Download Bloodborne Pathogens Training - University of Michigan

Bloodborne Pathogens Training
University of Michigan-Flint.
Environment, Health and Safety (EHS)
Course Information
This bloodborne pathogens training program is
required annually for UM employees who may
reasonably anticipate contact with blood or other
potentially infectious materials (OPIM), during the
performance of their duties.
Course Topics
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Bloodborne Pathogens Standard (copy available from EHS and online)
Bloodborne Pathogens
Mode of Transmission
Exposure Control Plan
Methods of Prevention (Universal Precautions)
UM Hepatitis B Immunization Program
Engineering Controls
Sharps Disposal
Personal Protective Clothing and Equipment (PPE)
Spill Response
BBP Waste
Communicable Diseases
Bloodborne Pathogens Standards and
Regulations
This program was designed to meet the requirements of:
Occupational Safety and Health Administration (OSHA) Occupational Exposure to
Bloodborne Pathogens
29 CFR 1910.1030 (1990).
Michigan Occupational Safety and Health Administration (MIOSHA) Bloodborne
Infectious Diseases
R 325.70001- R 325.70018 (1993).
Needle stick Safety and Prevention Act (2000)
Exposure Source Testing MI Act 368 of 1978
These standards apply to workers who are at risk of exposure
to pathogenic microorganisms associated with human blood.
What are Bloodborne Pathogens
Pathogenic Microorganisms
Bloodborne Pathogens: are pathogenic microorganisms that are present in
human blood or other potentially infectious materials (OPIM) and can cause
disease. Pathogenic microorganisms include, but are not limited to:
o HBV
o HCV
o HIV
o West Nile
o Malaria
o Syphilis
o Brucellosis
Other Potentially Infectious Materials
(OPIMs)
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Blood products, semen, vaginal secretions
Saliva in dental settings
Any body fluid that is contaminated with blood
Any body fluid of unknown source
Unfixed tissues or organs
HIV or HBV containing cells or cultures
Blood, organs or other tissues from experimental animals infected
with BBP
• Introduction of human-derived materials (i.e. tumor cells) into
animals.
Mode of Transmission
• Transmitted when infected blood or bodily fluid enters the opening of
mucosal membrane.
• Mucous Membranes are wet, thin tissue found in certain openings of the
human body. These openings include the mouth, eyes and nose.
• Breaks in the skin are an ideal way for the contaminate to enter:
 Cuts
 Punctures
 Abrasions
 Rashes
 Acne
 Hang Nails
Bandage affected area and wear double gloves to prevent
transmission through breaks in skin.
Hepatitis B (Hep B)
• Infection of the liver which may lead to liver disease, liver cancer and
possibly death. It is the leading occupational disease in the United
States.
• 12,000 cases of HBV were identified annually (up to the year 1992).
Numbers have decreased to approximately 800 cases annually since
the introduction of the immunization.
HBV is extremely stable.
It may survive 10 days outside of host!
Hepatitis B (cont’d)
Approximately 10% of infected individuals may become "carriers“.
This means that they may suffer from infection at a later time. They can also be infectious to others for the rest of their lives while
not demonstrating any symptoms of HBV.
Symptoms may occur 2-6 months after exposure and include:
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Fever
Vomiting
Jaundice (yellowing) of the eyes and/or skin
Loss of appetite
Dark-colored urine
Aches in muscles and joints
Hepatitis C (HCV)
• Viral infection of the liver that can be
transmitted via blood or other potentially
infected materials
• Symptoms similar to those caused by HBV
• Although 80% of individuals may have no
symptoms, these infected individuals may be
lifelong carriers. No vaccine is available.
• Very difficult for body’s immune system to
recover from HCV infection
• Leading indication for liver transplants in the
U.S.
Human Immunodeficiency Virus (HIV)
• Virus that causes Acquired Immunodeficiency Syndrome (AIDS)
• May be passed through infected blood or OPIMs that come in contact with
broken skin or mucous membranes
• Some infected individuals will develop AIDS as a result of their HIV
infection.
