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UW Bloodborne Pathogens for Researchers Training 3 minutes - fill out Form Welcome BBP Attendees! Please Pick up Handouts Hepatitis 1. Copy of Slides 2. Hepatitis B Vaccination Form 3. Hepatitis B Vaccine Information Sheet EH&S UW Bloodborne Pathogen Training If you decline the vaccination, check this line, sign and date 3 2 EH&S UW Bloodborne Pathogen Training 4 Bloodborne Pathogen (BBP) Rule Overview UW Bloodborne Pathogen Training Judy Cashman, RN EH&S Research & Occupational Safety 206-221-7770, [email protected] [email protected] If you have had vaccinations, check the line stating this, put in date or year UW Bloodborne Pathogen Training EH&S Bloodborne Pathogens Training for Researchers Needs to be filled out unless you have already done so in the past EH&S Fill out now Hand in as you leave – large manila envelopes 1 Hepatitis B Vaccine form B Vaccination About the Bloodborne Pathogens Program About Bloodborne Pathogens (BBP) Exposure Control What to do if you have an exposure – Enacted in 1993 – Safe sharps requirements in 2000 (Needlestick Safety and Prevention Act) Requirements for HIV/HCV/HBV labs Resources EH&S UW Bloodborne Pathogen Training Environmental Health and Safety JC Washington Administrative Code (WAC) 296-823 5 Reduce risk of BBP exposure to workers Annual Training required EH&S UW Bloodborne Pathogen Training 6 1 UW Bloodborne Pathogens for Researchers Training UW BBP Program BBP Statistics All UW employees with a reasonably anticipated potential for exposure to human source materials, including human blood and its components, human tissue, all human cell lines, as well as medications derived from blood (e.g., immune globulins, albumin) and other potentially infectious materials (OPIM), are required to comply with the UW BBP Program. In Washington, Labor & Industries (L&I) estimates ~44,000 needlestick injuries per year By Dec, 31, 2000, CDC reports: 57 health care workers have seroconverted following occupational exposure to HIV – 25 have developed AIDS – 3 were lab workers working with concentrated virus – Percutaneous exposure was the most common route Principal investigators (PIs)/supervisors are responsible for assessing activities in the workplace and determining if employees have a potential for occupational exposure. Requirements of the UW BBP Program: – Developing a BBP Exposure Control Plan – Offering the hepatitis B vaccine – Training 7 Roles & Responsibilities EH&S – Administer the UW BBP Program – Assist in obtaining the Hepatitis B Vaccine – Provide BBP Training – Issue Biological Use Authorization to labs – Consultation and Incident/accident follow-up investigation UW Bloodborne Pathogen Training – Develop/review lab Exposure Control Plan – Provide personal protective equipment – Provide lab specific safety training – Enforce safety rules 9 EH&S – Follow the exposure control plan – Ask questions – Suggest safer work practices/ procedures to your PI Environmental Health and Safety JC 10 Employee Health Center – Provide clinical services – Administer hepatitis B vaccine – Provide Post-exposure counseling – Wear required PPE UW Bloodborne Pathogen Training UW Bloodborne Pathogen Training Roles & Responsibilities Staff (You) EH&S Principal Investigator – ID hazards and who needs to be in the BBP Program Roles & Responsibilities 8 Roles & Responsibilities EH&S EH&S UW Bloodborne Pathogen Training 11 EH&S UW Bloodborne Pathogen Training 12 2 UW Bloodborne Pathogens for Researchers Training How are Suggestions or changes to work practices communicated? Bloodborne Pathogens Microorganisms that are present in human blood and its components and can cause disease. 1. 2. 3. 4. 