Download President`s Report - Tulane University

Bloodborne Pathogens
For Tulane National Primate Research
Center employees whose work involves a
high risk of exposure to HIV/SIV/SHIV,
HBV, or B-virus
May 2010
Tulane University - Office of Environmental Health & Safety (OEHS)
This training serves as a review of
Bloodborne Pathogens (BBP) in
relation to the specialized work at
TNPRC in working with nonhuman
primates (NHP).
Tulane University - Office of Environmental Health & Safety (OEHS)
Bloodborne Pathogens Standard
• 1991- OSHA’s “Occupational Exposure to
Bloodborne Pathogens” (29 CFR 1910.1030)
Goal: eliminate or minimize occupational exposure
to bloodborne pathogens
• Revised in 2001 in response to the Needlestick
Safety and Prevention Act
Goal: clarifies employer requirements to identify,
evaluate, and make use of safer, effective medical
devices.
Tulane University - Office of Environmental Health & Safety (OEHS)
How does animal blood fit into the
Bloodborne Standard?
• The standard covers animal blood only for those
animals purposely infected with HIV or HBV.
• Persons handling any animal blood should
follow general precautions as recommended by
the CDC/NIH, Biosafety in Microbiological and
Biomedical Laboratories (BMBL) 5th edition
Tulane University - Office of Environmental Health & Safety (OEHS)
What are Bloodborne Pathogens (BBP)?
• Pathogenic microorganisms that are
present in blood or other potentially
infectious materials (OPIM) that can cause
disease in humans.
• These pathogens include, but are not
limited to HBV (hepatitis B virus) and
HIV (human immunodeficiency virus).
Tulane University - Office of Environmental Health & Safety (OEHS)
Bloodborne Pathogens (BBP)
• Other examples of BBP include micro-organisms
that cause:
– hepatitis C virus, malaria, syphilis, babesiosis,
brucellosis, leptospirosis, arboviral infections,
relapsing fever, Creutzfeldt-Jakob disease, HTLV-1,
and viral hemorrhagic fever.
• It is important to know which pathogens (from
humans or animals) you may be exposed to at
work, especially in the laboratory or clinical
setting.
Tulane University - Office of Environmental Health & Safety (OEHS)
Nonhuman primates, by virtue of their
genetic, physiologic, and sometimes
social similarities to humans, are
particularly likely sources of infectious
agents that pose a threat to humans.
Tulane University - Office of Environmental Health & Safety (OEHS)
What are we concerned about here at
TNPRC?
• HIV (human immunodeficiency virus)
• SIV (simian immunodeficiency virus)
• SHIV (simian-human immunodeficiency
virus)
• HBV (hepatitis B virus)
• B-virus
Tulane University - Office of Environmental Health & Safety (OEHS)
HIV
(Human Immunodeficiency Virus)
Tulane University - Office of Environmental Health & Safety (OEHS)
HIV
• HIV is the virus that causes AIDS
(Acquired Immune Deficiency
Syndrome). Once a person has been
infected with HIV, it may be many years
before AIDS actually develops.
computer generated
art quality graphics of
HIV was done by
Russell Kightley of
Canberra, Australia.
• HIV kills or damages cells in the body’s
immune system, gradually destroying the
body’s ability to fight infection and
certain cancers.
Tulane University - Office of Environmental Health & Safety (OEHS)
HIV
As of December 2001, occupational exposure to
HIV has resulted in 57 documented cases of
HIV seroconversion among healthcare
personnel (HCP) in the United States.
At the end of 2003, an estimated 1,039,000 to
1,185,000 persons in the United States were
living with HIV/AIDS, with 24-27%
undiagnosed and unaware of their HIV
infection.
Tulane University - Office of Environmental Health & Safety (OEHS)
HIV
• Some infected with HIV have no symptoms for
up to ten years.
• Within a month or two after exposure to the virus
some experience flu-like illness such as:
• fever, headache fatigue, weight loss, diarrhea, night
sweats, enlarged lymph nodes
• These symptoms usually disappear within a week
to a month and are often mistaken for those of
another viral infection. During this period, the
individual is very infectious.
Tulane University - Office of Environmental Health & Safety (OEHS)
HIV
• The average risk for HIV transmission after
a percutaneous (e.g., needlestick) exposure
to HIV-infected blood has been estimated
to be approximately 0.3%.
• HIV does not survive well outside the
body, making the possibility of
environmental transmission remote.
