Bloodborne Pathogens Initial - PowerPoint Presentation

Bloodborne Pathogens Initial Training

The Standard Issued in 1991 by OSHA . “…applies to all occupational exposure to blood or other potentially infectious materials .” Revised in 2001 to include the Needle stick Safety and Prevention Act. Intent is worker protection Hard copies available Available online

Requirements of The Standard Employers are required to: Establish an Exposure Control Plan and keep it updated Provide annual safety training for employees Ensure engineering controls are in place Provide personal protective equipment (PPE) Ensure employees are offered Hepatitis B vaccination free of charge

Exposure Control Plan Defines which employees are included in the plan Covers potential exposures and ways to minimize them Indicates a plan for what to do should an exposure incident occur Describes incident reporting requirements

Employee Responsibilities Attend mandated BBP training and annual retraining Familiarize yourself with Exposure Control Plan Utilize work practice controls and PPE properly Report all exposure incidents and/or injuries to supervisor in a timely manner

Supervisor Responsibilities Identify all “occupational exposed” employees to BHS w/in 10 days of hire Ensure these employees attend BBP training and any additional training necessary Make PPE available Emergency action procedures in place and are followed Proper disinfection and disposal procedures followed

Other Potentially Infectious Materials (OPIMs) Materials that may carry and transmit BBPs Human blood and blood components Human cell lines, including embryonic stem cells Body cavity fluids (spinal, synovial, pleural, pericardial, peritoneal, amniotic) Breast milk Semen and vaginal secretions Saliva in dental procedures Any fluid that is visibly contaminated with blood Any unidentified fluids in a lab where human materials are used

Known Bloodborne Pathogens HIV Bloodborne Hepatitis viruses (Hepatitis B, D, C and E) Human T-lymphotropic virus Type I Hemorrhagic Fever viruses (Ebola, Marburg, Lassa) West Nile Virus Colorado Tick Fever viruses (a number of arboviruses) Plasmodium species (Malaria) Treponema species (Syphilis) Babesia species Brucella species (Brucellosis) Leptospira species Francisella species Streptobacillus moniliformis Spirillum minus Borrelia species (Lyme Disease) Creutzfeldt-Jacob agent (CJD)

Significant Bloodborne Pathogens Human Immunodeficiency Virus (HIV) Destroys host immune system resulting in death Effective anti-retroviral drugs available, no cure ~37 million living with HIV Hepatitis B Virus (HBV) Can destroy or damage host liver, resulting in death Host can recover from disease, chronically infected Preventable with vaccination 350 million chronic carriers 780,000 die each year due to complications (cirrhosis, cancer)-WHO Hepatitis C Virus (HCV) Can destroy or damage host liver, resulting in death Chronic infections, costly cure is available Hepatitis D Virus (HDV) Requires Hepatitis B co-infection to cause disease

Significant Bloodborne Pathogens Human Immunodeficiency Virus (HIV) Transmission risk-1:300 (0.3%) Hepatitis B Virus (HBV) Transmission risk- 1:2 (50%)!!! One drop can have 100 million virus particles present Hepatitis C Virus (HCV) Transmission risk-1:50 (1.8%) These statistics are from direct patient care settings. 86% of occupational exposures that result in seroconversion to HIV are caused by hollow bore needles.

Common Characteristics of BBPs Biohazardous Agents Transmission Direct Contact Person to person contact Indirect Person to object to person Parenteral inoculation Mucous membranes

Chain of Infection All components need to be present for successful transmission: Presence of virulent pathogen High concentration of pathogen (infectious dose) Mechanism of transmission of pathogen to host Portal of entry Susceptible host

Personal Risk Factors Factors that may suppress or alter immune system Age Stress Nutrition Pregnancy Diabetes Immunodeficiency through disease or drug use including the use of many prescription medications Chemotherapy

Protection in Healthy Adults Natural protection Intact Skin Cellular Immunity (leucocytes) Humoral Immunity (antibodies) Acquired immunity Vaccination Immunoglobulin administration Illness

Symptoms Symptoms are similar for most diseases “Flu-like” Fever Nausea Malaise Night sweats Some diseases have no initial symptoms Hepatitis B may be asymptomatic in some individuals

Hepatitis B Virus Vaccination Strongly endorsed by medical community Protection has been proven to last 7-15 years Became available in 1983, was required by 1991 Healthcare worker infection rates decreased by 95% between ‘83 and ‘95! CDC and WHO recommend vaccinations from birth-2 months onward Series of 3 shots Given over a 6 month period 95-97% effective at conferring immunity Some individuals will never develop immunity Also protects against Hepatitis D (without co-infection with B, D cannot cause disease)

Include your e-mail address for any necessary follow-ups. For those requesting the Hep B immunization, this form can be copied to give to your PI upon request. Hepatitis B vaccine

myhealth.uconn.edu (student health portal) Is not a university requirement Get your titers checked Get a booster Not Sure about your immunization status?

Exposure Incident Reduction Strategy Employ standard (universal) precautions in the workplace Engineering controls Work practice controls Use PPE!

Standard Precautions Employ standard (universal) precautions in the workplace Reduce the risk of transmission of BBPs and other pathogens from both recognized and unrecognized sources.

Exposure Incident Reduction Strategy Employ standard (universal) precautions in the workplace Engineering controls Work practice controls Use PPE!

