Bloodborne Pathogens and Biosafety powerpoint
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Bloodborne Pathogens and Biosafety powerpoint Presentation Transcript

  • 1. USC Environmental Health & Safety
  • 2. Goal
    • Safety: 385,000 percutaneous injuries/yr in hospitals
    • 1990 OSHA estimate: 9,000 bloodborne infections/yr, 200 deaths
    • Laboratory acquired infections - Sulkin and Pike: 3,921 cumulative cases, including brucellosis, typhoid, tularemia, tuberculosis, hepatitis, and venezuelan equine encephalitis
      • Less than 20% associated with known accident
      • Lab environment more hazardous than nature due to culturing, propagation of infectious agents
    • Recent events at U Chicago, Texas A&M
    • Compliance with Safety Regulations: Cal-OSHA BBP Standard, 1992
    • Education, prevention
  • 3. Lab acquired vaccinia infection, Virginia 2008
    • Worked in cancer research lab
    • Handled mice infected with vaccinia virus
    • Not vaccinated
  • 4. What are Bloodborne Pathogens?
    • microorganisms ( such as viruses or bacteria) that are carried in blood and can cause disease in people
    • malaria, syphilis, Hepatitis B Virus(HBV), Hepatitis C Virus , Human Immunodeficiency Virus (HIV)
  • 5. Am I at risk?
    • Work with blood or OPIM
    • OPIM - semen, vaginal secretions, saliva in dental procedures, CSF, or other internal body fluids
      • Organs, unfixed human tissue
      • HBV, HCV, HIV tissue cultures
      • Human cell lines
  • 6. Human Cell Lines
    • Cell lines may be infected or become infected/contaminated in subsequent handling/passaging
    • LCMV- Researchers infected working with nude mice (infected tumor cell line)
    • “ We recommend that all human cell lines be accorded the same level of biosafety consideration as a line known to carry HIV… Thus, it is best to use caution when handling any human cell line”
    • Universal Precaution
  • 7. Low Risk Materials
    • Urine, feces, vomit, tears, sweat, sputum, nasal secretions
    • Unless visibly contaminated with blood
  • 8. Routes Of Transmission
    • Sexual contact
    • Sharing needles
    • Blood Transfusion (very rarely in countries where blood is screened)
    • Birth: Expose through amniotic fluid, blood during the birthing process, and (less likely) through breast milk
    • Accidental puncture from contaminated needles, glass or other sharps
    • Contact between broken or damaged skin and infected body fluids
    • Contact between mucous membranes and infected body fluids
  • 9. Common procedures where exposure may occur
    • Handling containers of blood, fluid, tissue, or cultures
    • Phlebotomy
    • Pipetting, mixing, or handling blood, fluid, or tissue
    • Cleaning blood/body fluid spills
    • Handling contaminated sharps or other contaminated waste
      • Puncture from improperly disposed needle
    • Injections/inoculations
      • ~89% occupationally acquired HIV
  • 10. Determinants of Disease Transmission
    • Individual receiving the dose
    • Virulence / type of pathogen
    • Size of delivered dose (concentration)
    • Route of exposure
    • Type of bodily fluid
    • Whether post exposure prophylaxis was administered
  • 11. Diseases caused by BBP
    • Hepatitis B
    • Hepatitis C
    • AIDS(HIV)
  • 12. Hepatitis B
    • Inflammation of the liver
    • Risk of HBV infection after a single positive needle
    • stick is 30%
    • Durable virus (7 days outside body)
    • Acute or chronic
    • More than 350 million people are chronic carriers of HBV worldwide
    • (CDC) 800,000–1.4 million persons in the United States have chronic HBV infection
    • Annual number of unreported infections may be 10 times greater than the number of reported (many HBV infections are either asymptomatic or never reported)
    • rate of new HBV infections has declined ~80% since 1991
  • 13. Hepatitis B
    • Symptoms (weeks-~6months) – Fever, Jaundice, fatigue, abdominal pain, loss of appetite, nausea, vomiting, joint pain, dark urine
    • Complications - Cirrhosis (scarring) of the liver, liver cancer, liver failure, and death
    • Prevention - Hepatitis B Vaccine, PEP (Plasma fractionation of Hep B Antibody ), Universal Precautions
    http://phil.cdc.gov/phil/home.asp
  • 14. HEP B Vaccine