Tulane University - Office of Environmental Health & Safety (OEHS)
HIV- no cure or vaccine available
• Treatment protocols from the U.S. Public Health
Service have been developed using antiretroviral agents
from five classes of drugs to treat HIV infection. These
include:
• the nucleoside reverse transcriptase inhibitors, nucleotide
reverse transcriptase inhibitors, nonnucleoside reverse
transcriptase inhibitors, protease inhibitors, and a single
fusion inhibitor.
• The recommendations provide guidance to effectively
suppress the virus on the basis of HIV transmission risk
represented by the exposure.
Tulane University - Office of Environmental Health & Safety (OEHS)
HIV
• Side effects associated with the use of antiviral drugs
can be severe.
• The drug regimen is not a cure for AIDS, but it has
greatly improved the health of many people with AIDS
and it reduces the amount of virus circulating in the
blood to nearly undetectable levels.
• Researchers, however, have shown that HIV remains
present in hiding places such as the lymph nodes even
in people who have been treated.
Tulane University - Office of Environmental Health & Safety (OEHS)
SIV/SHIV
(Simian Immunodeficiency Virus/
Simian-Human Immunodeficiency Virus)
Tulane University - Office of Environmental Health & Safety (OEHS)
SIV
• Primate-borne retrovirus closely related to
HIV-1 and HIV-2
• Infection in monkeys can lead to chronic
wasting disease syndrome with depletion of
CD4 lymphocytes and lymphadenopathy
• Can be complicated by various opportunistic
complications – similar to AIDS, making it an
important animal study model.
Tulane University - Office of Environmental Health & Safety (OEHS)
SIV
• Natural seroprevalence in captive rhesus
monkeys appears to be low (0-1%)
• Found in variety of tissue and body fluids of
infected nonhuman primates
-including blood, plasma, CSF, and
parenchyma tissue
Tulane University - Office of Environmental Health & Safety (OEHS)
SHIV
• Laboratory-made hybrid of the simian and
human viruses created by wrapping the SIV
core in the HIV envelope
• Virus seems to affect monkeys much like
HIV affects humans
• Created to learn what genes are necessary to
overcome the species barriers to
pathogenesis
Tulane University - Office of Environmental Health & Safety (OEHS)
SIV/SHIV
• Risk of human infection has not been defined
• Since SIV/SHIV shares many similar
characteristics of HIV, many of the same
biosafety precautions are indicated.
Specific precautions in handling SIV/SHIV are
based on recommendations developed
for HIV and other lentiviruses.
Tulane University - Office of Environmental Health & Safety (OEHS)
SIV/SHIV
• In the lab, SIV/SHIV must be presumed to be
present in all SIV/SHIV cultures, in all materials
derived from such cultures, in all specimens from
SIV/SHIV antibody-positive nonhuman primates,
and in/on all equipment coming in contact with these
materials.
• Skin and mucous membranes should be considered a
pathway for virus entry.
• Contact with these sites should be considered an
exposure to SIV/SHIV.
Tulane University - Office of Environmental Health & Safety (OEHS)
HBV
(Hepatitis B Virus)
Tulane University - Office of Environmental Health & Safety (OEHS)
Hepatitis B Virus (HBV)
• Hepatitis B is caused by a virus that attacks
the liver and can cause lifelong infection,
cirrhosis, liver cancer, liver failure, or
death.
• In 2003, an estimated 73,000 people were
infected with HBV. People of all ages get
hepatitis B and about 5,000 die per year of
sickness caused by HBV.
Tulane University - Office of Environmental Health & Safety (OEHS)
Hepatitis B Virus
• The average volume of blood inoculated during
a needlestick injury with a 22-gauge needle is
approximately 1 µl, a quantity sufficient to
contain up to 100 infectious doses of HBV.
• HBV can survive outside the body at least 7
days and still be capable of causing infection.
Tulane University - Office of Environmental Health & Safety (OEHS)
Hepatitis B Virus
• About 30% of infected persons have no sign or
symptoms of HBV.
• If symptoms occur, they usually begin to appear on
the average of 12 weeks (range 9-21 weeks) after
exposure to hepatitis B virus.
• If you have symptoms, they might include:
•
•
•
•
jaundice
dark urine
joint pain
loss of appetite
•
•
•
•
abdominal discomfort
clay-colored bowel movements
fatigue
nausea
Tulane University - Office of Environmental Health & Safety (OEHS)
HBV IS PREVENTABLE!
A safe & effective vaccine is available.
• Hepatitis B vaccine prevents hepatitis B infection and
its serious consequences.
• If the vaccine is administered before infection, it
prevents the development of the disease and the carrier
state in almost all individuals.
• Hepatitis B vaccine consists of a series of three
injections – initial, one a month later, and one six
months from the first.
