Blood-borne diseases are those that can be spread through contamination by blood and other bodily fluids.  The most common are HIV/Aids, hepatitis B, hepatitis C, and viral hemorrhagic fevers. 

Blood-borne diseases can be transmitted by contact with contaminated blood, by high-risk sexual behavior or intravenous drug use. 

Because we have no way of knowing whose blood is infected or not, standard medical practice states that we should regard all blood and bodily fluids as potentially infectious.    This mind set minimizes transmission of blood-borne diseases.  Health care personnel need to be very cautious when dealing with blood or bodily fluids in labs, or clinical settings.  Extreme caution should be taken with instruments and needles during handling so as not to get poked.  Also proper disposal techniques and safety syringes or tips should be used. 

HIV is a disease spectrum of the human immune system caused by an infection with the human immunodeficiency virus (HIV).   It is also known as Human immunodeficiency virus infection or acquired immune deficiency syndrome.   HIV is spread through contaminated blood transfusions, hypodermic needles, and unprotected sexual intercourse and from mother to child during pregnancy, delivery or Breastfeeding.  HIV cannot be transmitted through saliva or tears. 

A person may have a brief experience of influenza like symptoms just after they acquire the infection followed by a period with out any symptoms.   As the infection progresses, the person becomes more and more susceptible to common infections because the infection interferes more and more with the immune system.   People are susceptible to things like tuberculosis, tumors, and various infections while their immunity is compromised.   AIDS occurs in the late stages of the infection and is characterized by an infection of the lung known as pneumocystis pneumonia, severe weight loss and a cancer called Kaposi’s sarcoma, as well as other AIDS-defining conditions. 

There is no vaccine or cure for HIV/Aids however, antiretroviral treatment can slow down the disease and possibly lead to a normal life expectancy.  The antiretroviral medications are very expensive and do have side effects.   Without any treatments, the average person survives 9-11 years after acquiring the disease.   

Hepatitis C is an infectious disease that primarily affects the liver.  It is caused by the hepatitis C virus (HCV).  Hepatitis C is primarily spread by blood-to-blood contact by intravenous drug users, blood transfusions, and poorly sterilized medical equipment. 

There are often no symptoms with Hepatitis C but with chronic infection there can be scarring of the liver, which can lead to cirrhosis appearing after many years.  Cirrhosis can lead to liver failure, liver cancer or esophageal and gastric varices (dilated veins which can hemorrhage and be life threatening). 

Hepatitis C is the leading reason for individuals to require a liver transplant, however, the virus usually recurs after the liver transplant. 

No vaccine is available for hepatitis C. 

Viral hemorrhagic fevers, also known as Haemorrhagic fevers or VHF’s , are animal and human illnesses that may be caused by 5 distinct families of RNA viruses.  The families include; Arenaviridae, Filoviradae, Bunyaviridae, Flaviviridae, and Rhabdoviridae.  The virus’ are spread by mosquito or tick bites as well as contact with infected blood or semen.  A few of the varieties can be inhaled from infected rat feces or urine. 

The symptoms of all viral hemorrhagic fevers include; fever and bleeding disorders and all can progress to very high fever, shock and death in many cases.  Some have mild illnesses (nephropathia epidemical or Hantavirus) while others are life-threatening diseases (Ebola virus).   Symptoms can take up to 21 days to develop. 

There are no treatments that exist for most viral hemorrhagic fevers other than drugs like ribavirin (Rebetol, Virazole) that help to shorten the course of some of the infections and prevent some complications.  Most people need some medical care especially to prevent dehydration and maintain electrolytes. 

It is best to avoid tick and mosquito bites especially in areas where the outbreaks of VHF’s have occurred.  Wear long pants and long shirts to with light colors and don’t go outside after dusk.   It is important to use mosquito sprays, bed nets and mosquito coils.  Also stay away from rodents and prevent them from getting into your home. 

