Bloodborne Pathogens Initial Training by UCONN
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Bloodborne Pathogens Initial Training
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Bloodborne Pathogens Initial Training by UCONN
- 2. The Standard • Issued in 1991 by OSHA. • “…applies to all occupational exposure to blood or other potentially infectious materials.” • Revised in 2001 to include the Needle stick Safety and Prevention Act. • Intent is worker protection • Hard copies available • Available online
- 3. Requirements of The Standard • Employers are required to: • Establish an Exposure Control Plan and keep it updated • Provide annual safety training for employees • Ensure engineering controls are in place • Provide personal protective equipment (PPE) • Ensure employees are offered Hepatitis B vaccination free of charge
- 4. Exposure Control Plan • Defines which employees are included in the plan • Covers potential exposures and ways to minimize them • Indicates a plan for what to do should an exposure incident occur • Describes incident reporting requirements
- 5. Employee Responsibilities • Attend mandated BBP training and annual retraining • Familiarize yourself with Exposure Control Plan • Utilize work practice controls and PPE properly • Report all exposure incidents and/or injuries to supervisor in a timely manner
- 6. Supervisor Responsibilities • Identify all “occupational exposed” employees to BHS w/in 10 days of hire • Ensure these employees attend BBP training and any additional training necessary • Make PPE available • Emergency action procedures in place and are followed • Proper disinfection and disposal procedures followed
- 7. Other Potentially Infectious Materials (OPIMs) Materials that may carry and transmit BBPs • Human blood and blood components • Human cell lines, including embryonic stem cells • Body cavity fluids (spinal, synovial, pleural, pericardial, peritoneal, amniotic) • Breast milk • Semen and vaginal secretions • Saliva in dental procedures • Any fluid that is visibly contaminated with blood • Any unidentified fluids in a lab where human materials are used
- 8. Known Bloodborne Pathogens • HIV • Bloodborne Hepatitis viruses (Hepatitis B, D, C and E) • Human T-lymphotropic virus Type I • Hemorrhagic Fever viruses (Ebola, Marburg, Lassa) • West Nile Virus • Colorado Tick Fever viruses (a number of arboviruses) • Plasmodium species (Malaria) • Treponema species (Syphilis) • Babesia species • Brucella species (Brucellosis) • Leptospira species • Francisella species • Streptobacillus moniliformis • Spirillum minus • Borrelia species (Lyme Disease) • Creutzfeldt-Jacob agent (CJD)
- 9. Significant Bloodborne Pathogens • Human Immunodeficiency Virus (HIV) • Destroys host immune system resulting in death • Effective anti-retroviral drugs available, no cure • ~37 million living with HIV • Hepatitis B Virus (HBV) • Can destroy or damage host liver, resulting in death • Host can recover from disease, chronically infected • Preventable with vaccination • 350 million chronic carriers • 780,000 die each year due to complications (cirrhosis, cancer)-WHO • Hepatitis C Virus (HCV) • Can destroy or damage host liver, resulting in death • Chronic infections, costly cure is available • Hepatitis D Virus (HDV) • Requires Hepatitis B co-infection to cause disease
- 10. Significant Bloodborne Pathogens • Human Immunodeficiency Virus (HIV) • Transmission risk-1:300 (0.3%) • Hepatitis B Virus (HBV) • Transmission risk-1:2 (50%)!!! • One drop can have 100 million virus particles present • Hepatitis C Virus (HCV) • Transmission risk-1:50 (1.8%) These statistics are from direct patient care settings. 86% of occupational exposures that result in seroconversion to HIV are caused by hollow bore needles.
- 11. Common Characteristics of BBPs • Biohazardous Agents • Transmission • Direct Contact • Person to person contact • Indirect • Person to object to person • Parenteral inoculation • Mucous membranes
- 12. Chain of Infection • All components need to be present for successful transmission: 1. Presence of virulent pathogen 2. High concentration of pathogen (infectious dose) 3. Mechanism of transmission of pathogen to host 4. Portal of entry 5. Susceptible host
- 13. Personal Risk Factors • Factors that may suppress or alter immune system • Age • Stress • Nutrition • Pregnancy • Diabetes • Immunodeficiency through disease or drug use including the use of many prescription medications • Chemotherapy
- 14. Protection in Healthy Adults • Natural protection • Intact Skin • Cellular Immunity (leucocytes) • Humoral Immunity (antibodies) • Acquired immunity • Vaccination • Immunoglobulin administration • Illness
- 15. Symptoms • Symptoms are similar for most diseases • “Flu-like” • Fever • Nausea • Malaise • Night sweats • Some diseases have no initial symptoms • Hepatitis B may be asymptomatic in some individuals
- 16. Hepatitis B Virus Vaccination • Strongly endorsed by medical community • Protection has been proven to last 7-15 years • Became available in 1983, was required by 1991 • Healthcare worker infection rates decreased by 95% between ‘83 and ‘95! • CDC and WHO recommend vaccinations from birth-2 months onward • Series of 3 shots • Given over a 6 month period • 95-97% effective at conferring immunity • Some individuals will never develop immunity • Also protects against Hepatitis D (without co-infection with B, D cannot cause disease)
- 17. Include your e-mail address for any necessary follow-ups. For those requesting the Hep B immunization, this form can be copied to give to your PI upon request. Hepatitis B vaccine
- 18. • myhealth.uconn.edu • (student health portal) • Is not a university requirement • Get your titers checked • Get a booster Not Sure about your immunization status?
