Program 2011 Biological Safety Office Environmental Health amp Safety wwwehsufledu 3523921591 bsoehsufledu Sharon Judge PhD Assistant Biosafety Officer Portions of this presentation were edited and adapted for clinical dentistry applications at UFCD by the Office of Clinic ID: 783362
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Slide1
UF Bloodborne Pathogen Training Program 2011
*Biological Safety OfficeEnvironmental Health & Safetywww.ehs.ufl.edu352-392-1591bso@ehs.ufl.edu
Sharon Judge, PhD
Assistant Biosafety Officer
*Portions of this presentation were edited and adapted for clinical dentistry applications at UFCD by the Office of Clinic Administration.OSHA requires that printed copy of this training be maintained in the clinic.
Slide22Bloodborne Pathogens (BBPs) ?
Pathogenic microorganisms present in blood or other potentially infectious material (OPIM)that are able to cause disease in humans. These pathogens include: Hepatitis B virus (HBV)Human immunodeficiency virus (HIV) Hepatitis C virus (HCV) Less Common disease agents such as Epstein-Barr virus (EBV), human T cell lymphoma virus (HTLV-1), malaria, syphilis,
babesiosis, brucellosis, leptospirosis,
arboviral diseases (WNV, EEE), Creutzfeldt-jacob disease, rabies, etc
Slide33BBP Standard
Implemented in 1991 by the Occupational Safety & Health Administration (OSHA) 29 CFR1910.1030 http://www.osha.gov/pls/oshaweb/owadisp.show_document?p_table=STANDARDS&p_id=10051Revised in 2001 – Safe sharps devices, maintain a log of injuries from contaminated sharps.UF follows OSHA requirement
General and workplace-specific trainingCompleted
BEFORE individual is assigned to tasks with the potential for BBP exposure and ANNUALLY thereafter
Slide44BBP Standard:In addition to training, individuals with potential exposure must also have the following:
Access to the regulatory text – required to print a copy for the work (clinic) area http://www.osha.gov/pls/oshaweb/owadisp.show_document?p_table=STANDARDS&p_id=10051And an explanation of it’s contentsA copy of the training material is adequateAccess to a copy of the UF Exposure Control Planhttp://www.ehs.ufl.edu/Bio/BBP/ECP2010.pdf
Access to any site-specific standard operating procedures (SOPs)http://www.ehs.ufl.edu/Bio/BBP/BBPSOPS.pdf
Slide55The OSHA BBP Standard
Scope & applicationDefinitionsExposure control, exposure control plan, & exposure determination by jobs/tasksComplianceEngineering and work practice controlsPersonal Protective Equipment (PPE)
HousekeepingRegulated waste and sharps
HIV/HBV research labs – held to a higher standardHBV vaccination and Post-exposure prophylaxis (PEP)
Communication to employees – signs, labels, trainingRecord keeping
Slide66UF BBP Program http://www.ehs.ufl.edu/Bio/BBP/default.htm
Chairs/Directors : ensure department’s complianceFaculty/Supervisors : have an exposure control plan in place that is appropriate & being followedEmployees, students, volunteers, etc: follow exposure control plan, report problems/exposuresSHCC/Employee Health: immunizations & post-exposure follow-upEH&S Biosafety: develop & coordinate UF program, track participants
Slide77Who at UF is enrolled in the program?
