BLOODBORNE PATHOGENS

1. BLOODBORNE PATHOGENS Presented by Office of Environmental Health and Safety

2. Goals of training: • Knowledge of regulatory requirements • Increase awareness of diseases • Provide information regarding: • Routes of exposure • Risk of transmission • Prevention

3. Regulated requirements • OSHA Bloodborne Pathogens standard • Designed to protect workers • In effect since 1992 • Goal: Prevent occupational transmission of diseases potentially present in blood and bodily fluids • Regulated in Calif. by Title 8

4. Some of the requirements: • Written plan • Use of controls • Cleaning and decontamination program • Sharps injury prevention plan • Training & protective equipment • HBV vaccinations

5. Body fluids that can transmit infection: • Blood • Semen • Vaginal secretions • Cerebrospinal fluid • Synovial fluid • Pleural fluid • Pericardial fluid • Peritoneal fluid • Amniotic fluid • Saliva (e.g. dental procedures) • Any unfixed human tissue or organ

6. PREVENTION: Universal precautions • Treat all blood and other potentially infectious body fluids as if infected • Avoid direct contact with blood and body fluids & contaminated materials • Wear PPE appropriate for job • Practice good housekeeping and personal hygiene

7. Universal precautions – cont. • Follow proper decontamination procedures • Dispose of all contaminated materials properly • Seek prompt medical attention in the event of exposure

8. Personal Protective EquipmentProvides a barrier Examples: • Latex/PVC gloves • Goggles, safety glasses w/side shields • Plastic or rubberized gowns/aprons • Surgical masks/face shields • Pocket mouth-mouth resuscitation masks

9. Special PPE precautions • Cover open cuts, rashes, and other broken skin. • Check condition before using • Remove carefully to avoid contaminating yourself or anything around you • Dispose properly • Don’t mix contaminated clothing or laundry with other laundry • Wash hands thoroughly after removing gloves.

10. Hygiene • Wash hands w/ soap and water • Don’t keep food or drink in work areas w/ exposure potential • Don’t eat, drink, smoke, apply make-up or lip balm, or handle contact lenses • Avoid splashing/spattering of potentially infectious materials • Don’t suction potentially infectious materials by mouth.

11. Housekeeping • Clean up all spills immediately. • Clean and decontaminate all equipment and surfaces after contact w/ blood and other potentially infectious materials. • Clean and sanitize pails and other reusable waste containers regularly. • Replace protective coverings, immediately upon obvious contamination, or at end of work day.

12. Cleaning vs. Sanitizing • Cleaning: Removal of infectious agent via mechanical means using a cleaning agent. • Sanitizing: Applying sanitizing agent, carefully following label instructions. Contaminated surfaces and equipment must be sanitized!

13. Sharps Injury Prevention • Evaluate and provide devices designed to prevent injury • Syringes w/ sliding sheath that engages after use • Needles that retract after use • Shielded or retracting catheters • IV delivery systems w/ catheter port/needle in protective covering • Provide training on new equipment • Keep a sharps injury log – which includes: • date and time of incident • type of sharp involved • description of incident • PI/Supervisor must immediately report all sharps incidents to EH&S

14. Proper Disposal Procedures Contaminated materials • Dispose in red, plastic biohazard bag. • Tie off bag tightly. • Place bag in labeled, rigid container with close-fitting lid. • All bags must be transported in labeled rigid containers with close-fitting lids. • Note that this requirement is in effect whenever the waste leaves the point of generation.

15. Disposal - cont. Potentially contaminated sharps • Dispose in rigid, labeled sharps containers. • Never: • Break off needles or blades • Attempt to retrieve sharps from a sharps container

16. Disposal - cont. • Bloodborne pathogen waste cannot remain on campus beyond one week. • Waste is currently picked up by a licensed contractor every Tuesday. • Contact EH&S at 8-7422 if you have bloodborne pathogen waste requiring disposal

17. HBV Vaccination • HBV vaccination series will be made available to employees at risk of exposure at no cost. • Employee may decline series by completing declination form. • If employee declines series, may elect to have series at a later time.

18. Post exposure • Wash needlesticks/cuts with soap & water. • Flush splashes to nose, mouth, or skin with water. • Irrigate eyes with clean water, saline, or sterile irrigants. • Report the exposure promptly!

19. Post exposure – cont. • After exposure incident; employee shall be offered post-exposure evaluation, including at no cost: • Medical exam • Blood testing

20. RISK OF INFECTION from Occupational Exposure Overall risk depends on: • # infected individuals in patient population • Type and # of blood/fluid contacts Risk factors following exposure: • Pathogen involved • Type of exposure • Amount of blood/fluid involved • Amount of virus present in blood/fluid at exposure

21. Bloodborne Diseases • HIV/Aids • HBV, HCV

22. Risk of infection cont. • HIV needlestick/cut: 0.3% • HIV mouth/nose/eye: 0.1% • HIV skin: 0.1% • HBV w/ pre-vaccination: no risk • HBV w/o pre-vaccination: 6 ~ 30 % depending on HBV antigen status of source individual • HCV: 1.8 %

23. HIV/AIDS Stats cont. • As of Dec. 2001: 57 documented cases of occupational HIV transmission to healthcare personnel Primarily from accidental “sticks”

24. AIDS: Advanced HIV • Definition: • Fewer than 200 CD4-T cells/mm blood (vs. healthy: 1000+) • Clinical conditions, opportunistic infections and cancers generally not affecting health people

25. Diagnosis of HIV • May take 1 ~ 6 months post infection for presence of sufficient # of antibodies using standard blood tests • Acute/recent exposures: screen for presence of HIV genetic mat’l • Depending on exposure circumstances, more tests may be necessary Prompt disclosure of details re: suspected exposure 4 Proper diagnosis procedure

26. HIV: Post exposure treatment • Determined on a case-by-case basis Treatment should be started within hours • Slows spread of HIV and delays start of opportunistic infections/conditions • Post Exposure Prophylaxis treatment 4 80% reduction infection risk

27. HEPATITIS – HBV, HCV • Virus that can cause acute liver infections or chronic liver disease (cirrhosis, liver cancer) • Approx. 300,000 cases of acute HBV infection annually. • 5 ~ 10% become chronically infected • Approx. one million chronic carriers • HBV: Highly effective vaccine available • No cure for HBV or HCV

28. HEPATITUS Routes of Exposure • HBV, HCV: Entrance of infected blood into the body. • Includes bodily fluids that could contain blood in amounts not visible to naked eye.

29. HBV Post Exposure Treatment May include: Depends on several factors: • Whether source individual is positive for HBV • Whether you have been vaccinated • Whether the vaccine provided you w/ immunity. No post exposure treatment for HCV

30. Comparison of HBV/HIV HBV: • More “sturdy”, can survive outside the body up to a week vs. less than a day for HIV • Likely to be more concentrated in blood and bodily fluids • Much higher risk of transmission. • One case of HBV transmission in athletics setting.

31. Summary… • Use Universal Precautions when in contact with bodily fluids. • Use PPE and use it properly • Sanitize – don’t just “clean”! • Protect yourself from HBV infection • Complete your vaccination series • Get your titer checked