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2. 2 Bloodborne 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

3. 3 BBP 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=10051 Revised in 2001 � Safe sharps devices, maintain a log of injuries from contaminated sharps. UF follows OSHA requirement General and workplace-specific training Completed BEFORE individual is assigned to tasks with the potential for BBP exposure and ANNUALLY thereafter

4. 4 BBP 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=10051 And an explanation of it�s contents A copy of the training material is adequate Access to a copy of the UF Exposure Control Plan http://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

5. 5 The OSHA BBP Standard Scope & application Definitions Exposure control, exposure control plan, & exposure determination by jobs/tasks Compliance Engineering and work practice controls Personal Protective Equipment (PPE) Housekeeping Regulated waste and sharps HIV/HBV research labs � held to a higher standard HBV vaccination and Post-exposure prophylaxis (PEP) Communication to employees � signs, labels, training Record keeping

6. 6 UF BBP Program http://www.ehs.ufl.edu/Bio/BBP/default.htm Chairs/Directors : ensure department�s compliance Faculty/Supervisors : have an exposure control plan in place that is appropriate & being followed Employees, students, volunteers, etc: follow exposure control plan, report problems/exposures SHCC/Employee Health: immunizations & post-exposure follow-up EH&S Biosafety: develop & coordinate UF program, track participants

7. 7 Who 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,�..etc

8. What constitutes OPIM?

9. How are BBPs commonlytransmitted at work? Cuts or punctures with contaminated sharp objects Splashes to mucous membranes (linings of eyes, nose, & mouth) Your mucous membranes are permeable, allow pathogens to pass through Contamination of broken or non-intact or skin (wounds, chapped skin, rashes)

10. UF Exposures (2008-2010) Note: 2010 Increase in sharps and splash exposures

11. 2010 Reported Sharps Exposures by Department

12. 12 Cornerstone of exposure prevention�STANDARD PRECAUTIONS� Any and all human blood or other potentially infectious material (OPIM) is treated as INFECTIOUS Use: Safety equipment Engineering Controls Safe practices Personal 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)

13. 13 What to treat with STANDARDPRECAUTIONS: Any human blood or OPIM �..&�.. objects/items that may be contaminated by blood or OPIM Any 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

14. Use Universal Precautions for all human cell lines ATCC 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�

15. Spread 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 HepB 5-10 % of adults will develop chronic infection; ~1.2 million people with chronic HBV 15-25% develop cirrhosis , liver failure, or liver cancer (~ 3000 deaths/year) Many people (~50%) are asymptomatic; if symptoms occur they include: Hepatitis B (HepB, HBV)

16. 16 Occupational Hepatitis B Exposures Needle sticks a real concern� 30% of susceptible/non-vaccinated individuals exposed to infected blood this way became infected Can 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 infected Risk of infection from blood/OPIM splash onto non-intact skin or mucous membranes� greater risk than other BBPs

17. 17 How to prevent Hepatitis B infections at work Get vaccinated! Use Standard Precautions Cleaning/disinfection is important because the virus can survive on surfaces

18. Safe Given to newborns, 120 million people in U.S. have received at least one dose Effective >95% develop immunity after full series (3 doses given at 0, 1, 6 months) In Gainesville, free to emplyees @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 time HepB Vaccine

19. Health-care workers or public safety workers at high risk for continued percutaneous or mucosal exposure to blood or body fluids, HBV research lab workers Performed 1-2 months after dose #3 for recently vaccinated individuals HepB surface antibody (anti-HBs) = 10 mIU/mL - immune Anti-HBs < 10 mIU/mL � revaccinate (3 doses) and retest anti-HBs Still negative � non-responder, need HBIG after exposure Previously vaccinated but not tested? Test for anti-HBs after an exposure; if negative, treat as susceptible. Post-vaccination testing

20. Transmitted primarily through contact with infected blood Many people asymptomatic (symptoms similar to HepB) ~1.8 % of Americans have been infected with HepC, 3.2 million chronically infected ~ 12,000 deaths/year Leading indication for liver transplant in U.S. Hepatitis C (HepC, HCV)

21. Percutaneous injury, esp. with deep punctures or extensive blood exposures ~2% develop infection Mucosal/non-intact skin exposures rarely documented Proper cleaning/disinfection of surfaces important HCV 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

22. 22 How to prevent Hepatitis C infections at work Universal Precautions for Prevention! NO VACCINE Antivirals (interferon/ribavirin) can have serious side effects, treatment lasts 24-48 weeks

23. 23 HIV CDC: 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).

26. Risk for HIV transmission after: Percutaneous injury � 0.3% Mucous membrane exposure � 0.09% Non-intact skin exposure � low risk (< 0.09%) Occupational HIV Exposures

27. 27 If HIV is such low risk, why worry? No cure � eventually fatal NO VACCINE Some HIV strains resistant to therapy Post-exposure therapy costly & has side effects. Cocktails of three or more antiretroviral drugs given

28. 28 How to prevent HIV infections at work Standard precautions ONLY!

29. 29 BBPs � comparing the risk of infection Risks 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 unvaccinated HepC :2% or 20 people per 1000 needle sticks HIV : 0.3% or 3 people per 1000 needle sticks

30. 30 Workplace-specific controls to protect against BBP exposure Engineering controls(Safety Equipment ) Work Practices Personal protective equipment (PPE)

31. Engineering Controls (Safety Equipment)

32. Work practices Controls

33. Needle Safety: NEVER RECAP NEEDLES USING BOTH HANDS Do Place needles directly into the Sharps Box Close & replace Sharps Box when it is � full Do not overfill the sharps box. Never attempt to re-open a closed Sharps Box

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36. 36 EPA listed tuberculocidal disinfectant http://www.epa.gov/oppad001/chemregindex.htm Cavicide 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.

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38. 38 Employer 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 

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44. 44 Store, Dispose of, or Clean PPE appropriately Do not take PPE home to wash Do not wear it out of the clinic area

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46. 46 No gloves outside of the clinic!Be aware that the general public does not if know gloves are clean and assumes they are contaminated. These photos should be scary! The potentially contaminated gloves have touched all sorts of things that others may touch without gloves. Anything transferred from the contaminated gloves to the item, may be picked up by the unsuspecting individual! These photos should be scary! The potentially contaminated gloves have touched all sorts of things that others may touch without gloves. Anything transferred from the contaminated gloves to the item, may be picked up by the unsuspecting individual!

47. 47 Site specific Exposure Control Plan (ECP) & Standard Operating Procedures (SOPs) Equipment, practices, and personal protective equipment used AT YOUR SITE to protect you & others Written down, reviewed, & updated on a regular basis � at least annually Accessible to all See EH&S website for a template to make your SOPs http://www.ehs.ufl.edu/Bio/BBP/BBPSOPS.pdf

48. 48 HIV & Hepatitis research labs�.. More stringent control measures Registration of work with EH&S Documented enrollment in a medical surveillance program CDC/NIH BSL2 guidelines at a minimum

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54. Factors considered in assessing need for PEP

55. Training records: Retain a minimum of 3 years Medical 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

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