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Welcome BBP Attendees! Bloodborne Pathogens Program Please Pick up Handout 1. Hepatitis B Vaccination Form 2. Hepatitis B Vaccine Information Sheet 3. Copy of Slides EH&S UW Bloodborne Pathogen Training 1 • 3 minutes - fill out Form Hepatitis B Vaccination Fill out now – Tear out from pack, Hand in -large manila (orange-brown) envelopes as you leave. EH&S UW Bloodborne Pathogen Training 2 Hepatitis B Vaccine form Needs to be filled out unless you have already done so in the past If you have had vaccinations, check the line stating this, put in date or year If you decline the vaccination, check this line, sign and date EH&S UW Bloodborne Pathogen Training 3 Bloodborne Pathogens Training for Researchers Judy Cashman, RN EH&S Research & Occupational Safety 206-221-7770, [email protected] [email protected] EH&S UW Bloodborne Pathogen Training 4 Overview • About the Bloodborne Pathogens Program • About Bloodborne Pathogens (BBP) • Exposure Control Plan • What to do if you have an exposure • Requirements for HIV/HCV/HBV labs • Resources EH&S UW Bloodborne Pathogen Training 5 Bloodborne Pathogen (BBP) Rule • Washington Administrative Code (WAC) 296-823 – Enacted in 1993 – Safe sharps requirements in 2000 (Needlestick Safety and Prevention Act) • Reduce risk of BBP exposure to workers • Annual Training required EH&S UW Bloodborne Pathogen Training 6 UW BBP Program • All UW employees with a reasonably anticipated potential for exposure to human source materials, including human blood and its components, human tissue, 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. • Requirements of the UW BBP Program: – Developing a BBP Exposure Control Plan – Offering the hepatitis B vaccine – Training 7 BBP Statistics In Washington, Labor & Industries (L&I) estimates ~44,000 needlestick injuries per year National Institute for Occupational Safety and Health (NIOSH) 2004 data: 57 health care workers have seroconverted following occupational exposure to HIV; 140 with possible (unconfirmed) seroconversion – 26 have developed AIDS – 3 were lab workers working with concentrated virus – Percutaneous exposure (sharps injury) was the most common route EH&S UW Bloodborne Pathogen Training 8 Roles & Responsibilities • EH&S – Administer the UW BBP Program – Provide BBP Training – Issue Biological Use Authorization to labs – Consultation and Incident/accident follow-up investigation EH&S UW Bloodborne Pathogen Training 9 Roles & Responsibilities • Employee Health Center – Provide clinical services – Administer hepatitis B vaccine – Provide Post-exposure counseling EH&S UW Bloodborne Pathogen Training 10 Roles & Responsibilities • Principal Investigator – ID hazards and who needs to be in the BBP Program – Develop/review lab Exposure Control Plan – Provide personal protective equipment – Provide lab specific safety training – Enforce safety rules EH&S UW Bloodborne Pathogen Training 11 Roles & Responsibilities • Staff (You) – Follow the exposure control plan – Wear required PPE – Ask questions – Suggest safer work practices/ procedures to your PI EH&S UW Bloodborne Pathogen Training 12 How are Suggestions or changes to work practices communicated? 1. 2. 3. 4. 5. staff meetings email 1:1 suggestion box/other Don’t know/not sure EH&S UW Bloodborne Pathogen Training 13 Bloodborne Pathogens • Microorganisms that are present in human blood and its components and can cause disease. • 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 14 Other Potentially Infectious Materials (OPIM) • 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 -Any body fluid contaminated with blood or OPIM 15 Not Risk for BBP transmission …unless you can SEE the blood in them…but still handle with caution. – Urine – Feces – Vomit – Sweat – Tears – Saliva EH&S UW Bloodborne Pathogen Training 16 Where can I go if I have a question about “OPIM”? • Check the Washington Administrative Code (WAC) 296-823 • See the EH&S website: http://www.ehs.washington.edu/rbs/bbp.shtm • Check the lab Biosafety Manual http://www.ehs.washington.edu/rbsbiosafe/bsmanualindex.shtm • Ask my manager EH&S UW Bloodborne Pathogen Training 17 Call EH&S: 206-221-7770 EH&S UW Bloodborne Pathogen Training 18 Transmission of BBP Occupational Exposure 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 EH&S UW Bloodborne Pathogen Training 19 BBP - Occupational Exposure • Skin – Needle sticks or contaminated sharps injuries – Open wound contamination: cut, rash, dermatitis, psoriasis • Mucous membrane exposure: eyes, nose, mouth EH&S UW Bloodborne Pathogen Training 20 Transmission Risk of BBP Risk of infection depends on several factors: Pathogen involved Type/route of exposure Amount of virus in infected blood during exposure Amount of infected blood involved in the exposure If post-exposure treatment was taken Specific immune response of infected individual Courtesy of Owen Mumford, Inc. EH&S UW Bloodborne Pathogen Training 21 Transmission Risk following Exposure to Infected Blood Virus Hepatitis