Ansell Certified | Bloodborne Pathogens Module 5 ... · Bloodborne Pathogens COURSE 2 MODULE 5...

COURSE 2 | MODULE 5

BloodbornePathogens

Introduction

Gloves

Gowns

Facemasks, Respirators

Goggles, Face Shields

Glossary

Review

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Introduction

Introduction to Standard PrecautionsUniversal precautions refers to the practice, in medicine, of avoiding contact with patients’ bodily fluids, by means of the wearing of nonporous articles such as medical gloves, goggles, and face shields. The practice was introduced in 1985–88. In 1987, the practice of universal precautions was adjusted by a set of rules known as body substance isolation. In 1996, both practices were replaced by the latest approach known as standard precautions (healthcare).

Under standard precautions, all patients are considered to be possible carriers of blood-borne pathogens. The guideline recommends wearing gloves when collecting or handling blood and body fluids contaminated with blood, wearing face shields when there was danger of blood splashing on mucous membranes and disposing of all needles and sharp objects in puncture-resistant containers.

Standard precautions is designed for doctors, nurses, patients, and healthcare support workers who are required to come into contact with patients, bodily fluids or contaminated surfaces. This also includes staff and others who might not come into direct contact with patients.

Pathogens fall into two broad categories, bloodborne (carried in the body fluids) and airborne.

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Bloodborne Pathogens

COURSE 2 | MODULE 5

STANDARD PRECAUTIONSAND PPE

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Personal Protective Equipment (PPE)Personal protective equipment or PPE is designed to protect workers from serious workplace injury or illness resulting from contact with workplace hazards.

PPE for healthcare includes a variety of devices such as face mask, glove, or clothing that acts as a barrier between infectious materials and the skin, mouth, nose, or eyes (mucous membranes). When used properly, personal protective equipment can help prevent the spread of infection from one person to another.

Employers have the responsibility to provide work place safety devices and to train healthcare providers how to use the safety device. Healthcare providers then have the responsibility to wear the protective safety device in the manner in which it was intended to be worn to prevent injury or illness.

The selection of PPE is based on the nature of the patient interaction and/or the likely mode(s) of transmission.

GlovesMedical gloves manufactured for healthcare purposes are generally subject to regulatory approval and clearance.

Gloves are used to prevent contamination of healthcare personnel hands when:

• anticipating direct contact with blood or body fluids, mucous membranes, non intact skin and other potentially infectious material

• having direct contact with patients who are colonized or infected with pathogens transmitted by the contact route e.g., VRE, MRSA, RSV

• handling or touching visibly or potentially contaminated patient care equipment and environmental surfaces

Gloves

Nitrile Examination Gloves Powder-free Latex Examination Gloves

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COURSE 2 | MODULE 5


Introduction

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Gloves (continued)The extent to which gloves will protect healthcare personnel from transmission of bloodborne pathogens (e.g., HIV, HBV, and HCV) following a needlestick or other puncture that penetrates the glove barrier has not been determined. Although gloves may reduce the volume of blood on the external surface of a sharp by 46-86%, the residual blood in the lumen of a hollow bore needle would not be affected; therefore, the effect on transmission risk is unknown.

Non-sterile disposable medical gloves made of a variety of materials (e.g., latex, vinyl, nitrile) are available for routine patient care. The selection of glove type for non-surgical use is based on a number of factors, including the task that is to be performed, anticipated contact with chemicals and chemotherapeutic agents, latex sensitivity, sizing, and facility policies for creating a latex-free environment.

For contact with blood and body fluids during non-surgical patient care, a single pair of gloves generally provides adequate barrier protection. However, there is considerable variability among gloves; both the quality of the manufacturing process and type of material influence their barrier effectiveness.

While there is little difference in the barrier properties of unused intact gloves, studies have shown repeatedly that vinyl gloves have higher failure rates than latex or nitrile gloves when tested under simulated and actual clinical conditions. For this reason either latex or nitrile gloves are preferable for clinical procedures that require manual dexterity and/or will involve more than brief patient contact. Heavier, reusable utility gloves are indicated for non-patient care activities, such as handling or cleaning contaminated equipment or surfaces.