• Some individuals develop flu-like symptoms within 7-21 days after
exposure.
• Recent studies suggest the best independent predictors of primary HIV
infection are rash and fever among individuals recently exposed to HIV.
• HIV will not survive long outside host (~90-99% reduction within several
hours).
Controlling the Risk of Exposure
Here are the ways to reduce your likelihood of exposure to blood or other
potentially infectious materials:
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Universal Precautions
Exposure Control plan (ECP)
Hepatitis B Vaccination
Engineering Controls
Workplace Controls
Safe Work Practices
Personal Protective Equipment (PPE)
Proper Hand-washing Technique
Reporting exposures immediately and seeking medical follow-up treatment as soon as possible
Universal Precautions
An infection control method where ALL human blood and other
potentially infectious materials are treated as if known to be infectious.
Exposure Control Plan (ECP)
• The ECP must be made available to all employees who are determined
to be at risk.
• Employees must be familiar with the ECP and know where it is located.
• ECP reviewed/revised ANNUALLY with input from employees.
• ECP is readily available to employees.
Reporting an Exposure Incident
• Is it work related?
• Date and time of exposure
• Details of the procedure being performed, including where and how the
exposure occurred. If related to a sharp device, the type and brand of device
and how and when in the course of handling the device the exposure
occurred must be included in the report
• Details of the exposure, including the type and amount of fluid or material
and the severity of the exposure
• Details about the exposure source if known
• Details about the exposed person… vaccinated?
• May need to attach sheet of paper with details to work connection form
Hepatitis B Vaccination
• Available to Category A employees at no cost
• Series of 3 injections:
1st: given at anytime
2nd: 1 month after first injection
3rd: 5 months after 2nd injection
• Provides protective levels of antibody in 97% of healthy individuals
• You cannot get HBV from the vaccine
• No booster shot required (lifelong immunity)
• According to the FDA, the current shot is one of the safest available
• Side effects may include: soreness, redness and swelling at injection site
• For further information, EHS encourages you to contact your primary care
physician/practitioner
Hepatitis B (cont’d)
• Vaccination need not be offered if…
▫ Individuals have previously received the complete series
▫ Antibody testing has revealed the individual is immune
▫ The vaccine is contraindicated for medical reasons
• The vaccine is NOT mandatory.
• Employer must offer the vaccine, however, you do not have to accept the vaccine.
• You may decline the vaccination series, in which you will be asked to sign a declination
form.
• To receive the Hepatitis B Vaccine, please contact: UM-Flint EHS @ (810)766-6763
Hepatitis B Forms
No Vaccines for HCV and HIV
• There is no vaccine against HCV and no treatment after exposure that
will prevent infection.
• There is no vaccine against HIV.
• The Public Health Service, under recommendations from the CDC,
suggests a 4-week course of administration of the antiretroviral drugs
depending upon the risk of transmission (exposures involving a larger
volume of blood with larger amount of HIV). This should begin within
hours after exposure.
Engineering Controls
Are used to isolate or remove the potential hazard from the workplace.
Controls are used in combination with safe work practice controls.
 Sharps disposal containers
 Hand washing facilities &waterless soap dispensers
 Biohazard bags/waste containers
 Spill/clean-up kits
 Use tongs for picking up hazardous object
Sharps disposal
containers
Hand washing
facilities
Biological Safety
Cabinets
Autoclave
Facilities
Mechanical means to
remove broken sharps
items
Sharps
• Departments generating sharp waste are
responsible for proper disposal.
• Must use a puncture resistant plastic
container
• Must be located in area where sharps are
used
• Sharp containers can only be filled to
indicator line or ¾ full. Call EHS (810)7666763 for removal.
• Do NOT OVERFILL sharps container.
Overfilled sharps container pose a risk to all
workers.
