Departmental Safety Representative DSR Session: Bloodborne Pathogens

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Departmental Safety Representative (DSR)
SessionBloodborne Pathogens

• Kellie Mayer
• Bloodborne Pathogens Coordinator

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Bloodborne Pathogens

• Any pathogenic microorganisms or OPIM (other
  potentially infectious materials) present in
  human blood that can cause disease in humans.
• Goal eliminate or minimize occupational
  exposure to Hepatitis B virus (HBV), Human
  Immunodeficiency virus (HIV), Hepatitis C virus
  (HCV), and other bloodborne pathogens

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We know blood and blood products are included in
this BBP scope, but what are Other Potentially
Infectious Materials (OPIM)?
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OPIM includes the following

• Synovial, pleural, pericardial, and peritoneal
  fluid
• Cerebrospinal fluid
• Semen
• Vaginal secretions
• Amniotic fluid
• Saliva (in dental procedures)

• Any unfixed tissue or organ from a human
• Any body fluid visibly contaminated with blood
• All body fluid where it is difficult to
  distinguish between body fluids
• Cell or tissue cultures that were HIV or HBV
  infected

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Job Duties with Possible Bloodborne Exposure

• Drawing/processing blood/body fluids
• Working in an area where HIV or HBV is produced
  or research is being performed
• Cleaning glassware or disposing of waste
  contaminated with blood or OPIM
• Transporting blood or OPIM
• Working in a laboratory area where equipment or
  work benches can become contaminated either by a
  spill or accident
• Handling laundry, spills or containers of
  infectious wastes
• First aid, removing bandages

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Job classifications in which employees may have
occupational exposure are

• Athletic personnel
• Instructors/Professors/ Faculty
• Childcare Workers
• Security Personnel
• Laboratory Staff
• Housekeeping
• Facilities services staff

• MDs, Residents, Interns, PAs
• Veterinarians and vet staff
• Nursing Staff RN's, LPN's, NA's
• Scientific Department Personnel
• Laundry staff
• Housing and Resident Life

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Bloodborne Pathogens Standard

• 29 CFR 1910.1030, Occupational Exposure to
  Bloodborne Pathogens
• Needlestick Safety and Prevention Act, P.L.
  106-430 2001 July 2001
• Exposure Control Plan updated once a year with
  input from staff
• Hepatitis B vaccine
• Follow-up protocol after a bloodborne exposure
• Safety devices and PPE

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Bloodborne Pathogens Standard

• The BBP Standard applies to all employers with
  employees with reasonably anticipated
  occupational exposure to blood or OPIM.
• The Needlestick Safety and Prevention Act
  modified the Bloodborne Pathogens standard expand
  the requirement that employers identify,
  evaluate, and make use of effective safer medical
  devices

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Modes of transmission of BBP

• Percutaneous - the direct inoculation of
  infectious material by piercing through the skin
  barrier (needlestick or other accidental injury
  with a sharp, contaminated object)
• Direct inoculation - exposure of blood or OPIM to
  pre-existing lesions, cuts, abrasions, or rashes
  (dermatitis) provides a route of entry into the
  body.
• Mucous membrane contact - splashing blood or
  serum into an individual's unprotected eyes,
  nose, or mouth

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Penetration by contaminated sharps is the most
common mode of transmission of bloodborne
pathogens in the workplace.
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Hepatitis B Virus (HBV)

• Hepatitis B is caused by a virus that attacks the
  liver and can cause lifelong infection,
  cirrhosis, liver cancer, liver failure, or death.
  
• In 2003, an estimated 73,000 people were infected
  with HBV. People of all ages get hepatitis B and
  about 5,000 die per year of sickness caused by
  HBV.

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Hepatitis B Virus

• About 30 of infected persons have no sign or
  symptoms of HBV.
• If symptoms occur, they usually begin to appear
  on the average of 12 weeks (range 9-21 weeks)
  after exposure to hepatitis B virus.
• If you have symptoms, they might include
• jaundice abdominal discomfort
• dark urine clay-colored bowel movements
• joint pain fatigue
• loss of appetite nausea

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HBV IS PREVENTABLE!A safe effective vaccine
is available.

• If the vaccine is administered before infection,
  it prevents the development of the disease and
  the carrier state in almost all individuals.
• Hepatitis B vaccine consists of a series of three
  injections initial, one a month later, and one
  six months from the first.
• Available FREE of charge from employer for
  high-risk employees

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HIV

• HIV (human immunodeficiency virus) is the virus
  that causes AIDS (Acquired Immune Deficiency
  Syndrome). Once a person has been infected with
  HIV, it may be many years before AIDS actually
  develops.
• HIV kills or damages cells in the bodys immune
  system, gradually destroying the bodys ability
  to fight infection and certain cancers.

computer generated art quality graphics of HIV
was done by Russell Kightley of Canberra,
Australia.
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HIV

• As of December 2001, occupational exposure to HIV
  has resulted in 57 documented cases of HIV
  seroconversion among healthcare personnel (HCP)
  in the US.
• The average risk for HIV transmission after a
  percutaneous exposure to HIV-infected blood has
  been estimated to be approximately 0.3.
• HIV does not survive well outside the body,
  making the possibility of environmental
  transmission remote.

