Bloodborne Infections

What are • Bloodborne

pathogens (BBPs) are
Bloodborne pathogenic
microorganisms that

Pathogens?

Snohomish Health District

are present in human
blood and can cause
diseases in humans.
Bloodborne Pathogen Transmission

Bloodborne pathogens are transmitted through contact with infected human blood
and other body fluids such as
Semen
Vaginal secretions
Cerebrospinal fluid
Synovial fluid
Pleural fluid
Peritoneal fluid
Amniotic fluid
Saliva
 Bloodborne infections

 Infections that can be transmitted through contact with infected

blood, or OPIM
 Capable of causing serious infections and death
 The most common are; HIV, HBV and HCV
 Viruses which attacks the liver
 Liver performs many functions vital to life
 Blood reservoir, blood filter, carbohydrate, fat, protein
metabolism, storage of vitamins, iron, etc.
 Healthcare providers; first aid responders, nurses, doctors are more
at risk
 Potentially Infectious Materials
 Any visibly contaminated body
fluid
 Blood (human)  Any body fluid where
 Semen differentiation is difficult

 Vaginal secretions
 Any unfixed tissue or organ

 Cerebrospinal fluid
 Aqueous and vitreous humors in
the eyes
 Pleural fluid
 Pericardial fluid
 Peritoneal fluid
 Amniotic fluid
 Saliva in dental proc.
 Signs/Symptoms
Bloodborne Infections
BBP Diseases

Hepatitis B (HBV) Flu Hepatitis C (HCV) HIV

like symptoms Flu-like symptoms Fatigue/Night Sweats
Fatigue/Fever Diarrhea/Weight Loss
Weight Loss/Diarrhea Opportunistic Infections

HBV and HCV affect the HIV affects

liver by causing the immune
inflammation system
 TRANSMISSION OF BBI

May be transmitted in:

• Blood Body fluids
• Breaks in the skin
• Broken glass or sharp metal contaminated with blood or body
fluids
• Needles contaminated with blood or body fluids Touching
contaminated objects than touching ones
• mouth, nose, eyes
Mucous
Membranes
Bloodborne pathogens may also be
transmitted through the mucous
membranes of the
 Eyes

 Nose

 Mouth
 9

Bloodborne Diseases
 Hepatitis B (HBV) 10

Snohomish Health District

• Hepatitis means “inflammation of the liver”
• Primarily transmitted through “blood-to- blood”
contact
• May lead to serious liver conditions such as cirrhosis or
liver cancer
• Virus can survive in the environment for 1 week or
longer
 Hepatitis B
 Hepatitis B is a disease of the liver caused by infection with the hepatitis B virus (HBV)
 Infection occurs when blood or body fluids from an infected person enters the body of a person who is
not immune 
 HBV is spread through:
 Sex with an infected person without using a condom (the efficacy of latex condoms in preventing infection
with HBV is unknown, but their proper use may reduce transmission)
 Sharing drugs, needles, or "works" when "shooting" drugs
 Exposure to blood and body fluids on the job
 From an infected mother to her baby during birth
 Hepatitis B (HBV) 1
2

07/31/2023
 "There is no "cure" or specific treatment for HBV, but many people who contract
the disease will develop antibodies which help them get over the infection and
protect them from getting it again. It is important to note, however, that there are
different kinds of hepatitis, so infection with HBV will not stop someone from
getting another type.
 Hepatitis B Virus
 Once in blood, transported to liver, where it infects liver cells
 Incubation period (time from exposure to onset of symptoms) , about 2 weeks
to 6 months.
 Virus spread in the liver, causing acute hepatitis, chronic hepatitis and liver cancers
 Likelihood of chronic infections is inversely related to age
 Chronic infections occur in 90% of infected neonates, 25 % of under-fives and 5% in adults
 Presence of viral protein in the blood is a useful marker of infection
 Phases of HBV 14

Snohomish Health District

• Acute phase – time when a person becomes
infected and for a few weeks to several months
later
• Chronic phase – while some individuals recover
after the acute phase, others remain infected for
the rest of their lives. 2-6% of adults who contract
hepatitis B become chronic carriers.
 1
5