During patient care, transmission of infectious organisms can be reduced by adhering to the principles of working from “clean” to “dirty”, and confining or limiting contamination to surfaces that are directly needed for patient care. It may be necessary to change gloves during the care of a single patient to prevent cross-contamination of body sites. It also may be necessary to change gloves if the patient interaction also involves touching portable computer keyboards or other mobile equipment that is transported from room to room. Discarding gloves between patients is necessary to prevent transmission of infectious material.

Gloves must not be washed for subsequent reuse because microorganisms cannot be removed reliably from glove surfaces and continued glove integrity cannot be ensured. Furthermore, glove reuse has been associated with transmission of MRSA and gram-negative bacilli.

When gloves are worn in combination with other PPE, they are put on last. Gloves that fit snugly around the wrist are preferred for use with an isolation gown because they will cover the gown cuff and provide a more reliable continuous barrier for the arms, wrists, and hands. Gloves that are removed properly will prevent hand contamination. Hand hygiene following glove removal further ensures that thehands will not carry potentially infectious material that might have penetrated through unrecognized tears or that could contaminate the hands during glove removal.

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Gloves (cont’d.)


COURSE 2 | MODULE 5


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Gowns



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GownsGowns help prevent contamination between caregivers and patients, and they protect the caregiver’s clothing.

Surgical gowns

Surgical gowns are garments worn during medical procedures. They are considered standard OR attire during procedures. You should consider using a surgical gown to cover your trunk, arms, legs, and clothing when you may be splattered by someone else’s body fluids (such as blood, respiratory secretions, vomit, urine or feces).

Isolation gowns

Isolation gowns are generally used outside the operating room area to protect the HCW’s arms and exposed body areas and prevent contamination of clothing with blood, body fluids, and other potentially infectious material. The need for and type of isolation gown selected is based on the nature of the patient interaction, including the anticipated degree of contact with infectious material and potential for blood and body fluid penetration of the barrier.

The wearing of isolation gowns and other protective apparel is generally mandated by government agencies. Clinical and laboratory coats or jackets worn over personal clothing for comfort and/or purposes of identity are not considered PPE.

Isolation gowns are always worn in combination with gloves, and with other PPE when indicated. Gowns are usually the first piece of PPE to be donned. Full coverage of the arms and body front, from neck to the mid-thigh or below will ensure that clothing and exposed upper body areas are protected. Isolation gowns should be removed before leaving the patient care area to prevent possible contamination of the environment outside the patient’s room. Isolation gowns should be removed in a manner that prevents contamination of clothing or skin. (The outer, “contaminated”, side of the gown is turned inward and rolled into a bundle, and then discarded into a designated container for waste or linen to contain contamination.

Gowns

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COURSE 2 | MODULE 5


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Face ProtectionFacemasks and Respirators

Facemasks and respirators are devices that may help prevent the spread of germs (viruses and bacteria) from one person to another. They are one part of an infection-control strategy that should also include frequent hand washing and social distancing. Facemasks and respirators should not be shared. Facemasks and respirators may become contaminated with germs (viruses and bacteria) that can be spread between people.

The following provides basic information about facemasks and respirators.

Facemasks

A facemask is a loose-fitting, disposable device that creates a physical barrier between the mouth and nose of the wearer and potential contaminants in the immediate environment. Facemasks may be labeled as surgical, laser, isolation, dental or medical procedure masks. They may come with or without a face shield.

Facemasks are made in different thicknesses and with different ability to protect you from contact with liquids. These properties may also affect how easily you can breathe through the facemask and how well the facemask protects you. If worn properly, a facemask is meant to help block large-particle droplets, splashes, sprays or splatter that may contain germs (viruses and bacteria) from reaching your mouth and nose. Facemasks may also help reduce exposure of your saliva and respiratory secretions to others.

While a facemask may be effective in blocking splashes and large-particle droplets, a facemask, by design, does not filter or block very small particles in the air that may be transmitted by coughs, sneezes or certain medical procedures. Facemasks also do not provide complete protection from germs and other contaminants because of the loose fit between the surface of the facemask and your face.

Facemasks are not intended to be used more than once. If your mask is damaged or soiled, or if breathing through the mask becomes difficult, you should remove the facemask, discard it safely, and replace it with a new one. To safely discard your mask, place it in a plastic bag and put it in the trash. Wash your hands after handling the used mask.




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Face Protection (continued)

Surgical Masks

Surgical masks are used to protect the mouth and nose from splashes or sprays of blood/body fluids, or respiratory secretions, and are sometimes placed on coughing patients to reduce dissemination of respiratory secretions. They may have either ear loops or ties, and can be either pleated or made of molded material. Surgical masks are cleared by the regulatory agencies as having fluid-resistant properties.