Custodians, medical providers, dentists/dental staff, autopsy staff, clinical laboratory staff, research lab staff & students, biomedical engineers, athletic trainers, event staff, police, emergency responders, physical plant workers,…..etcALL employees, staff, students, volunteers, affiliates with potential exposure to bloodborne pathogens (BBP) from human blood / other potentially infectious material (OPIM)
Slide8What constitutes OPIM?YESNO
* unless visibly contaminated with bloodCerebrospinal fluidTearsSynovial fluidFecesPeritoneal fluidUrinePericardial fluid
Nasal secretionsPleural fluid
SputumSemen/Vaginal secretions
SweatSalivaVomitBreast milk
Amniotic
fluid
Slide9How are BBPs commonlytransmitted at work?Cuts or punctures
with contaminated sharp objectsSplashes to mucous membranes (linings of eyes, nose, & mouth) Your mucous membranes are permeable, allow pathogens to pass throughContamination of broken or non-intact or skin (wounds, chapped skin, rashes)
Slide10UF Exposures (2008-2010) Note: 2010 Increase in sharps and splash exposures
Slide112010 Reported Sharps Exposures by DepartmentDentistry reported 10 exposures
Slide1212Cornerstone of exposure prevention“STANDARD PRECAUTIONS”
Any and all human blood or other potentially infectious material (OPIM) is treated as INFECTIOUSUse:Safety equipmentEngineering ControlsSafe practicesPersonal Protective Equipment (PPE)
To protect yourself & others in the work environment
“Standard Precautions” is an alternate, clinical / hospital term = Universal Precautions + “body substance isolation” (standard of care for all patients, all body fluids)
Slide1313What to treat with STANDARDPRECAUTIONS:
Any human blood or OPIM …..&…..objects/items that may be contaminated by blood or OPIMAny unfixed tissue or organ, other than intact skin, from a living or dead person Cell or tissue cultures that may contain BBP agents Blood/ tissues from animals infected with BBP agents
Slide14Use Universal Precautions for all human cell linesATCC started testing newly manufactured/deposited cell lines for common viral pathogens (HIV, HepB, HepC, HPV, EBV, and CMV) in January 2010
Many infectious agents yet to be discovered and for which there is no test Remember HIV?What about XMRV?Research using human cell lines…
Slide15Spread through direct contact with infected body fluids (blood, semen, vaginal fluids)More transmissible than Hep C virus and HIV Infection may be acute or chronic
~4.3-5.6% of Americans have been infected with HepB5-10 % of adults will develop chronic infection; ~1.2 million people with chronic HBV15-25% develop cirrhosis , liver failure, or liver cancer (~ 3000 deaths/year)Many people (~50%) are asymptomatic; if symptoms occur they include:Hepatitis B (HepB, HBV)
Fever
Abdominal
pain
Fatigue
Loss
of appetite
Nausea
Vomiting
Jaundice
Joint pain
Dark
urine
Slide1616Occupational Hepatitis B ExposuresNeedle sticks
a real concern… 30% of susceptible/non-vaccinated individuals exposed to infected blood this way became infectedCan be transmitted by surface contact with dried blood or OPIM! HBV can remain infective in dried blood @ room temperature for at least 1 week (MacCannell et al., Clin Liver Dis 2010; 14:23-26)Many people have no idea how they became infectedRisk of infection from blood/OPIM splash onto non-intact skin or mucous membranes… greater risk than other BBPs
Slide1717How to prevent Hepatitis B infections at workGet vaccinated
!Use Standard PrecautionsCleaning/disinfection is important because the virus can survive on surfacesOSHA BBP standard requires that employees with potential exposure be offered the vaccine at no cost.
Occupational infections have decreased 95% since HepB vaccine became available in 1982
Slide18SafeGiven to newborns, 120 million people in U.S. have received at least one doseEffective >95% develop immunity after full series (3 doses given at 0, 1, 6 months)
In Gainesville, free to employees @UF SHCC (392-0627)Bring completed Acceptance/Declination statement with you http://www.ehs.ufl.edu/Bio/BBP/TNV.pdf If you decline, can change mind at any timeHepB Vaccine
NOTE: Decline in children and adolescents since implementation of childhood vaccinations.
Slide19Health-care workers or public safety workers at high risk for continued percutaneous or mucosal exposure to blood or body fluids, HBV research lab workersPerformed 1-2 months after dose #3 for recently
vaccinated individualsHepB surface antibody (anti-HBs) ≥ 10 mIU/mL - immuneAnti-HBs < 10 mIU/mL – revaccinate (3 doses) and retest anti-HBsStill negative – non-responder, need HBIG after exposurePreviously vaccinated but not tested? Test for anti-HBs after an exposure; if negative, treat as susceptible.
