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1 AUSTRALIA Safetycare Australia Pty. Ltd. Telephone (03) Facsimile (03) CANADA Safetycare Inc. Telephone (905) Facsimile (905) USA Safetycare Inc. Telephone (714) Facsimile (714) UNITED KINGDOM Safetycare (UK) Limited. Telephone (0208) Facsimile (0208) SINGAPORE MALAYSIA SafetyMax Corp Pte. Ltd. Telephone Facsimile SafetyMax Sdn Bhd Telephone (603) Facsimile (603) The information contained in this Facilitator s guide is distributed and sold as a guide and for informational purposes only. Safetycare makes no representation or warranty as to the compliance of this program with any and all applicable laws of the purchaser's jurisdiction. 2. Safetycare's liability for any damages to the purchaser or to any other party shall not exceed the amount paid by the purchaser for the guide. In no event shall Safetycare be responsible for any indirect or consequential damages or loss of profits, even if Safetycare has been advised of the possibility of such damage. Some provinces/states do not allow the limitations or exclusion of liability for incidental or consequential damages, so the above limitations or exclusions may not apply to the purchaser. 3. This Facilitator s Guide is supplied as part of the subscription service; Montie. This guide is only to be used during a valid subscription period. Where a Montie subscription is not valid, this guide may not be used. Facilitator s Guide BLOODBORNE PATHOGENS MANAGING THE RISK Copyright - All Rights Reserved

2 FACILITATOR S GUIDE Bloodborne Pathogens Managing the Risk CONTENTS Introduction to the Facilitator s Guide 3 Introduction to the Video Program; Bloodborne Pathogens Managing the Risk 4 Transcript of Video Program 5 Part 1 - Bloodborne Pathogens; An Overview 10 Part 2 - Hepatitis B, Hepatitis C and HIV 11 Part 3 - How Infection Occurs 13 Part 4 - Control of Hazards 14 Part 5 - Clean up of Blood and Body Fluid spills 16 Part 6 - Use of Gloves and Hand Washing 17 Part 7 - What to do if you have been exposed 18 Questionnaire 19 Answers 21 2

3 INTRODUCTION TO THE FACILITATOR S GUIDE Bloodborne Pathogens Managing the Risk This Facilitator s Guide is supplied as part of the subscription service; Montie. This guide is only to be used during a valid subscription period. Where a Montie subscription is not valid, this guide may not be used. The aim of this Facilitator s Guide, when used in conjunction with the Video program, is to provide the facilitator with discussion points important to the overall development of the program and to allow participants the opportunity of discussing the impact the program may have on current work practices and whether in fact changes may be required. The time allocated to the program will be determined by which areas are seen as important to each Organisation, the time taken to develop the points made in the program and whether other data specific to your own environment is included in addition to, or instead of, the program examples. EACH FACILITATOR SHOULD CAREFULLY READ THE GUIDE DISCUSSION NOTES SUGGESTED AND PREPARE THEIR OWN INPUT ACCORDINGLY. The program transcript is included to allow your Organisation to fully research the program content and develop specific examples critical to the performance of your own workforce. Where the Video program is made available to small or remote sections of your Organisation, some other examples or discussion points may be preferred to suit the needs of these people and if so, should be developed prior to distribution of the program. Maximum benefit will then be obtained by your people. All information included in the Facilitator s Guide may be copied and distributed with the exception of the transcript of the Video program. Any information which is copied or distributed must only be used internally by the Organisation which purchased the guide. 3

4 SCREEN SHOT FROM THE VIDEO PROGRAM INTRODUCTION TO THE VIDEO PROGRAM Duration: 13 mins Hepatitis B, Hepatitis C and HIV are three Bloodborne Diseases which are a concern in the workplace, but what is a Bloodborne Disease? How can it be passed from one person to another? What can you do to reduce your risk of exposure? And what should you do if you may have been exposed to a Bloodborne Disease? This program covers: A definition of Bloodborne Pathogens Hepatitis C Hepatitis B HIV/AIDS How infection occurs Control of hazards Clean up of blood and body fluid spills Use of gloves and hand washing What to do if you have been exposed The objective of this program is to increase awareness of Bloodborne Pathogens and by so doing, increase awareness of the standards for worker responsibility in observing and being active in daily safety procedures. Bloodborne Pathogens can cause disease but the risks should not be overdramatised. Following procedures that have been laid down will go a long way to protect you from infection. 4

