UWSP Bloodborne Pathogens Training

1. UWSP Bloodborne Pathogens Training UWSP Environmental Health and Safety

2. EHS Officer Director of Environmental Health and Safety University of Wisconsin - Stevens Point 101 George Stien Building Stevens Point, WI 54481 (715) 346-2320 (715) 346-3780 (fax) dbartosh@uwsp.edu www.uwsp.edu/ehs UWSP Environmental Health and Safety

3. BLOODBORNE PATHOGENS AWARENESS • Bloodborne pathogens are microorganisms such as viruses or bacteria that are carried in blood and can cause disease in people. • Types of Bloodborne Pathogens include: • Malaria • Syphilis • Hepatitis B (HBV) C (HCV) • HIV • OSHA’s Bloodborne Pathogens standard prescribes safeguards to protect workers against the health hazards from exposure to blood and other potentially infectious materials, and to reduce their risk from this exposure UWSP Environmental Health and Safety

4. Who is covered by the OSHA Bloodborne Pathogen Standard? • All employees who could be “reasonably anticipated” as the result of performing their job duties to face contact with blood and other potentially infectious materials • “Good Samaritan” acts such as assisting a co-worker with a nosebleed would not be considered occupational exposure UWSP Environmental Health and Safety

5. UWSP BLOODBORNE PATHOGENS EXPOSURE CONTROL PLAN • Outlines specific procedures for UWSP. • http://www.uwsp.edu/ehs/policy_downloads/BBPexpcon.doc UWSP Environmental Health and Safety

6. Human Blood , human blood components, and products made from human blood. OPIM (Other Potentially Infectious Materials): saliva in dental procedures, semen, vaginal secretion, internal body fluids (I.e.spinal, synovial,etc); other external body fluids visibly contaminated with blood; along with all body fluids in situations where it is difficult or impossible to differentiate between body fluids Other unfixed human tissues or organs (other than intact skin); HIV-containing cell or tissue cultures, organ cultures, and HIV- or HBV- containing culture media or other solutions; and blood, organs, or other tissues from experimental animals infected with HIV or HBV. What is Regulated Material? UWSP Environmental Health and Safety

7. UWSP Environmental Health and Safety

8. BBP TRANSMISSION • BBP most commonly transmitted through: • Sexual Contact • Sharing of needles • From mothers to their babies at/before birth • Accidental puncture from contaminated needles, broken glass, or other sharps • Contact between broken or damaged skin and infected body fluids • Contact between mucous membranes and infected body fluids UWSP Environmental Health and Safety

9. How does exposure occur? • Occupational Transmission of Bloodborne Pathogens: • Anytime there is blood-to-blood contact with infected blood or body fluids, there is a potential for transmission. Unbroken skin forms a good barrier against bloodborne pathogens. Infected blood can enter your body through open sores, cuts, abrasions, acne, burns, and open blisters. • Most common occupational exposure: needlesticks • Cuts from contaminated sharps (scalpels, broken glass, etc.) • Contact of mucous membranes (for example, the eye, nose, mouth) or broken (cut or abraded) skin with contaminated blood. UWSP Environmental Health and Safety

10. HEPATITIS B (HBV) • Hepatitis B (HBV): Disease caused by a virus that attacks the liver. Can cause lifelong infection, cirrhosis (scarring) of the liver, liver cancer, liver failure, and death. Acute & Chronic Cases. Most serious. • Signs & Symptoms: Jaundice, fatigue, abdominal pain, loss of appetite, nausea, vomiting, joint pain, flu. • Transmission: Occurs when blood or body fluids from an infected person enters the body of a person who is not immune.  Can be treated to overcome infection. More infectious than HIV. • Prevention:Hepatitis B vaccine; Universal precautions. • NOTE: Number of new infections per year has declined from an average of 260,000 in the 1980s to about 79,000 in 1999. UWSP Environmental Health and Safety

11. HEPATITIS C (HCV) • Hepatitis C: Causes chronic liver disease. Deaths <3%. • Signs & Symptoms:Jaundice, fatigue, abdominal pain, loss of appetite, nausea, dark urine. • Transmission: Occurs when blood or body fluids from an infected person enters the body of a person who is not infected. Transfusion (prior to pre blood testing). NOTE: Most infections are due to illegal injection drug use. • Prevention: No vaccine available. Use universal precautions. Post exposure medical care. UWSP Environmental Health and Safety