Post-vaccination testing
Slide20Transmitted primarily through contact with infected bloodMany people asymptomatic (symptoms similar to HepB)
~1.8 % of Americans have been infected with HepC, 3.2 million chronically infected~ 12,000 deaths/yearLeading indication for liver transplant in U.S.Hepatitis C (HepC, HCV)
Slide21Percutaneous injury, esp. with deep punctures or extensive blood exposures~2% develop infection
Mucosal/non-intact skin exposures rarely documented Proper cleaning/disinfection of surfaces importantHCV in dried blood samples remains infective for at least 16 hours (Kamili et al., Infect Control Hosp Epidemiol 2007; 28:519-524)
Occupational
HepC Exposures
Slide2222How to prevent Hepatitis C infections at workUniversal Precautions for Prevention!
NO VACCINEAntivirals (interferon/ribavirin) can have serious side effects, treatment lasts 24-48 weeks
Slide2323HIVCDC: Greater than 1 million people in the United States are currently infected.
At least one-fourth of them do not know they are infected, putting them at high risk for transmitting the virus to others. The annual incidence rate of HIV/AIDS in Florida remains more than twice the national average. In 2007, Florida reported 6235 cases HIV, 3896 cases AIDS (Florida DOH HIV/AIDS Annual Report 2007).
Slide24HIV/AIDS - U.S. and Florida
> 1 million living with HIV/AIDS~56,000 new infections/year~20% don’t know they are infected
Florida ranks 3rd among states in the number of reported HIV/AIDS cases
Slide25HIV Attacks immune system destroys white blood cells (CD4+ T cells)
Leaves patient immune suppressed & susceptible to infections & certain tumorsMany people show no symptoms for a long time (years) Eventually leads to development of AIDS (acquired immune deficiency syndrome) Early symptoms very similar to flu:
Fever Headache
Tiredness Enlarged lymph nodes Treatment focuses on ways to lower blood levels of virus
Slide26Risk for HIV transmission after:Percutaneous injury – 0.3%Mucous membrane exposure – 0.09%Non-intact skin exposure – low risk (< 0.09%)
Occupational HIV Exposures57 documented occupationalinfections in U.S. (139 possible infections)84% resulted from percutaneous exposure!
Slide2727If HIV is such low risk, why worry?No cure – eventually fatal
NO VACCINESome HIV strains resistant to therapyPost-exposure therapy costly & has side effects.Cocktails of three or more antiretroviral drugs given
Slide2828How to prevent HIV infections at workStandard precautions ONLY!
Slide2929BBPs – comparing the risk of infectionRisks of becoming infected with (one of the below listed BBPs) from a needle stick accident:
HepB: 30% or 300 people per 1000 needle sticks, if unvaccinatedHepC :2% or 20 people per 1000 needle sticksHIV : 0.3% or 3 people per 1000 needle sticks
Slide3030Workplace-specific controls to protect against BBP exposureEngineering controls(Safety Equipment )Work Practices
Personal protective equipment (PPE)
Maximum protection when these controls overlap
Slide31Engineering Controls (Safety Equipment)Task specific - Examples:
Sharps boxNon-slip floorsCleanable Work Surfaces & Dental ChairsLeak-proof transport containers
Safety devices including needles/syringes and scalpels
SAFETY Sharps DEVICES as available at
http://www.healthsystem.virginia.edu/internet/epinet/safetydevice.cfm#1
Slide32Work practices ControlsSafer ways of doing things:
Pre-plan your work (unit dose)Decontamination/Disinfection of equipment and surfacesMinimize splashes Barrier covers on equipment and surfaces Proper handling of spills
Hand Hygiene
No food or drink in areas where blood or OPIM is generated/handled/ stored
Slide33Needle Safety: NEVER RECAP NEEDLES USING BOTH HANDS
Do Place needles directly into the Sharps BoxClose & replace Sharps Box when it is ¾ full Do not overfill the sharps box.Never attempt to re-open a closed Sharps Box
Slide3434When possible retract tissue with another instrument (mouth mirror
)Recapping NeedlesUse a scoop techniqueUse a cap holder if supplied on the tray
Needle Safety:
**Never leave a needle uncapped anywhere in your operating field.
Know where your needles and other sharps are—AT ALL TIMES!!!!!!!