Laser Masks

Promoted as having a higher filtration compared to the standard surgical mask but it may not meet the required filtration of a respirator mask.

Procedure/Isolation/Dental Masks

Procedure or isolation masks may also be used to protect the mouth and nose, but are not cleared by regulatory agencies for fluid resistant properties. There is no evidence to show that surgical masks are more protective than procedure masks, but there may be more variation in quality and performance among procedure masks. Many procedure masks have built-in eye protection, and are available in pleated or molded styles.


Procedure mask with eye shield

Pleated surgical mask with ties

Pleated surgical mask with loops

Molded surgical mask

Facemasks, Respirators(cont’d.)


COURSE 2 | MODULE 5


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Respirators (N95, P2, FFP2NR)

During surgical procedures that use a laser or electrosurgical unit, the thermal destruction of tissue creates a smoke byproduct. Each year, millions of workers, including surgeons, nurses, anesthesiologists, and surgical technologists, are exposed to laser or electrosurgical smoke. Surgical plumes have contents similar to other smoke plumes, including carbon monoxide, polyaromatic hydrocarbons, and a variety of trace toxic gases. As such, they can produce upper respiratory irritation, and have in vitro mutagenic potential. Although there has been no documented transmission of infectious disease through surgical smoke, the potential for generating infectious viral fragments, particularly following treatment of venereal warts, may exist.

The composition and exposure hazards associated with surgical smoke depend on a variety of factors such as the type of surgical procedure and device (i.e. laser, electrosurgical, ultrasonic); type and infectious nature of the tissue; extent of tissue ablation; the duration of surgery; and the worker’s proximity to the surgical field. The hazards reported to be associated with exposure to surgical smoke are substantiated by research evidence. Ninety-five percent of surgical smoke is made up of water, but the remaining 5% contains potentially hazardous particles including blood fragments, bacteria, viruses and lung-damaging dust. Beside maintaining OR air exchanges at a minimum of 15 air exchanges per hour, smoke evacuators and room (wall) suction systems are the two additional control methods recommended to reduce surgical smoke levels. Surgical masks do not protect wearers from airborne particles small enough to be inhaled through the larynx and into the lungs.

While smoke particles larger than 5 µm are captured by traditional masks, many smaller particles are liberated by laser and electrosurgery, and particles smaller than 2 µm can be deposited in the lung alveoli. Most significant and perhaps easily misunderstood is the fact that surgical and laser masks do not seal to the face and thereby allow contaminants to enter the worker’s breathing zone through gaps between the wearer’s face and the mask.




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Respirators (N95, P2, FFP2NR)

For these reasons, government agencies around the world have set standards that pertain to respiratory protection. These agencies include but are not limited to the World Health Organization (WHO), the CDC, NIOSH, Australian Standards, and the European Committee for Standardization. They recommend the use of properly fitted, filtering face piece respirators rather than surgical and laser masks. Filtering face piece respirators with an N95, P2 or FFP2NR filter class designation prevent all sizes of particles from passing through the filter media and entering the wearer’s breathing zone. Even taking some face piece seal leakage around the respirator into account, a properly fitted N95, P2 or FFP2NR reduces the wearer’s exposure against a range of very small particles (less than 1μm) to large droplet sized particles (> 60μm) by at least 10-fold. Thus, healthcare personnel should wear respiratory protection at least as protective as a fit-tested N95, P2 or FFP2NR filtering face piece respirator when working with known disease transmissible cases (i.e., HPV) and/or during aerosol-generating procedures or with aerosol transmissible diseases (i.e., TB, varicella, rubeola).

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COURSE 2 | MODULE 5


Introduction

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Review

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Guidance on eye protection for infection control has been published by most regional government agencies. The eye protection chosen for specific work situations (e.g., goggles or face shield) depends upon the circumstances of exposure, other PPE used, and personal vision needs. Personal eyeglasses and contact lenses are NOT considered adequate eye protection.

Eye protection must be comfortable, allow for sufficient peripheral vision, and must be adjustable to ensure a secure fit. Indirectly-vented goggles with a manufacturer’s anti-fog coating may provide the most reliable practical eye protection from splashes, sprays, and respiratory droplets from multiple angles. Newer styles of goggles may provide better indirect airflow properties to reduce fogging, as well as better peripheral vision and more size options for fitting goggles to different workers. Many styles of goggles fit adequately over prescription glasses with minimal gaps.