Sharps (cont’d)
Examples of sharps are:
• Needles
• Scalpels
• Razor blades
• Lancets
• Contaminated glass Pasteur pipettes
• Glass capillary tubes
• Contaminated broken glass
• Contaminated microscope slides and cover slips
• Exposed ends of dental wires
Workplace Controls
• Wash hands after contacting body
fluids or contaminated surfaces
• Keep fingernails short
• Scrub nail area
• Clean surfaces regularly
• Keep disinfectant solution and
waterless hand disinfectant nearby.
• Keep PPE in stock and readily available.
Safe Work Practices
• Personal Protective Equipment (PPE) must be removed before leaving
the work area
• Clothing penetrated with blood or OPIM must be removed
immediately
• Follow proper protocol for cleaning blood/bodily fluid spills
• Wash hands immediately after removing gloves or other protective
clothing.
• Wash hands after contact with blood or OPIM.
ECDC Soiled Clothing
• Remove clothing immediately
• Place in a labeled plastic bag (To Be Washed) and separate from
normal laundry and use proper laundering techniques. (Make sure
water is hot, 82oC, and is on the hot cycle for at least 10 mins)
• Child’s clothing should be placed in a labeled plastic bag (Soiled) and
should be sent home with parents
DPS/Medical Staff Soiled Clothing
• Remove clothing immediately
• Place in a labeled plastic bag (Biohazard)
• Have clothing be sent to proper laundering facilities that will
decontaminate the uniform
BBP Exposures
Eyes: Flush with water
Skin: Wash thoroughly with soap and water for
15 mins.
IMMEDIATELY notify Supervisor & EHS.
Go to UM Medical Provider
for post-exposure follow-up
Protective Work Clothing and
Equipment (PPE)
• PPE shall be provided at no cost to the employee.
• Examples: GLOVES, goggles, apron, “booties”
• Assure appropriate PPE is readily accessible and fits properly
• Supervisor will monitor and ensure employee uses PPE.
• Provide for cleaning, laundering, or disposal of PPE.
Protective Work Clothing and
Equipment (PPE)
Hand Protection:
• Ensure equipment is available
• Non-latex products must be available for
individuals with latex allergies
• Disposable gloves should be replaced if they
are peeling, cracked, discolored, or if they
have punctures, tears, or other evidence of
deterioration
• Gloves of appropriate size must be available
• Do not re-use disposable gloves
• Remove gloves before leaving the work area
• Always wash hands after removing gloves
Blood/Body Fluid Spills
• All spills must be safely cleaned as soon as possible.
• Wear gloves, gowns or lab coats and eye protection
during clean up.
• A solution of 1:10 bleach and water or an EPAapproved disinfectant should be used.
• If broken glass is involved, it should be carefully
removed using a mechanical device such as tongs or
forceps and the broken glass placed in the sharps
container.
Spill Clean-up Procedure
http://www.youtube.com/watch?v=gn
OtvAztKoQ
Spill Clean-up Procedure
• Put on personal
protective equipment
• Cover and saturate with
disinfectant. Let stand 15 20 minutes. Clean and
Dispose of Paper Towel
• Remove sharp objects
carefully with
forceps/tongs
• Re-spray area with
disinfectant
• Re-wipe with paper towel
• Circle spill with
disinfectant. Use bleach
(1:10 dilution), Lysol,
Virex, or EPA registered
tuberculocidal
disinfectant
• Decontaminate materials
used to clean spill
Disinfectant Procedure Information
• Take the necessary precautions when handling disinfectants
because of them are caustic and hazardous chemicals
• Always prepare all disinfectants daily. Some prepared diluted
mixtures, like bleach and water, are not stable and lose it’s
efficacy as a disinfectant when not made daily
• When using, spray on and allow to air dry
• If area is heavily soiled, clean with detergent and water first
• Impervious (waterproof) surfaces are cleaned differently than
porous/fabric surfaces.