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HIV

• Some infected with HIV have no symptoms for up to
  ten years.
• Within a month or two after exposure to the virus
  some experience flu-like illness such as
• fever, headache, fatigue, weight loss, diarrhea,
  night sweats, enlarged lymph nodes
• These symptoms usually disappear within a week to
  a month and are often mistaken for those of
  another viral infection. During this period, the
  individual is very infectious.

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HCV

• Hepatitis C virus (HCV) is a liver disease
• After a needlestick or sharps exposure to HCV
  positive blood , about 1.8 healthcare workers
  will get infected with HCV.
• Recent studies suggest that HCV may survive on
  environmental surfaces at room temperature at
  least 16 hours, but no longer than 4 days.

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HCV
80 of persons infected have no signs or symptoms
for HCV. When present, symptoms may include

• jaundice
• fatigue
• dark urine

• abdominal pain 
• loss of appetite
• nausea

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Occupational Exposure Prevention

• The risk of occupational exposure can be
  minimized or eliminated using a combination of
  engineering and work practice controls, personal
  protective clothing and equipment, training,
  medical surveillance, warning signs or labels,
  and other provisions described in this next
  section.  

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Standard Precautions

• Guidelines to decrease the risk of occupational
  exposure to blood or body fluids
• A system of infection control which assumes that
  every direct contact with body fluids is
  infectious and requires every employee exposed to
  direct contact with body fluids to be protected
  as though such body fluids were infected with a
  bloodborne pathogen
• Provides adequate protection against bloodborne
  infections from both humans and animals

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• Engineering Controls means controls (e.g., sharps
  disposal containers, self-sheathing needles or
  shielded needle devices, needleless devices,
  blunt needles, plastic capillary tubes) that
  isolate or remove the bloodborne pathogens
  hazards from the workplace.
• Work Practice Controls means controls that reduce
  the likelihood of exposure by altering the manner
  in which a task is performed such as prohibiting
  recapping of needles by a two-handed technique.

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Engineering and Work Practice Controls

• The employer must
• Evaluate available engineering controls (safer
  medical devices)
• Train employees on safe use and disposal
• Implement appropriate engineering controls/devices

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Personal Protective Equipment

• Gloves (latex or nonlatex)
• When to use them
• when there is reasonable anticipation
• of employee hand contact with blood, OPIM,
  mucous membranes, or non-intact skin
• when handling or touching contaminated surfaces
  or items.

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Latex Allergies

• Latex gloves have proven effective in preventing
  transmission of many infectious diseases to
  health care workers. However, for some workers,
  exposures to latex may result in allergic
  reactions.
• For further reading
• http//www.cdc.gov/niosh/topics/latex/
• http//www.osha.gov/SLTC/latexallergy/index.html

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Personal Protective Equipment

• Gowns, aprons, fluid-resistant clothing
• Face shields, eye protection (safety glasses,
  goggles)
• Surgical mask and/or N-95 respirator
• Surgical caps, shoe covers

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Even though the use of PPE is very important in
controlling exposure to BBPs, it is your last
line of defense against exposure if engineering
and work practice controls fail.

• Do not rely only on PPE for protection.

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Housekeeping Sharps Disposal

• Keep sharps container upright,
• readily available in the work area
• Never place sharps into the regular trash
• Use a leak-proof, puncture-resistant
• sharps container labeled with the biohazard
  symbol
• Do not overfill - dispose of sharps container as
  biohazard waste when it is 2/3 full

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Training

• OSHA standards require that all employees with
  occupational exposure participate in a training
  program. 
• Training must be provided at the time of initial
  assignment to tasks where occupational exposure
  may take place and at least annually thereafter. 

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Warning Signs and Labels

• Fluorescent orange or orange-red label
• with word Biohazard and biohazard symbol in
  contrasting color must be provided on
• Containers of regulated waste
• Refrigerators/freezers used to store blood/OPIM
• Containers used to store, transport, or ship
  blood/OPIM
• Contaminated equipment
• Red bags may be substituted for biohazard labels
  on biohazardous waste bags.

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Housekeeping Decontamination
Work surfaces should be decontaminated with an
appropriate disinfectant such as 10 bleach
solution or an EPA approved disinfectant after
completion of procedures, immediately or as soon
as feasible when surfaces are overtly
contaminated or after any spill, and at the end
of the work shift.
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What is the difference between cleaning and
disinfecting?