Never use two hands when recapping - use the one-handed scoop method.
Slide3535%
Clean-up and disposalrelatedCircumstances Associated with Hollow-Bore Needle Injuries NaSH June 1995—December 2003 (n=10,239)
Slide3636EPA listed tuberculocidal disinfectant
http://www.epa.gov/oppad001/chemregindex.htmCavicide or Opticide
Follow manufacturers recommendation for contact time of surface exposure to disinfectant
A FRESHLY MADE (w/in 24 hr) solution of household bleach diluted 1:10 with water Ethanol; isopropyl alcohol products evaporate too quickly to be effective. Do not use.
Decontamination/Disinfection of equipment & surfaces: Disinfectants
Slide3737Indications for Hand Hygiene
When hands are visibly dirty, contaminated or soiled, wash with non-antimicrobial or anti-microbial soap and water.Should be washed for at least 20 seconds and dried thoroughly before donning gloves. Pay attention to areas
between fingers and around nails.
If hands are
not visibly soiled, use an alcohol based hand sanitizer for routinely decontaminating hands.
Use enough sanitizer to moisten all surfaces of the hands and rub until dry.
Less damaging to skin than soap
Use before and after wearing gloves or patient contact.
Note residue around cuticles & under watchband after thorough hand washing (using “
Glo
-Germ” )
Slide3838Employer responsibilities for PPE
: Supplied by employer - It must be available It must fit
It must be suitable to the task
Cleaned or disposed of properly
Personal Protective Equipment (PPE)
Procedure driven - Wear
it when & where you’re supposed to
PPE must
not
be worn in any common area, hallway
or
office = OSHA BBP rule
Slide39Face and EyesMask
Glasses (with side shields)GogglesFace ShieldWith maskPersonal Protective Equipment (PPE)
Site specific & appropriate to the task - Refer to area’s site specific written standard operating procedures
Body – Examples
Coats Gowns Aprons Sleeves
Head
Shoe Covers
Slide4040According to the CDC, the correct order for donning personal protective equipment is:
Cover gownFully cover torso from neck to knees , arms to end of wristMaskFit flexible band to nose bridgeFit snug to face and over chin, covering noseGoggles, safety glasses with side shield or face shieldGloves
Extend to cover wrist of cover gown
Slide4141According to the CDC, the correct order for removing personal protective equipment is:
Gloves Outside of glove is contaminated!When removing, grasp outside of glove with opposite gloved hand and peel offGoggles, safety glasses with side shield or face shieldOutside of goggles is contaminated!Remove by grasping ear piece
Cover gown
Gown front and sleeves are contaminated!Unfasten tiesPull away from neck and shoulders, touching inside of gown only
Turn gown inside out and roll into a ball then discardMaskFront of mask is contaminated – DO NOT TOUCH!Grasp bottom, then elastics and remove
Slide42Pay attention to how you remove your gloves
Grasp the top or wrist of one glove, being careful not to touch anything but the glove.
Pull the glove off, turning it inside out. Continue holding the glove.
Go under the cuff of the other glove, being careful not to touch its outside surface.
Pull the glove off, turning it inside out and pulling it over the first glove. Both gloves should now be inside out, one inside the other.
Discard both gloves into an approved waste container
.
Then wash hands or use hand sanitizer!