• Do not use commercially pre-saturated wipes to sanitize
surfaces as their efficacy has not been tested
• The contamination of the wipe during use may not be
sufficiently controlled by the bleach solution in the wipe
Hand-washing
• First line of defense against infectious disease
• Hands and other skin surfaces must be washed immediately, and
thoroughly, after handling potentially infectious materials
• Wash hands and lather, rubbing front and back for at least 20 seconds with
soap
• Rinse under running warm water from wrists to fingertips
• Dry with paper towel and turn faucet off with paper towel
http://www.youtube.com/watch?v=vYwypSLiaTUD
Employee Responsibilities
• Know and understand your department’s ECP
What PPE should be worn? When?
What do you do if you are not sure if a substance is a BBP or not?
Who in your department is authorized to clean up blood? Category A or B?
What are you?
• ALWAYS Follow SAFE Work Practices… maintain a clean and sanitary
environment.
• Wash hands.
• Get HBV Vaccine . . . or sign declination form. Discuss other vaccinations
that are available for you with your family physician.
• Report all exposure incidents immediately
• Participate in your department’s annual ECP review.
Other Communicable Diseases
West Nile
Meningitis
Norovirus
H1N1
Tuberculosis (TB)
West Nile
• Derived from being bitten by an infected mosquito
The most serious form of WNV is Fatal
Encephalitis: inflammation of the brain
• Incubation period is 2-15 days
Symptoms include:
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High fever
Neck stiffness
Disorientation
Coma
Tremors
Convulsions
Muscle weakness
Paralysis
According to the CDC, 1 in 150 people get infected, however, 4 out of 5
people infected with the virus express asymptomatic infections. This means
that they do not show any signs of sickness.
West Nile
According to the CDC, 1 in 150 people get infected, however, 4 out of 5 people infected with the
virus express asymptomatic infections. This means that they do not show any signs of sickness.
There are 3 possible outcomes from being
infected with WNV:
 Asymptomatic: you do not show any signs of infection (most people fall into this category)
 Develop West Nile Fever: experience symptoms (expressed in 20% of infected individuals)
 Severe West Nile Disease, West Nile Meningitis, West Nile Encephalitis: experience severe symptoms and possibly
die (expressed in 1% of infected individuals)
Meningitis
• Inflammation of the membrane (meninges) that covers the brain and spinal cord
• Caused by either:
Viral Meningitis(Aseptic) Bacterial Meningitis
Viral Meningitis
• Caused by Enteroviruses
• Less severe and is healed without any specific treatment
• Symptoms include:
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High fever
Severe Headache
Stiff neck
Sensitivity to bright light
Sleepiness or trouble waking up
Nausea, vomiting
Lack of appetite
• Symptoms last between 7-10days with full recovery
• No specific treatment
Bacterial Meningitis
• Highly severe and some forms are
contagious
• 2 strains of the leading cause of Bacterial
Meningitis are Streptococcus pneumoniae
and Neisseria meningitis
• Symptoms include:
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High fever
Headache
Stiff neck
Discomfort looking into bright lights
Nausea
Vomiting
Confusion
Sleepiness
Brain damage
Hearing loss
Learning disability
Disability
Bacterial Meningitis (cont’d)
• Transmitted via respiratory and throat secretions
• Modes of transmission include:
▫ Coughing
▫ Kissing
▫ Sneezing
• Not as contagious as the flu, therefore, you cannot become infected through
casual contact
• Example: You will not become infected if you breathe in the same air that
someone with meningitis breathed
• Incubation period ranges from several hours to 2 days
• There are vaccines against some forms of meningitis.
• According to the CDC, the current vaccines available are safe and effective
Norovirus
• A type of Gastroenteritis: inflammation of the stomach and small and
large intestines
• Caused by a host of viruses that produces the outcome of vomiting
and diarrhea
• According to the CDC, it is the leading cause of foodborne-disease
outbreaks in the United States
• Common name: Stomach Flu, but not caused by Influenza
Norovirus
• Symptoms:
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Watery diarrhea
Vomiting
Headache
Fever
Abdominal cramps
• Symptoms begin 1 to 2 days after infection and lasts for 1 to 10 days
depending on the strain of virus.