There are several types of viral hemorrhagic fever vaccinations being developed currently but are not yet available.  There is a vaccine for the yellow fever, which is considered safe and effective but not for uses with children 9 months or younger or pregnant women.

Universal precautions are infection control guidelines followed to limit contact with blood and bodily fluids to protect people from blood borne diseases such as Hepatitis B, Hepatitis C, HIV/Aids, and viral hemorrhagic fevers.  The guidelines were put into place in 1985-88.Some of the guidelines included wearing gloves, goggles, masks, face shields and protective clothing.

Employers must ensure all employees are trained and educated in infection prevention and control regarding blood borne diseases and safe practices in the work place before they begin work.Employers must ensure employees have proper educational certification to be hired for the job as well as provide educational programs or on the job training in areas not covered in the employees training courses.

Employees need to be trained with regards to the following:

  • Hand washing
  • Vaccinations required for the job
  • How to use personal protective equipment safely
  • Preventing injuries from needle sticks and sharp instruments(never cut, clip, bend, break or recap waste needles)
  • Proper passing and receiving of instruments safely
  • Proper disposal of sharps
  • Proper disposal of biomedical waste in approved containers

For the prevention of exposure to blood borne pathogens, employers must also provide: 

  • Puncture resistant containers for sharps, needles, blades, syringes and clinical glass
  • Bio medical waste containers for removal of all blood borne pathogen waste, including sharps containers

Universal precautions should be taken when workers are exposed to blood or the following bodily fluids:

  • Serum, plasma
  • Saliva that is or could be contaminated with blood
  • Semen
  • Vaginal secretions
  • Synovial fluid (in the joints)
  • Cerebrospinal fluid (in the brain and spine)
  • Pleural fluid (in the lungs)
  • Peritoneal fluid (in the abdomen)
  • Pericardial fluid (around the heart)
  • Amniotic fluid (in the amniotic sac around an unborn baby)
  • Organs and tissues

Universal precautions do not apply with the following bodily fluids unless there is a chance they could be contaminated with blood or other pathogen containing bodily fluids: 

  • Saliva
  • Urine
  • Tears
  • Sweat
  • Nasal secretions
  • Vomitus
  • Sputum (mucus coughed up from the lower airways)
  • Feces

**Universal precautions should be applied to any bodily fluids that are contaminated with blood or when it is difficult to identify which bodily fluid it is.

For exposure to be considered significant, one of the infectious fluids listed above must come into contact with tissues in one of the following ways:

  • Percutaneous injury: needle stick or puncture/cut with a sharp object or instrument.
  • Contact with mucous membranes: splash to eyes or mouth.
  • Contact with non-intact skin: prolonged or extensive contact with exposed skin, which is chapped or scraped, with blood or other potentially infectious bodily fluids.
  • Bites resulting in exposure to either the person biting or the person being bitten.
  • Keep patient/client medical histories up to date to ensure you are current with possible blood born pathogens and transmissions
  • Treat all clients as high risk.

Use proper hand washing techniques

  1. Use warm water not hot water
  2. Use enough antimicrobial soap to achieve a lather
  3. Rub vigorously for at least 15 seconds
  4. Ensure all surfaces of the hands are scrubbed including the fingers and fingertips. 
  5. Rinse thoroughly under running water
  6. Dry thoroughly with a disposable paper towel.

Do not wear jewelry or prosthetic nails.

  1. Keep nails short and with smooth edges both for cleanliness and to prevent glove punctures. 
  2. Jewelry interferes with proper hand washing techniques and can puncture gloves as well.
  3. Do not wear artificial nails.

