgs/safefood/NEWSLTR/v8n3s06.html

Slide 38: Acknowledgements