B # of virus particles/ml of blood 6 13 10 -10 (Millions – trillions) Hepatitis C 6 10 (Millions) HIV (AIDS) 3 10-10 (Tens – thousands) Source: Centers for Disease Control and Prevention Risk of infection following parenteral (needlestick or cut) exposure 1 in 3 (30%) 1 in 30 (3%) 1 in 300 (0.3%) 22 Hepatitis B • Statistically the greatest risk • 6-30% risk following exposure incident (nonimmunized) • Incubation period is 6 weeks- 6 months (45-180 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 – can persist at room temp for 7 days. EH&S UW Bloodborne Pathogen Training 23 Hepatitis C • Most common chronic bloodborne infection • 80% infected without symptoms (CDC) • Incubation period 2 weeks6 months • ~16 hrs-4 days on surfaces • No vaccine EH&S UW Bloodborne Pathogen Training 24 Hepatitis B and C Symptoms • • • • • • • jaundice fatigue loss of appetite nausea abdominal discomfort dark urine clay-colored stool Normal eyes Jaundiced eyes EH&S UW Bloodborne Pathogen Training 25 Human Immunodeficiency Virus (HIV) • 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 • Enlarged lymph nodes, mycological oral infections, fatigue, weight loss • Symptom-free period of 5-10 years can occur EH&S UW Bloodborne Pathogen Training 26 What is the most common route of exposure to BBP in the workplace? 1. Injury from contaminated needlesticks and/or sharps 2. Eye and mucous membrane exposure 3. Open wound contamination (cut, dermatitis, psoriasis) EH&S UW Bloodborne Pathogen Training 27 Exposure Control Plan (ECP) • Must include BBP standard (WA State Rule) online at: http://www.lni.wa.gov/safety/rules/ chapter/823/ • Biosafety Manual contains UW Core ECP, in Appendix A See online at: http://www.ehs.washington.edu/ rbsbiosafe/bsmanualindex.shtm EH&S UW Bloodborne Pathogen Training 28 Exposure Control Plan 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 EH&S UW Bloodborne Pathogen Training 29 Exposure Control Plan 1. Exposure Determination: • By job classification • By tasks and procedures • Without consideration of PPE worn EH&S UW Bloodborne Pathogen Training 30 Exposure Control Plan 2. Control Employee Exposure: • Universal precautions • Engineering controls • Work practices • Personal Protective Equipment EH&S UW Bloodborne Pathogen Training 31 ECP- Universal Precautions • Blood and OPIM ALWAYS considered infectious • Appropriate barriers and procedures must be used when contact with blood or OPIM is anticipated EH&S UW Bloodborne Pathogen Training 32 ECP-Engineering Controls TOOLS to Prevent Exposure Biological Safety Cabinet (BSC) EH&S UW Bloodborne Pathogen Training 33 Safe BSC Use Video: 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. 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. http://vimeo.com/groups/34691/videos/7642083 EH&S UW Bloodborne Pathogen Training 34 ECP-Engineering Controls • 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 EH&S UW Bloodborne Pathogen Training 35 ECP-Engineering Controls • Safer Medical Devices – Needleless systems – Sharps with engineered sharps injury protections (SESIP) – Self-blunting needles – Plastic capillary tubes Unprotected position Protected position 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). – Exemptions for safer needle requirements, if not using these EH&S UW Bloodborne Pathogen Training 36 ECP-Engineering Controls Sharps disposal containers - 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 37 Sharps Containers with Problems 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 HOLDER FOR SYRINGE EH&S UW Bloodborne Pathogen Training 40 More Tips on Safe Sharps Handling Know what Sharps include: http://www.ehs.washington.edu/rbsresplan/sharp.shtm 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 10/7/2015 EH&S UW Bloodborne Pathogen Training ECP-Work Practice Controls • • • • Hand washing No food/cosmetics No mouth pipetting Change out gloves regularly EH&S UW Bloodborne Pathogen Training 42 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 DEMO of GLOVE REMOVAL: https://depts.washington.edu/ehas/pubcookie/train/bbpx/bbp6a.php 43 ECP-Work Practice Controls • Written cleaning and decontamination schedule and procedures • Decontamination Agents: – Bleach 1:10 – EPA certified agent (alcohol is not) – Quaternary Compounds – Premixed: • Environcide • clavicide • Contact time is critical EH&S UW Bloodborne Pathogen Training 44 ECP- Work Practice Controls • Decontamination Place absorbent material atop spill, sufficiently spray/cover entire area. Some start at the edges and work in, others just cover the area. 2. You want to ensure that you cover the contaminated area. 1. SPILLS VIDEO: https://depts.washington.edu/ehas/pubcookie/ train/bbpx/bbp7.php EH&S UW Bloodborne Pathogen Training 45 ECP-Work Practice Controls Key Concept Perform all tasks in a manner that reduces spraying, splashing or aerosolization. EH&S UW Bloodborne Pathogen Training 46 ECP-Work Practice Controls Regulated Waste 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 EH&S UW Bloodborne Pathogen Training 