Slide4343REMEMBER TO USE SAFE WORK PRACTICES TO PROTECT YOURSELF AND LIMIT THE SPREAD OF CONTAMINATION
Keep hands away from faceLimit surfaces touchedChange gloves between patients, when worn/torn or heavily contaminatedPerform hand hygiene
Slide4444Store, Dispose of, or Clean PPE appropriately
Do not take PPE home to washDo not wear it out of the clinic area
Personal protective equipment (PPE
)-Other Considerations:
…Wear closed toe shoes !
Acid + Flip flops
Slide4545GLOVES
Latex Nitrile Vinyl – Not recommended - DO NOT hold up well
Do not re-use gloves
Do not wash gloves
Some chemicals (soaps, lotions, & hand sanitizers) you use may breakdown the gloves – use glove compatibility chart
Slide4646No gloves outside of the clinic!Be aware that the general public does not if know gloves are clean and assumes they are contaminated.
Slide4747Site specific Exposure Control Plan (ECP) & Standard Operating Procedures (SOPs)Equipment, practices, and personal protective equipment used AT YOUR SITE
to protect you & othersWritten down, reviewed, & updated on a regular basis – at least annuallyAccessible to allSee EH&S website for a template to make your SOPshttp://www.ehs.ufl.edu/Bio/BBP/BBPSOPS.pdf
Slide4848HIV & Hepatitis research labs…..More stringent control measuresRegistration of work with EH&SDocumented enrollment in a medical surveillance program
CDC/NIH BSL2 guidelines at a minimum
Slide49Steps to Take If An Exposure OccursWash the area very thoroughly with soap &
water: flush mucous membranes for 15 minutesNotify supervisor/facultyCall 1-866-477-6824, the Needle Stick Hotline, for exposures within 1 hour of Gainesville. Go to nearest medical facility outside of Gainesville area.
Get immediate medical attention (1-2 hr max)
Allow Medical to follow up with the appropriate testing & the required written opinion
Slide50Also for scalpel cuts, glass cuts, splashes, etc
In Gainesville Vicinity:
Slide51If material has splashed into your eyes, immediately use an emergency eyewash or another source of clean running water or saline irrigation to flush them for at least 15 minutes. Hold the eyes open and roll them around to make certain that water reaches their entire surface.
Know where the closest eyewash station is located. Staff check to verify station is in working order on a regular basis and maintain a log sheet.
Slide5252Stop the procedure, cleanse the skin with antibacterial soap or flush eyes with clean water.Injured health care worker (HCW); faculty, resident, staff or student calls the Student Health Care Center (SHCC) Needlestick
Hotline at 9-1-866-477-6824. Identify yourself as UFCD employee or student and that you’ve had an exposure. Provide information about the event as requested by SHCC.Attending dental faculty confirms permission from source patient to test for Hepatitis B, Hepatitis C and HIV at no expense to them. A written consent is signed by source patient and scanned into in dental electronic record to acknowledge that consent was obtained for testing related to occupational exposure. No further details are included.HCW and source patient go to Shands lab on 3rd floor, room 3152 for lab tests. (Lab forms will be completed by SHCC and faxed to the Shands lab.)The source patient may be verbally informed of their test results by the exposed dental HCW or attending faculty. SHCC must provide the results – as SHCC originally ordered the tests.