• Cleaning and disinfecting are not the same thing.
  In most cases, cleaning with soap and water is
  adequate. It removes dirt and most of the germs.
• You should disinfect areas where there are both
  high concentrations of dangerous germs and a
  possibility that they will be spread to others.
• Disinfectants, including solutions of household
  bleach, have ingredients that destroy bacteria
  and other germs.

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Exposure Control Plan

• The ECP must be updated annually to include
• changes in technology that reduce/eliminate
  exposure
• annual documentation of consideration and
  implementation of safer medical devices
• solicitation of input from non-managerial
  employees

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Employee Responsibilities

• Completing training/orientation as required
• Following the Exposure Control Plan and the
  Standard Precautions Policy
• Using work practices, engineering controls, and
  personal protective equipment as outlined in the
  Exposure Control Plan
• Obtaining the HBV vaccine or signing the
  declination form

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Employee Responsibilities

• Reporting exposure incidents to their supervisor
  and assisting the supervisor in completing First
  Report of Injury/Illness and EPINet Forms
• Pursuing follow-up care after an occupational
  exposure

Failure to follow these policies could result in
disciplinary action.
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Recordkeeping

• Sharps Injury Log
• Maintained by Office of Environmental Health
  Safety (OEHS) independently from OSHA 300 Log
• Contains necessary documented information for
  each needlestick/sharp related incident
• type and brand of device involved
• department or area of incident
• description of incident
• Training records 3 years

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Recordkeeping

• Confidential medical records duration
• of employment 30 years
• EPINet (Exposure Prevention Information Network)
  forms
• helps to track trends, problem areas, types of
  medical devices, etc. related to BBP occupational
  exposure incidents and injuries
• First Report of Injury and Illness Form

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Where do I go and what must I do if I am exposed?
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What to Do Post-Exposure

• Wash exposed area with soap and water for 5
  minutes
• if at TNPRC, please use one of the bite kits that
  are available in each work area for your 15
  minute scrub using betadine
• if eye or mucous membrane contact, flush with
  sterile water or saline for 5 minutes
• Report the incident to your supervisor.
• Complete First Report of Occupational
  Injury/Illness Form
• Report for medical evaluation (please review the
  next few slides for places to report)

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Where to Go Post-Exposure General Medical
Surveillance

• Any bloodborne pathogens exposure incident is an
  event for which immediate attention must be
  sought, as the effectiveness of prophylaxis
  depends on the immediacy of its delivery.
• Seek medical attention in the same manner that it
  would be sought should any occupational injury
  occur (e.g., emergency room, physician's office,
  urgent care clinic).

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Where to Go Post-Exposure Injuries Sustained at
TNPRC (Tulane National Primate Research Center)

• Go to Employee Health (B- Bldg) at TNPRC for
  medical evaluation during business hours.
• Report to Employee Health at TNPRC for follow-up
  visits
• If an exposure incident occurs after hours or on
  the weekend, your supervisor will notify the
  veterinarian on call and page the nurse at
• [phone] for further instructions.

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Where to Go Post-Exposure Injuries Sustained
while on Rotation at Another Facility

• If on rounds at another hospital, report there
  for initial visit but you must still notify the
  Bloodborne Pathogen Coordinator at [phone].

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It is VERY important to bring the patients
source blood (if available) with you when you
report for initial evaluation. Your care is
dependant on the HIV, HBV, and HCV status of the
source patient to whom you were
exposed.Similarly, when dealing with nonhuman
primates it is important to note which monkey was
the source for the bite/scratch to allow for
proper evaluation of infection in the source
animal.
Failure to do this can result in delayed or
unnecessary treatment for you.
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Summary of Post-Exposure Employee Responsibilities

• Wash/flush exposed injury area for 5 minutes (15
  minutes if at TNPRC for possible B virus
  exposure).
• 2. Promptly report the incident to your
  supervisor.
• 3. Complete the First Report of Injury and EPINet
  forms.
• 4. Report to appropriate clinic/emergency
  department (depending on your location) for
  medical evaluation.

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You can always reach the Bloodborne Pathogens
Coordinator 24 hours a dayby work cell phone
[phone] or call [phone] and press 1.
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• Tulane UniversityOffice of Environmental Health
  Safety (OEHS)Please contact the BBP
  Coordinator for questions, comments, and/or
  interactive discussion. Kellie C. Mayer
  (504-419-1391) kmayer_at_tulane.edu
• If unable to proceed to quiz, type the link below
  into your browser
• http//aurora.tcs.tulane.edu/ehs/enterssn.cfm?test
  num25

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