5 TRANSCRIPT OF THE VIDEO PROGRAM Bloodborne Pathogens Managing the Risk Copyright Safetycare. All rights reserved Hepatitis B, Hepatitis C and HIV are three bloodborne diseases which are a concern in the workplace, but what is a bloodborne disease, how can it be passed from one person to another, what can you do to reduce your risk of exposure and what should you do if you may have been exposed to a bloodborne disease? Bloodborne Pathogens are micro-organisms which are present in human blood and can cause infection and disease in people who are exposed to blood containing the pathogen. Bloodborne pathogens can be transmitted through contact with contaminated blood or other infected bodily fluids including semen, vaginal secretions and cerebrospinal fluid. There are many different diseases which can be caused by Bloodborne Pathogens. Hepatitis B, Hepatitis C and HIV are three well known examples. Hepatitis B Hepatitis B is a bloodborne virus which affects the liver. If you become infected with Hepatitis B you may develop symptoms no more serious than the flu. A small percentage of people infected with Hepatitis B become carriers, but show no symptoms. Hepatitis B can cause you to be ill for a long time... from weeks to a lifetime. If chronic, it can lead to cirrhosis, which is fibrotic scarring of the liver, and liver cancer... however, the mortality rate from Hepatitis B is quite low. The good news about Hepatitis B is you can be vaccinated against this virus, either before exposure or immediately after exposure. Hepatitis C Hepatitis C is also a bloodborne virus which affects the liver. Many people infected with Hepatitis C experience no noticeable symptoms. However, if long term hepatitis develops, this can result later in cirrhosis and liver cancer. There is no vaccine against Hepatitis C but treatment methods for infection are usually very effective. 5

6 Human Immunodeficiency Virus The Human Immunodeficiency Virus affects the human immune system. An HIV infection is obviously a serious concern, particularly when it develops into AIDS, the Acquired Immunodeficiency Syndrome. HIV/AIDS primarily affects you by making you more susceptible to other opportunistic infections such as pneumonias, TB and various cancers. However, since the introduction of Highly Active Anti-retroviral Therapy, the virus can be more effectively managed. There is no vaccine available for HIV. Comparison of viral particles If you have direct blood to blood contact with infected blood it does not necessarily mean that you will become infected. It is however true that you are much more likely to be infected with blood infected with Hepatitis B than blood infected with Hepatitis C or HIV. This is because there are many more viral particles present in blood infected with Hepatitis B than Hepatitis C...AND... substantially more viral particles in blood infected with Hepatitis B than blood infected with HIV. It is commonly stated that the chances of becoming infected following a single workplace exposure to blood infected with Hepatitis B range between 6% and 30%. With blood containing Hepatitis C the chance is no more than about 3% and with HIV the chances are estimated to only be around.03%, a very small likelihood indeed. How Infection Occurs Bloodborne pathogens must find a direct route of entry into the body before infection can occur. Generally this means that the infected material must enter the body through a break in the skin, such as a cut, a burn, a rash like eczema, or through breaks caused by dermatitis or acne. Infection can also occur from splashing of infected material into the eyes and other mucous membranes, most commonly the mouth or nose, OR from penetration from a sharp object that has been contaminated with infected material, for example broken glass or a needle. Saliva, tears, sweat and vomit must contain blood to be potentially infective for a bloodborne disease. 6

