Download Bloodborne Pathogens PowerPoint - Environmental Health and Safety

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
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• 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.
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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
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Bloodborne Pathogens Training
for Researchers
Judy Cashman, RN
EH&S Research & Occupational Safety
206-221-7770, [email protected]
[email protected]
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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
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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
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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
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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
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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
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Roles & Responsibilities
• Employee Health
Center
– Provide clinical services
– Administer hepatitis B
vaccine
– Provide Post-exposure
counseling
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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
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Roles & Responsibilities
• Staff (You)
– Follow the exposure control plan
– Wear required PPE
– Ask questions
– Suggest safer work practices/ procedures to your PI
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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
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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
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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
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Not Risk for BBP transmission

…unless you can SEE the blood in them…but
still handle with caution.
– Urine
– Feces
– Vomit
– Sweat
– Tears
– Saliva
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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
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Call EH&S: 206-221-7770
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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
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BBP - Occupational Exposure
• Skin
– Needle sticks or contaminated sharps
injuries
– Open wound contamination: cut, rash,
dermatitis, psoriasis
• Mucous membrane exposure: eyes, nose,
mouth
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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.
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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%)
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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.
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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
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Hepatitis B and C Symptoms
•
•
•
•
•
•
•
jaundice
fatigue
loss of appetite
nausea
abdominal discomfort
dark urine
clay-colored stool
Normal eyes
Jaundiced eyes
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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
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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)
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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
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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
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Exposure Control Plan
1. Exposure
Determination:
• By job classification
• By tasks and
procedures
• Without
consideration of PPE
worn
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Exposure Control Plan
2. Control Employee Exposure:
• Universal precautions
• Engineering controls
• Work practices
• Personal Protective Equipment
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ECP- Universal Precautions
• Blood and OPIM ALWAYS
considered infectious
• Appropriate barriers and
procedures must be used
when contact with blood
or OPIM is anticipated
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ECP-Engineering Controls
TOOLS to
Prevent
Exposure
Biological Safety Cabinet
(BSC)
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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
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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
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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
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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!
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Sharps Containers with Problems
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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
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HOLDER FOR SYRINGE
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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
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ECP-Work Practice Controls
•
•
•
•
Hand washing
No food/cosmetics
No mouth pipetting
Change out gloves regularly
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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
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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
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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
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ECP-Work Practice Controls
Key Concept
Perform all tasks
in a manner that
reduces spraying,
splashing or
aerosolization.
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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
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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
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ECP- Signs and Labels
http://www.ehs.washington.edu/rbsbiosafe/postbz.shtm
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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
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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.
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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
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ECP-Medical Management
3. Medical Management
a. Hepatitis B vaccine
b. Post exposure evaluation
c. Follow-up
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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
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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
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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
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ECP-Medical Management:
Post Exposure Evaluation
• Document exposure
incident and ID source
• Testing and Post-Exposure
treatment
• Counseling
• Evaluation and follow-up
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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:
_________________
_______________________________
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ECP- Hazard Communication
Hazard Communication
• Annual UW BBP
training
• Laboratory specific
hazards training
• Exposure Control Plan
– annual review
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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
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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.
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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
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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
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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!
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