5. staff meetings email 1:1 suggestion box/other Don’t know/not sure Human Immunodeficiency Virus (HIV) - AIDS Hepatitis B virus (HBV) – Hepatitis B Hepatitis C virus (HCV) – Hepatitis C Brucella spp. (bacterium) – Brucellosis Babesia (parasite) - Babesiosis Treponema pallidum- Syphilis Arboviruses- Viral hemorrhagic fever, West Nile Virus Prions- Creutzfeld-Jakob Disease Plasmodium spp. - Malaria EH&S UW Bloodborne Pathogen Training 13 Other Potentially Infectious Materials (OPIM) EH&S HIV/HBV/HCV containing cultures (cell, tissue, or organ), and solutions Blood, organs or tissues from animals infected w/ HIV/HBV/HCV Human cell lines including established Unfixed tissues or organs, Semen, Cerebrospinal Fluid, Peritoneal Fluid, Pericardial Fluid, Amniotic Fluid, Synovial fluid, Vaginal Secretions 15 UW Bloodborne Pathogen Training Environmental Health and Safety JC EH&S UW Bloodborne Pathogen Training 16 Occupational Exposure Check the Washington Administrative Code (WAC) 296-823 See the EH&S website: www.ehs.washington.edu/ Call Research and Occupational Safety: 206-221-7770 Check the lab Biosafety Manual Ask my manager EH&S …unless you can SEE the blood in them…but still handle with caution. – Urine – Feces – Vomit – Sweat – Tears – Saliva Transmission of BBP Where will I go if I have a question about “OPIM”? 14 Not Risk for BBP transmission -Any body fluid contaminated with blood or OPIM UW Bloodborne Pathogen Training Reasonably anticipated skin, eye, mucous membrane, or parenteral (piercing of the skin) contact with blood or OPIM that may result from the performance of an employee's duties Exposure Incident is a specific contact with blood or OPIM that is capable of transmitting a bloodborne disease 17 EH&S UW Bloodborne Pathogen Training 18 3 UW Bloodborne Pathogens for Researchers Training Transmission Risk of BBP BBP-Occupational Exposure Risk of infection depends on several factors: Skin Pathogen involved – Needle sticks or contaminated sharps injuries – Open wound contamination: cut, rash, Type/route of exposure Amount of virus in infected blood during exposure dermatitis, psoriasis Amount of infected blood involved in the exposure Mucous membrane exposure: eyes, If post-exposure treatment nose, mouth was taken Specific immune response of infected individual EH&S UW Bloodborne Pathogen Training 19 Transmission Risk following Exposure to Infected Blood Virus # of virus particles/ml of blood 6 Hepatitis B 13 10 -10 (Millions – trillions) Hepatitis C 10 6 (Millions) HIV (AIDS) 10-10 3 (Tens – thousands) Source: Centers for Disease Control and Prevention EH&S UW Bloodborne Pathogen Training 20 Hepatitis B Risk of infection following parenteral (needlestick or cut) exposure 1 in 3 (30%) 1 in 30 (3%) 1 in 300 (0.3%) Statistically the greatest risk 6-30% risk following exposure incident (nonimmunized) Incubation period is 6 weeks- 6 months (45180 days) 30-50% of infected develop clinical illness 0.5-1% of infected develop rapid fatal liver disease 2-10% of infected develop chronic active hepatitiscarrier state, infectious for life. Very stable-persists at room temp for 7days. 21 Hepatitis C Courtesy of Owen Mumford, Inc. EH&S UW Bloodborne Pathogen Training 22 Hepatitis B and C Symptoms Most common chronic bloodborne infection 80% infected without symptoms (CDC) Incubation period 2 weeks-6 months ~16 hrs-4 days on surfaces No vaccine jaundice fatigue loss of appetite nausea abdominal discomfort dark urine clay-colored stool Normal eyes Jaundiced eyes EH&S UW Bloodborne Pathogen Training Environmental Health and Safety JC 23 EH&S UW Bloodborne Pathogen Training 24 4 UW Bloodborne Pathogens for Researchers Training Human Immunodeficiency Virus (HIV) What is the most common route of exposure to BBP in the workplace? Fragile – lives only a few hours outside the body Causes Acquired Immunodeficiency Syndrome (AIDS) AIDS allows development of opportunistic disease, which ultimately causes death. A flu-like illness can occur 1-6 weeks after exposure to the virus: -Fever, sweats, malaise, muscle pains, nausea, diarrhea 1. Injury from contaminated needlesticks and/or sharps 2. Eye and mucous membrane exposure 3. Open wound contamination (cut, dermatitis, psoriasis) Enlarged lymph nodes, mycological oral infections, fatigue, weight loss Symptom-free period of 5-10 years can occur EH&S UW Bloodborne Pathogen Training 25 EH&S Must include BBP standard (WA State Rule) online at: http://www.lni.wa.gov/wisha/Rules/ bbpathogens/default.htm Biosafety Manual contains UW Core ECP, in Appendix A See online at: 1. Exposure Determination 2. Method of Compliance or implementation 3. Hepatitis B vaccination, PostExposure evaluation and follow-up 4. Communication of Hazards to employees 5. Record keeping http://www.ehs.washington.edu/ rbsbiosafe/bsmanualindex.shtm UW Bloodborne Pathogen Training 27 EH&S UW Bloodborne Pathogen Training Exposure Control Plan Exposure Control Plan 1. Exposure 2. Control Employee Exposure: Determination: By job classification By tasks and procedures Without consideration of PPE worn EH&S UW Bloodborne Pathogen Training Environmental Health and Safety JC 26 Exposure Control Plan Exposure Control Plan (ECP) EH&S UW Bloodborne Pathogen Training 29 Universal precautions Engineering controls Work practices Personal Protective Equipment EH&S UW Bloodborne Pathogen Training 28 30 5 UW Bloodborne Pathogens for Researchers Training ECP- Universal Precautions EH&S ECP-Engineering Controls Blood and OPIM ALWAYS considered infectious TOOLS to Prevent Exposure Appropriate barriers and procedures must be used when contact with blood or OPIM is anticipated UW Bloodborne Pathogen Training Biological Safety Cabinet (BSC) 31 EH&S Proper Use of a Biological Safety Cabinet (SD – 2002) An excellent review of safe BSC work practices covering preplanning, PPE, cabinet preparation, work practices, spills, and post process steps. http://vimeo.com/groups/34691/videos/7642083 33 EH&S ECP-Engineering Controls Unprotected position Protected position – Self-blunting needles – Exemptions for safer needle requirements, if not using these EH&S 34 Sharps disposal containers Safer Medical Devices – Plastic capillary tubes UW Bloodborne Pathogen Training ECP-Engineering Controls – Needleless systems – Sharps with engineered sharps injury protections (SESIP) Centrifuge Safety Features – Receive training – Safety cups/buckets or O-ring – When in Biosafety Cabinet (BSC) place at rear, don’t perform other work while running – Wait 5 minutes to unload – Stop immediately for unusual vibration or noise and notify supervisor – Ensure proper balancing – Do not overfill NOTE! There are three differences for BSC work at the UW. Important: Sharps are not prohibited in BSCs at the UW. Water can be used after the decontaminating bleach and is recommended by Baker for their BSCs. Good hand washing is more about sudsing soap and scrubbing for at least 20 seconds than the use of germicidal soap. UW Bloodborne Pathogen Training 32 ECP-Engineering Controls Safe BSC Use Video: EH&S UW Bloodborne Pathogen Training Example of needle guard with protected sliding sheath that is pushed forward after use and locks (with some designs the shield must be twisted to engage the lock). UW Bloodborne Pathogen Training Environmental Health and Safety JC 35 - Closable Puncture-resistant Leak-proof Labeled or color-coded Upright, conveniently placed in area where sharps used - DO NOT OVERFILL! EH&S UW Bloodborne Pathogen Training 36 6 UW Bloodborne Pathogens for Researchers Training Sharps Containers with Problems ECP-Work Practice Controls Key Concept Perform all tasks in a manner that reduces spraying, splashing or aerosolization. EH&S UW Bloodborne Pathogen Training 37 EH&S UW Bloodborne Pathogen Training 38 ECP-Work Practice Controls Handle sharps safely to minimize exposure to blood or OPIM: Don’t recap or remove needles Don’t bend, shear or break needles Place contaminated reusable sharps immediately in appropriate containers until properly decontaminated EH&S UW Bloodborne Pathogen Training 39 EH&S More Tips on Safe Sharps Handling Know what Sharps include: http://www.ehs.washington.edu/rbsresplan/sharp.shtm (needles, IV tubing with needles attached, scalpel blades, lancets, syringes that have been removed from their original sterile containers, and glass tubes that could be broken during handling) Develop and implement specific policies for safe handling: http://safeneedle.org/us-needlesticks/preventingneedlestick-injuries-a-checklist/ Do not handle broken glassware directly by hand 9/18/2013 