    • USC offers the vaccines to employees FREE OF CHARGE
    • Series of 3 inoculations (shots) and Titer check
    • After vaccination cellular immunity persists (despite low antibody levels)
  • 15. Hepatitis C
    • After a needlestick or sharps exposure to HCV-positive blood, the risk of HCV infection is approximately 1.8%
    • 75-80% chronic
    • 3.2 million persons in the U.S.- chronic HCV infection
    • Vaccine? No
    • PEP? No
  • 16. Hepatitis C Virus
    • Of every 100 persons infected with HCV, approximately
    • 75–85 will go on to develop chronic infection
    • 60–70 will go on to develop chronic liver disease
    • 5–20 will go on to develop cirrhosis over a period of 20–30 years
    • 1–5 will die from the consequences of chronic infection (liver cancer or cirrhosis)
    • 8,000–10,000 deaths each year in the United States (chronic)
  • 17. Hepatitis C
    • Symptoms - Jaundice, fatigue, abdominal pain, loss of appetite, nausea, dark urine
    • Complications – Chronic liver disease, death
    • Transmission : Occurs when blood or body fluids from an infected person enters the body of a person who is not infected
    • Prevention – Universal precautions
  • 18. HIV
    • Attacks Immune System
    • Infects/Kills T-Helper Cells (CD4)
    • Final Stage of HIV Infection: AIDS – Acquired Immunodeficiency Syndrome
    • Opportunistic infections – Kaposi’s sarcoma, CMV
    • Workers have been infected with HIV after being stuck with needles containing HIV-infected blood or after infected blood gets into a worker’s open cut or a mucous membrane
    Electron microscope image of HIV, seen as small spheres on the surface of white blood cells. http://www.biologyimagelibrary.com/imagelibrary/images/12646_1_PHIL_1843_lores_BIL260805.JPG
  • 19. HIV
    • Fragile retrovirus
    • Risk of transmission after percutaneous exposure to HIV infected blood is approximately .3%
    • ROT after splash to eye/mouth/nose ~.1%
    • 57 healthcare workers with documented
    • occupationally acquired HIV infection
    • CDC ~56,300 new HIV infections in the
    • US in 2006
    • http://www.agen.ufl.edu/~chyn/age2062/lect/lect_14/Lect_14.htm
  • 20. Healthcare Personnel with Documented and Possible Occupationally Acquired AIDS/HIV Infection, by Occupation, 1981-2006 U.S. Infect Control Hosp Epidemiol 2003;24:86-96. Occupation Documented Possible Nurse 24 35 Clinical Laboratory Worker 16 17 Nonsurgical Physician 6 12 Non-Clinical Laboratory Technician 3 - Housekeeping or Maintenance 2 13 Dentist or Dental Worker - 6
  • 21. What is risk with lentiviral vectors?
    • Potential for generation of replication-competent lentivirus (RCL)
    • Potential for insertional mutagenesis/oncogenesis
    • Host range
    • Mitigated by the nature of the vector system (and its safety features) or exacerbated by the nature of the transgene insert encoded by the vector.
  • 22.  
  • 23. Universal Precaution
    • Treat all blood and body fluids as if infectious
    • For labs: Biosafety Level 2 (BSL2) containment
      • Defined by CDC/NIH
      • Combination of laboratory practices and techniques, safety equipment, and laboratory facilities
      • Many BSL2 safety procedures extend to non-lab settings
  • 24. BSL2: Standard Microbiological Practices
    • Access to lab limited during experiments
    • Washing hands after handling viable materials, after removing gloves, and before leaving lab
    • No eating, drinking, smoking, handling contacts, or applying cosmetics
    • Safe handling of sharps, plastic substituted for glass
    • Minimize splash/aerosols
    • Decontaminate work surfaces daily and after spills
    • Proper disposal of contaminated items as biohazardous waste
  • 25. Biohazard Waste Disposal
    • Gauze
    • Plastic serological pipettes
    • Plastic pipette tips
    • Petri dishes
    • Culture vials/plates
    • Counter top covers
    • Contaminated PPE
  • 26. Sharps
    • Contaminated broken glassware
    • Scalpels, blades, capillary tubes
    • Slides & cover slips
    • Glass pipettes
    • Glass capillary tubes
    • Needles and syringes
  • 27. Liquid Waste
    • Decon. tissue and media with 10% bleach solution~ 15 minute contact
    • May then be poured down drain
    • USC does not have a permit to autoclave medical waste!