7 Control of Hazards Potential exposure to Bloodborne Pathogens in the workplace is often a consequence of an accident or injury. It is therefore important that both a risk assessment strategy and an effective hazard control strategy are in place to eliminate or adequately control ALL hazards that can lead to accidents and injuries. Effective housekeeping also improves the overall safety of the workplace. A keen, neat and orderly workplace is a key factor in accident prevention. In the workplace if you are dealing with blood or blood products, are a member of a first-aid or emergency response team, or happen to be at an accident scene where blood is present it is important to treat all blood and other bodily fluids as if they were infected. This approach is widely used around the world and is often referred to as Universal Precautions. Other names which are also used include Standard Precautions, Routine Practices and Body Substance Isolation. However, regardless of the name, the key is to treat ALL blood and bodily fluids as if they were infected. To help achieve this it is ideal to have, in one or more identifiable locations, fluid resistant personal protective equipment, including face shields, masks, disposable and utility gloves, waterproof aprons or disposable gowns, protective footwear, and close fitting glasses and goggles... plus a first-aid kit. A spill clean up kit should also be available that includes gloves, pick-up scoop, scraper, an appropriate disinfectant, paper towels and plastic bags for disposal. If an accident occurs which causes bleeding, have the victim contain his or her own bleeding if possible. Again, if possible, have the victim bandage the wound to help stop the bleeding and help reduce the likelihood of blood contact. In a serious accident situation your action could mean the difference between life and death and you may wish to become involved rather than waiting for the emergency response team or medical assistance to arrive. If you do, don t rush in... assess the risk, consider your health and safety and the health and safety of others. Consider the availability and use of personal protective equipment and you can then at least make an informed decision on the level of risk you are prepared to take. 7

8 Clean up of Blood and Body Fluid spills All blood and body fluid spills should be cleaned up. An established written procedure should be followed. Procedures do vary from place to place but the main principles in the clean-up procedure include: Secure the area Wear all appropriate personal protective equipment. Gloves are essential and other items such as face shields, gowns and boots maybe required. Use disposable towels or other absorbent materials to soak up any fluids. These should then be placed into plastic bags. Contaminated surfaces and areas close by must be disinfected with an appropriate disinfectant. The disinfectant must be applied for a sufficient time for it to be effective. Contaminated clothing can be cleaned through regular laundering. Once removed clothing should be placed into a plastic bag. Once removed, single use or disposable personal protective equipment should be placed into a plastic bag for disposal. Once removed, reusable personal protective equipment should placed in plastic bags and then be disinfected and cleaned according to the manufacturer s instructions. Other items may also be contaminated and again these need to be bagged, if possible, and then disinfected and cleaned according to the manufacture s instructions. During the whole clean-up process cross contamination can be a problem and double bagging should be done whenever this is a possibility. The precise details regarding the use, labelling and disposal of plastic bags, bio-hazard bags and the use of items such as sharps containers should be detailed in the written procedure. Use of Gloves and Hand Washing Arguably the most important aspect of dealing with blood and body fluids is the wearing of gloves and the thorough washing of your hands immediately after taking them off. Disposable gloves should be put on carefully according to the manufacturer s instructions and then checked for any noticeable flaws. Utility or reusable gloves must be made from suitable material and be in good condition. Glove removal technique is important. Roll the first glove off the hand inside out. Then use the clean inside part of the first glove to remove the second glove. 8

9 Always wash your hands immediately after taking off gloves. What to do if you have been exposed If you have direct contact with some one else s blood, if you think you may have had contact or if you have been splashed with a victim s bodily fluids, what should you do? The first step is to wash the area thoroughly. If you think you could have been splashed in the eyes, use an eye wash to bathe the eyes completely. For other areas of the body, a thorough soap and water scrub is necessary. You should then seek immediate medical advice as to any further steps that could be or should be taken. Every incident involving exposure to blood or other bodily fluids should be immediately reported to the appropriate personnel within your organisation. Remember, a direct route of entry into the body is necessary for an infection to be possible. Protective equipment acts as a barrier between infected fluids and the route of entry. Bloodborne pathogens can cause disease but the risks should not be overdramatized. Following procedures that have been laid down will go a long way to protect you from infection. 9

10 PART ONE BLOODBORNE PATHOGENS; AN OVERVIEW Hepatitis B Hepatitis C HIV are three bloodborne diseases which are a concern in the workplace. What is a bloodborne disease? How can it be passed from one person to another? What can you do to reduce your risk of exposure?, and What should you do if you have been exposed? Bloodborne Pathogens are micro-organisms which are present in human blood and can cause infection and disease in people who are exposed to blood containing the pathogen. Bloodborne pathogens can be transmitted through contact with contaminated blood or other infected bodily fluids including semen, vaginal secretions and cerebrospinal fluid. There are many different diseases which can be caused by Bloodborne Pathogens. Hepatitis B, Hepatitis C and HIV are three well known examples. DISCUSSION Discuss the following question with participants. 1. Why is it important to be aware of Bloodborne Diseases? 10