• Available FREE of charge from employer
Tulane University - Office of Environmental Health & Safety (OEHS)
What treatment is available for HBV?
• In the occupational setting, multiple doses of
Hepatitis B Immune Globulin initiated within 1
week following percutaneous exposure to hepatitis
B surface antigen-positive blood provides an
estimated 75% protection from HBV infection.
• There is no cure available for acute HBV
infection. There are antiviral drugs available for
the treatment of chronic HBV infection.
Tulane University - Office of Environmental Health & Safety (OEHS)
B-virus
Tulane University - Office of Environmental Health & Safety (OEHS)
What is B-Virus?
• Other names: Cercopithecine herpesvirus-1,
Herpes B virus, Monkey B virus, Herpes Virus
Simiae
• Herpes group of viruses that occurs naturally
in macaques and produces very mild disease in
the monkey but can cause fatal encephalitis in
humans.
Tulane University - Office of Environmental Health & Safety (OEHS)
How Do I get B-Virus?
• Exposure to contaminated monkey saliva,
secretions, or tissues most commonly
through:
• Bites or scratches
• Splashes
• Needlesticks
• Indirectly (contact with contaminated cage, etc)
Tulane University - Office of Environmental Health & Safety (OEHS)
What are the chances that I will get
B-Virus?
• The risk of actually acquiring B-Virus
infections from macaques is very low. The
approximate proportion of people who work with
primates have historically become ill with Herpes
B is much fewer that 1%.
• Only 22 cases of human infection have been
described. Of these cases, 20 infected
developed encephalitis and 15 of these patients
died as a result of their infection.
Tulane University - Office of Environmental Health & Safety (OEHS)
Who Is Most at Risk for B-Virus?
• animal caretakers
• laboratory personnel
• anyone who is exposed to monkeys or
monkey tissues
• immune-suppressed individuals may also
face a higher risk for infection
Tulane University - Office of Environmental Health & Safety (OEHS)
B-virus
Signs and Symptoms (for monkeys)
• Most have no obvious sign of infection.
• Some have ulcerations on the mouth, face, lips
genitals, and/or eye.
• Virus resides permanently in the monkey and
can be periodically reactivated (usually if
stressed or immunosuppressed). The virus can
be shed by monkeys without visible lesions or
symptoms.
Tulane University - Office of Environmental Health & Safety (OEHS)
B-Virus:
Signs and Symptoms (for humans)
*These generally occur within one month of exposure.
• Vesicular (small blister) skin
lesions at or near the site of
injury
• Localized neurological
symptoms such as pain,
numbness or itching near the
wound site
• Flu-like aches and pains
• Fever and chills
• Headaches lasting more
than 24 hours
• Fatigue
• Lack of muscular
coordination
• Shortness of breath
Tulane University - Office of Environmental Health & Safety (OEHS)
Precautions to Consider
• Exercise caution at all times. Nonhuman primates can
and will bite.
• Wear appropriate, protective clothing.
• Work together with at least one other person when
handling nonhuman primates. Minimize direct handling.
• Report any observed facial, lip or oral lesions in the
nonhuman primates to a veterinarian.
• For bite or scratch injuries involving a monkey, or
scratches with cages or equipment that might be
contaminated with their secretions, wash thoroughly and
seek medical care immediately.
Tulane University - Office of Environmental Health & Safety (OEHS)
How can I protect myself from
B-virus infection?
• Read TNPRC Procedure on Herpes B
virus
• Follow all standard procedures for your
area
• Wash Hands!!!!
Tulane University - Office of Environmental Health & Safety (OEHS)
How could I be exposed to these
pathogens at work?
Tulane University - Office of Environmental Health & Safety (OEHS)
Chain of Infection
Infection Control = Break any link in the chain
Tulane University - Office of Environmental Health & Safety (OEHS)
Modes of transmission of BBP
• Percutaneous - the direct inoculation of infectious
material by piercing through the skin barrier
(needlestick, bites, scratches from animals or cages)
• Non-intact skin - exposure of infectious material to preexisting lesions, cuts, abrasions, or rashes provides a
route of entry into the body.
• Mucous membrane contact – splashes of infectious
material to an individual's unprotected eyes, nose, or
mouth in clinical or laboratory settings.
Tulane University - Office of Environmental Health & Safety (OEHS)
What can I do to prevent
occupational exposure
incidents?
Tulane University - Office of Environmental Health & Safety (OEHS)
Occupational Exposure Prevention
The risk of occupational exposure can be
minimized or eliminated using a combination
of engineering and work practice controls,
personal protective clothing and equipment,
training, medical surveillance, HBV
vaccination, warning signs or labels, and other
provisions described in this training section.
