Departmental Safety Representative (DSR) Session: Bloodborne Pathogens

1. Departmental Safety Representative (DSR) Session:Bloodborne Pathogens Kellie Mayer Bloodborne Pathogens Coordinator

2. Bloodborne Pathogens • Any pathogenic microorganisms or OPIM (other potentially infectious materials) present in human blood that can cause disease in humans. • Goal: eliminate or minimize occupational exposure to Hepatitis B virus (HBV), Human Immunodeficiency virus (HIV), Hepatitis C virus (HCV), and other bloodborne pathogens

3. We know blood and blood products are included in this BBP scope, but what are Other Potentially Infectious Materials (OPIM)?

4. Synovial, pleural, pericardial, and peritoneal fluid Cerebrospinal fluid Semen Vaginal secretions Amniotic fluid Saliva (in dental procedures) Any unfixed tissue or organ from a human Any body fluid visibly contaminated with blood All body fluid where it is difficult to distinguish between body fluids Cell or tissue cultures that were HIV or HBV infected OPIM includes the following:

5. Job Duties with Possible Bloodborne Exposure • Drawing/processing blood/body fluids • Working in an area where HIV or HBV is produced or research is being performed • Cleaning glassware or disposing of waste contaminated with blood or OPIM • Transporting blood or OPIM • Working in a laboratory area where equipment or work benches can become contaminated either by a spill or accident • Handling laundry, spills or containers of infectious wastes • First aid, removing bandages

6. MD’s, Residents, Interns, PA’s Veterinarians and vet staff Nursing Staff: RN's, LPN's, NA's Scientific Department Personnel Laundry staff Housing and Resident Life Athletic personnel Instructors/Professors/ Faculty Childcare Workers Security Personnel Laboratory Staff Housekeeping Facilities services staff Job classifications in which employees may have occupational exposure are:

7. Bloodborne Pathogens Standard • 29 CFR 1910.1030, Occupational Exposure to Bloodborne Pathogens • Needlestick Safety and Prevention Act, P.L. 106-430 2001 July 2001 • Exposure Control Plan updated once a year with input from staff • Hepatitis B vaccine • Follow-up protocol after a bloodborne exposure • Safety devices and PPE

8. Bloodborne Pathogens Standard • The BBP Standard applies to all employers with employees with reasonably anticipated occupational exposure to blood or OPIM. • The Needlestick Safety and Prevention Act modified the Bloodborne Pathogens standard expand the requirement that employers identify, evaluate, and make use of effective safer medical devices

9. Modes of transmission of BBP • Percutaneous - the direct inoculation of infectious material by piercing through the skin barrier (needlestick or other accidental injury with a sharp, contaminated object) • Direct inoculation - exposure of blood or OPIM to pre-existing lesions, cuts, abrasions, or rashes (dermatitis) provides a route of entry into the body. • Mucous membrane contact - splashing blood or serum into an individual's unprotected eyes, nose, or mouth

10. Penetration by contaminated sharps is the most common mode of transmission of bloodborne pathogens in the workplace.

11. Hepatitis B Virus (HBV) • Hepatitis B is caused by a virus that attacks the liver and can cause lifelong infection, cirrhosis, liver cancer, liver failure, or death. • In 2003, an estimated 73,000 people were infected with HBV. People of all ages get hepatitis B and about 5,000 die per year of sickness caused by HBV.

12. Hepatitis B Virus • About 30% of infected persons have no sign or symptoms of HBV. • If symptoms occur, they usually begin to appear on the average of 12 weeks (range 9-21 weeks) after exposure to hepatitis B virus. • If you have symptoms, they might include: • jaundice • abdominal discomfort • dark urine • clay-colored bowel movements • joint pain • fatigue • loss of appetite • nausea

13. HBV IS PREVENTABLE!A safe & effective vaccine is available. • If the vaccine is administered before infection, it prevents the development of the disease and the carrier state in almost all individuals. • Hepatitis B vaccine consists of a series of three injections – initial, one a month later, and one six months from the first. • Available FREE of charge from employer for high-risk employees

14. HIV • HIV (human immunodeficiency virus) is the virus that causes AIDS (Acquired Immune Deficiency Syndrome). Once a person has been infected with HIV, it may be many years before AIDS actually develops. • HIV kills or damages cells in the body’s immune system, gradually destroying the body’s ability to fight infection and certain cancers. computer generated art quality graphics of HIV was done by Russell Kightley of Canberra, Australia.