47 Define sharps waste ALWAYS sharps waste: • needles and IV tubing with needles • syringes without needles • lancets • scalpel blades Sharps waste if CONTAMINATED with biohazards (including recombinant or synthetic DNA/RNA): • razor blades • broken glass • fragile glass items, Pasteur pipettes, • slides and cover slips 48 ECP- Signs and Labels http://www.ehs.washington.edu/rbsbiosafe/postbz.shtm EH&S UW Bloodborne Pathogen Training 49 Precautions required when transporting blood • 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/ohsreslab/biowaste.shtm#trans EH&S UW Bloodborne Pathogen Training 50 ECP-Personal Protective Equipment (PPE) Type and amount of PPE required depends on the task and anticipated exposure. – 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. – Provided at no cost to employee. Nitrile gloves for alcohol. EH&S UW Bloodborne Pathogen Training 51 ECP - Laundry For Contaminated articles: – Handle as little as possible • Bag/contain where used • Don’t sort or rinse where used • Place in leak-proof, labeled or colorcoded containers or bags – Wear PPE when handling and/or sorting • Gloves • Gown - Consolidated Laundry, NOT your home laundry, is to be used for laundering EH&S UW Bloodborne Pathogen Training 52 ECP-Medical Management 3. Medical Management a. Hepatitis B vaccine b. Post exposure evaluation c. Follow-up EH&S UW Bloodborne Pathogen Training 53 ECP- Medical Management Hepatitis B Vaccine • Must be offered within 10 days of initial assignment • 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 54 ECP-Medical Management What to do if exposed? 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. 2. GET Medical Help EH&S UW Bloodborne Pathogen Training 55 ECP-Medical Management How to Get Medical Help? • Call UW Employee Health Center at 206-685-1026 – Harborview Sites: 206-744-3081 • After hours or clinic is closed, go to nearest Emergency Room (ER) • Call 911 • Follow the EH&S Exposure Poster http://www.ehs.washington.edu/manuals/posters/exposureresponse poster.pdf EH&S UW Bloodborne Pathogen Training 56 ECP-Medical Management: Post Exposure Evaluation • Document exposure incident and ID source • Testing and Post-Exposure treatment • Counseling • Evaluation and follow-up EH&S UW Bloodborne Pathogen Training 57 Health Care Professional Written Opinion for Need for Hepatitis B vaccination Health Care Professional’s WrittenOpinion For Exposure Evaluation Use with Chapter 296 -823 WAC, Occupational Exposure to Bloodborne Pathogens Post Employee’s Name: ______________________________________ Date of Incident: t ______________________________________ Date of Evaluation: ______________________________________ Health Pro fessional’s Address: ______________________________________ ______________________________________ 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 is____ is not ____ indicated. ________________________________ Employee to receive within 15 days of the evaluation Health Care Professional’s Name ___________________________________ Health Care Professio nal’s Signature __________________________ 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.” Employer’s Name Employer’s Address : _____________________________________________ _____________________________________________ _____________________________________________ Confidential Fax: _________________ _______________________________ EH&S UW Bloodborne Pathogen Training 58 ECP- Hazard Communication Hazard Communication • Annual UW BBP training • Laboratory specific hazards training • Exposure Control Plan – annual review EH&S UW Bloodborne Pathogen Training 59 ECP-Records Record Keeping • Training records- EH&S and PIkeep 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 UW Bloodborne Pathogen Training 60 Additional Requirements HIV/HBV/HCV Research Labs • Lab specific biosafety manual-reviewed annually • Special Practices – – – – – 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. • Training – Demonstrated proficiency-microbiological practices and practices and operations specific to the facility BEFORE work w/virus. EH&S UW Bloodborne Pathogen Training 61 Resources • 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/rules/chapter/823 • Centers for Disease Control and Prevention (CDC) Biosafety in Microbiological and Biomedical Laboratories (BMBL)website: http://www.cdc.gov/biosafety/publications/bmbl 5/index.htm EH&S UW Bloodborne Pathogen Training 62 Resources • EH&S Site-Specific Exposure Control Plan: http://www.ehs.washington.edu/forms/rbs/ researchlaboratorysupplementalform.doc • Specimen Handling Transport EH&S Class: http://www.ehs.washington.edu/eposhiphazmat/ index.shtm • EH&S Research and Occupational Safety: 206-221-7770, [email protected], http://www.ehs.washington.edu/rbs/index.shtm EH&S UW Bloodborne Pathogen Training 63 QUESTIONS? "If I hear & see - I learn, but may forget, But if I do, I understand." Be sure to look at your workplace Exposure Control Plan! See you next year… online! EH&S UW Bloodborne Pathogen Training 64