EH&S UW Bloodborne Pathogen Training Environmental Health and Safety JC UW Bloodborne Pathogen Training 40 ECP-Work Practice Controls Hand washing No food/cosmetics No mouth pipetting Dispose of gloves after use EH&S UW Bloodborne Pathogen Training 42 7 UW Bloodborne Pathogens for Researchers Training ECP-Work Practice Controls ECP-Work Practice Controls Remove gloves safely and properly – Grasp near cuff of glove and turn it inside out. Hold in the gloved hand. – Place fingers of bare hand inside cuff of gloved hand and also turn inside out and over the first glove. – Dispose gloves into proper waste container – Bleach 1:10 – EPA certified agent (alcohol is not) – Quaternary Compounds – Premixed: Environcide clavicide DEMO of GLOVE REMOVAL: https://depts.washington.edu/ehas/pubcookie/train/bbpx/bbp6a.php EH&S UW Bloodborne Pathogen Training Written cleaning and decontamination schedule and procedures Decontamination Agents: 43 Contact time is critical EH&S UW Bloodborne Pathogen Training 44 ECP-Work Practice Controls ECP- Work Practice Controls Regulated Waste 1. 2. Decontamination Place absorbent material atop spill, sufficiently spray/cover entire area. Some start at the edges and work in, others just cover the area. You want to ensure that you cover the contaminated area. SPILLS VIDEO: https://depts.washington.edu/ehas/pubcookie /train/bbpx/bbp7.php EH&S UW Bloodborne Pathogen Training Close immediately before removing or replacing Place in second container if leaking possible or if outside contamination of primary container occurs Contaminated equipment must have biohazard sign attachedinform supervisor BIOHAZARDOUS WASTE, incl. Flow Charts http://www.ehs.washington.edu/ohsreslab/biowaste.shtm 45 EH&S UW Bloodborne Pathogen Training 46 Precautions required when transporting blood ECP- Signs and Labels Put in secondary leakproof container – Plastic ziplock, or styrofoam If in a Biohazard container or other designated container, don’t need label – Consider where the sample will travel (the end user) More information on EH&S website http://www.ehs.washington.edu/rbsbiosafe/postbz.shtm EH&S UW Bloodborne Pathogen Training Environmental Health and Safety JC 47 http://www.ehs.washington.edu/rbsbiosafe/appendixb.pdf EH&S UW Bloodborne Pathogen Training 48 8 UW Bloodborne Pathogens for Researchers Training ECP-Personal Protective Equipment (PPE) ECP-Laundry For Contaminated articles: Type and amount of PPE required depends on the task and anticipated exposure. – Handle as little as possible – Must not permit blood or OPIM to pass through or reach outer or inner clothing, mucous membranes or skin. – If clothing becomes contaminated, immediately remove it. – Must be removed prior to leaving the work area. PPE must not be worn in common areas. UW Bloodborne Pathogen Training – Wear PPE when handling and/or sorting evaluation c. Follow-up 50 3 injections at 0, 1, 6 months Check titer 1-2 months after series 96-99% effective No boosters needed Call your Employee Health Center for an appointment – FREE – During work hours EH&S UW Bloodborne Pathogen Training 52 ECP-Medical Management What to do if exposed? How to Get Medical Help? 1. DO First Aid Parenteral (break through skin): Immediately thoroughly wash wound with sudsing soap and water—for 15 minutes. Mucous Membrane: Immediately thoroughly flush mucous membrane with water for 15 minutes. Call UW Employee Health Center at 206685-1026 – Harborview Sites: 206-744-3081 After hours or clinic is closed, go to nearest Emergency Room (ER) Call 911 EMERGENCY POSTER: http://www.ehs.washington.edu/manuals/posters/ehs exposureresponseposter.pdf 2. GET Medical Help Environmental Health and Safety JC UW Bloodborne Pathogen Training Must be offered within 10 days of initial assignment 51 ECP-Medical Management UW Bloodborne Pathogen Training Gown EH&S Gloves Hepatitis B Vaccine b. Post exposure • EH&S a. Hepatitis B vaccine • Place in leak-proof, labeled or color-coded containers or bags ECP- Medical Management 3. Medical Management UW Bloodborne Pathogen Training Don’t sort or rinse where used 49 