- 19. Exposure Incident Reduction Strategy • Employ standard (universal) precautions in the workplace • Engineering controls • Work practice controls • Use PPE!
- 20. Standard Precautions • Employ standard (universal) precautions in the workplace • Reduce the risk of transmission of BBPs and other pathogens from both recognized and unrecognized sources.
- 21. Exposure Incident Reduction Strategy • Employ standard (universal) precautions in the workplace • Engineering controls • Work practice controls • Use PPE!
- 22. Engineering Controls Equipment that comes between you and the hazard “To err is human”-Alexander Pope • To reduce parenteral exposures Sharps containers Dustpan & brush or large forceps “safe” needles
- 23. Safer Sharps Devices • To reduce parenteral exposures • An estimated 1,000 sharps injuries happen EVERY DAY in the U.S.
- 24. Safe Sharps Practices • If you have never used a sharp, be sure you are trained prior to handling • Incident Prevention • Needles and other sharp instruments should only be used when there is no alternative • Try to use plastic instead of glass whenever possible • Always keep sharps in view • Try to limit use to one open needle or sharp at any given time when possible.
- 25. Engineering Controls Equipment that comes between you and the hazard • Contains spills, splashes and aerosols Spill clean up and containment Biological safety cabinet for aerosol containment
- 26. Engineering Controls Equipment that comes between you and the hazard • Additional aerosol and splash protection Centrifuge safety cups Pipette devices and good pipette practice! Splash shield
- 27. Engineering Controls • Controls to decontaminate surfaces and equipment • Must be tuberculocidal • 1:10 solution of at least 5.25% strength household bleach • Check concentration! • Bleaches with fragrance and splash less bleaches are not considered sanitizers. • EPA number • Iodine/iodophore – Wescodyne is not EPA registered and is not tuberculocidal. • phenol containing products • Alcohol preparations do not meet requirements • Not enough contact time • Check labels or contact EHS to ensure you comply!
- 28. Engineering Controls • Check contact time requirements • CDC Guideline for Disinfection and Sterilization • Excellent source of information for effective use of disinfectants
- 29. Decontamination Appropriate hand washing • OSHA requires hand washing with soap and running water for at least 20 seconds after procedures when blood or body fluids are present. Soap or Hand sanitizer? • Use lots of hand sanitizer to increase contact time. • “Washing hands with soap and water is the best way to reduce the number of microbes…if soap and water are not available, use alcohol-based hand sanitizer…soap and water are more effective than hand sanitizers at removing or inactivating certain kinds of germs.” www.CDC.gov • Lots of proteinaceous material present? Just use soap.
- 30. Decontamination
- 31. Exposure Incident Reduction Strategy • Employ standard (universal) precautions in the workplace • Engineering controls • Work practice controls • Use PPE!
- 32. • Clutter is dangerous, keep work area tidy • No re-capping needles • No re-using disposable PPE • No applying cosmetics (including lip balm) or contact lenses • Keep sharps disposal container close to work area • Disinfect area before and after work • Follow spill clean-up procedure • Footwear • Shoes should cover whole foot • Don’t work late or alone • Know emergency response procedures • Call 911 from campus phone Work Practice Controls
- 33. Signs and Labels • Signs must be posted to warn of potential hazard • Post on all entry doors • Post on all equipment that contains, stores or transports biohazardous agents
- 34. Exposure Incident Reduction Strategy • Employ standard (universal) precautions in the workplace • Engineering controls • Work practice controls • Use PPE!