11 PART TWO HEPATITIS B, HEPATITIS C AND HIV Hepatitis B Hepatitis B is a bloodborne virus which affects the liver. If you become infected with Hepatitis B you may develop symptoms no more serious than the flu. A small percentage of people infected with Hepatitis B become carriers, but show no symptoms. Hepatitis B can cause you to be ill for a long time, from weeks to a lifetime. If chronic, it can lead to cirrhosis, which is fibrotic scarring of the liver, and liver cancer, however, the mortality rate from Hepatitis B is quite low. The good news about Hepatitis B is you can be vaccinated against this virus, either before exposure or immediately after exposure. Hepatitis C Hepatitis C is also a bloodborne virus which affects the liver. Many people infected with Hepatitis C experience no noticeable symptoms. If long term hepatitis develops, this can result later in cirrhosis and liver cancer. There is no vaccine against Hepatitis C but treatment methods for infection are usually very effective. Human Immunodeficiency Virus The Human Immunodeficiency Virus affects the human immune system. An HIV infection is obviously a serious concern, particularly when it develops into AIDS, the Acquired Immunodeficiency Syndrome. HIV/AIDS primarily affects you by making you more susceptible to other opportunistic infections such as pneumonias, TB and various cancers. However, since the introduction of Highly Active Anti-retroviral Therapy, the virus can be more effectively managed. 11

12 There is no vaccine available for HIV. PART TWO HEPATITIS B, HEPATITIS C AND HIV continued DISCUSSION Discuss the following question with participants. 1. Why are these Bloodborne Diseases so serious? 12

13 PART THREE HOW INFECTION OCCURS Bloodborne pathogens must find a direct route of entry into the body before infection can occur. Generally this means that the infected material must enter the body through a break in the skin, such as a cut, a burn, a rash like eczema, or through breaks caused by dermatitis or acne. Infection can also occur from splashing of infected material into the eyes and other mucous membranes, most commonly the mouth or nose, OR from penetration from a sharp object that has been contaminated with infected material, for example broken glass or a needle. Saliva, tears, sweat and vomit must contain blood to be potentially infective for a bloodborne disease. DISCUSSION Discuss the following questions with participants. 1. Can you catch a bloodborne disease from saliva alone? 2. What is an example in your workplace where broken glass or needles could potentially be found? 13

14 PART FOUR CONTROL OF HAZARDS Potential exposure to Bloodborne Pathogens in the workplace is often a consequence of an accident or injury. Effective housekeeping improves the overall safety of the workplace. A keen, neat and orderly workplace is a key factor in accident prevention. In the workplace if you are dealing with blood or blood products, are a member of a first-aid or emergency response team, or happen to be at an accident scene where blood is present it is important to treat all blood and other bodily fluids as if they were infected. This approach is widely used around the world and is often referred to as: Universal Precautions Other names which are also used include Standard Precautions, Routine Practices and Body Substance Isolation. However, regardless of the name, the key is to treat all blood and bodily fluids as if they were infected. To help achieve this it is ideal to have, in one or more identifiable locations: Fluid resistant personal protective equipment, Face shields Masks Disposable and utility gloves Waterproof aprons or disposable gowns Protective footwear Close fitting glasses and goggles First-aid kit. A spill clean up kit should also be available that includes: Gloves Pick-up scoop Scraper Appropriate disinfectant Paper towels Plastic bags for disposal. 14

15 PART FOUR CONTROL OF HAZARDS continued If an accident occurs which causes bleeding, have the victim contain his or her own bleeding if possible. Again, if possible, have the victim bandage the wound to help stop the bleeding and help reduce the likelihood of blood contact. In a serious accident situation your action could mean the difference between life and death and you may wish to become involved rather than waiting for the emergency response team or medical assistance to arrive. If you do, don t rush in. Assess the risk; consider your health and safety and the health and safety of others. Consider the availability and use of personal protective equipment and you can then at least make an informed decision on the level of risk you are prepared to take. DISCUSSION Discuss the following questions with participants. 1. Where is fluid resistant personal protective equipment located in your workplace? 2. Why is it important to treat all blood as though it is infected? 15

