Bloodborne Pathogens and Biosafety powerpoint

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Bloodborne Pathogens and Biosafety powerpoint

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

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