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BLOODBORNE PATHOGENS

BLOODBORNE PATHOGENS. Purpose. Reduce / eliminate exposure potential Comply with Ohio ’ s Public Employment Risk Reduction Act (reference OSHA). 2. Exposure Determination. Employees in the following job classifications have reasonably anticipated occupational exposure:

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BLOODBORNE PATHOGENS

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  1. BLOODBORNE PATHOGENS

  2. Purpose • Reduce / eliminate exposure potential • Comply with Ohio’s Public Employment Risk Reduction Act (reference OSHA) 2

  3. Exposure Determination • Employees in the following job classifications have reasonably anticipated occupational exposure: • Physicians, nurses, and lab technicians at SHC; Nursing Faculty • Trainers in Intercollegiate Athletics • Employees with first aid responsibilities at the Ice Arena • RSC: Lifeguards, Facility Managers, Outdoor Pursuit Center • Recycling Center staff • First aiders in Child Studies • University Police Officers • BSW / BRW who may clean-up blood/body fluid in a work area • Chemistry/Biochemistry who work with blood products 3

  4. Topics Bloodborne diseases and their transmission Reducing exposure potential Exposure incidents Hepatitis B vaccine Spill cleanup 4

  5. Bloodborne diseases and their transmission • Percutaneous, parenteral (i.e., through the skin layer) • Contact with mucous membranes of eyes, nose, mouth (via splash, direct contact) • Sex with infected partner • Maternal-Neonatal (i.e., mother to unborn child/infant) Significant risk variables: volume, concentration, mode of transmission, immune status 5

  6. Bloodborne diseases and their transmission Universal Precautions A simple approach to infection control. A concept that assumes that all human blood and certain human body fluids are treated as if known to be infected by bloodborne pathogens. Always Presume Contamination 6

  7. Bloodborne diseases and their transmission Terms • BBP (bloodborne pathogens) • HIV (human immunodeficiency virus) • AIDS (acquired immunodeficiency syndrome) • HBV (hepatitis B virus)* • OPIM (other potentially infectious materials) *or one of the other hepatitis viruses (e.g., HCV) 7

  8. Bloodborne diseases and their transmission Other Potentially Infectious Materials OPIM • semen and vaginal secretions • saliva (in dental procedures) • ANY body fluid visibly contaminated with blood • ALL body fluids in situations where it is difficult or impossible to differentiate between body fluids • Other internal fluids from the brain or spine, joints, lungs, around the heart or abdomen, or in the womb • Any unfixed (not preserved) human tissue or organ 8

  9. Bloodborne diseases and their transmission Not Considered OPIM • Vomit • Perspiration • Tears • Urine • Feces 9

  10. Bloodborne diseases and their transmission Human Immunodeficiency Virus • Target in Body • Virus Concentration • Risk (contaminated needlestick) • External viability • Vaccine Available immune system low (5 - 10)* 1 in 200 chance 3 to 5 hrs no *measured in viral bodies / milliliter of blood H I V AIDS Time Span (?) 10

  11. Bloodborne diseases and their transmission AIDS Epidemiology (U.S.) Persons living With diagnosis of HIV Infection Cases Reported Deaths 1994 1996 2002 2004 2006 2008 2010 71,874 59,347 38,132 38,726 25,551 23,049 18,926 49,095 36,510 16,948 17,154 15,679 16,276 492,673 601,741 762,084 Source: Centers for Disease Control and Prevention HIV Surveillance Report.. 2010. v22. 11

  12. Bloodborne diseases and their transmission U.S. Adult AIDS cases reported through 2010 Number (%) • Male-to male sexual contact • Injected drug use • Male-to male sexual contact and Injected drug use • High-risk heterosexual contact • Other (Hemopilia/coagulation disorder; Receipt of tranfusion; Not reported or Identified) • TOTAL 490,588 54 174,022 20 75,036 8 61,937 7 99,527 11 901,110 100 Source: Centers for Disease Control and Prevention HIV Surveillance Report. 2010. v22 12

  13. Bloodborne diseases and their transmission Hepatitis • “Hepa” = liver; “titis” = inflammation of • 6 types = A, B, C, D, E, and G • Types B (HBV) and C are bloodborne • Type D and G only occurs in those already infected with type B • Types A, E spread through fecal-oral mode of transmission • Hepatitis B and C can be ACUTE or CHRONIC 13