07/31/2023
 The symptoms of HBV are very much like a mild "flu".
 Initially there is a sense of fatigue, possible stomach pain, loss of appetite, and even nausea. As the
disease continues to develop, jaundice (a distinct yellowing of the skin and eyes), and a darkened urine
will often occur.
 However, people who are infected with HBV will often show no symptoms for some time.
 After exposure it can take 1-9 months before symptoms become noticeable. Loss of appetite and
stomach pain, for example, commonly appear within 1-3 months, but can occur as soon as 2 weeks or
as long as 6-9 months after infection.
HBV Transmission
Outside the Workplace

 Unprotected sex
 Intravenous drug
use
(sharing needles)
 Blood transfusions
 HBV Symptoms

About 50 to 60% of people infected with HBV will show symptoms, but even
without symptoms, infected people are still infectious to others
 Mild flu-like symptoms
 Fatigue
 Weakness
 Nausea
 Abdominal pain
 Headache
 Fever
 Possible jaundice
 Darkened urine
 Exposure to HBV

 Percutaneous injury; eg needle stick or cut with sharp object

 Contact of body fluids with mucous membranes
 HBV Vaccine

 HBV infections can be prevented by vaccine

 HBV vaccine is a series of three shots given at day 0, one month and 6 months from day 0
 After the series is complete a blood test will be done to confirm that antibodies have formed to
protect you from the virus
 The vaccine stimulate the bodies immune system to produce antibodies against HBV
 All persons at risk of exposure are required to get HBV vaccine
 Hepatitis C Virus (HCV) 20

Snohomish Health District

• Primarily spread by exposure to infected blood
• Incubation period ranges from 2 weeks to 6 months, most
commonly 6-9 weeks
• Prevalent worldwide
Hepatitis C
 Hepatitis C infection is the leading indication for liver transplant
 Symptoms
 Jaundice
 Fatigue
 Dark urine
 Abdominal pain 
 Loss of appetite
 Nausea
 80% of infected persons have no signs or symptoms
 WHO’s goal is to eliminate viral hepatitis as a
major public health problem by 2030

million infections (in 2015) 6-10 million deaths (in 2015) to 1.34
to 900,000 infections (by 2030) under 500,000 deaths (by 2030)
Only 21% of estimated 58 million people with chronic
HCV infection were diagnosed in 2019 with variation
by regions

Source: Global progress report on HIV, viral hepatitis and sexually transmitted infections, 2021
 Hepatitis C (Continued)

 HCV has the ability to mutate, thus currently there is no

vaccine products to prevent transmission.
 Primary mode of infection for occupational exposure
would be through contact with contaminated blood.
 Average incubation period is 6 - 7 weeks with a range of
2 -16 weeks.
Hepatitis C (Continued)

 Since there is no protective antibody response identified, no one is immune to HCV.

 Chronic liver disease develops in about 85% of persons infected with HCV.
 20% of the chronically infected progress to cirrhosis and liver cancer.
 Symptoms may take decades to show.
Cirrhosis of the Liver
 Pathogenesis

 Transported to liver by blood, infects liver cells

 Incubation period from 2 to 26 weeks
 Acute infections usually asymptomatic, can resolve in 2 to 12 weeks
 Diagnosis by detection of antibodies or viral RNA
 55% of patient progress to chronic infections, can result in cirrhosis and liver cancer
 If progressing to chronic infection, most complaint is fatigue
Symptoms of HCV infections

Approximately 70% to 80% people infected with HCV are asymptomatic

Symptoms include the following;
 Fever
 Fatigue
 Loss of appetite
 Nausea
 Vomiting
 Abdominal pains, jaundice, dark urine
 Human Immunodeficiency Virus
 Progress summary

 In 2019 over 95% of people living with HIV knew their status in 2019. However, knowledge of
status among men (88%) , young people 15 - 24 years (70%) with young men at 54% and young
women at 78%. Adult ART Coverage among People Living HIV stands at 84%, males at 70%
and females at 93% . Viral load suppression among people living with HIV stood at 79% and
96% among those on ART. In 2019, the Government announced a policy shift to extend free ART
to non-citizens to close a significant gap in the country’s response to the epidemic. This will
further improve ART Coverage and the number of People with suppressed Viral Loads. The
Government has adopted the WHO recommendation to move patients to TLD (Dolutegravir +
Lamivudine + Tenofovir) as a cost effectiveness measure
HIV testing and treatment cascade, Botswana (2019)

Source: Spectrum file

Scope of the HIV/AIDS pandemic 31

 HIV/AIDS affects every region of the world.

