Annual Blood Borne Pathogen Training (Healthcare & Research version)

1. Annual Blood Borne Pathogen Training (Healthcare & Research version) Environmental Health & Safety Department Jay Abbt Daron White

2. Annual update for PVAMU employees with potential exposure to blood or other potentially infectious materials (OPIM)

3. The following program meets the training requirements set forth by the OSHA Bloodborne Pathogens Standard. • This training module is a self-study designed to provide a review of the following: • Bloodborne pathogens (BBP) • Modes of transmission of BBP • Exposure control principles and practices as they relate to bloodborne pathogens

4. Bloodborne Pathogens Standard • OSHA (1991)- “Occupational Exposure to Bloodborne Pathogens” (29 CFR 1910.1030) • Revised in 2001 in response to the Needlestick Safety and Prevention Act Goal: eliminate or minimize occupational exposure to Hepatitis B virus (HBV), Human Immunodeficiency virus (HIV), Hepatitis C virus (HCV), and other bloodborne pathogens

5. What are Bloodborne Pathogens (BBP)? • Any pathogenic microorganisms or OPIM (other potentially infectious materials) present in human blood that can cause disease in humans. • Primary focus in our setting is HBV, HCV, and HIV- which will be detailed further in this presentation. • Other examples of BBP include microorganisms that cause: • malaria, syphilis, babesiosis, brucellosis, leptospirosis, arboviral infections, relapsing fever, Creutzfeldt-Jakob disease, HTLV-1, and viral hemorrhagic fever.

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

7. OPIM includes the following: • 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

8. HBV, HIV, HCV Let’s look at each of the BBP of concern in detail

9. 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 2006, an estimated 46,000 people were newly infected with HBV. It is estimated that 1.25 million Americans are chronically infected.

10. Hepatitis B Virus • HBV infection is a well recognized occupational risk for healthcare personnel. • The average volume of blood inoculated during a needlestick injury with a 22-gauge needle is approximately 1 µl, a quantity sufficient to contain up to 100 infectious doses of HBV. • HBV can survive outside the body at least 7 days and still be capable of causing infection.

11. 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

12. HBV IS PREVENTABLE!A safe & effective vaccine is available. • Hepatitis B vaccine prevents hepatitis B infection and its serious consequences. • 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

13. What treatment is available for HBV? • In the occupational setting, multiple doses of Hepatitis B Immune Globulin initiated within 1 week following percutaneous exposure to hepatitis B surface antigen-positive blood provides an estimated 75% protection from HBV infection. • There is no cure available for acute HBV infection. There are antiviral drugs available for the treatment of chronic HBV infection.

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.

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 United States. At the end of 2003, an estimated 1,039,000 to 1,185,000 persons in the United States were living with HIV/AIDS, with 24-27% undiagnosed and unaware of their HIV infection.

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. HIV • 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.

18. HIV- no cure or vaccine available • Treatment protocols from the U.S. Public Health Service have been developed using antiretroviral agents from five classes of drugs to treat HIV infection. These include: • the nucleoside reverse transcriptase inhibitors, nucleotide reverse transcriptase inhibitors, nonnucleoside reverse transcriptase inhibitors, protease inhibitors, and a single fusion inhibitor. • The recommendations provide guidance to effectively suppress the virus on the basis of HIV transmission risk represented by the exposure.

19. HIV • Side effects associated with the use of antiviral drugs can be severe. • The drug regimen is not a cure for AIDS, but it has greatly improved the health of many people with AIDS and it reduces the amount of virus circulating in the blood to nearly undetectable levels. • Researchers, however, have shown that HIV remains present in hiding places such as the lymph nodes even in people who have been treated.

20. HCV • Hepatitis C virus is a liver disease • After a needlestick or sharps exposure to HCV positive blood , about 1.8% healthcare workers will get infected with HCV. • Estimated 4.1 million (1.6%) Americans have been infected with HCV, of whom 3.2 million are chronically infected.

21. HCV Long term effects of HCV: • Chronic infection: 75%-85% of infected persons • Cirrhosis: 20% of chronically infected persons • Deaths from chronic liver disease: 1%-5% of infected persons may die • Leading indication for liver transplant

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

23. HCV • Currently, there is no cure for hepatitis C, and no effective vaccine is currently available. • National recommendations for the control of occupational exposure to HCV rely more on the prevention of transmission. In addition, several blood tests that measure either antibodies to HCV or HCV-RNA are available for hepatitis C screening. These tests are useful in determining current immune status and monitoring ongoing infection.

