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BLOODBORNE PATHOGENS
Purpose
• Reduce / eliminate exposure potential
• Comply with Ohio’s Public Employment
Risk Reduction Act (reference OSHA)
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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, Kinesiology who work with blood products
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Topics
Bloodborne diseases and their transmission
Reducing exposure potential
Exposure incidents
Hepatitis B vaccine
Spill cleanup
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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
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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
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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)
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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
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Bloodborne diseases and their transmission
Not Considered OPIM
•Vomit
•Perspiration
•Tears
•Urine
•Feces
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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
HIV
Time Span (?)
AIDS
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Bloodborne diseases and their transmission
AIDS Epidemiology (U.S.)
Cases Reported
1994
1996
2002
2004
2006
2008
2010
2013
71,874
59,347
38,132
38,726
25,551
23,049
18,926
Persons living With
Deaths diagnosis of HIV Infection
49,095
36,510
16,948
17,154
15,679
16,276
15,529
492,673
601,741
762,084
1.1 million
Source: Centers for Disease Control and Prevention
www.CDC.gov
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Bloodborne diseases and their transmission
U.S. Adult AIDS cases reported for
2011
Number
(%)
•Male-to male sexual contact
30,573
62
•Injected drug use
3,648
7.5
•Male-to male sexual contact and
Injected drug use
1407
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•*High-risk heterosexual contact
13,402
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•Other (Hemopilia/coagulation disorder;
Receipt of tranfusion; Not reported or
Identified)
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0.1
* Sexual contact with someone known to be infected with HIV
Source: Centers for Disease Control and Prevention
www.CDC.gov
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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
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Bloodborne diseases and their transmission
Hepatitis B virus
•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
*measured in viral bodies / milliliter of blood
Source: American Liver Foundation
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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
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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
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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
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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
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Exposure Control Methods
1. Signs and Labels
•“Medical Waste”
•“Infectious Waste”
•“Infectious”
•“Biohazard”
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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
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Exposure Control Methods
3. Engineering Controls
Examples: •Sharps Containers
•Biohazard waste bags & boxes
•One-way valves on resuscitation devices
•Hand washing facilities
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Exposure Control Methods
4. Personal Protective Equipment
•Types
•Limitations
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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
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Exposure Control Methods
6. Contaminated Waste Disposal
•Infectious Waste
•Red bags
•Labeling requirements
•Biohazard boxes
•Drop-off sites
•Sharps disposal
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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.
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Exposure Incidents
Blood or OPIM Contacts:
1. Mucous membranes
Eyes
Mouth
Nose
2. Non-intact skin
3. Contaminated Sharp
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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
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Exposure Incidents
Post-exposure evaluation
and follow-up
•Confidential medical evaluation and blood
testing offered at no cost to employee
•Voluntary
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Exposure Incidents
What is involved in
an exposure evaluation?
•Report to Miami’s Convenient Care Clinic or the
Nursing Supervisor at Student Health Services
•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)
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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
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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
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HBV vaccine
HBV program at Miami University
•Eligibility requirements*
•Administration site (Student Health Services)
•Schedule (Call SHS for appointment)
•Consent / Declination procedures
* Employees determined to have a reasonably anticipated
high risk of occupational exposure
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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
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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
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HBV vaccine
Contraindications
(Conditions suggesting treatment
should not be administered)
•Yeast allergy
•Immunodeficiency disease
•Recent febrile illness / infection
•Pregnancy
•Lactation
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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
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Spill cleanup
•Kits
•Decontamination
•Precautions
•Procedure
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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
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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
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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
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Spill cleanup
Spill cleanup procedure
1. Secure the site (keep others away)
2. Inspect and put on appropriate PPE
3. In an area free of contamination, position red
bag so materials can be dropped in without
soiling outside of bag
4. Carefully use only as much decontaminant as
you need to saturate the spill area, cover with
paper towels, and allow to soak
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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
6. Dispose of sharp objects in a sharps container or a
sturdy puncture-resistant container
7. Place all materials in red bag
8. Remove disposable PPE and place in red bag
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Spill cleanup
Spill cleanup procedure
9. Touching outside of red bag only, close and secure
with twist tie or knot
10. Decontaminate area again and allow to air dry
11. Arrange for pickup and disposal of red bag
12. Wash your hands with soap and water!
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BLOODBORNE PATHOGENS
Course Revision
2013
Miami University
Environmental Health and Safety Offices
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Information
You are encouraged to contact your BBP Trainer or
the Environmental Safety & Risk Management Offices
to discussquestions 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/
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