 Millions of people are infected with HIV or live in families affected by HIV.
 More than 90% of people living with HIV/AIDS are in the developing world.
 95% of all HIV-related deaths are in the developing world, largely among young adults.
 The number of new infections continues to grow.
Adults and Children Estimated 32
to be Living with HIV in 2020
Epidemiology of HIV in Botswana 33
Regional HIV/AIDS Statistics

 Estimates of HIV prevalence in a country are often

based on HIV prevalence in antenatal (ANC) clinics
 Botswana is one of the countries most severely
affected by HIV
 In Botswana,33.4% (2005) of pregnant women in ANC are HIV-infected
 With PMTCT interventions; less than 4% born with HIV
What is HIV? 34

H: Human
I: Immunodeficiency
V: Virus
 What is HIV? (Continued) 35

 HIV is a virus that attacks the immune system

of people it infects.
 HIV replicates and kills white blood cells, called CD4+
cells.
 When the immune system is weakened by HIV, the illness
progresses to AIDS.
 HIV
 Human immunodeficiency virus
 Infection occurs when blood or body fluids from an infected person enters the body of a person who
is not infected 
 HIV is spread through:
 Sex with an infected person without using a condom (the efficacy of latex condoms in
preventing infection with HIV is unknown, but their proper use may reduce transmission)
 Sharing drugs, needles, or "works" when "shooting" drugs
 Exposure to blood and body fluids on the job
 From an infected mother to her baby when she is pregnant, when she delivers the baby, or if she
breast-feeds her baby
 Leads to the disease AIDS
 Destroys the immune system
 Routes of Transmission 37

HIV may be transmitted through contact with infected body fluids:

 Sexual transmission
 Sharing contaminated needles
 Needle stick injuries
 Blood-to-blood transmission
 Vertical and horizontal transmission (mother-to-child transmission)
.

 .
 What does a HIV Test Mean? 39

Positive Negative
+ -
No HIV antibody found.
• HIV antibody found.
•

• May not have HIV (consider the window

• Havethe virus and can period).
• Retest in three months.
pass to others.
• Need
to begin treatment
immediately.
 40

What is AIDS?
A: Acquired
I: Immune
D: Deficiency
S: Syndrome
 HIV Symptoms

 Symptoms of HIV infection can vary, but often include:

Weakness
Fever
Sore throat
Nausea
Headaches
Diarrhea
White coating on tongue
Weight loss
 What is AIDS? (Continued) 42

 AIDS is a syndrome or group of infections that attack the

body when the immune system is weak.
 Infections that characterize AIDS are called opportunistic
infections (OI).
 A diagnosis of AIDS is made based on clinical symptoms
or specific blood tests.
What Fluids Can Transmit HIV?
43

Blood
Rectal fluids
Semen
Vaginal fluids
Breast Milk
 Viral Load & CD4 Count 44

CD4 (T4) Count

Number of white blood cells
in the blood

Viral Load
Amount of HIV in the blood
Window Period
45

The period of time after someone may have been

exposed to HIV, but before a test can detect it (up to
3 months).

*IMMEDIATELY
INFECTIOUS*
 HIV/AIDS Symptoms

Many people who are

You cannot rely on The only way to know
infected with HIV do
symptoms to know if you are infected is to
not have any
whether or not you are be tested for HIV
symptoms at all for 10
infected infection
years or more

You also cannot rely The symptoms of

on symptoms to AIDS are similar to the
establish that a person symptoms of many
has AIDS other illnesses
Difference between HIV and AIDS 47

HIV Infection:
 Individual may show no signs of illness.
 Most people with HIV infection will develop AIDS.
 Progression to AIDS can take several months to more than 15 years
AIDS:
 Diagnosis of AIDS is based on specific clinical criteria and laboratory tests.
 Characterized by serious illnesses including opportunistic infections
 Four Stages of HIV Infection 48