NOTE:
If HCW is faculty or paid resident, they should contact Workers Compensation at 392-4940 to open a claim so expenses will be covered by Workers Comp. Follow-up visits for HCW are scheduled according to SHCC guidelines.NOTE: Exposed HCWs may contact SHCC with any questions or concerns at 392-0627. Ask for Mr. Tony Mennella
.UFCD OCCUPATIONAL EXPOSURE FLOWCHART
Slide5353The Latest Post-Exposure Prophylaxis (PEP) Guidelines for Occupational Exposures to BBP are at:
http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5409a1.htm - HIV http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5011a1.htm - HIV, HBV, HCV
Post-exposure follow up must be offered by the employer, confidential, & offered at no cost to the employee
Slide54Factors considered in assessing need for PEPType of exposureType/amount
of fluid/tissueInfectious status of sourceSusceptibility of exposed personPercutaneous injury (depth, extent, device)BloodPresence of HepB surface antigen (HBsAg) and HepB e antigen (
HBeAg)HepB vaccine and vaccine response status
Mucous membrane exposureFluids containing bloodPresence of
HepC antibodyImmune statusNon-intact skin exposurePresence of HIV antibody
Bites resulting
in blood exposure to either person
CDC PEP Guidelines:
http://www.cdc.gov/mmwr/PDF/rr/rr5409.pdf
http://www.cdc.gov/mmwr/PDF/rr/rr5011.pdf
Slide55Training records: Retain a minimum of 3 yearsMedical records for immunization or post-exposure follow up:Retain for duration of employment + 30 yrs (includes HepB vaccination records, vaccination declination statement) Confidential sharps injury log (type of device involved, where and how injury occurred): Retain for 5 years from date of exposure
Record Keeping Requirements
Slide5656Questions may be directed to the Office of Clinic Administration: 352.273.6820
“Thank you for your continued efforts to comply with the OSHA and BBP standards in your daily work practices. This is the cornerstone for protecting you, your colleagues and your patients in the work place.”
Slide57Changing Topics…Biomedical Waste Training57
Slide582011 UF Biomedical Waste Training
*Biological Safety OfficeEnvironmental Health & Safety352.392.1591www.ehs.ufl.edu
bso@ehs.ufl.edu
*Portions of this presentation were edited for clinical dentistry and site-specific applications by the UFCD Office of Clinic Administration
Phone: 352.273.6820
Slide59Biomedical Waste Training
State regulations require that all employees who may have contact with BMW receive: initial training at time of hire annual refresher training Training shall cover:Identification, handling, use of protective clothing, segregation, storage, labeling, transport, procedures for decontaminating BMW spills, contingency plan for emergency transport, and procedure for containment and treatment of BMW.
Training must be facility and site specific
Training Log/roster must be kept for a minimum of 3 years Documentation of individual employee training is to be kept in their department.
Slide60Any solid or liquid waste which may present a threat of infection to humansIncludes but is not limited to:Non-liquid human tissue and body partsBlood, blood products and OPIM (as defined in OSHA BBP standard) from humans and other primatesLaboratory/clinical waste containing/contaminated with blood, tissue, cell cultures & other potentially infectious body fluids
Laboratory/veterinary wastes containing human disease-causing agentsDiscarded sharps (medical items intended to cut or puncture skin, e.g. needles, syringe/needle combinations, burs, scalpels)What is Biomedical Waste (BMW)?
Slide61Biomedical waste – specifically regulated by the State of Florida Dept. of HealthBMW is infectious for humans & a subset of biological wasteVarious regulations affect biological waste (NIH, USDA, etc)Biological waste includes rDNA, animal, & plant pathogensHazardous waste is a non-specific term. At UF, most often used to describe chemical waste or chemically-contaminated waste (pharmaceutical waste also handled as chemical waste).
Biomedical vs. Biological vs. Hazardous Waste
Slide62Used, absorbent materials saturated with blood, body fluids, or secretions/excretions contaminated with blood & absorbent materials saturated with blood or blood products that have dried (bandages, gauze, sponges, wound care material).
Non-absorbent disposable devices (needles, carpules, disposable gloves, intact glass and hard plastic, etc) contaminated with blood, body fluids, or secretions/excretions contaminated with blood but have not been sterilized or disinfected by an approved method.Extracted teeth and biopsy specimensOther contaminated solid waste which represents a significant risk of infection b/c they are generated in medical facilities which care for persons suffering from diseases requiring isolation criteria.
Examples of BMW?
