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UF Bloodborne Pathogen Training Program 2011

UF Bloodborne Pathogen Training Program 2011. * Biological Safety Office Environmental Health & Safety www.ehs.ufl.edu 352-392-1591 bso@ehs.ufl.edu. Sharon Judge, PhD Assistant Biosafety Officer.

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UF Bloodborne Pathogen Training Program 2011

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  1. UF Bloodborne Pathogen Training Program 2011 *Biological Safety Office Environmental Health & Safety www.ehs.ufl.edu 352-392-1591 bso@ehs.ufl.edu Sharon Judge, PhD Assistant Biosafety Officer *Portions of this presentation were edited and adapted for clinical dentistry applications at UFCD by the Office of Clinic Administration. OSHA requires that printed copy of this training be maintained in the clinic.

  2. Bloodborne Pathogens (BBPs) ? • Pathogenic microorganisms present in blood or other potentially infectious material (OPIM)that are able to cause disease in humans. These pathogens include: • Hepatitis B virus (HBV) • Human immunodeficiency virus (HIV) • Hepatitis C virus (HCV) • Less Common disease agents such as Epstein-Barr virus (EBV), human T cell lymphoma virus (HTLV-1), malaria, syphilis, babesiosis, brucellosis, leptospirosis, arboviral diseases (WNV, EEE), Creutzfeldt-jacob disease, rabies, etc

  3. BBP Standard • Implemented in 1991 by the Occupational Safety & Health Administration (OSHA) • 29 CFR1910.1030 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. • UF follows OSHA requirement • General and workplace-specific training • Completed BEFORE individual is assigned to tasks with the potential for BBP exposure and ANNUALLY thereafter

  4. BBP Standard:In addition to training, individuals with potential exposure must also have the following: • Access to the regulatory text – required to print a copy for the work (clinic) area http://www.osha.gov/pls/oshaweb/owadisp.show_document?p_table=STANDARDS&p_id=10051 • And an explanation of it’s contents • A copy of the training material is adequate • Access to a copy of the UF Exposure Control Plan http://www.ehs.ufl.edu/Bio/BBP/ECP2010.pdf • Access to any site-specific standard operating procedures (SOPs) http://www.ehs.ufl.edu/Bio/BBP/BBPSOPS.pdf

  5. The OSHA BBP Standard • Scope & application • Definitions • Exposure control, exposure control plan, & exposure determination by jobs/tasks • Compliance • Engineering and work practice controls • Personal Protective Equipment (PPE) • Housekeeping • Regulated waste and sharps • HIV/HBV research labs – held to a higher standard • HBV vaccination and Post-exposure prophylaxis (PEP) • Communication to employees – signs, labels, training • Record keeping

  6. UF BBP Program http://www.ehs.ufl.edu/Bio/BBP/default.htm • Chairs/Directors : ensure department’s compliance • Faculty/Supervisors : have an exposure control plan in place that is appropriate & being followed • Employees, students, volunteers, etc: follow exposure control plan, report problems/exposures • SHCC/Employee Health: immunizations & post-exposure follow-up • EH&S Biosafety: develop & coordinate UF program, track participants

  7. Who at UF is enrolled in the program? Custodians, medical providers, dentists/dental staff, autopsy staff, clinical laboratory staff, research lab staff & students, biomedical engineers, athletic trainers, event staff, police, emergency responders, physical plant workers,…..etc ALL employees, staff, students, volunteers, affiliates with potential exposure to bloodborne pathogens (BBP) from human blood / other potentially infectious material (OPIM)

  8. What constitutes OPIM?

  9. How are BBPs commonlytransmitted at work? • Cuts or punctureswith contaminated sharp objects • Splashes to mucous membranes (linings of eyes, nose, & mouth) • Your mucous membranes are permeable, allow pathogens to pass through • Contamination of broken or non-intact or skin (wounds, chapped skin, rashes)

  10. UF Exposures (2008-2010) Note: 2010 Increase in sharps and splash exposures

  11. 2010 Reported Sharps Exposures by Department Dentistry reported 10 exposures

  12. Cornerstone of exposure prevention“STANDARD PRECAUTIONS” • Any and all human blood or other potentially infectious material (OPIM) is treated as INFECTIOUS Use: • Safety equipment • Engineering Controls • Safe practices • Personal Protective Equipment (PPE) To protect yourself & others in the work environment “Standard Precautions” is an alternate, clinical / hospital term = Universal Precautions + “body substance isolation” (standard of care for all patients, all body fluids)

  13. What to treat with STANDARDPRECAUTIONS: • Any human blood or OPIM …..&….. • objects/items that may be contaminated by blood or OPIM • Any unfixed tissue or organ, other than intact skin, from a living or dead person • Cell or tissue cultures that may contain BBP agents • Blood/ tissues from animals infected with BBP agents

  14. Research using human cell lines… • Use Universal Precautions for all human cell lines • 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? • What about XMRV?