It is important to remind healthcare personnel that even if Droplet Precautions are not recommended for a specific respiratory tract pathogen, protection for the eyes, nose and mouth by using a mask and goggles, or face shield alone, is necessary when it is likely that there will be a splash or spray of any respiratory secretions or other body fluids as defined in Standard Precautions Disposable or non-disposable face shields may be used as an alternative to goggles.

As compared with goggles, a face shield can provide protection to other facial areas in addition to the eyes. Face shields extending from chin to crown provide better face and eye protection from splashes and sprays; face shields that wrap around the sides may reduce splashes around the edge of the shield. Removalof a face shield, goggles and mask can be performed safely after gloves havebeen removed, and hand hygiene performed. The ties, ear pieces and/or headband used to secure the equipment to the head are considered “clean” and therefore safe to touch with bare hands. The front of a mask, goggles and face shield are considered contaminated.

After Implementation of PPE


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Designated containers for used disposable or reusable PPE should be placed in a location that is convenient to the site of removal to facilitate disposal and containment of contaminated materials. Hand hygiene is always the final step after removing and disposing of PPE.


COURSE 2 | MODULE 5


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Review

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Glossary Carrier (noun) \ kar-ee-er\A person that shows no symptoms of a disease but harbors the infectious agent of that disease and is capable of transmitting it to others

HBV Hepatitis B is an infectious inflammatory illness of the liver caused by the hepatitis B virus (HBV). Originally known as “serum hepatitis”

HCVHepatitis C is an infectious disease affecting primarily the liver, caused by the hepatitis C virus (HCV)

HIV HIV or Human Immunodeficiency Virus causes severe damage to the immune system; sometimes called AIDS

Isolation (noun) \ ahy-suh-ley-shuh n\In health care, isolation refers to various measures taken to prevent contagious diseases from being spread from a patient to other patients, health care workers, and visitors, or from others to a particular patient

MRSA MRSA stands for methicillin-resistant Staphylococcus aureus; the term is used to describe a number of strains of the bacteria, Staphylococcus aureus, that are resistant to a number of antibiotics, including methicillin Mucous membrane (noun) \ myoo-kuh s\ mem-breyn\A lubricating membrane lining an internal surface or an organ, as the alimentary, respiratory, and genitourinary canals

Respirator mask (noun) \ res-puh-rey-ter\ mask\There are several types of particulate filtering face piece respirators worn over the mouth and nose to filter airborne particles and help protect the respiratory system; these types of masks are certified by regulatory agencies

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COURSE 2 | MODULE 5


Introduction

Gloves

Gowns



Glossary

Review

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Review • Under standard precautions all patients are considered to be possible

carriers of blood-borne pathogens. The guideline recommends wearing gloves when collecting or handling blood and body fluids contaminated with blood, wearing face shields when there was danger of blood splashing on mucous membranes and disposing of all needles and sharp objects in puncture-resistant containers.

• Personal protective equipment or PPE is designed to protect workers from serious workplace injury or illness resulting from contact with workplace hazards. When used properly, personal protective equipment can help prevent the spread of infection from one person to another.

• Gloves are used to prevent contamination of healthcare personnel hands when anticipating direct contact with blood or body fluids, mucous membranes, non-intact skin and other potentially infectious material; having direct contact with patients who are colonized or infected and when handling or touching visibly or potentially contaminated equipment and environmental surfaces.

• Gowns help prevent contamination between caregivers and patients, and they protect the caregiver’s clothing. Surgical gowns are garments worn during medical procedures. Isolation gowns are generally used outside the operating room area to protect the HCW. The need for and type of isolation gown selected is based on the nature of the patient interaction, including the anticipated degree of contact with infectious material and potential for blood and body fluid penetration of the barrier.

• Masks may be used in combination with goggles to protect the mouth, nose and eyes, or a face shield may be used instead of a mask and goggles, to provide more complete protection for the face, as discussed below. Masks should not be confused with particulate respirators (such as N95, P2 or FFP2NR) that are used to prevent inhalation of small particles that may contain infectious agents transmitted via the airborne route.

• PPE should be disposed of in proper containers and hand hygiene completed.

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