Use Barriers to protect mucous membranes of the eyes, nose and mouth:

  1. Gloves
    1. Patient care gloves should be worn with each patient and changed between patients
    2. Gloves should be changed right after use with a patient and then hands should be washed immediately to avoid any transfer of microorganisms.
    3. If gloves are torn, cut or punctured they should be changed immediately and hands washed before re-gloving.
    4. Sterile surgical gloves should be worn during oral surgeries
    5. Never wash, disinfect or sterilize patient or surgical gloves for reuse
    6. Utility clean up gloves should be worn for clean up and disinfecting.  Use the appropriate chemical and puncture resistant utility gloves
  2. Protective eye wear/face shields
    1. Protects the eyes, nose and mouth from splattering blood or bodily fluids during procedures
    2. Clean with soap and water and with disinfectant wipes or sprays between each patient. 
    3. Be careful what kind of sprays or solutions are used as some can ruin the eyeglass part of the protective eyewear/shields and make them blurry.
  3. Masks
    1. Protects the nose and mouth from splattering blood and saliva
    2. Change masks between patients or even during treatment if the mask becomes wet
  4. Gowns
    1. Protective clothing is worn over street clothes or in place of street clothes to protect them from contamination.
    2. Protective clothing can be reusable or disposable gowns, lab coats or uniforms.
    3. Reusable clothing should be laundered daily. 
    4. Laundry contaminated with blood or other infectious bodily fluids should be changed between each patient and laundered in office or taken away in appropriate bags to be laundered off site. 
    5. Protective clothing should also be changed immediately if it is visibly soiled or wet with blood or infectious bodily fluids.
  5. Shoe covers
    1. Shoe cover can be worn to protect shoes from blood and bodily fluid splatters onto the shoes
    2. Street shoes should not be worn as work shoes.

    **Protective barriers should be removed prior to leaving the operatory or work area to limit the spread of contamination.

 

Other Protective Gear

 

    1. Protective needle caps
    2. Heavy duty utility clean up gloves
    3. Long handled scrubbing brushes
    4. Instrument washing machines or ultrasonic machine

 

Sterilization of instruments

  1. Wash and scrub all instruments and equipment before sterilization with warm soapy water or in an ultrasonic cleaner machine.   (A long handled steel scrubbing brush for manual cleaning)
  2. Ensure all visible blood and materials are removed
  3. Wash with warm soapy water and then disinfect anything that cannot go into the sterilizers; hand mirrors, lamps, etc.
  4. Use properly working sterilizers to ensure instruments are clean and sterile and will not transmit pathogens patient to patient or to the health care worker.

Follow Blood and Bodily Fluid Spills Protocols

  1. Use barriers; gloves, protective eye wear and mask
  2. Clean up with disposable materials like paper towel
  3. Use antimicrobial cleaners or bleach to clean the area
  4. Dispose of the biomedical waste appropriately in tightly sealed bags
  5. Dispose of the biomedical waste into appropriate medical and biohazardous materials containers or other approved containers.

Follow disposal of blood and bodily fluid protocols

  1. Dispose of all sharps into the appropriate puncture resistant sharps containers.  Seal it up properly and dispose of it accordingly in an approved biomedical container.
  2. Ensure all garbage bags are sealed up tight
  3. Dispose of all biomedical waste into appropriate medical and bio hazardous materials containers or other approved containers. 

**Biomedical waste including all sharps containers cannot be put into regular garbage containers.  Call “Waste Management” in the yellow pages to have the proper secure disposal containers provided.

Biomedical waste may be in a solid or liquid form. Infectious waste includes discarded blood, sharps, microbiological cultures and stocks, body parts, human or animal tissue, used bandages and dressings, discarded gloves, other medical supplies that may have been in contact with blood and body fluids, and laboratory waste.   Waste sharps include potentially contaminated needles,scalpels, lancets and other instruments capable of penetrating skin.