- 35. Personal Protective Equipment • Protective clothing • To cover street clothes • Worn closed • The correct size for you - not oversized or too tight • Choose the right material
- 36. Personal Protective Equipment • Face and mucous membrane protection • To serve as a barrier to splashes of potentially infectious materials • Use during spill clean up, first aid and with large volumes of materials
- 37. Personal Protective Equipment • Gloves appropriate to the task • Non-latex exam gloves for most lab work • Verify integrity before donning gloves • Remove carefully to avoid contaminating hands • Do not reuse disposable gloves • Do not wear gloves outside of the laboratory • Wash hands after removing gloves • Make these measures second nature
- 39. PPE Rules to Remember • Use proper PPE for the situation • Gloves, goggles, lab coat, surgical masks, etc… • Always check PPE to ensure it free of tears or defects • Remove PPE and wash hands before leaving lab • Wear correctly and wear the right size
- 40. “Workers are the first line of defense for themselves, others in the laboratory and the public from exposure to hazardous agents. Protection depends on conscious and proficient use of good microbiological practices and the correct use of safety equipment.” BMBL Containment cannot compensate for poor technique. Safe Work Practices
- 41. If a Spill Happens: • Wear PPE • Contain spill with absorbent material • Remove sharp objects if necessary • Cover spill with disinfectant (tuberculocidal) • If it is a large spill, undiluted disinfectant may need to be used to achieve effective final concentration • Allow to sit for at least 15 minutes (reference decon. time) • Dispose of materials as necessary in appropriate biohazard waste receptacle • Wipe area again with disinfectant
- 42. If there is an exposure incident: • Needle stick or other percutaneous exposure: • Wash the wound with soap and water • If there is no soap use an alcohol based solution • Do not scrub-could create more entry points for pathogens • Do not suck on the wound • Apply antiseptic and a clean dressing • Mouth, Nose or Eye exposures • Irrigate with copious amounts of cold water for10-15 minutes
- 43. Exposure Incident Procedures • Employee responsibilities • Self treat exposed area • Report the incident • Supervisor responsibilities • Document the incident • Advise employee that medical treatment is available
- 44. Required Reporting Information If the incident involves a sharp object of any kind, you must record the: • Type and brand of device involved • Department or area of incident • Description of incident
- 45. Exposure Incident Procedures • Medical treatment providers for the Storrs Campus • Student Health Services • Students Only • Windham Community Memorial Hospital • Staff and Faculty • Students when Health Services is closed • Walk-in clinic location in Storrs downtown
- 46. Exposure Incident Procedures • Medical treatment provider responsibilities • Discuss all treatments and options • Very specific monitoring and procedures • Disclose possible side effects of treatments or post exposure prophylaxis (PEP) • Keep all information confidential as required by state of Connecticut and Federal privacy laws • Medical evaluation remains confidential • Post exposure follow-up • Return to treatment provider as directed for follow- up evaluations
- 47. Recordkeeping • Medical records • Hepatitis B vaccine status • Any exposure records and follow-up results for said exposures • Kept confidential and separate from personnel record • Training records: • Training Dates (this is an annual training!)
Editor's Notes
- OSHA-Occupational Safety and Health Administration is the main federal agency charged with the enforcement of safety and health legislation. Prior to The Standard, HBV infection was considerably higher in populations working in clinical and lab settings.
- Note-some of these can be transmitted sexually or via IV drug use.
- HBV is of special note because it is highly infectious, the effects are potentially life-threatening and chronic and there is no cure. However it is preventable! It can exist at extremely high titers in the blood. One needle stick incident can provide the injured with the equivalent of 100 infectious doses. ID50 is the infective dose, or dose required to infect 50% of lab animals (or cells in culture) in a trial setting.
- Interesting to note, any disruption in the skin can lead to transmission including acne, dermatitis, sunburns and blisters. Several cases of malaria transmitted to healthcare workers who had chapped hands! Ways they are NOT transmitted-touching an infected person, coughing or sneezing or using the same equipment, materials, toilets, water fountains, showers etc…
- Should you become infected, the symptoms for most BBP diseases are:
- Short of vaccination and normal host barriers and immunities, how do we protect ourselves? That is where the exposure incident reduction strategy comes in. The standard requires that every employer has one in place, as mentioned before.
- Infectious or toxic materials should never to mixed by bubbling air from a pipet or aspirating the mixture (pipetting up and down).
- Keep sharps container close-examples of LAIs including person standing between worker and sharps container getting stuck and a nurse crossing her hand to reach sharps container getting stuck. Also, H20s upright needle habit.
- Nitrile gloves are designed to tear apart at the slightest defect so any defect will be immediately apparent
- More organic material=longer contact time between disinfectant and spilled material.
- Why? Because the Standard says we have to, plus it will help us track and determine if more training is necessary to help prevent future incidents.
- Treatments and options including side-effects. For example, anti-retrovirals have a lot of side effects. The patient should be made aware of the side effects of any treatments administrated. You may be asked to disclose other activities that may have lead to potential exposures (STDs? Drugs? Tattoos? Travel? Etc…) If possible HIV exposure a full 28 day, three drug regimen will be prescribed to circumvent seroconversion.