  14. Target in Body • Virus Concentration (one tsp. of blood) • Risk from contaminated needlestick • External viability • Vaccine Available liver 500M* 1 in 2.5 chance 7 days yes Bloodborne diseases and their transmission Hepatitis B virus *measured in viral bodies / milliliter of blood Source: American Liver Foundation 14

  15. Bloodborne diseases and their transmission HBV Confirmed Transmission • Sexual contact (includes anal & oral sex) • Contaminated needles (esp. I.V. drug use) • Maternal-Neonatal • Blood transfusions (negligible) • Other: intra-family, -institutional, hemodialysis, oral (rare), household • Approximately 1/3 unknown sources Source: American Liver Foundation 15

  16. Bloodborne diseases and their transmission HBV Symptoms • Loss of appetite • Nausea, vomiting, fever, stomach or joint pain • Extreme fatigue • Yellowing of the skin or eyes • Dark Urine • 30 - 40% with acute HBV show no symptoms Source: American Liver Foundation 16

  17. Bloodborne diseases and their transmission HBV facts (U.S.) • Approximately 5,000 deaths annually • 140 - 320K new infections annually • Young adults account for 90% of reported cases • 1.25 million Americans are HBV carriers • 90 - 95% of adults recover from HBV • Chronic carriers have 100% greater chance of developing liver cancer Source: American Liver Foundation 17

  18. Exposure Control Methods 1. Signs and Labels 2. Exposure Control Plan 3. Engineering Controls 4. Personal Protective Equipment 5. First Aid Situations 6. Contaminated waste disposal 7. Contaminated laundry 18

  19. Exposure Control Methods 1. Signs and Labels • “Medical Waste” • “Infectious Waste” • “Infectious” • “Biohazard” 19

  20. Exposure Control Methods 2. Exposure Control Plan Covers: • Spill response • Housekeeping • HBV program • Exposure incidents • Infectious waste disposal • PPE • Work practices Availability - BBP Trainer or EHSO 20

  21. Exposure Control Methods 3. Engineering Controls • Sharps Containers • Biohazard waste bags & boxes • One-way valves on resuscitation devices • Hand washing facilities Examples: 21

  22. Exposure Control Methods 4. Personal Protective Equipment • Types • Limitations 22

  23. Exposure Control Methods 5. First Aid Situations • University Police are designated first responders • Encourage self-care if possible • Avoid bare-hand pressure without barrier • Glove accessibility 23

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  25. Exposure Control Methods 6. Contaminated Waste Disposal • Infectious Waste • Red bags • Labeling requirements • Biohazard boxes • Drop-off sites • Sharps disposal 25

  26. Exposure Control Methods 7. Contaminated Laundry • Wear gloves for handling and thoroughly wash hands afterwards • If blood or OPIM gets on personal clothing, remove it and wash the clothing as soon as feasible following the detergent manufacturer’s directions. 26

  27. Exposure Incidents Blood or OPIM Contacts: Mucous membranes Eyes Mouth Nose Non-intact skin 3. Contaminated Sharp 27

  28. Exposure Incidents Exposure Incident Examples • Blood/OPIM splash on non-healthy or non-intact skin (e.g., rash, a recent cut, chapped skin, broken cuticles, skin that is chafed, scraped, etc.) • Blood/OPIM splash to eyes, nose, or mouth • Puncture injuries with potentially contaminated object (e.g., needlesticks, contaminated glass, etc.) • Rubbing eyes or nose with contaminated gloves or clothing 28

  29. Exposure Incidents Contact with Blood / OPIM • Needlestick / puncture injury • Mucous membrane contact 30

  30. Exposure Incidents Post-exposure evaluationand follow-up • Confidential medical evaluation and blood testing offered at no cost to employee • Voluntary 31

  31. Exposure Incidents What is involved in an exposure evaluation? • Report to the Nursing Supervisor at the Student Health Center (SHC) • Medical personnel will document how the exposure occurred and the route of entry • They will request the identity of the source individual and seek consent to test their blood for hepatitis and HIV (you will be given the results of these tests) 32

