2012 UF Bloodborne Pathogen Training

1. 2012 UF BloodbornePathogen Training Biological Safety Office Environmental Health & Safety 352-392-1591 www.ehs.ufl.edu bso@ehs.ufl.edu

2. BBP Standard • 1990: Occupational Safety & Health Administration (OSHA) estimates >200 deaths & 9000 infections/year from occupational BBP exposure • BBP standard implemented in 1991 to protect workers from occupational exposure • 29 CFR 1910.1030 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

3. BBP Training Requirement • UF follows OSHA requirement • ALL employees, staff, students, volunteers, affiliates with potential exposure to BBP from human blood/OPIM • General and workplace-specific training • Completed BEFORE individual is assigned to tasks with the potential for BBP exposure and ANNUALLY thereafter • In addition to training, individuals with potential exposure must also have: • Access to the regulatory text and an explanation of its contents • Access to a copy of the UF Exposure Control Plan http://www.ehs.ufl.edu/Bio/BBP/ECP2012.pdf • Access to site-specific Standard Operating Procedures (SOPs)http://www.ehs.ufl.edu/Bio/BBP/BBPSOPS.pdf

4. Bloodborne Pathogens (BBPs) • Pathogenic microorganisms present in blood and other potentially infectious material (OPIM) that are able to cause disease in humans • Hepatitis B virus (HBV, HepB) • Hepatitis C virus (HCV, HepC) • Human immunodeficiency virus (HIV) • Less commonly, human T-lymphotropic virus (HTLV-1), Epstein-Barr virus (EBV), malaria, brucellosis, rabies, leptospirosis, babesiosis, syphilis, Creutzfeld-Jakob disease, arboviral infections (WNV, EEE), etc.

5. What constitutes OPIM?

6. Research using human cell lines… • Cell lines may be infected or become infected/contaminated in subsequent handling/passaging • 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? • Use Universal Precautions for all human cell lines

7. HIV/Hepatitis Research Labs • More stringent control measures • Work must be registered with EH&S Biosafety Office (rDNA or BA registration – forms online at http://www.ehs.ufl.edu/Bio/Registration_Forms.htm) • Enrollment in medical surveillance program • Follow CDC/NIH BSL-2 containment practices at a minimum

8. How are BBPs commonly transmitted in the workplace? • Cuts or punctures with contaminated sharp objects (needles, glass, scalpels, etc) • Splashes to mucous membranes (eyes, nose, mouth) • Contamination of broken/non-intact skin

9. “UNIVERSAL PRECAUTIONS”Cornerstone of exposure prevention • All human blood or OPIM is treated as infectious • Standard precautions = universal precautions + body substance isolation. Applies to blood & all other body fluids, secretions, excretions (except sweat), nonintact skin, and mucous membranes

10. Hepatitis B (HepB, HBV) • Spread through direct contact with infectedblood or OPIM; 50-100 times more infectious than HIV • Infection may be acute or chronic • 5-10 % of infected adults will develop chronic infection; ~1.2 million people with chronic HBV • 15-25% develop cirrhosis, liver failure, or liver cancer (~ 3000 deaths/year) • Symptoms of acute infection can appear 6 wks - 6 mos after exposure & include:

11. Occupational HepB Exposures • Needlestick/sharp injury from HepB contaminated source • ~30% of these exposures results in infection • Mucosal exposure to blood/body fluids • Exposure to nonintact skin from contaminated surfaces and equipment • HBV can remain infective in dried blood at RT for at least 1 week (MacCannell et al., Clin Liver Dis 2010; 14:23-36) What besides Universal Precautions & appropriate cleaning & disinfection can be used to prevent HepB infection….. ?

12. HepB Vaccine • 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 mos) • In Gainesville, free to UF employees @SHCC (392-0627) • Bring completed Acceptance/Declination statement http://www.ehs.ufl.edu/Bio/BBP/TNV.pdf • If you decline, can change mind at any time

13. Postvaccination testing • 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 • HepB surface antibody (anti-HBs) ≥ 10 mIU/mL - immune • Anti-HBs < 10 mIU/mL – revaccinate (3 doses) and retest anti-HBs • Still negative – nonresponder, need HBIG after exposure • Previously vaccinated but not tested? Test for anti-HBs after an exposure; if negative, treat as susceptible.

14. Hepatitis C (HepC, HCV) • Transmitted primarily through contact with infected blood • ~3.2 million Americans chronically infected; many do not know they are infected b/c they are asymptomatic (if symptoms do occur, similar to HepB) • ~ 12,000 deaths/year • Leading indication for liver transplant in U.S.

15. Occupational HepC Exposures • Percutaneous injury, esp. with deep punctures or extensive blood exposures • ~2% develop infection • Mucosal/nonintact 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) • Universal Precautions for Prevention! • NO VACCINE • Antivirals (peginterferon/ribavirin) can have serious side effects, treatment lasts 24-48 weeks • New HCV protease inhibitors – boceprevir & telaprevir (approved 5/11). Given in combination with traditional therapy, many side effects, drug resistance, only effective for genotype 1

16. HIV • Transmitted through contact with infected blood/OPIM • Attacks & destroys CD4+ T cells • Can be asymptomatic for many years • AIDS - occurrence of opportunistic infections or HIV-related cancers & a decline in CD4+ T cell (<200/µl blood) • 1.2 million Americans living with HIV • 135,000 (11%) in FL (ranks 3rd among states in # of reported infections) • 20% don’t know they are infected • ~50,000 new infections/year

17. Occupational HIV Exposures • Risk for HIV transmission after: • Percutaneous injury – 0.3% • Mucous membrane exposure – 0.09% • Nonintact skin exposure – low risk (< 0.09%) 57 documented occupational infections in U.S. (139 possible infections) 84% resulted from percutaneous exposure!