16 PART FIVE CLEAN UP OF BLOOD AND BODY FLUID SPILLS All blood and body fluid spills should be cleaned up. An established written procedure should be followed. Procedures do vary from place to place but the main principles in the clean-up procedure include: Secure the area Wear all appropriate personal protective equipment. Gloves are essential and other items such as face shields, gowns and boots maybe required. Use disposable towels or other absorbent materials to soak up any fluids. These should then be placed into plastic bags. Contaminated surfaces and areas close by must be disinfected with an appropriate disinfectant. The disinfectant must be applied for a sufficient time for it to be effective. Contaminated clothing can be cleaned through regular laundering. Once removed clothing should be placed into a plastic bag. Once removed, single use or disposable personal protective equipment should be placed into a plastic bag for disposal. Once removed, reusable personal protective equipment should placed in plastic bags and then be disinfected and cleaned according to the manufacturer s instructions. Other items may also be contaminated and again these need to be bagged, if possible, and then disinfected and cleaned according to the manufacture s instructions. During the whole clean-up process cross contamination can be a problem and double bagging should be done whenever this is a possibility. DISCUSSION Discuss the following questions with participants. 1. Why is double bagging an important thing to consider when cleaning up blood or body fluid spills? 2. Why is it important to secure the area prior to cleaning up a spill? 16

17 PART SIX USE OF GLOVES AND HAND WASHING Arguably the most important aspect of dealing with blood and body fluids is the wearing of gloves and the thorough washing of your hands immediately after taking them off. Disposable gloves should be put on carefully according to the manufacturer s instructions and then checked for any noticeable flaws. Utility or reusable gloves must be made from suitable material and be in good condition. Glove removal technique is important: Roll the first glove off the hand inside out. Then use the clean inside part of the first glove to remove the second glove. Always wash your hands immediately after taking off gloves. DISCUSSION Discuss the following questions with participants. 1. What does correct glove removal technique achieve? 2. What is a potential flaw that you might find in a glove? 17

18 PART SEVEN WHAT TO DO IF YOU HAVE BEEN EXPOSED If you have direct contact with some one else s blood, if you think you may have had contact or if you have been splashed with a victim s bodily fluids, what should you do? The first step is to wash the area thoroughly. If you think you could have been splashed in the eyes, use an eye wash to bathe the eyes completely. For other areas of the body, a thorough soap and water scrub is necessary. You should then seek immediate medical advice as to any further steps that could be or should be taken. Every incident involving exposure to blood or other bodily fluids should be immediately reported to the appropriate personnel within your organisation. DISCUSSION Discuss the following question with participants. 1. Who is the appropriate person within your organisation to report a blood exposure incident to? 18

19 QUESTIONNAIRE 1. Which of these are common Bloodborne Diseases? (circle correct answer/s) - Hepatitis B - Cancer - HIV - Hepatitis C 2. Is there a vaccine available for HIV/AIDS? (circle correct answer) - Yes - No 3. What is the only way you can be infected by a bloodborne pathogen? (circle correct answer) - By infected material finding a direct route of entry into the body. - By using a piece of equipment after an infected person has used it. - By not washing your hands. - By eating food in a work area 4. If you happen to be at an accident scene where blood is present, what should your attitude be toward the blood? (circle correct answer) - Assume all blood is free from bloodborne pathogens - Treat all blood as though it is infected - Don t worry about whether it s infected or not 19

20 5. What should a spill clean up kit contain? (circle correct answer/s) - Gloves - Pick-up scoop - Appropriate disinfectant - All of the above 6. If an accident occurs which causes bleeding, should you have the victim contain his or her own bleeding if possible? (circle correct answer) - Yes - No 7. Complete the glove removal technique: Roll the first glove off the hand inside out (circle correct answer) - There is no such thing as glove removal technique - Then use the clean inside part of the first glove to remove the second glove. - Take the second glove off as quickly as possible - Have someone else remove the second glove for you 8. If you have direct contact with some one else s blood, what is the first step: (circle correct answer) - Don t worry about it - Wash the area thoroughly - Speak to your supervisor 20

21 ANSWERS TO QUESTIONNAIRE 1. Hepatitis B Hepatitis C HIV 2. No 3. By infected material finding a direct route of entry into the body. 4. Treat all blood as though it is infected 5. All of the above 6. Yes 7. Then use the clean inside part of the first glove to remove the second glove. 8. Wash the area thoroughly 21

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