15. HIV • As of December 2001, occupational exposure to HIV has resulted in 57 documented cases of HIV seroconversion among healthcare personnel (HCP) in the US. • The average risk for HIV transmission after a percutaneous exposure to HIV-infected blood has been estimated to be approximately 0.3%. • HIV does not survive well outside the body, making the possibility of environmental transmission remote.

16. HIV • Some infected with HIV have no symptoms for up to ten years. • Within a month or two after exposure to the virus some experience flu-like illness such as: • fever, headache, fatigue, weight loss, diarrhea, night sweats, enlarged lymph nodes • These symptoms usually disappear within a week to a month and are often mistaken for those of another viral infection. During this period, the individual is very infectious.

17. HCV • Hepatitis C virus (HCV) is a liver disease • After a needlestick or sharps exposure to HCV positive blood , about 1.8% healthcare workers will get infected with HCV. • Recent studies suggest that HCV may survive on environmental surfaces at room temperature at least 16 hours, but no longer than 4 days.

18. jaundice fatigue dark urine abdominal pain  loss of appetite nausea HCV 80% of persons infected have no signs or symptoms for HCV. When present, symptoms may include:

19. Occupational Exposure Prevention The risk of occupational exposure can be minimized or eliminated using a combination of engineering and work practice controls, personal protective clothing and equipment, training, medical surveillance, warning signs or labels, and other provisions described in this next section.  

20. Standard Precautions • Guidelines to decrease the risk of occupational exposure to blood or body fluids • A system of infection control which assumes that every direct contact with body fluids is infectious and requires every employee exposed to direct contact with body fluids to be protected as though such body fluids were infected with a bloodborne pathogen • Provides adequate protection against bloodborne infections from both humans and animals

21. Engineering Controls means controls (e.g., sharps disposal containers, self-sheathing needles or shielded needle devices, needleless devices, blunt needles, plastic capillary tubes) that isolate or remove the bloodborne pathogens hazards from the workplace. • Work Practice Controls means controls that reduce the likelihood of exposure by altering the manner in which a task is performed such as prohibiting recapping of needles by a two-handed technique.

22. Engineering and Work Practice Controls • The employer must: • Evaluate available engineering controls (safer medical devices) • Train employees on safe use and disposal • Implement appropriate engineering controls/devices

23. Personal Protective Equipment • Gloves (latex or nonlatex) • When to use them: • when there is reasonable anticipation of employee hand contact with blood, OPIM, mucous membranes, or non-intact skin • when handling or touching contaminated surfaces or items.

24. Latex Allergies Latex gloves have proven effective in preventing transmission of many infectious diseases to health care workers. However, for some workers, exposures to latex may result in allergic reactions. For further reading: http://www.cdc.gov/niosh/topics/latex/ http://www.osha.gov/SLTC/latexallergy/index.html

25. Personal Protective Equipment • Gowns, aprons, fluid-resistant clothing • Face shields, eye protection (safety glasses, goggles) • Surgical mask and/or N-95 respirator • Surgical caps, shoe covers

26. Even though the use of PPE is very important in controlling exposure to BBPs, it is your last line of defense against exposure if engineering and work practice controls fail. Do not rely only on PPE for protection.

27. Housekeeping: Sharps Disposal • Keep sharps container upright, • readily available in the work area • Never place sharps into the regular trash • Use a leak-proof, puncture-resistant • sharps container labeled with the biohazard symbol • Do not overfill - dispose of sharps container as biohazard waste when it is 2/3 full

28. Training • OSHA standards require that all employees with occupational exposure participate in a training program.  • Training must be provided at the time of initial assignment to tasks where occupational exposure may take place and at least annually thereafter. 

29. Warning Signs and Labels • Fluorescent orange or orange-red label • with word “Biohazard” and biohazard symbol in contrasting color must be provided on: • Containers of regulated waste • Refrigerators/freezers used to store blood/OPIM • Containers used to store, transport, or ship blood/OPIM • Contaminated equipment • Red bags may be substituted for biohazard labels on biohazardous waste bags.

30. Housekeeping: Decontamination Work surfaces should be decontaminated with an appropriate disinfectant such as 10% bleach solution or an EPA approved disinfectant after completion of procedures, immediately or as soon as feasible when surfaces are overtly contaminated or after any spill, and at the end of the work shift.