• Transmitted through contaminated food and beverages via the oralfecal pathway
H1N1 (Variant Influenza Virus)
• Respiratory disease normally
affecting pigs, caused by a
specific strain that affects
human beings
• Spread through the direct
contact of infected pig or
infected person
• According to the CDC, human
to human transmission is not
as easily spread
• Symptoms are similar to those
of the human flu
Tuberculosis (TB)
• It is an airborne disease caused by bacterium, Mycobacterium
tuberculosis, which attacks the lungs. It can also attack the
kidneys, spine and brain. If untreated it can be fatal.
There are 2 forms of TB:
Latent TB: when the bacteria lives in the host’s body without
making the person sick. They test positive for the TB skin test,
however, they are not infectious
Active TB: when the bacteria is active in the host’s body and
makes the person sick and is infectious.
• People can become infected if some one with active TB sings,
speaks, coughs or sneezes in the nearby area.
Tuberculosis
(TB)
If infectious, there is a treatment.
• TB disease can be treated by taking several drugs for 6 to 9
months. There are 10 drugs currently approved by the U.S.
Food and Drug Administration (FDA) for treating TB. Of the
approved drugs, the first-line anti-TB agents that form the
core of treatment regimens include:
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isoniazid (INH)
rifampin (RIF)
ethambutol (EMB)
pyrazinamide (PZA)
• Regimens for treating TB disease have an initial phase of 2
months, followed by a choice of several options for the
continuation phase of either 4 or 7 months (total of 6 to 9
months for treatment).
• Treatment regimen must be fully completed to fully cured.
If not taken as prescribed and correctly, infected person’s TB
bacteria will become resistant to medication and would
require a stronger and expensive medication.
Questions
Bibliography
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http://rlv.zcache.com.au/bio_hazard_or_biohazard_sign_symbol_warning_purple_postcard-p239192129277273011z74oh_125.jpg (Purple Biohazard Sign)
http://www.papermasters.com/Images/bloodborne-pathogens.jpg (Bloodborne Pathogens Sign)
http://i.telegraph.co.uk/multimedia/archive/01487/hiv_1487944c.jpg (HIV)
http://www.nature.com/nprot/journal/v2/n3/covers/largecover.gif (HBV)
http://srxa.files.wordpress.com/2011/06/hepatitis_c1.gif (HCV)
http://scienceray.com/biology/ecology/managing-jaundice/ (Jaundice Hands)
http://www.fronine.com.au/images/mixmate05.jpg (Vortex Machine)
http://blogs.palmbeachpost.com/becoming-a-doctor/files/2009/07/pipetting.jpg (Pipet)
http://www.servoprax.com/images/5000/00249_1.jpg (Centrifuge Machine)
http://www.torranceca.gov/Images/Mosquito_rdax_400x277.jpg (WNV)
http://www.cdc.gov/ncidod/dvbid/westnile/images/WNV_03_a.gif (WNV Map)
http://www.doctortipster.com/wp-content/uploads/2011/04/Aseptic-Meningitis11.jpg (Viral Meningitis)
http://nchistorytube2.wikispaces.com/file/view/viral-meningitis.jpg/213342706/viral-meningitis.jpg (Viral Meningitis microscopic)
http://www.about-child.com/wp-content/uploads/2011/07/Bacterial-Meningitis-In-Children-3.jpg (Bacterial Meningitis)
http://feww.files.wordpress.com/2010/01/bacterial-meningitis-lg.jpg?w=711 (Bacterial Meningitis microscopic)
http://www.defendingfoodsafety.com/uploads/image/Norovirus.jpg (Norovirus)
http://knol.google.com/k/-/-/30e8n4orj1dsd/1ubdd7/fig2-allflu.jpg (H1N1)
http://img.webmd.com/dtmcms/live/webmd/consumer_assets/site_images/articles/health_and_medical_reference/infectious_disease/understanding_tuberculosis_basics.jpg (TB)