Dental waste includes all of the biomedical waste as well as:

  • Suturing materials
  • Hand piece burs
  • Endodontic files and instruments
  • Ortho bands and ligatures
  • Sharp old or broken dental instruments

**Many of which should be placed into puncture resistant sharps containers.

Have written procedures and actions ready in advance in the office

  1. Ensure everyone is aware of what they need to do
  2. Have key names and phone numbers available in case of exposure
  3. Have First aid supplies ready and in a place everyone is aware of 

Ensure everyone knows their roles

  1. Who will give immediate medical evaluation and intervention
  2. Who is the qualified person that will determine if post-exposure prophylaxis is required? 
  3. Who will decide if the doctor should be called to decide if post-exposure prophylaxis or other medications are needed?

Start immediate first aid and evaluation procedures

  1. Needle Stick, puncture with a sharp instrument or contact with non-intact skin (exposed lesion)
    1. Wash area with soap and warm water
    2. Do not squeeze the wound or cut
    3. Do not wash the affected area with antiseptics or bleach
  2. Splash into eyes, nose or mouth
    1. Use water to flush splashed blood or bodily fluids from the nose, or mouth. 
    2. Wash both eyes with a steady stream of clean water, saltwater solution (saline) or sterile irritant ensuring
    3. If only one eye was splashed ensure the water runs from the clean eye into the contaminated eye so you don’t contaminate both eyes.
  3. Call the doctor right away if necessary 
    1. In some cases, medicine may be recommended and should be started right away.

Obtain consent from the exposed worker and source patient about their infection and immune status.

Document all necessary information

Keep a log of potentially contaminated needle stick and sharps injuries.  It should be done ensuring secure, confidentiality and respect to the exposed workers or persons.  It should include:

  1. The type of device or instrument involved in the incident
  2. The department or work area the incident occurred in
  3. An explanation of how the expose occurred, including:
    1. Location and time of the event
    2. What happened
    3. Control measures in place at the time,
    4. Work practices and procedures that were followed
    5. What personal protective equipment was used at the time
    6. A history of the training the worker had been provided.

Do source and worker testing, if necessary.  Patient consent is required to do testing unless it is judged to be mandatory under the Saskatchewan Mandatory Testing and Disclosure (Bodily Substances) Act.

Confidential post-exposure counseling

Ensure patient and source confidentiality

Obtain consent from the exposed worker/client to do some antibody serologic testing, baseline and follow up, for hepatitis B, Hepatitis C, HIV/Aids, viral hemorrhagic fevers and liver function testing.

Repeat the HIV test at 6 weeks, 3 months, and 6 months.

Repeat the hepatitis B and hepatitis C at 3 months, and 6 months.

It is also highly recommended that all antibody serologic testing be tested again at 12 months post exposure. 

http://en.wikipedia.org/wiki/Blood-borne_disease

http://www.healthunit.org/professionals/exposure_blood/managing-exposures-blood-borne-pathogens.pdf

http://en.wikipedia.org/wiki/Biomedical_waste

http://www.google.ca/url?sa=t&rct=j&q=&esrc=s&source=web&cd=5&ved=0CDkQFjAE&url=http%3A%2F%2Fwww.rcdso.org%2Fsave.aspx%3Fid%3Dab90c89d-dcf4-4a2c-9a8a-bb91a316b6a0&ei=FaulVJ36FIq4oQTOv4CwDw&usg=AFQjCNEmgwBQq1wh1PywgncrQH72srXmwg&bvm=bv.82001339,d.cGU

http://en.wikipedia.org/wiki/Blood-borne_disease

http://en.wikipedia.org/wiki/Immunization

http://en.wikipedia.org/wiki/HIV/AIDS

http://en.wikipedia.org/wiki/Hepatitis_C

http://en.wikipedia.org/wiki/Viral_hemorrhagic_fever

http://www.mayoclinic.org/diseases-conditions/viral-hemorrhagic-fevers/basics/causes/con-20028631

http://www.health.gov.sk.ca/immunization-manual

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Saskatchewan Dental Assistants’ Association
P.O. Box 294 Kenaston SK S0G 2N0
T 306.252.2769 | F 306.252.2089
E sdaa@sasktel.net