ECP-Medical Management EH&S Bag/contain where used – Provided at no cost to employee. Nitrile gloves for alcohol. EH&S 53 EH&S UW Bloodborne Pathogen Training 54 9 UW Bloodborne Pathogens for Researchers Training Health Care Professional Written Opinion ECP-Medical Management: Post Exposure Evaluation Health Care Professional’s Written O Use with Chapter 296 Document exposure incident and ID source Counseling Evaluation and follow-up ______________________________________ Date of Incident: ______________________________________ t Date of Evaluation: Health Professional’s Telephone: The employee named above has been in formed of the results of the evaluation for exposure to blood or other potentially infectious materials. ____ The employee named above has been told about any health conditions resulting from exposure to blood or other potentially infectious materials whi ch require further evaluation or treatment. ____ Hepatitis B vaccination Health Care Professional’s Name ___________________________________ Health Care Professio nal’s Signature UW Bloodborne Pathogen Training 5. Annual UW BBP training Laboratory specific hazards training Exposure Control Plan – annual review 57 Additional Requirements HIV/HBV/HCV Research Labs Training – Demonstrated proficiency-microbiological practices and practices and operations specific to the facility BEFORE work w/virus. UW Bloodborne Pathogen Training Environmental Health and Safety JC UW Bloodborne Pathogen Training 56 Record Keeping Training records- EH&S and PI- keep 3 years Medical records-kept at Employee Health Center for duration of employment plus 30 years You &/or Supervisor fill out the OARS (online) report after incident-EHS EH&S Labs doors closed when working with virus No bench work/must use BSC Limited needle/syringe use Limited access only to those aware of hazards PPE in labs—NOT to be worn outside lab, decontaminated before laundered. EH&S EH&S _______________________________ UW Bloodborne Pathogen Training 58 Resources Lab specific biosafety manual-reviewed annually Special Practices – – – – – _____________________________________________ _________________ ECP-Records Hazard Communication UW Bloodborne Pathogen Training _____________________________________________ _____________________________________________ 55 ECP- Hazard Communication EH&S __________________________ Date Return this form to the employer and provide a copy to the employee within 15 days. Please label the outside of the envelope “Confidential.” Confidential Fax: is ____ is not ____ indicated. ________________________________ EH&S ______________________________________ ____ Employer’s Address : ______________________________________ ______________________________________ Employer’s Name 4. Employee to receive within 15 days ______________________________________ Health Pro fessional’s Address: Testing and PostExposure treatment pinion For Post -Exposure Evaluation -823 WAC, Occupational Exposure to Bloodborne Pathogens Employee’s Name: 59 International Sharps Injury Prevention Society (ISIPS): http://www.isips.org/ WA State Department of Safety and Health BBP page: http://www.lni.wa.gov/Safety/Topics/AtoZ/BBP athogens/default.asp Centers for Disease Control and Prevention (CDC) Biosafety in Microbiological and Biomedical Laboratories (BMBL)website: http://www.cdc.gov/OD/ohs/biosfty/bmbl5/bm bl5toc.htm EH&S UW Bloodborne Pathogen Training 60 10 UW Bloodborne Pathogens for Researchers Training QUESTIONS? Resources EH&S Site-Specific Exposure Control Plan: http://www.ehs.washington.edu/forms/rbs/resea rchlaboratorysupplementalform.doc Specimen Handling Transport EH&S Class: http://www.ehs.washington.edu/eposhiphazmat/i ndex.shtm EH&S Research and Occupational Safety: 206-221-7770, [email protected], http://www.ehs.washington.edu/rbs/bbp.shtm UW Bloodborne Pathogen Training Environmental Health and Safety JC But if I do, I understand." Be sure to look at your workplace Exposure Control Plan! See you next year… online! EH&S "If I hear & see - I learn, but may forget, 61 EH&S UW Bloodborne Pathogen Training 62 11