Engineering Controls Equipment that comes between you and the hazard “To err is human”-Alexander Pope To reduce parenteral exposures Sharps containers Dustpan & brush or large forceps “safe” needles

Safer Sharps Devices To reduce parenteral exposures An estimated 1,000 sharps injuries happen EVERY DAY in the U.S.

Safe Sharps Practices If you have never used a sharp, be sure you are trained prior to handling Incident Prevention Needles and other sharp instruments should only be used when there is no alternative Try to use plastic instead of glass whenever possible Always keep sharps in view Try to limit use to one open needle or sharp at any given time when possible.

Engineering Controls Equipment that comes between you and the hazard Contains spills, splashes and aerosols Spill clean up and containment Biological safety cabinet for aerosol containment

Engineering Controls Equipment that comes between you and the hazard Additional aerosol and splash protection Centrifuge safety cups Pipette devices and good pipette practice! Splash shield

Engineering Controls Controls to decontaminate surfaces and equipment Must be tuberculocidal 1:10 solution of at least 5.25% strength household bleach Check concentration! Bleaches with fragrance and splash less bleaches are not considered sanitizers. EPA number Iodine/iodophore Wescodyne is not EPA registered and is not tuberculocidal. phenol containing products Alcohol preparations do not meet requirements Not enough contact time Check labels or contact EHS to ensure you comply!

Engineering Controls Check contact time requirementsCDC Guideline for Disinfection and SterilizationExcellent source of information for effective use of disinfectants

Decontamination Appropriate hand washing OSHA requires hand washing with soap and running water for at least 20 seconds after procedures when blood or body fluids are present. Soap or Hand sanitizer? Use lots of hand sanitizer to increase contact time. “Washing hands with soap and water is the best way to reduce the number of microbes…if soap and water are not available, use alcohol-based hand sanitizer…soap and water are more effective than hand sanitizers at removing or inactivating certain kinds of germs.” www.CDC.gov Lots of proteinaceous material present? Just use soap.

Decontamination Sterilization Disinfection Antisepsis Sanitization

Exposure Incident Reduction Strategy Employ standard (universal) precautions in the workplace Engineering controls Work practice controls Use PPE!

Clutter is dangerous, keep work area tidy No re-capping needles No re-using disposable PPENo applying cosmetics (including lip balm) or contact lenses Keep sharps disposal container close to work area Disinfect area before and after work Follow spill clean-up procedure Footwear Shoes should cover whole foot Don’t work late or alone Know emergency response procedures Call 911 from campus phone Work Practice Controls

Signs and Labels Signs must be posted to warn of potential hazard Post on all entry doors Post on all equipment that contains, stores or transports biohazardous agents

Exposure Incident Reduction Strategy Employ standard (universal) precautions in the workplace Engineering controls Work practice controls Use PPE!

Personal Protective Equipment Protective clothing To cover street clothes Worn closed The correct size for you - not oversized or too tight Choose the right material

Personal Protective Equipment Face and mucous membrane protection To serve as a barrier to splashes of potentially infectious materials Use during spill clean up, first aid and with large volumes of materials

Personal Protective Equipment Gloves appropriate to the task Non-latex exam gloves for most lab work Verify integrity before donning gloves Remove carefully to avoid contaminating hands Do not reuse disposable gloves Do not wear gloves outside of the laboratory Wash hands after removing gloves Make these measures second nature

Personal Protective Equipment

PPE Rules to Remember Use proper PPE for the situation Gloves, goggles, lab coat, surgical masks, etc… Always check PPE to ensure it free of tears or defects Remove PPE and wash hands before leaving lab Wear correctly and wear the right size

“Workers are the first line of defense for themselves, others in the laboratory and the public from exposure to hazardous agents. Protection depends on conscious and proficient use of good microbiological practices and the correct use of safety equipment.” BMBL Containment cannot compensate for poor technique. Safe Work Practices

If a Spill Happens: Wear PPE Contain spill with absorbent material Remove sharp objects if necessary Cover spill with disinfectant (tuberculocidal) If it is a large spill, undiluted disinfectant may need to be used to achieve effective final concentration Allow to sit for at least 15 minutes (reference decon . time) Dispose of materials as necessary in appropriate biohazard waste receptacle Wipe area again with disinfectant

If there is an exposure incident: Needle stick or other percutaneous exposure: Wash the wound with soap and water If there is no soap use an alcohol based solution Do not scrub -could create more entry points for pathogens Do not suck on the wound Apply antiseptic and a clean dressing Mouth, Nose or Eye exposures Irrigate with copious amounts of cold water for10-15 minutes

Exposure Incident Procedures Employee responsibilities Self treat exposed area Report the incident Supervisor responsibilities Document the incident Advise employee that medical treatment is available

Required Reporting Information If the incident involves a sharp object of any kind, you must record the: Type and brand of device involved Department or area of incident Description of incident

Exposure Incident Procedures Medical treatment providers for the Storrs Campus Student Health Services Students Only Windham Community Memorial Hospital Staff and Faculty Students when Health Services is closed Walk-in clinic location in Storrs downtown

Exposure Incident Procedures Medical treatment provider responsibilities Discuss all treatments and options Very specific monitoring and procedures Disclose possible side effects of treatments or post exposure prophylaxis (PEP) Keep all information confidential as required by state of Connecticut and Federal privacy laws Medical evaluation remains confidential Post exposure follow-up Return to treatment provider as directed for follow-up evaluations

Recordkeeping Medical records Hepatitis B vaccine status Any exposure records and follow-up results for said exposures Kept confidential and separate from personnel record Training records: Training Dates (this is an annual training!)