Slide63Described in Chapter 64E-16 FL Administrative Code http://www.doh.state.fl.us/environment/community/biomedical/pdfs/64E16_1.pdfSegregation, handling, labeling, storage, transport & treatment are regulated. Prescribe specific:
Sanitary practicesTrainingBiomedical waste plan – provides guidance & describes requirements for proper management of biomedical waste at the generating site or facilityPermits required to generate, store, treat, & transport BMW – UF has permitInspections by the state – has ability to levy finesEnforcementState of Florida Requirements
Slide64Content of this presentation closely follows the UF Biomedical Waste Plan which is located in EH&S Biosafety Office. Contact 352-392-1591. The BMW plan for Shands UF is located in the Environmental Services Dept., Room G137 (South Tower) and Room B301.8 (North Tower). Contact 352-265-0480.Other departments at UF/Shands may create and maintain a BMW plan for their area using the following template: http://www.doh.state.fl.us/environment/community/biomedical/index.html
Biomedical Waste Plan
Slide65International biological hazard symbol on the containerThe phrase “Biomedical Waste”, “
Infectious Waste” or “Biohazardous” must be on the containerBagged waste must be in red bags.How is BMW identified?
Slide66Segregated at point of origin into its proper container“Point of origin” is the operatory, lab, patient/exam/procedure room or other area where the BMW is generatedChoices for proper BMW container:Red biowaste bagLabeled fiberboard box lined with a biowaste bagSharps container – puncture resistant container specifically designed for sharps
Segregation of BMW at UF/Shands
Slide6767Biowaste Waste MinimizationCost savings can be significant!New policy for “clean” labware – see
http://www.ehs.ufl.edu/HMM/labware.htm - cardboard box labeled “clean lab ware”The following should not be put into the biowaste box unless contaminated:*Paper *Disposable cover gowns *Packaging / wrappings *Paper towels
Slide6868For biowaste items that can cut, but are not intended to do so…
(broken glass, Pasteur pipettes, pipettes, cotton tip applicators, etc)Dispose of in a way that they can’t do harmOptions: Sharps box Sturdy box in a biohazard bag Sleeve/bundle pipettes & place in biohazard bag
Slide69Chemically or radiologically contaminated gloves, tubes, etc. do not go into a biomedical waste box. They go into their appropriate waste container.Call EH&S (352-392-1591) before putting hazardous (chemical) or radioactive warning stickers on biomedical waste containers.Remember – the biomedical waste box is not a universal disposal container! It is more expensive to dispose of than regular trash.
Segregation: Do not mix BMW with radioactive or chemical waste!
Slide70Do Not Bend or Break Needles or ScalpelsDiscard directly into a leak-proof, puncture resistant containerReplace container when ¾ fullLabel sharps container with facility’s name and address prior to offsite transport
UF lab or UFCD Clinic, date, Faculty or Principal Investigator (PI) name, room and phone #Segregate medical sharps into sharps containers
Slide71Container should be located where the sharps are used: patient operatories, procedure areas, exam rooms, lab, etc.UF uses disposable containers transported for disposal by StericycleOnly sharps should go into sharps containers
Soft items quickly overfill containers and may cause sharps to stick out of the top of the box. Sharps boxes containing items other than sharps and syringes need to be replaced ASAP, but definitely within the 30 days of first useSharps
Slide72RED autoclave bags – must meet certain documented standards of State of FL, BBP & DOTe.g. Fisher #01-828E (Medical Action Industries)
Red bags are to be available where neededNo liquid waste in red bags!Once sealed, containers must stay sealed. If container breaks or is punctured, put the whole broken container in a new one.Infectious/potentially infectious waste must be stored in a covered, leak-proof container
What do we do with non-sharp BMW?
Slide73Slide74BMW StorageBMW must be staged in an area away from general traffic & accessible only to authorized personnel. Storage area must be:Labeled with biohazard sticker
Secure (locked/non-accessible)Easily cleanable & tidyWaste cannot be stored > 30 days“The 30 day period shall commence when the first non-sharps item of biomedical waste is placed into a red bag or sharps container, or when a sharps container containing only sharps is sealed.”