  15. Hepatitis B (HepB, HBV) • Spread through direct contact with infectedbody fluids (blood, semen, vaginal fluids) • More transmissible than Hep C virus and HIV • Infection may be acute or chronic • ~4.3-5.6% of Americans have been infected with HepB • 5-10 % of adults will develop chronic infection; ~1.2 million people with chronic HBV • 15-25% develop cirrhosis , liver failure, or liver cancer (~ 3000 deaths/year) • Many people (~50%) are asymptomatic; if symptoms occur they include:

  16. Occupational Hepatitis B Exposures • Needle sticks a real concern… 30% of susceptible/non-vaccinated individuals exposed to infected blood this way became infected • Can be transmitted by surface contact with dried blood or OPIM! HBV can remain infective in dried blood @ room temperature for at least 1 week (MacCannell et al., Clin Liver Dis 2010; 14:23-26) Many people have no idea how they became infected • Risk of infection from blood/OPIM splash onto non-intact skin or mucous membranes… greater risk than other BBPs

  17. How to prevent Hepatitis B infections at work • Get vaccinated! • Use Standard Precautions • Cleaning/disinfection is important because the virus can survive on surfaces • OSHA BBP standard requires that employees with potential exposure be offered the vaccine at no cost. • Occupational infections have decreased 95% since HepB vaccine became available in 1982

  18. 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 months) • In Gainesville, free to employees @UF SHCC (392-0627) • Bring completed Acceptance/Declination statement with you http://www.ehs.ufl.edu/Bio/BBP/TNV.pdf • If you decline, can change mind at any time NOTE: Decline in children and adolescents since implementation of childhood vaccinations.

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

  20. Hepatitis C (HepC, HCV) • Transmitted primarily through contact with infected blood • Many people asymptomatic (symptoms similar to HepB) • ~1.8 % of Americans have been infected with HepC, 3.2 million chronically infected • ~ 12,000 deaths/year • Leading indication for liver transplant in U.S.

  21. Occupational HepC Exposures • Percutaneous injury, esp. with deep punctures or extensive blood exposures • ~2% develop infection • Mucosal/non-intact 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)

  22. How to prevent Hepatitis C infections at work • Universal Precautions for Prevention! • NO VACCINE • Antivirals (interferon/ribavirin) can have serious side effects, treatment lasts 24-48 weeks

  23. HIV • CDC: Greater than 1 million people in the United States are currently infected. • At least one-fourth of them do not know they are infected, putting them at high risk for transmitting the virus to others. • The annual incidence rate of HIV/AIDS in Florida remains more than twice the national average. • In 2007, Florida reported 6235 cases HIV, 3896 cases AIDS (Florida DOH HIV/AIDS Annual Report 2007).

  24. HIV/AIDS - U.S. and Florida • > 1 million living with HIV/AIDS • ~56,000 new infections/year • ~20% don’t know they are infected • Florida ranks 3rd among states in the number of reported HIV/AIDS cases

  25. HIV • Attacks immune system • destroys white blood cells (CD4+ T cells) • Leaves patient immune suppressed & susceptible to infections & certain tumors • Many people show no symptoms for a long time (years) • Eventually leads to development of AIDS • (acquired immune deficiency syndrome) • Early symptoms very similar to flu: • Fever • Headache • Tiredness • Enlarged lymph nodes • Treatment focuses on ways to lower blood levels of virus

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

  27. If HIV is such low risk, why worry? • No cure – eventually fatal • NO VACCINE • Some HIV strains resistant to therapy • Post-exposure therapy costly & has side effects. Cocktails of three or more antiretroviral drugs given

  28. How to prevent HIV infections at work • Standard precautions ONLY!

  29. BBPs – comparing the risk of infection Risks of becoming infected with (one of the below listed BBPs) from a needle stick accident: HepB: 30% or 300 people per 1000 needle sticks, if unvaccinated HepC :2% or 20 people per 1000 needle sticks HIV : 0.3% or 3 people per 1000 needle sticks

  30. Workplace-specific controls to protect against BBP exposure • Engineering controls(Safety Equipment ) • Work Practices • Personal protective equipment (PPE) Maximum protection when these controls overlap

  31. Engineering Controls (Safety Equipment) Task specific - Examples: • Sharps box • Non-slip floors • Cleanable Work Surfaces & Dental Chairs • Leak-proof transport containers • Safety devices including needles/syringes and scalpels SAFETY Sharps DEVICES as available athttp://www.healthsystem.virginia.edu/internet/epinet/safetydevice.cfm#1

  32. Work practices Controls • Safer ways of doing things: • Pre-plan your work (unit dose) • Decontamination/Disinfection of equipment and surfaces • Minimize splashes • Barrier covers on equipment and surfaces • Proper handling of spills • Hand Hygiene • No food or drink in areas where blood or OPIM is generated/handled/ stored

  33. Needle Safety: NEVER RECAP NEEDLES USING BOTH HANDS Do Place needles directly into the Sharps Box Close & replace Sharps Box when it is ¾ full Do not overfill the sharps box. Never attempt to re-open a closed Sharps Box

  34. Needle Safety: Know where your needles and other sharps are—AT ALL TIMES!!!!!!! **Never leave a needle uncapped anywhere in your operating field. • When possible retract tissue with another instrument (mouth mirror) • Recapping Needles • Use a scoop technique • Use a cap holder if supplied on the tray Never use two hands when recapping - use the one-handed scoop method.

