Bloodborn Pathogens

 

The main bloodborne pathogens that EMS is concerned with in the OSHA BBP standard include Hepatitis B (HBV), Hepatitis C (HCV), and the Human Immunodeficiency Virus (HIV).  Other BBP diseases can include malaria, syphilis and brucellosis.  Anytime contact is made with a patient’s bodily fluids, such as blood, the care provider is at risk of contracting a BBP.  Proper PPE must be worn at all times to limit exposure.

 

 

Access to the OSHA 1910.1030 standard for bloodborne pathogens can be found here.  This standard defines the various components of bloodborne pathogens, including abbreviations for various diseases, locations you may contract a bloodborne pathogen, and more.

Hepatitis B

For more information on HBV, see WebMD’s article.

Hepatitis B is a virus that infects the liver, causing inflammation and in more serious cases can cause cirrhosis (the replacing of healthy liver tissue with scar tissue, eventually preventing the liver from working properly) and liver cancer.  HBV is transmitted primarily through blood contact, but also through other bodily fluids.  As many as 1 to 1.4 million Americans are infected with the disease and between 18,000 and 32,000 new infections occur annually.  Once contracted, adults have a 5-10% chance of HBV to become chronic, however small children have a higher chance of infection; 90% of infants that come into contact with HBV will contract the disease.

HBV is able to survive in dried blood for up to seven days.  This means that when cleaning the ambulance, washing the laundry or reviewing a med bag (that has some blood on it) can all be situations that pose a threat to EMTs.

Symptoms of HBV

Symptoms can take up to 6 months after infection to display.  According to WebMD, about a third of those infected with the disease never display any symptoms, and will find out through a blood test.

  • Jaundice (Yellowing of the skin and eyes; pee develops into brown or orange)
  • Light-colored poop
  • Fever
  • Long-lasting fatigue (weeks or months)
  • Stomach troubles (loss of appetite, nausea, vomiting, pain)

Treatment & Vaccines

If an infection is suspected, you should see your doctor as quickly as you can (within two weeks of infection). The doctor will administer the vaccine to help boost the immune system.  The vaccine is available for all age groups prior to infection as well, free of charge.  Information on the vaccine can be found on the CDC website.  Beyond preventing the infection, there is no cure.  If the disease becomes chronic active HBV, there are a number of treatment courses your doctor may prescribe to manage the symptoms (such as the liver inflammation).

Hepatitis C

For more information on HCV, see WebMD’s article.

Hepatitis C is a virus that infects the liver, similar to Hepatitis B.  Unlike HBV, HCV is chronic in between 70%-85% of infected persons.  Those infected may be unaware of the infection as the symptoms are not always present, however there is no vaccine to prevent HCV.  Like HBV, HCV is contracted through contact with infected blood or bodily fluid.  HCV can also be passed from mother to child during birth.

Symptoms of HCV

Symptoms can take up to 6 months after infection to display.

  • Jaundice (Yellowing of the skin and eyes; pee develops into brown or orange)
  • Long-lasting fatigue (weeks or months)
  • Stomach troubles (loss of appetite, nausea, vomiting, pain)

Treatment & Vaccines

Through a regimented treatment course prescribed by your doctor, HCV can be cured in most patients in 8-12 weeks.  There is currently no vaccine for HCV.

Human Immunodeficiency Virus

For more information on HIV, see the CDC’s website.

HIV weakens a person’s immune system by destroying the white blood cells that fight off diseases and infection.  This increases susceptibility and risk of common illnesses such as the cold, flu or infections.  HIV is transmitted through blood, semen & pre-seminal fluid, rectal fluid, vaginal fluid and breast milk.  The fluids must come in direct contact with either a mucous membrane (includes rectum, vagina, penis and mouth), damaged tissue (open cut, burn, etc), or be directly injected into the bloodstream (such as accidental needle stick).

Outside of the human body, HIV cannot reproduce and will die.  It cannot be spread via mosquitoes, ticks or other insects, saliva, tears or sweat (that is not mixed with blood), hugging, shaking hands, sharing toilds or dishes or closed-mouth kissing, or other sexual acts that don’t involve exchanging bodily fluids.