Packages must be labeled as biomedical waste with the biohazard symbol, lab name, location, phone & date
Some locations stage the waste & then transport it to outdoor containers removed for disposal by a designated hauler
Slide75Wear appropriate PPE (gloves, clothing cover, safety glasses) when handling non-inactivated wasteUse Universal Precautions – assume all BMW is infectiousTransport waste in leak-proof containersKnow how to handle spills
Handling BMW
Slide76At UF: Includes UFCDLabs must furnish their own PPE and red bags (Fisher #01-828E)Sharps containers and BMW boxes are available from Building Services custodians or from AG133 at the Health Science Center (call 392-5775) or from Physical Plant Stores, Bldg 705 near the Motor Pool (call 392-1115)At Shands, staff may obtain any of the supplies by:Contacting Environmental Services at 352-265-0480 orSpeaking to an Environmental Services staff associate on the unit they are working
Supplies for Handling and Containing BMW
Slide77Transportation of BMW is provided by the following registered BMW transporter:
Stericycle, Inc.4245 Maine AveEaton Park, FL 33840407-361-5454State of Florida Permit # 53-64-00911Who Picks Up/Transports BMW for
Shands/UF?
Slide78Stericycle has a number of other sites in the state that they can pull transport equipment from to facilitate emergency situationsContingency Plan
Slide79BMW shall be treated by heat, incineration, or other equivalent method suitable for hazard inactivation acceptable to the State of Florida.Shands/UF BMW is treated by Stericycle, Inc.Autoclave which sterilizes the waste orIncineration which destroys the wasteNote: CJD BMW must be marked for incineration per hospital policy by the area that has filled the container. See ICP 03-15, Guideline for the Management of Patients with Suspected or Confirmed Creutzfeldt-Jakob Disease (CJD) or other prion disease
Treatment of BMW
Slide80At UF, all lab waste handled by UF custodial staffUF Policy:Laboratory waste containing infectious, potentially infectious, or rDNA organisms must be inactivated prior to disposalProperly performed autoclave or bleach treatment is acceptable
Storage of all non-inactivated waste in this category is restricted to within the generating laboratorySpecific requirements apply for waste containing biological toxins. Contact the Biological Safety Office at 352-392-1591Pretreatment of biological waste from UF labs prior to disposal by Stericycle
Slide81Requirements:Biological indicator testing every 40 hrs of use (every 6 mos if autoclaving non-infectious material exclusively)Log bookRegular maintenance250°F/121°C, 15-20 lb pressureLarge loads/resistant pathogens need more timeTypical bag of Biohazardous Waste =
60 minTransport BMW to autoclave in closed bag and leak-proof containerAutoclaving
Slide82Acceptable for liquid material if done correctlyAdd full strength household bleach to final concentration of 10% (5000 ppm available chlorine). Mix. Contact time should be at least 30 minutes. Pour down drain to sanitary sewer.Beware of other disinfectants = “hazardous chemicals”, harmful work with and can’t go down drain, must be picked up by EH&S
Bleach Inactivation of BMW
Slide83Proper spill handling:Notify people in the areaDon appropriate PPE
Place absorbent material on spillApply appropriate disinfectant – allow sufficient contact time (30 min)Pick up material (watch for glass – use tongs or dust pan); dispose of material into biomedical wasteReapply disinfectant and wipeFor large/high hazard spills, call the Biosafety Office (352-392-1591)
For routine disinfection of surfaces where BMW is handled, use a 1:10 solution of freshly diluted bleach or a
tuberculocidal disinfectant (ethanol products evaporate too quickly!)UFCD uses Opticide or Cavicide
, disinfectant to clean and disinfect surfaces. Utilize spray,wipe,spray method. If using disinfectant wipes: use wipe, discard, wipe method. Surface must remain wet for the length of time recommended by manufacturer in order for effective disinfection.
BMW Spills & Surface Disinfection
Slide84Questions?Contact: The UF Biological Safety Office352-392-1591
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