31. What is the difference between cleaning and disinfecting? • Cleaning and disinfecting are not the same thing. In most cases, cleaning with soap and water is adequate. It removes dirt and most of the germs. • You should disinfect areas where there are both high concentrations of dangerous germs and a possibility that they will be spread to others. • Disinfectants, including solutions of household bleach, have ingredients that destroy bacteria and other germs.

32. Exposure Control Plan: The ECP must be updated annually to include: • changes in technology that reduce/eliminate exposure • annual documentation of consideration and implementation of safer medical devices • solicitation of input from non-managerial employees

33. Employee Responsibilities • Completing training/orientation as required • Following the Exposure Control Plan and the Standard Precautions Policy • Using work practices, engineering controls, and personal protective equipment as outlined in the Exposure Control Plan • Obtaining the HBV vaccine or signing the declination form

34. Employee Responsibilities • Reporting exposure incidents to their supervisor and assisting the supervisor in completing First Report of Injury/Illness and EPINet Forms • Pursuing follow-up care after an occupational exposure Failure to follow these policies could result in disciplinary action.

35. Recordkeeping • Sharps Injury Log • Maintained by Office of Environmental Health & Safety (OEHS) independently from OSHA 300 Log • Contains necessary documented information for each needlestick/sharp related incident: • type and brand of device involved • department or area of incident • description of incident • Training records – 3 years

36. Recordkeeping • Confidential medical records – duration • of employment + 30 years • EPINet (Exposure Prevention Information Network) forms • helps to track trends, problem areas, types of medical devices, etc. related to BBP occupational exposure incidents and injuries • First Report of Injury and Illness Form

37. Where do I go and what must I do if I am exposed?

38. What to Do: Post-Exposure • Wash exposed area with soap and water for 5 minutes • if at TNPRC, please use one of the bite kits that are available in each work area for your 15 minute scrub using betadine • if eye or mucous membrane contact, flush with sterile water or saline for 5 minutes • Report the incident to your supervisor. • Complete First Report of Occupational Injury/Illness Form • Report for medical evaluation (please review the next few slides for places to report)

39. Where to Go Post-Exposure: General Medical Surveillance • Any bloodborne pathogens exposure incident is an event for which immediate attention must be sought, as the effectiveness of prophylaxis depends on the immediacy of its delivery. • Seek medical attention in the same manner that it would be sought should any occupational injury occur (e.g., emergency room, physician's office, urgent care clinic).

40. Where to Go Post-Exposure: Injuries Sustained at TNPRC (Tulane National Primate Research Center) • Go to Employee Health (B- Bldg) at TNPRC for medical evaluation during business hours. • Report to Employee Health at TNPRC for follow-up visits • If an exposure incident occurs after hours or on the weekend, your supervisor will notify the veterinarian on call and page the nurse at (985) 966-6515 for further instructions.

41. Where to Go Post-Exposure: Injuries Sustained while on Rotation at Another Facility • If on rounds at another hospital, report there for initial visit but you must still notify the Bloodborne Pathogen Coordinator at (504) 988-6608.

42. It is VERY important to bring the patient’s source blood (if available) with you when you report for initial evaluation. Your care is dependant on the HIV, HBV, and HCV status of the source patient to whom you were exposed.Similarly, when dealing with nonhuman primates it is important to note which monkey was the source for the bite/scratch to allow for proper evaluation of infection in the source animal. Failure to do this can result in delayed or unnecessary treatment for you.

43. Summary of Post-Exposure Employee Responsibilities • Wash/flush exposed injury area for 5 minutes (15 minutes if at TNPRC for possible B virus exposure). 2. Promptly report the incident to your supervisor. 3. Complete the First Report of Injury and EPINet forms. 4. Report to appropriate clinic/emergency department (depending on your location) for medical evaluation.

44. You can always reach the Bloodborne Pathogens Coordinator 24 hours a dayby work cell phone (504)419-1391 or call (504)988-5486 and press 1.

45. Tulane UniversityOffice of Environmental Health & Safety (OEHS)Please contact the BBP Coordinator for questions, comments, and/or interactive discussion. Kellie C. Mayer (504-419-1391) kmayer@tulane.edu If unable to proceed to quiz, type the link below into your browser https://pandora.tcs.tulane.edu/ehs/enterssn.cfm?testnum=25 Proceed to Quiz