12. HEPATITIS A (HAV) • Hepatitis A is a liver disease caused by the hepatitis A virus. Hepatitis A can affect anyone. • Signs & Symptoms: Jaundice, fatigue, abdominal pain, loss of appetite, nausea, diarrhea, fever. • Transmission: HAV is usually spread from person to person by putting something in the mouth (even though it may look clean) that has been contaminated with the stool of a person with hepatitis A.  • Prevention: Always wash your hands with soap and water after using the bathroom, changing a diaper, before preparing and eating food. Good personal hygiene and proper sanitation. • Hepatitis A vaccine. UWSP Environmental Health and Safety

13. HIV/AIDS • What is HIV and how can I get it? HIV - the human immunodeficiency virus - virus that kills body’s "CD4 cells." CD4 cells (T-helper cells) help the body fight infection & disease. • What is AIDS - the acquired immunodeficiency syndrome - is a disease where HIV destroys the body’s immune system. There is no cure. • HIV is found in varying concentrations or amounts in blood, semen, vaginal fluid, breast milk, spinal, synovial, saliva, sweat and tears, other bodily fluids. UWSP Environmental Health and Safety

14. HIV/AIDS • Signs & Symptoms:The only way to determine infection is to test. Many people infected with HIV do not have symptoms at all for many years. • The following may be warning signs of infection with HIV: rapid weight loss; dry cough;recurring fever or profuse night sweats; profound and unexplained fatigue; swollen lymph glands in the armpits, groin, or neck; diarrhea > week; white spots or unusual blemishes on the tongue, in the mouth, or in the throat; pneumonia; red, brown, pink, or purplish blotches on or under the skin or inside the mouth, nose, or eyelids; memory loss, depression, and other neurological disorders. • Do not assume infection. Each symptoms can be related to other illnesses. Testing must be accomplished. UWSP Environmental Health and Safety

15. HIV/AIDS • Transmission:General: Sexual contact with infected individual; sharing needles; blood transfusions; mother to baby; breast feeding. • Occupational Transmission: Needle Sticks/Sharps, Infected blood/fluid into open cut or a mucous membrane (for example, the eyes or inside of the nose). • Only one case of doctor to patient. • No additional routes of transmission have been recorded. UWSP Environmental Health and Safety

16. HIV/AIDS • You cannot get HIV: • By working with or being around someone who has HIV. • From sweat, spit, tears, clothes, drinking fountains, phones, toilet seats, or through everyday things like sharing a meal. • From insect bites or stings. • From donating blood properly. • From a closed-mouth kiss (but there is a very small chance of getting it from open-mouthed kissing with an infected person because of possible blood contact). UWSP Environmental Health and Safety

17. HIV/AIDS • PREVENTION • Personal – abstinence, safe sex, don’t shoot drugs, needle/razor safety, don’t share other personal hygiene items, tattoo/body piercing, pregnancy issues. • Occupational – Follow Universal Precautions & Proper Work Practices. See slide 23. UWSP Environmental Health and Safety

18. TUBERCULOSIS (TB) • TB is a disease caused by bacteria that can attack any part of your body, but usually attack lungs. TB disease once leading cause of death in the U.S. • TB, can be fatal if not treated. However, several antibiotics are available that are very effective. UWSP Environmental Health and Safety

19. TB Types • Latent TB:Breathe in TB bacteria and become infected, but able to fight bacteria and stop growth. The bacteria become inactive, but remain alive and can become active later. Many latent TB infections never develop into disease. But in other people, especially with weak immune systems, bacteria become active and cause TB disease. • TB Disease: Active bacteria the body has not be able to fight and individuals becomes sick. UWSP Environmental Health and Safety

20. LATENT TB INFECTION V. TB DISEASE Latent TB Infection TB Disease • Have no symptoms • Do not feel sick • Cannot spread TB to others • Usually have a positive skin test • Chest x-ray and sputum test normal • Symptoms include • bad cough > 2 weeks • pain in the chest • coughing up blood or sputum • weakness or fatigue • weight loss/no appetite • chills/fever • sweating at night • May spread TB • Usually have a positive skin test • May have abnormal chest x-ray, and/or positive sputum smear or culture UWSP Environmental Health and Safety