1. Seroconversion: HIV exposure and infection occurs, antibodies develop

2. Asymptomatic: No clinical symptoms of HIV infection, viral replication controlled by
immune system
3. Symptomatic: Clinical symptoms of HIV infection, varying degrees of immune suppression
4. AIDS: Opportunistic infection(s), most advanced stage of HIV infection
Natural History of HIV Infection

DR. S.K CHATURVEDI

 Opportunistic Infections associated
with AIDS

Bacterial
 Tuberculosis (TB)
 Pneumocystis pneumonia

Viral
 Kaposi Sarcoma-purple-red blotches on the skin
 Influenza (flu)
 Severity of Illness 51

The following Blood tests can monitor the progression of HIV infection
Viral load:
 Amount of HIV in the blood
 Increases as the HIV replicates
 Used to monitor disease progression
CD4 count:
 Amount of CD4 cells in the blood.
 Declines as HIV infection progresses
 Used to monitor immune suppression
 HIV Infection and Seroconversion 52

 HIV-infected: HIV has entered the body

 HIV-positive: Blood test detects HIV antibodies in the blood, and determines that individual
is infected with HIV
 The window period is the time between when a person is actually infected with HIV and
when antibodies to HIV can be detected by an HIV test.
 A test may not detect HIV during this period, but the virus can still be transmitted .
 HIV Disease
 Severityof illness is determined by amount of virus in

DR. S.K CHATURVEDI

the body (increasing viral load) and the degree of
immune suppression (decreasing CD4+ counts)
 Higher the viral load, the sooner immune suppression
occurs
 Progression of HIV Infection

DR. S.K CHATURVEDI

 HIGH viral load (number of copies of HIV in the
blood)

 LOW CD4 count (type of white blood cell)

 Increasing clinical symptoms (such as opportunistic

infections)
HIV Disease

DR. S.K CHATURVEDI

Direct infection of organ systems
• HIV can directly infect the:
• Brain (HIV dementia)
• Gut (wasting)
• Heart (cardiomyopathy)
 HIV Disease: Summary

DR. S.K CHATURVEDI

• HIV multiplies inside the CD4+ cells, destroying them
• As CD4+ cell count decreases and viral load increases,
the immune defences are weakened
• HIV-infected people become vulnerable to opportunistic
infections
• HIV is a chronic viral infection with no known cure
• Without ARV treatment, HIV progresses to symptomatic
disease and AIDS
Transmission cntd

HIV does not reproduce outside the human body, therefore cannot be transmitted through;

 Saliva, tears, sweat

 Insects bites including mosquitoes
 Air or water
 Casual contact like shaking hands or sharing dishes
 Closed mouth or “social” kissing
Symptoms of HIV infection 58

 Some people may become asymptomatic, but there are still infectious!
 Many people do not know they are infected until they become symptomatic.
 HIV can be transmitted during every stage, even when a person has no symptoms and feels
well.
 There is an increased risk of transmission when the viral load is high
 Progression of HIV Infection 59

 Opportunistic Infections (OIs)

 Develop as HIV weakens the immune system.
 Do not cause disease in people with healthy immune systems.
 Caused by various organisms like bacteria and viruses
 Can affect the lungs, brain, eyes, and other organs.
 Leads to a diagnosis of AIDS
 Antiretroviral (ARV) drugs can slow replication
of the virus, and delay onset of AIDS.
 Opportunistic Infections 60

AIDS-defining conditions:
 Tuberculosis (TB)
Leading cause of death among people with AIDS in Botswana
 Candidiasis
 Kaposi’s sarcoma
 Pneumocystis jiroveci pneumonia (PCP)
Leading cause of death among infants with AIDS in Botswana
 Disease Comparison

 Of the three Bloodborne infections, HBV is the most contagious

 33% of individuals exposed to HBV will become infected
 While 2% of individuals exposed to HCV will get infected
 Of the three; HIV is the least contagious
 1/300 or 0.33% of people exposed to HIV will get infected

NB: Every exposure has the potential to transmit the virus

 PrEP 62

Pre-Exposure Prophylaxis (PrEP): daily medicine can prevent HIV

from making copies of itself in the body.

 PrEP is only prescribed for people who are HIV-negative and who are at
ongoing substantial risk of getting HIV.

