Bloodborne and Airborne Pathogens

1. Bloodborne and Airborne Pathogens Boston Biomedical Research Institute

2. OSHA Bloodborne Pathogen Standard • Designed to eliminate or minimize employees’ exposure to human blood and other potentially infectious materials (OPIM) in the workplace • OPIM at BBRI: • Adenoviruses, Reteroviruses, Lentiviruses • Bacteria. • Genetically modified E.coli

3. Who is covered? • All employees who may reasonably expect to be exposed to blood and OPIM that may contain pathogens • Anyone whose job involves handling or possibly being exposed to blood or blood products, or OPIM

4. What are pathogens? • Germs transmitted from one person to another through contact with blood or OPIM Germs transmitted from one person to another through contact with blood or OPIM Microscopic Germs

5. You do NOT need to directly contact someone carrying a bloodborne pathogen to be at risk for exposure! Risks also come from: Clinical specimens Biohazardous trash Blood- or body fluid-soaked laundry Needles or sharps Caution!

6. Annual Training Required: • How diseases are transmitted and their symptoms • Protective measures to prevent exposure • Procedures to be followed if exposed

7. Exposure Control Plan • OSHA requirement • Must describe: • Exposure prevention • Engineering and work practice controls • Universal precautions • Personal protective equipment

8. Engineering Controls • Needleless systems • Eye wash stations • Handwashing facilities • Biohazard labels

9. Sharps • Needles and other sharps are a great risk to healthcare workers • Other systems are needleless, have needle shields, retractable needles, or other protective devices • Employers are required to evaluate the feasibility of such devices when appropriate

10. Sharps Containers • Approved sharps containers must be present for safe disposal of used sharps • Sharps containers must be: • Leak proof • Puncture resistant • Securely closeable • Labeled with a biohazard warning

11. Handling Sharps: Guidelines: • Employers must put sharps disposal containers in easily accessible areas where sharps are used • Needles must not be recapped, removed, bent, sheared, or broken • The entire needle/syringe assembly must be disposed of in a sharps container • A mechanical device may be used to recap a contaminated needle or remove it from a disposable syringe, when necessary. - The exposure control plan must specify when, why and how this is done and by whom.

12. Handwashing and Eye Wash Stations • Handwashing facilities must be provided (when possible) • Waterless antiseptic hand cleanser may be provided when handwashing is not possible • Eye wash stations must be available when appropriate

13. Warning Labels Must be displayed on: Must be displayed on: • Containers for waste that may contain biohazardous waste • Freezers and refrigerators used for blood or OPIM • Containers used to transport, ship, or store blood or OPIM • Contaminated equipment until properly cleaned • Entrances to places containing OPIM

14. BBRI INFECTIOUS WASTE DISPOSAL • All biological trash shall be autoclaved • Use appropriate bags supplied in the autoclave room. • Follow proper procedure for decontamination • After sterilized trash can be placed in the general waste stream • If biohazard material is not autoclaved it must be disposed of according to proper procedures. i.e sharp boxes, red biohazardous bags for shipment offsite by authorized transporters

15. Waste Infectious waste must be disposed of in labeled red containers or in containers clearly marked with a universal biohazard symbol

16. Work Practice Controls • Use of personal protective equipment (PPE) • Handwashing • Decontamination and sterilization of equipment and areas • Safely handling sharps • Correctly disposing of wastes • Safely handling laundry • Work area restrictions • Keep doors to BL2- Tissue culture rooms closed

17. Handwashing Guidelines • Immediately wash any exposed skin (ideally with antibacterial soap) • Be gentle with any scabs or sores • Wash all surfaces, including the backs of hands, wrists, between the fingers, and under fingernails • Wash hands immediately after removing gloves or other PPE Antiseptic towelettes and waterless antibacterial handwashing liquid can be used when soap and running water are not available After a potential exposure, a thorough scrubbing with soap and water is still recommended as soon as possible