Tulane University - Office of Environmental Health & Safety (OEHS)
Standard Precautions
• Guidelines to decrease the risk of occupational
exposure to blood or body fluids.
• A system of infection control which assumes that
every direct contact with body fluids is infectious
and requires every employee exposed to direct
contact with body fluids to be protected as though
such body fluids were infected with a bloodborne
pathogen.
• Provides adequate protection against bloodborne
infections from both humans and animals.
Tulane University - Office of Environmental Health & Safety (OEHS)
Employee Responsibilities
• Completing training/orientation as required
• Following the Standard Precautions Policy
and the Exposure Control Plan (Written plan
provided to eliminate or minimize
occupational exposure to BBP.)
• Using work practices, engineering controls,
and personal protective equipment as outlined
in the Exposure Control Plan
Tulane University - Office of Environmental Health & Safety (OEHS)
Employee Responsibilities
• Reporting exposure incidents to your supervisor and
assisting the supervisor in completing First Report of
Injury/Illness Form
• Knowing in advance what to do if an exposure
incident occurs
• Pursuing follow-up care at after an exposure incident
with Employee Health in B-building, Room 112
(Nurse Janey)
Failure to follow these policies could result
in disciplinary action.
Tulane University - Office of Environmental Health & Safety (OEHS)
Engineering Controls
• Sharps with Engineered Sharps Injury
Protection (SESIP)– a non-needle sharp or
needle with a built-in safety feature or
mechanism that effectively reduces the risk of
an exposure incident
Examples include:
Self-sheathing syringe
Tulane University - Office of Environmental Health & Safety (OEHS)
More Examples of Engineered
Sharps Safety Devices
In use
After use
Retractable needle technology
Add-ons (needle covers)
Retractable lancets
Self-blunting needles
Engineering Controls
• Needleless Systems = Device
that does not use a needle for:
• collection of body fluids
• administration of
medication/fluids
• any other procedure with
potential percutaneous exposure
to a contaminated sharp
• Squeeze cages
• Transfer boxes
Tulane University - Office of Environmental Health & Safety (OEHS)
Work Practice Controls
• Contaminated needles/sharps shall not
be bent, recapped or removed unless
there is no feasible alternative or if
required by a specific medical procedure
• Such bending, recapping, or removal
must be done through use of mechanical
device or a one-handed technique
• Use puncture-resistant sharps
container for disposal of sharps
Tulane University - Office of Environmental Health & Safety (OEHS)
Work Practice Controls
• No food/drink/smoking, handling of contacts,
or application of cosmetics in work area where
there is potential for exposure
• Minimize splashing, spraying, spattering, and
generation of droplets
• Use secondary containment for transport,
shipping, or storage of containers
• Decontaminate surfaces and equipment
Tulane University - Office of Environmental Health & Safety (OEHS)
Personal Protective Equipment
• Gloves (latex or nonlatex)
– When to use them:
• when there is reasonable anticipation
of employee hand contact with blood, mucous
membranes, non-intact skin, or other potentially
infectious materials
• when performing vascular access procedures
• when handling or touching contaminated surfaces or
items.
– Remove prior to leaving the work area and discard
as biohazard waste
Tulane University - Office of Environmental Health & Safety (OEHS)
Handwashing
• Employees must wash their hands
immediately or as soon as feasible after
removal of gloves or other personal
protective equipment.
• Wash as soon as possible if gross
contamination occurs
• Alternate methods:
– Antiseptic towelettes
– Waterless handwashing gels
Tulane University - Office of Environmental Health & Safety (OEHS)
Personal Protective Equipment (PPE)
• Gowns, aprons, fluid-resistant
clothing
• Face shields, eye protection
(safety glasses, goggles)
• Surgical mask and/or N-95
respirator
• Surgical caps, shoe covers
Tulane University - Office of Environmental Health & Safety (OEHS)
Training
• Training is required:
– at the time of initial employment and assignment
(or transfer) to job tasks where occupational exposure
may occur
– within one year of the employee's previous training
and annually thereafter
– when changes such as modification of tasks or
procedures or institution of new tasks or procedures
affect the employee's potential for occupational
exposures, and as new standards for safe work
practices evolve
Tulane University - Office of Environmental Health & Safety (OEHS)
HBV Vaccination
• FREE to employee - paid for by your department
(available from Occupational Health) for highrisk employees
• If you initially refuse the vaccine, you may
change your mind later and still receive it.