 PrEP reduces the risk of getting HIV when taken consistently:

 by about 99% through sex
 at least 74% among People Who Inject Drugs (PWID)
 PEP 63

Post-Exposure Prophylaxis (PEP): a 28-day regimen of HIV medicine, started

within 72 hours, of possible exposure to HIV to prevent the virus from making
copies of itself in the body.
 PEP is only prescribed for HIV-negative individuals who believe they were
exposed to HIV, such as, during sex, shared needles (works), or were sexually
assaulted.
 PEP is effective in preventing HIV, but not 100%.
 Every time use condoms.
 Always use safe injection practices.
Prevention of BBI

 The Exposure Control Plan

 This is a health and safety plan designed to prevent exposure to BBI
 The plan should be included in the health and safety policy of each workplace
Methods of
Compliance
 Training
of
Employees

Work
Universal
Practice
Precautions
Controls

Employee
Protection
Vaccines
Engineering
Where
Controls
Possible

Personal
Administrative
Protective
Controls
Equipment
 Observe Universal Precautions

 Infection control guidelines designed to protect workers from exposure to diseases

spread by blood and certain body fluids.
 All persons should be assumed to be infectious for bloodborne diseases such as
AIDS and hepatitis B.
 Universal Precautions
 Wash hands before and after
all inmate or specimen
contact
 Treat the blood of all persons
as potentially infectious
 Treat all linen soiled with
blood or body secretions as
potentially infectious
 Wear gloves if contact with
blood or body fluids is
possible
 Immediately place used
syringes in a nearby
impermeable container; do
not recap or manipulate
needles or sharps in any way
 Wear protective eyewear and
mask if splatter with blood or
body fluids is possible
 Wear a mask if there is a risk
of infection by TB or other
airborne organisms
Personal Protective Equipment
 Types of PPE
70

Snohomish Health District

Gloves Face masks

Eye Lab coats Disposable

protection coveralls
Personal Protective Equipment (PPE)

 PPE provides protection against exposure to infectious materials and must be

routinely used when contact with blood or body fluids is anticipated
 Selection of PPE is task oriented
 PPE is appropriate when under normal conditions it prevents blood and body
fluids from reaching an employee’s
 work clothes, street clothes, undergarments
 skin, mouth, eyes, other mucus membranes
Examples of PPE
 Gloves
 Gowns, aprons, sleeves
 Laboratory coats
 Face shields or masks
 Eye protection
 Mouthpieces
 Resuscitation bags, pocket masks
 Foot protection
Gloves

Gloves should be made of latex, nitril, rubber, or other water impervious material

Inspect gloves before use

Double gloving can provide an additional layer of protection

If you have cuts or sores on your hands, you should cover these with a bandage or similar
protection as an additional precaution before donning your gloves

Don’t touch the outside of used gloves

Removing Contaminated Gloves

 PINCH one glove back by the cuff until it comes off inside out.
 Discard or cup in the palm of your gloved hand.
Removing Contaminated Gloves

HOOK a finger of your bare hand inside the cuff of the remaining glove
PULL BACK so this glove also comes off inside-out with the first glove
tucked inside it
WASH HANDS!
Rules to Follow

 Treat all blood or potentially infectious body fluids as if they are contaminated
 Always wear personal protective equipment in exposure situations
 Replace PPE that is torn or punctured
 Remove PPE before leaving work area
 Properly disinfect or dispose of used PPE
 Wash hands immediately after removing PPE
Hand Washing Technique
 Wash Hands

 When visibly soiled

 After using the bathroom
 After removing gloves
 After blowing your nose
 After sneezing in your hands
 Before and after eating, handling
food, drinking or smoking
Technique for Hand Washing

 Remove rings and watches before washing

 If hands-free dispenser is not available, dispense paper towels before washing
 Hand should be positioned lower than the arms to avoid contamination
Decontamination
Procedures
Decontamination & Sterilization

All surfaces, tools, equipment and other objects that come in

contact with blood or potentially infectious materials must be
decontaminated and sterilized as soon as possible.

Equipment and tools must be cleaned and decontaminated before

servicing or being put back to use
Decontamination

Solution of 5.25%
Diluted between 1:10
sodium hypochlorite
and 1:100 with water
(household bleach)