21. TB - Transmission • Transmission: spread through air from person to person when the bacteria is aerosolized by someone with TB disease. When a person breathes in TB bacteria, the bacteria can settle in the lungs and grow. From there, can move through the blood to other body parts, such as kidney, spine, and brain. TB in the lungs or throat can be infectious. TB in other parts of the body, such as the kidney or spine, usually not infectious. • Cannot get TB from touching someone’s clothes, drinking glass, handshake, or toilet. • Most likely to spread it to people they spend time with every day and are in close contact. UWSP Environmental Health and Safety

22. TB Prevention • Prevention: Testing, Medical Treatment, Isolation, Notification, Medical clearance. • TB patients are no longer considered infectious if: 1) are on adequate therapy; 2) had favorable clinical response to therapy; and 3) have three consecutive negative test results. UWSP Environmental Health and Safety

23. Universal Precautions / Work Practices • Treat all human blood and Other Potentially Infectious Materials as if they are infectious • Observed in all situations where there is a potential for contact with blood or other potentially infectious materials • To protect yourself, it is essential to have a barrier between you and the potentially infectious material. • PPE and BBP Containers (i.e. Sharps containers). • Report any suspected exposure to your Supervisor and/or Employee Health Services. UWSP Environmental Health and Safety

24. Personal Protective Equipment • Specialized clothing or equipment worn by an employee for protection against infectious materials in all possible exposure situations. • Gloves, masks, eye protection, coveralls, face shields, etc. Ensure Readily Available! • Must be properly cleaned, laundered, repaired, and disposed of. • Must be removed when leaving area or upon contamination asap. UWSP Environmental Health and Safety

25. Specific Universal Precautions • Gloves must be worn during contact with blood or other body fluids that contain visible blood, such as urine, feces, or vomit. Inspect. Do not reuse. Remove properly. Wash hands thoroughly. • Use safety glasses or goggles, face shields, masks, and other barriers if risk of splash, spray, or vaporization. • Cuts, sores, or breaks on both the care giver’s and patient’s exposed skin should be completely covered with bandages or other barriers. UWSP Environmental Health and Safety

26. Specific Universal Precautions • Hands and other parts of the body should be washed immediately after contact with blood or other body fluids, and surfaces soiled with blood should be disinfected appropriately. • Practices that increase the likelihood of blood contact, such as sharing of razors and toothbrushes, should be prevented. • Needles and other sharp instruments should be used only when medically necessary. More…. UWSP Environmental Health and Safety

27. NEEDLES/SHARPS • Handle with extreme care! • Needles, broken glass, razors, or other sharp objects must be disposed of in labeled sharps containers. • Needles should never be recapped. • Needles/Sharps should be moved by using a mechanical device or tool such as forceps, pliers, or broom and dust pan – NOT BY HAND. • Never break or shear needles. • Broken glassware that has been visibly contaminated with blood must be sterilized with an approved disinfectant solution before it is disturbed or cleaned up. • Glassware that has been decontaminated may be disposed of in an appropriate sharps container: • Uncontaminated broken glassware may be disposed of in a closable, puncture resistant container such as a coffee can. UWSP Environmental Health and Safety

28. Work Practice Controls Examples: • Wash hands after removing gloves and as soon as possible after task or exposure. • Do not bend or break sharps. • Place sharps in containers ASAP. • Do not eat, drink, smoke, apply cosmetics, or handle contact lenses in any potential exposure area. • Prevent splashing, spraying, or aerosolizing bodily fluids. UWSP Environmental Health and Safety

29. Hand Washing • Use warm running water and nonabrasive soap. Towelettes / lotions should not take the place of hand washing. • Wet the hands & apply soap to hands. • Rub hands together vigorously for at least 15 seconds. Be sure to scrub between fingers, under fingernails, and around the tops and palms of the hands, and up to wrist or other affected areas. • Rinse hands under warm running water. Leave the water running while drying hands. • Dry hands with clean, disposable (or single use) towel, avoid touching the faucet handles or towel holder with clean hands. • Turn the faucet off using the towel as a barrier between your hands and the faucet handle. • Discard the used towel. • Consider using hand lotion to prevent chapping of hands. • Assist children. • Wash hands frequently – before and after tasks, eating, drinking, applying makeup, washroom, contact, handling items, etc. UWSP Environmental Health and Safety