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

  36. Decontamination/Disinfection of equipment & surfaces: Disinfectants • EPA listed tuberculocidal disinfectant http://www.epa.gov/oppad001/chemregindex.htm • Cavicide or Opticide • Follow manufacturers recommendation for contact time of surface exposure to disinfectant • A FRESHLY MADE (w/in 24 hr) solution of household bleach diluted 1:10 with water • Ethanol; isopropyl alcohol products evaporate too quickly to be effective. Do not use.

  37. Indications for Hand Hygiene • When hands are visibly dirty, contaminated or soiled, wash with non-antimicrobial or anti-microbial soap and water. • Should be washed for at least 20 seconds and dried thoroughly before donning gloves. Pay attention to areas between fingers and around nails. • If hands are not visibly soiled, use an alcohol based hand sanitizer for routinely decontaminating hands. • Use enough sanitizer to moisten all surfaces of the hands and rub until dry. • Less damaging to skin than soap • Use before and after wearing gloves or patient contact. Note residue around cuticles & under watchband after thorough hand washing (using “Glo-Germ” )

  38. Employer responsibilities for PPE: Supplied by employer - It must be available It must fit It must be suitable to the task Cleaned or disposed of properly Personal Protective Equipment (PPE) • Procedure driven - Wear it when & where you’re supposed to • PPE must not be worn in any common area, hallway or office = OSHA BBP rule

  39. Personal Protective Equipment (PPE) Site specific & appropriate to the task - Refer to area’s site specific written standard operating procedures • Face and Eyes • Mask • Glasses (with side shields) • Goggles • Face Shield • With mask Body – Examples • Coats • Gowns • Aprons • Sleeves • Head • Shoe Covers

  40. According to the CDC, the correct order for • donning personal protective equipment is: • Cover gown • Fully cover torso from neck to knees , arms to end of wrist • Mask • Fit flexible band to nose bridge • Fit snug to face and over chin, covering nose • Goggles, safety glasses with side shield or face shield • Gloves • Extend to cover wrist of cover gown

  41. According to the CDC, the correct order for removing personal protective equipment is: • Gloves • Outside of glove is contaminated! • When removing, grasp outside of glove with opposite gloved hand and peel off • Goggles, safety glasses with side shield or face shield • Outside of goggles is contaminated! • Remove by grasping ear piece • Cover gown • Gown front and sleeves are contaminated! • Unfasten ties • Pull away from neck and shoulders, touching inside of gown only • Turn gown inside out and roll into a ball then discard • Mask • Front of mask is contaminated – DO NOT TOUCH! • Grasp bottom, then elastics and remove

  42. Pay attention to how you remove your gloves • Grasp the top or wrist of one glove, being careful not to touch anything but the glove. • Pull the glove off, turning it inside out. Continue holding the glove. • Go under the cuff of the other glove, being careful not to touch its outside surface. • Pull the glove off, turning it inside out and pulling it over the first glove. Both gloves should now be inside out, one inside the other. • Discard both gloves into an approved waste container. • Then wash hands or use hand sanitizer!

  43. REMEMBER TO USE SAFE WORK PRACTICES TO PROTECT YOURSELF AND LIMIT THE SPREAD OF CONTAMINATION • Keep hands away from face • Limit surfaces touched • Change gloves between patients, when worn/torn or heavily contaminated • Perform hand hygiene

  44. Personal protective equipment (PPE)-Other Considerations: Store, Dispose of, or Clean PPE appropriately • Do not take PPE home to wash • Do not wear it out of the clinic area …Wear closed toe shoes ! Acid + Flip flops

  45. GLOVES • Latex • Nitrile • Vinyl – Not recommended - DO NOT hold up well Do not re-use gloves Do not wash gloves Some chemicals (soaps, lotions, & hand sanitizers) you use may breakdown the gloves – use glove compatibility chart

  46. No gloves outside of the clinic!Be aware that the general public does not if know gloves are clean and assumes they are contaminated.

  47. Site specific Exposure Control Plan (ECP) & Standard Operating Procedures (SOPs) • Equipment, practices, and personal protective equipment used AT YOUR SITE to protect you & others • Written down, reviewed, & updated on a regular basis – at least annually • Accessible to all • See EH&S website for a template to make your SOPs http://www.ehs.ufl.edu/Bio/BBP/BBPSOPS.pdf

  48. HIV & Hepatitis research labs….. • More stringent control measures • Registration of work with EH&S • Documented enrollment in a medical surveillance program • CDC/NIH BSL2 guidelines at a minimum

  49. Steps to Take If An Exposure Occurs • Wash the area very thoroughly with soap & water: flush mucous membranes for 15 minutes • Notify supervisor/faculty • Call 1-866-477-6824, the Needle Stick Hotline, for exposures within 1 hour of Gainesville. Go to nearest medical facility outside of Gainesville area. • Get immediate medical attention (1-2 hr max) • Allow Medical to follow up with the appropriate testing & the required written opinion

  50. In Gainesville Vicinity: Also for scalpel cuts, glass cuts, splashes, etc

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