18. Decontamination and Sterilization • Clean and sterilize all reusable sharps after use (i.e., knives, scissors, scalpels) • Decontaminate equipment and working surfaces, bench tops, and floors with 10% bleach solution • At end of work shift • As surfaces become obviously contaminated • After any spill of blood or OPIM • Disinfect jewelry, nail brushes, etc. after handwashing

19. Blood or OPIM in liquid or semi-liquid state Items with dried blood that could be spread by handling Contaminated sharps Lab specimens containing blood or OPIM Items contaminated with blood or OPIM that could release liquid or semi-liquid blood or OPIM if squeezed Regulated Waste Special handling:

20. Laundry • Uniforms, clothing, and cloth supplies should be kept free from contamination when possible • Clothing that becomes contaminated with blood or OPIM must be put in special labeled and color-coded laundry bags • Anyone handling contaminated laundry must be trained to handle bloodborne pathogens • Never take contaminated clothing home to wash

21. In places where blood or OPIM is stored/handled DO NOT! Smoke Put on lip balm, hand lotion, or cosmetics Eat or drink Handle contact lenses Store food Lab Area Restrictions

22. Personal Protective EquipmentPPE

23. PPE • Gloves • Lab Coats • Eye shields, goggles • Face masks, face shields • Caps • Booties

24. OSHA Standard Requires that your employer: • Provide PPE at no cost • Train you how to use equipment • Must clean, repair, or replace it as needed

25. PPE Dispose of contaminated PPE: • Dispose of contaminated PPE • Different protective equipment require different disposal methods • Put articles such as used gloves in a designated disposal container • Store contaminated clothing in clearly labeled bags until decontaminated, laundered, or properly disposed of

26. Universal Precautions Handle all blood and OPIM as if they are contaminated Treat all materials as if they are infected with bloodborne pathogens, including: • Blood • Semen and vaginal secretions • Saliva that may contain blood • Cerebrospinal fluid • Synovial fluid, Pleural fluid

27. Universal Precautions All Body Fluids • OSHA now applies universal precautions to all body fluids because it is impossible to know by looking whether other body fluids may contain blood • Assume that all body fluids may be infectious and always follow universal precautions • Body substance isolation (BSI) guidelines also define all body fluids and substances as infectious

28. For Unexpected Exposure • If blood or OPIM splashes in your eyes or other mucous membranes, flush area with running water for 20 minutes • Wash any exposed area well with soap, using an antibacterial soap • Gently treat any scabs and sores • Report the exposure to your supervisor • Save any potentially contaminated object for testing purposes • Seek medical care

29. Employer Responsibilities • Identify and document source of blood or OPIM • Obtain consent and arrange to test the source blood • Inform you of the test results • Arrange for you to have your blood tested • Arrange counseling and medical care for you as needed

30. Treatment and medical care depend on the type of exposure: Treatment may include HBV vaccination or hepatitis B immune globulin (HBIG) Confidential exposure report form kept in the employee’s personnel file Substance involved Route of transmission Severity of the exposure Follow-up After Exposure

31. Exposure Control Plan • Require using universal precautions • State the opportunity for HBV vaccination, contact BBRI healthcare provider – Tufts Health Plan • Include other measures appropriate for your specific work environment • Identify the job positions and individuals to receive training- All Lab employees • Establish necessary engineering controls and work practice controls • Specify PPE to be used

32. Additional Employer Requirements • Investigators to Inform new employees about their plan • Conduct training before performing any work that puts you at risk for exposure • Provide refresher training annually or whenever changes made to lab policies and procedures

33. Infectious Disease Transmission Transmission - BloodborneHepatitis B virus (HBV) Hepatitis C virus (HCV) Human immunodeficiency virus (HIV) - Airborne - Vector - Direct or indirect contact

34. OPIM Cerebrospinal fluid Synovial fluid Pleural fluid Peritoneal fluid Pericardial fluid Any body fluid visibly contaminated with blood (such as vomit or urine) • Saliva containing blood • Semen • Vaginal secretions • Breast milk • Amniotic fluid • OPIM at BBRI: • Adenoviruses, Reteroviruses, Lentiviruses • Bacteria. • Genetically modified E.coli Blood in saliva during dental exam

35. NO The risk of infection after an exposure depends on: Whether pathogens are present in the source blood or body fluid The number of pathogens present The type of injury or exposure Your current health and immunization status Do Exposures Always Cause Infection?