30. What is Regulated Waste? • The Bloodborne Pathogens Standard defines: • (1) liquid or semi-liquid blood or OPIM; • (2) items contaminated with blood or OPIM and which would release these substances in a liquid or semi-liquid state if compressed; • (3) items that are caked with dried blood or OPIM and are capable of releasing these materials during handling; • (4) contaminated sharps; and • (5) pathological and microbiological wastes containing blood or OPIM. UWSP Environmental Health and Safety

31. Regulated Waste • Must be placed in closeable, leak-proof containers built to contain all contents during handling, storing, transporting or shipping and be appropriately labeled or color-coded. • Contact UWSP EHS at Extension 2320 or 4464 with questions regarding Bloodborne Pathogens and for waste pickup and disposal. UWSP Environmental Health and Safety

32. Clean Up • All regulated waste must be disposed in the proper biohazard waste "stream". • Bloodborne pathogens biohazard kits are available to clean small amounts of bodily fluids. The kits are available from Central Stores (item #8102104, $8.40). Contain items to protect responders such as gloves, protective clothing, and disinfectants. • All regulated waste must be disposed in properly labeled containers or red biohazard bags, sealed, and stored correctly. • Large spills beyond supplies or ability require contacting Protective Services at 3456. • EHS for waste pickup at extension 4464 or 2320. UWSP Environmental Health and Safety

33. Clean Up • Disinfectant in kit from stores. • A solution of household bleach (Clorox) diluted between 1:10 and 1:20 with water. • Check the label of all disinfectants to make sure they meet this EPA requirement. • Entire area must be cleaned (including any affected equipment). • Use proper PPE. • Proper tools to clean up sharps (tongs, dustpan, etc). UWSP Environmental Health and Safety

34. Laundry • Handle contaminated laundry as little as possible and use PPE • Must be bagged or containerized at location where used • No sorting or rinsing at location where used • Must be placed and transported in labeled or color-coded containers • Contact EHS 2320 for details. UWSP Environmental Health and Safety

35. Biohazard Warning Labels • Warning labels required on: • Containers of regulated waste • Refrigerators and freezers containing blood and other potentially infectious materials • Other containers used to store, transport, or ship blood or other potentially infectious materials • Red bags or containers may be substituted for labels if marked properly. UWSP Environmental Health and Safety

36. Hepatitis B VaccinationRequirements • Hepatitis B vaccine is an additional protective measure offered to all employees who receive occupational exposure. • Must make available to all employees at risk of exposure • The vaccination must be performed by a licensed healthcare professional • Declination form signed for those who do not wish to have vaccination. UWSP Environmental Health and Safety

37. UWSP Hepatitis B Vaccination • The cost of the vaccination is the responsibility of the employee's department. Cost for three doses = $108.00. • Vaccinations provided by the Portage County Health Department, 817 Whiting Avenue, 345-5350. Series of three. • Contact EHS at 2320 to coordinate vaccination arrangements. UWSP Environmental Health and Safety

38. What to do if an exposure occurs? • Wash exposed area with soap and water. • Use non-abrasive soap. • Flush splashes to nose, mouth, or skin with water for minimum of 15 minutes. • Irrigate eyes with water or saline for 15 minutes. • Report the exposure to your Supervisor. • Direct the worker to a healthcare professional for immediate follow-up care. (i.e. post Hep. B vaccine, HIV inhibitors). UWSP Environmental Health and Safety

39. Post-Exposure Follow-Up • Document routes of exposure and how exposure occurred with accident investigation. Contact Safety and Loss Control (x2618)office to complete injury reports as needed. • Complete “Determination of Exposure to Blood/Body Fluids” form WKC-8165 or hospital equivalent. • Record injuries from contaminated sharps in a sharps injury log, if required. Contact EHS at 2320. • Obtain consent from the source individual and the exposed employee and test blood as soon as possible after the exposure incident • Provide risk counseling and offer post-exposure protective treatment for disease when medically indicated. • Provide written opinion of findings to employer and copy to employee within 15 days of the evaluation. UWSP Environmental Health and Safety

40. Summary • Beware of your surroundings and potential for exposure. • Follow Universal Precautions & Proper Work Practices. • Clean up and dispose of waste properly. • Continue to educate yourself. UWSP Environmental Health and Safety

41. More Info / Resources • UWSP EHS –www.uwsp.edu/ehs/ or Contact: Jeff Karcher, 346-2320 • www.osha.gov • www.cdc.gov • www.nih.gov • www.ncaa.org ?? Questions ?? UWSP Environmental Health and Safety