Tulane University - Office of Environmental Health & Safety (OEHS)
Warning Signs and Labels
• Fluorescent orange or orange-red label
with word “Biohazard” and biohazard symbol in
contrasting color must be provided on:
• Containers of regulated waste
• Refrigerators/freezers used to store blood/OPIM
• Containers used to store, transport, or ship
blood/OPIM
• Contaminated equipment
• Red bags may be substituted for biohazard labels
on biohazardous waste bags.
Tulane University - Office of Environmental Health & Safety (OEHS)
Housekeeping:
Sharps Disposal
• Keep sharps container upright,
readily available in the work area
• Never place sharps into the regular trash
• Use a leak-proof, puncture-resistant
sharps container labeled with the biohazard symbol
• Do not overfill - dispose of sharps container as
biohazard waste when it is 2/3 full
Tulane University - Office of Environmental Health & Safety (OEHS)
Housekeeping: Decontamination
Work surfaces should be decontaminated with
an appropriate disinfectant such as 10% bleach
solution or an EPA approved disinfectant after
completion of procedures, immediately or as
soon as feasible when surfaces are overtly
contaminated or after any spill, and at the end of
the work shift.
Tulane University - Office of Environmental Health & Safety (OEHS)
Where do I go and what
must I do if I am
exposed?
Tulane University - Office of Environmental Health & Safety (OEHS)
What to Do: Post-Exposure
• Wash exposed area with soap and water for 15
minutes; if eye or mucous membrane contact, flush
with water or saline for 15 minutes
• Report the incident to your supervisor so the
veterinarian can be notified to examine the source
monkey to see if it is shedding virus.
• Complete First Report of Injury/Illness Form
• Report to the Occupational Health Trailer for
evaluation and follow-up visits
Tulane University - Office of Environmental Health & Safety (OEHS)
Recordkeeping
• Sharps Injury Log
– Maintained by Office of Environmental Health
& Safety (OEHS) independently from OSHA
300 Log
• Training records – 3 years
• Confidential medical records – duration
of employment + 30 years
Tulane University - Office of Environmental Health & Safety (OEHS)
REMEMBER:
Don't wait.
Immediately report all exposures.
You may have to make a quick decision about
starting an antiretroviral agent as prophylaxis.
The time frame for beginning this treatment is
critical. Reporting is also essential for
establishing a claim for Workers
Compensation benefits.
Tulane University - Office of Environmental Health & Safety (OEHS)
Summary of Post-Exposure
Employee Responsibilities
1. Perform 15 minute scrub procedure using soap and
water. If mucous membrane contact, flush injured
area with sterile saline or water for 15 minutes.
2. Promptly report the incident to your supervisor.
3. Report to Employee Health during business hours
for medical evaluation or report to your supervisor
after hours for instructions.
4. Complete the First Report of Injury forms.
Tulane University - Office of Environmental Health & Safety (OEHS)
Tulane University encourages you to
contact your Bloodborne Pathogens
Coordinator or supervisor for questions,
comments, or suggestions.
TNPRC Employee Health
(985)871-6475
Bloodborne Pathogens Coordinator
(985)892-2040
ext. 6653
Office of Env. Health & Safety (OEHS) (504)988-5486
Tulane University - Office of Environmental Health & Safety (OEHS)
You can always reach the
Bloodborne Pathogens Coordinator
24 hours a day
by work cell phone (504)419-1391
or call (504)988-5486 and press 1.
Tulane University - Office of Environmental Health & Safety (OEHS)
Why was this training so vital?
Healthcare and research personnel are at a great
risk for occupational exposure to bloodborne
pathogens.
Through information and awareness Tulane
University aims to minimize any risk to our
employees and continue the commitment to
safety in the workplace.
Tulane University - Office of Environmental Health & Safety (OEHS)
References
•
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•
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•
•
HIV/SIV
http://www.cdc.gov/mmwr/preview/mmwrhtml/00001303.htm
http://www.cdc.gov/ncidod/EID/vol11no09/05-0179.htm
http://www.cdc.gov/ncidod/EID/vol11no07/04-0957.htm
HBV
http://www.cdc.gov/ncidod/diseases/hepatitis/b/index.htm
B virus
http://www.cdc.gov/mmwr/preview/mmwrhtml/00015936.htm
http://www.cdc.gov/ncidod/diseases/BVIRUS.pdf
http://dcminfo.wustl.edu/occhealth/factsheet_herpesb.html
BBP
http://www.osha.gov/SLTC/bloodbornepathogens/index.html
http://www.cdc.gov/niosh/topics/bbp/
Tulane University - Office of Environmental Health & Safety (OEHS)
Tulane University
Office of Environmental Health & Safety (OEHS)
Kellie C. Mayer
Bloodborne Pathogens Coordinator
(504) 419-1391
[email protected]
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