24. How does a bloodborne infection occur? • How might I get exposed in the workplace?

25. Chain of Infection Infection Control = Break any link in the chain

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

27. Modes of transmission of BBP • 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 in clinical or laboratory settings poses a genuine risk of infection.

28. Duties that might put you at risk for an occupational exposure: • Perform drawing of blood from human patients or animals • Process blood for experimentation • Work with human or animal blood or body fluids • Use unfixed tissue in preparations or experimentation • Work in an area where HIV or HBV research is being performed or produced • Clean glassware contaminated with blood or OPIM

29. Duties that might put you at risk for an occupational exposure: • Dispose of waste contaminated with blood or OPIM • Transport blood or OPIM • Work in a laboratory where equipment or work benches can become contaminated • Handle containers of infectious wastes • Clean blood spills, including dried blood • Handle laundry that contains sharps or is soiled with blood or OPIM • Perform lifesaving procedures

30. Risk Factors for Infection • Pathogenicity of organism • Dose (how much blood or infectious agent) • Route of entry (injection vs. contact with mucous membrane or open wound) • Host susceptibility • Work practices

31. Now that we have reviewed how an exposure can occur, let’s look at how to prevent exposure.

32. 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, HBV vaccination, warning signs or labels, and other provisions described in this training section.  

33. 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

34. 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

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

36. Exposure Control Plan • Written plan provided to eliminate or minimize occupational exposure to BBP. • PVAMU Safety Manual • Can be obtained from EHS website. • Reviewed annually.

37. Exposure Control Plan Updates include: • Changes in technology that reduce/eliminate exposure (engineering controls) • Annual documentation of consideration and implementation of safer medical devices • Input from non-managerial employees (who are responsible for direct patient care) in selecting and evaluating safer medical devices

38. Engineering Controls • Sharps with Engineered Sharps Injury Protection (SESIP)– a non-needle sharp or needle with a built-in safety feature or mechanism that effectively reduces the risk of an exposure incident • Examples include: Self-sheathing syringe

39. More Examples of Engineered Sharps Safety Devices In use After use Retractable needle technology Retractable lancets Self-blunting needles Add-ons (needle covers)

40. Engineering Controls • Needleless Systems = Device that does not use a needle for: • collection of body fluids • administration of medication/fluids • any other procedure with potential percutaneous exposure to a contaminated sharp

41. Work Practice Controls • Contaminated needles/sharps shall not be bent, recapped or removed unless there is no feasible alternative or if required by a specific medical procedure • Such bending, recapping, or removal must be done though use of mechanical device or a one-handed technique • Use puncture-resistant sharps • container for disposal of sharps

42. Work Practice Controls • No food/drink/smoking, handling of contact lenses, or application of cosmetics in work area where there is potential for exposure • Minimize splashing, spraying, spattering, and generation of droplets • No mouth pipetting • Use secondary containment for transport, shipping, or storage of containers • Decontaminate surfaces and equipment

43. Handwashing • Employees must wash their hands immediately or as soon as feasible after removal of gloves or other personal protective equipment. • Wash as soon as possible if gross contamination occurs • Alternate methods: • Antiseptic towelettes • Waterless handwashing gels

44. Personal Protective Equipment (PPE) PPE is appropriate only if it does not permit blood/OPIM to pass through and/or reach the employee’s clothing, skin, eyes, mouth, or other mucous membranes under normal use.

45. 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 performing vascular access procedures • when handling or touching contaminated surfaces or items. • Remove prior to leaving the work area and discard as biohazard waste

46. 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

47. Personal Protective Equipment • Gowns, aprons, fluid-resistant clothing • Face shields, eye protection (safety glasses, goggles) • Respirators • Surgical caps, shoe covers

48. 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.

49. Training • Training is required: • at the time of initial employment and assignment • (or transfer) to job tasks where occupational exposure may occur • within one year of the employee's previous training and annually thereafter (if the employee remains in an at-risk position) • when changes such as modification of tasks or procedures or institution of new tasks or procedures affect the employee's potential for occupational exposures, and as new standards for safe work practices evolve.

50. HBV Vaccination • FREE to employee - paid for by your department if you are at high-risk for exposure • If you initially refuse the vaccine, you may change your mind later and still receive it.