For EMS, the most likely scenario is either coming in contact with an HIV positive individual with open bodily fluids (such as a trauma patient) or an accidental needle stick.  Scientists estimate the chance of being stuck with a needle of an HIV positive individual be less than 1%.

Stages of HIV

There are three stages of HIV – Acute HIV Infection, Clinical Latency, and Acquired Immunodeficiency Syndrome (AIDS).  Each stage comes with its own symptoms and treatments.

Stage 1: Acute HIV Infection

HIV symptoms can begin to show within 2-4 weeks of infection, which may last a few weeks.  Patients in stage one are highly contagious but are often unaware of their illness.

  • Flu-like symptoms

Stage 2: Clinical Latency

Also referred to as asymptomatic HIV infection or chronic HIV infection, HIV is still active but is reproducing at lower levels than stage one.  Symptoms can be non-existent for patients in stage two. This stage can last up to a decade or longer, and are still infectious during this time.  With treatment, this stage can last up to three times longer and are much less likely to transmit the disease.  Symptoms may develop at the end of stage two, prior to stage three.

Stage 3: Acquired Immunodeficiency Syndrome

AIDS is the final stage of HIV, and denotes that the immune system of the host has been compromised.  In this case, symptoms will range as the patient will be infected with opportunistic illnesses, which take advantage of the fact the immune system is damaged.  Once acquiring AIDS, life expectancy is only 3 years without treatment.

Other common symptoms of AIDs include:

  • Chills
  • Fever
  • Sweats
  • Swollen lymph glands
  • Weakness
  • Weight loss

Treatment & Vaccines

No cure exists for HIV.

Whitewater Fire Department Exposure Plan

Per the November 9, 2009 revision of the exposure control plan, the following should be followed when a significant exposure incident occurs.  This plan can be found in EMS Manager, under the Policies and Procedures folder.

  1. EMT/Firefighter are to immediately respond to Fort Atkinson Hospital. (Time is of the essence for possible vaccines)
  2. EMT/Firefighter will be admitted to the ER and seen by the ER doctor.  If you are not admitted and only ask their opinion, no follow-up will occur.
  3. ER Physician will assess the EMT/Firefighter and determine if he/she feels the event was a significant exposure incident.
  4. With confirmation of significant exposure event, the EMT/Firefighter will be referred to the physician that oversees all significant exposure incidents.
  5. A complete work-up order form for testing, notification of business health, follow-up contact with patient, follow-up contact with employer, treatment decisions, and counseling requirements will be completed.
  6. The patient will receive personal follow-up contact by Fort Healthcare Business Health.
  7. Captain/Chief/Workman’s compensation will be notified via a information form letter advising the following
    1. Patient’s Name
    2. Any need for HBV Immunization
    3. Confirmation the patient received counseling

Limiting Exposure

Whitewater Fire/Rescue utilizes many tools to help limit and prevent exposure to BBP.  In most cases, sharps that are utilized are self-containing, where the needle is covered after use through a mechanism, such as our needles that retract into the plastic case or blood glucose needles that retract into the plastic housing.  In addition, PPE is available in all ambulances, which includes gloves (to be worn on every call), eye protection, facial masks (both surgical and N95 rated), facial mask and more.  When at nursing facilities, if the patient has a known illness, often times there will be a cart with additional PPE available, such as bootees and gowns.  All PPE should be utilized when the incident indicates usage.

When working with bodily fluids, any clothing that is infected should be sanitized by washing or discarded.  Work clothes should only be washed utilizing the facility at the station and not in a home washer, and especially not with any other clothing. In the event of an exposure to the eye, the eye should be flushed for at least 15 minutes to.

Remember – any area of the ambulance where PPE is worn, must be cleaned to prevent spreading of BBP.  When removing PPE, care should be made not to be contaminated by the PPE you are wearing.  More information on PPE and its removal can be found here.  Removed PPE should be discarded into a biohazard bag and delivered to the hospital for proper disposal.

After every call, hands should be washed regardless if patient contact was made or if gloves were worn. Food or drink should never be eaten/drank in a location where bodily fluids may be present.

More Information

More information can be found in the YouTube video posted by Boone County Fire District in Missouri.

References