18. If HIV is such low risk, why worry? • No cure • No vaccine • Antiretroviral therapy – cocktail of 3 or more drugs, costly, side effects, drug resistance • Always use Universal Precautions!

19. Comparing the risks… • Risks of becoming infected after a needle stick injury: 30% 2% 0.3% *If unvaccinated*

20. UF Exposures (2008-2011) Number of exposures

21. Sharps Exposures by Department (UF) • All others includes 1 exposure each in the following departments: • ACS • EH&S • Nursing • Pharmacy • Psychiatry • Rec Sports

22. Sharps Exposures by Department (UFHSCJ) • All others includes 1 exposure each in the following departments: • Cardiology • CMFM • IM • Neurology

23. Controls to Protect Against BBP Exposures

24. Know and use prudent practices, protective devices and PPE needed to minimize risk Engineering Controls - Safety needles, sharps containers, BSC’s Work Practices - Waste disposal, spill cleanup Administrative Controls - Training, vaccinations Personal Protective Equipment - Gloves, lab coat, eye protection

25. Engineering Controls • Sharps container • Biosafety cabinet • Cleanable work surfaces/chairs • Leak-proof transport containers • Safety needles/syringes

26. List of safety sharps devices available can be found at: http://www.healthsystem.virginia.edu/internet/epinet/safetydevice.cfm#1

27. Safe Work Practices • Know what they are and follow them! • Minimize splashes/aerosols • Safe handling of sharps • Proper hand washing • Decontaminate work surfaces daily and after spills • Know how to handle spills (covered in BMW training) • Proper disposal of contaminated items • No eating, drinking, smoking, handling contacts or applying cosmetics in areas where blood/OPIM is handled or stored

28. Hand washing is critical! • Hand transmission important route of infection • Hands easily contaminated during lab procedures • Usually no barrier between hands and face • Hand-to-face contact common → 15-27 times/half hour (Collins & Kennedy, 1999) • Wash hands frequently & thoroughly • After handling infectious/potentially infectious materials • After removing gloves • Before leaving the lab Pay attention to frequently missed areas – fingertips, between fingers, under jewelry

29. DO NOT RECAP NEEDLESDon’t bend, break, or detach from syringe NO!! NO!! • Discard needles directly into sharps container • Do not overfill the sharps box – close and replace when ¾ full • Never attempt to re-open a closed sharps box

30. Circumstances Associated with Hollow-Bore Needle Injuries NaSH June 1995—December 2003 (n=10,239) 35% disposal related

31. Decontamination/Disinfection • FRESHLY DILUTED (w/in 24 hrs) 1:10 solution of household bleach • EPA listed tuberculocidal disinfectant • http://www.epa.gov/oppad001/chemregindex.htm • Clorox, amphyl, lysol, sporicidin • Ethanol evaporates too quickly to be an effective disinfectant!

32. Personal Protective Equipment (PPE) • Must be supplied by the employer • Wear it WHEN and WHERE you are supposed to • Do not wear in common areas (offices, hallways, bathrooms, cafeterias, etc) or when handling common-use items (doorknobs, elevator buttons, telephones) • It must fit, be suitable to the task (use common sense), and be cleaned or disposed of properly (this does not mean taking it home to wash!) • Gloves • Latex or nitrile – vinyl does not hold up well! • Face and Eye Protection • Surgical mask, goggles, glasses w/side shield, face shield • Body • Gowns, aprons, lab coats, shoe covers Absolutely no open toed shoes in the lab!

33. Labeling • BBP standard requires that warning labels are placed on: • Containers of regulated waste • Refrigerators & freezers containing blood or OPIM • Containers used to store, transport, or ship blood or OPIM • Use red bags for waste containers

34. If you have an exposure: • Wash wound with soap & water for 5 minutes; flush mucous membranes for 15 minutes • Seek immediate medical attention (1-2 hrs max) • In Gainesville, call 1-866-477-6824 (Needle Stick Hotline) • In Jacksonville, 7am-4pm, go to Employee Health Suite 505 in Tower 1; Other hours, go to ER • Other areas, go to the nearest medical facility • Notify supervisor • Contact UF Worker’s Compensation Office, 352-392-4940 • Allow medical to follow-up with appropriate testing & required written opinion

35. Factors considered in assessing need for PEP CDC PEP Guidelines: http://www.cdc.gov/mmwr/PDF/rr/rr5409.pdf http://www.cdc.gov/mmwr/PDF/rr/rr5011.pdf

36. This completes the PowerPoint segment of the BloodbornePathogenTraining Please exit the session and click on the link for Tests & Quizzes on the left hand side of the screen. You must take the quiz & score at least 75% to fulfill the training requirement.