  32. Exposure Incidents Post-exposure testing • Voluntary blood tests • HIV antibody test requires several blood tests over a period of time • If medically indicated, you will be offered a vaccine for Hepatitis B • Recordkeeping 33

  33. HBV vaccine • Noninfectious • Produced in yeast cells • Developed free of human blood or blood products • Used to promote immunity to HB infection in individuals considered at high risk of potentially being exposed to the virus 34

  34. HBV vaccine HBV program at Miami University • Eligibility requirements* • Administration site (SHC) • Schedule (Call SHC for appointment) • Consent / Declination procedures * Employees determined to have a reasonably anticipated high risk of occupational exposure 35

  35. HBV vaccine Pre- vs. Post-exposure vaccination • Preventive / pre-exposure vaccination protects against unidentified exposure incidents • Vaccine series may be initiated following exposure incident • Best started within 48 - 72 hours • Student Health Services suggests initiation no later than 7 days after exposure • 70 to 75% effective in preventing HBV infection 36

  36. HBV vaccine Side Effects • Local effects: redness, soreness, swelling, firmness at site of injection • Generalized effects: slight fever, nausea, vomiting, diarrhea, headache, chills, mild muscle aches and/or joint pain • Allergic / hypersensitivity reaction: rash, itching, swelling not limited to injection site • No known harmful effects if previously infected or positive for HBV antibody 37

  37. HBV vaccine Contraindications (Conditions suggesting treatment should not be administered) • Yeast allergy • Immunodeficiency disease • Recent febrile illness / infection • Pregnancy • Lactation 38

  38. HBV vaccine Efficacy (Vaccine’s effectiveness) • Active immunity in 80 to 95 percent of persons completing the series of three injections • Immunity projected to last indefinitely • Positive immunity protects against all modes of transmission • May donate blood if vaccine given as a preventive measure 39

  39. Spill cleanup • Kits • Decontamination • Precautions • Procedure 40

  40. Spill cleanup Spill cleanup kits • Accessibility requirements • Know the locations of the kits in your work area and make sure you have easy access to them • Know how to use your department’s kit • Follow directions included with the kit and use all personal protective equipment provided in it 41

  41. Spill cleanup Decontamination • Use 10% bleach solution for 15-minute soak time* • Undiluted bleach for a minimum exposure of 30 seconds • EPA-registered TUBERCULOCIDAL disinfectants • Check the label of the disinfectant you are using. “HIV-Effective” does NOT necessarily mean it is effective against hepatitis viruses. *mix solution and use within 24 hours 42

  42. Spill cleanup Spill cleanup precautions • Minimize spread of spill • Avoid splashing or spraying • Assume gloved hands are contaminated • Avoid using brushes or brooms • Dispose of sharps appropriately 43

  43. Spill cleanup Spill cleanup procedure Secure the site (keep others away) Inspect and put on appropriate PPE In an area free of contamination, position red bag so materials can be dropped in without soiling outside of bag Carefully use only as much decontaminant as you need to saturate the spill area, cover with paper towels, and allow to soak 1. 2. 3. 4. 44

  44. Spill cleanup Spill cleanup procedure 5. For non-level surfaces (e.g., walls), thoroughly clean area with 10% bleach solution (or other EPA-approved disinfectant) and allow to air dry Dispose of sharp objects in a sharps container or a sturdy puncture-resistant container Place all materials in red bag Decontaminate area again and allow to air dry 6. 7. 8. 45

  45. Spill cleanup Spill cleanup procedure Remove PPE and place in red bag Touching outside of red bag only, close and secure with twist tie Arrange for pickup and disposal of red bag Wash your hands with soap and water! 9. 10. 11. 12. 46

  46. BLOODBORNE PATHOGENS Course Revision 2012 Miami University Environmental Health and Safety Offices 47

  47. Information You are encouraged to contact your BBP Trainer or the Environmental Health and Safety Offices to discuss questions you may have regarding this program. Refer to the following websites for more information: http://www.units.muohio.edu/ehso/bbp.html http://www.cdc.gov/hiv/hivinfo.htm Information in English and Información en Español http://www.liverfoundation.org/ 48

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