  • 28. BSL2: Special Practices
    • Only those who have been advised of potential hazards may enter lab
    • Biohazard sign when agent in use, include relevant contact information, info on agent, what to do if exposed, PPE
    • PI ensures all are appropriately trained on potential hazards of work involved, how to prevent exposure, offered appropriate immunizations
    • Training on hazards, exposure prevention, SOP’s
    • Sharps precautions , engineered sharps, handling broken glassware
    • Infectious agents placed in container with cover that prevents leakage during collection, handling, processing, storage, transport, shipping
    • Decontamination of equipment/work surfaces
    • Report exposures to PI, seek treatment
  • 29. Safety engineered sharps
    • 2001 Needlestick Prevention Act
  • 30. Labeling
    • International biohazard symbol
    • Biohazardous waste
    • Door signs
    • Incubators
    • Freezers
    • Refrigerators
    • Shipping boxes
  • 31. Decontamination
    • Work surfaces, tools, and equipment
    • 1:10 bleach solution
    • Lysol or other EPA registered disinfectant
    • 15 minute minimum decontamination time
  • 32. Handling, storage, transport procedures
      • Specimens must be placed in a container which prevents leakage during collection, handling, processing, storage, transport, or shipping (use secondary container), container must be labeled with biohazard symbol
  • 33. BSL2: Safety Equipment
    • Requires the use of a BSC for large volumes or potential aerosol generation
    • Use of centrifuge safety cups/sealed rotors for aerosol containment
    • Face protection for anticipated splashes or sprays when outside BSC
    • Lab coats, leave before leaving lab
    • Gloves whenever potential contact with hazardous agents
  • 34. Biosafety Cabinets
  • 35. Biosafety Cabinets
    • Sweeping motions of arms
    • Disinfect surfaces before and after use
    • Front intake
    • UV
    • Bunsen burners alternatives (i.e. sterile loops, touch-plate microburners)
    • Substitute plasticware for glassware or other sharp instruments whenever possible (i.e. pasteur pipettes)
    • Must be professionally decontaminated/recertified before moving
    • Recertify annually
  • 36. BSL2: Lab facilities
    • Lockable doors
    • Sink for handwashing
    • No carpets/rugs
    • Chairs covered
    • in non-porous material
    • BSC away from doors
    • Eyewash station
  • 37. Emergency procedures for spills
    • Inform others in lab and restrict access
    • Leave area and allow aerosols to settle
    • Don personal protective equipment
    • If broken glass present, never handle directly by hand, use forceps to remove and dispose into sharps containers
    • Place paper towels/absorbent over spill
    • Apply disinfectant(10% bleach) directly onto paper towels and allow 15 minute contact time to disinfect
    • Clean spill by wiping around the perimeter and moving inwards
    • Discard materials as biohazardous waste
    • Wash hands with soap and water
  • 38. Emergency procedures for exposures
    • Flush affected area with water for 15 minutes
    • Inform supervisor
    • Know where to get
    • treatment
    • Avoid working alone
    • in lab!
  • 39. Treatment Locations
    • HSC
    • Business Hours
    • Internal Medicine (HCC)
    • 1520 San Pablo St.
    • Los Angeles, CA 90033
    • (323) 442-5100
    • After Hours
    • White Memorial Hospital
    • 1904 Bailey Street, Suite 100
    • Los Angeles, CA 90033
    • (323) 222-9675
  • 40. Exposure Incident
    • Report incident to supervisor immediately and seek medical treatment!
    • File Supervisor’s report of injury
    • File Sharps Injury Form
    • Report all exposure incidents to IBC
  • 41. USC Exposure Control Plan
    • http://capsnet.usc.edu/LabSafety/BioSafety/BloodBornePathogensProgram
    • How to elim/minim exposure to human/NHP materials that might contain BBP
    • Outlines PI responsibility: Update ECP, GLS/BBP, Hep B vaccination
    • Methods of Compliance: Safety Equipment
    • Good Work Practices : PPE, hand washing, labeling
    • Medical Surveillance Program: PE eval./follow up
  • 42. Contact Information
    • Environmental Health and Safety
      • 323.442.2200(office)
      • [email_address]
      • HSC, CHP 148