36. Hepatitis B • Caused by hepatitis B virus (HBV) • Transmitted by blood and OPIM • Found in all body fluids. • Blood and semen are the most infectious • Major cause of liver damage, cirrhosis, and liver cancer

37. How is HBV Spread? • Injection • Needlesticks • Puncture wounds • Mucous membranes • Eyes and mouth • Nonintact skin (abrasions) • Sexual activity • Infected mother to newborn at birth

38. HBV Transmission • Contaminated environmental surfaces • At room temperature HBV may survive for several days in dried body fluids on surfaces • HBV more easily transmitted than HIV: - Lives longer outside the body - Little blood needed to cause infection

39. HBV not transmitted by: • Food or water • Fecal matter • Through the air • sneeze or cough • Casual contact • shaking hands, hugging, kissing, or sharing a meal, utensils, or a drinking glass

40. Symptoms of HBV Often no symptoms at all Flu-like symptoms may appear gradually Loss of appetiteNauseaFatigueMuscle or joint achesMild feverStomach painOccasionally jaundice Only certain way to know is to have a blood testBlood test may not indicate the virus shortly after being infected

41. OSHA Standard and HBV Vaccine • Best protection • Requires employers to offer the HBV vaccine to employees at risk at no cost, during their normal work hours • You have the right to: • Refuse the vaccine (You must sign a declination form) • Waiver available on BBRI intranet if needed • Change your mind and have the vaccination at a later date

42. Prevention of HBV Infection • Get the HBV vaccine • Use barrier devices to prevent contact with any blood and OPIM • Handle sharps carefully • Avoid recreational IV drugs, tattooing, and body piercing without sterile tools • Do not share personal items

43. Hepatitis C • Liver disease caused by the hepatitis C virus (HCV) • Lives in the blood of people with the disease • Spread via the blood • 2.7 million people in the U.S. have chronic HCV infection • Many people who carry HCV have some liver damage but do not get sick from it • Other people develop cirrhosis of the liver, resulting in eventual liver failure

44. How is HCV Spread? • From a pregnant woman to the fetus • Rarely, though sexual contact • In healthcare, via direct contact with infectious blood through an accidental needlestick or sharps injury • Most often through drug injections with contaminated needles • Unclean tattoo or body piercing tools • Sharing contaminated toothbrushes, razorsor other personal items

45. Most infected people do not have symptoms Some have: Symptoms of HCV - Fatigue - Loss of appetite - Nausea - Anxiety - Weight loss - Alcohol intolerance - Abdominal pain - Loss of concentration - Jaundice

46. HCV Testing • Anyone who has: • Been exposed to HCV-positive blood • Used intravenous recreational drugs • Received a blood transfusion or organ transplant • Been on kidney dialysis prior to 1992 • Been treated with a blood product prior to 1987 • Signs of liver disease

47. HCV Testing Is Important • Treatment can be given to protect the liver from additional damage • HCV carriers can take preventive measures to avoid spreading HCV to others

48. Prevention of HCV Infection No vaccine available for HCV and there is No cure Prevention is critical

49. Preventive Measures • Handle needles and other sharps with caution • Use barriers to prevent contact with blood and OPIM (wear gloves) • Avoid recreational intravenous drug use • Never reuse or share syringes, or drug paraphernalia • Do not share toothbrushes, razors, or other personal care items • Remember the health risks associated with tattoos and body piercing if tools are not sterile or sanitary practices are not followed

50. HIV and AIDS • Acquired immunodeficiency syndrome (AIDS) is caused by the human immunodeficiency virus (HIV) • There are almost one million HIV-positive people in the U.S. • AIDS damages cells essential for immune function • People with AIDS are more susceptible to opportunistic infections • The disease is eventually fatal