BLOODBORNE PATHOGENS

Presented by Office of Environmental Health and Safety

Goals of training:

• Knowledge of regulatory requirements • Increase awareness of diseases • Provide information regarding: – Routes of exposure – Risk of transmission – Prevention

Regulated requirements

• OSHA Bloodborne Pathogens standard – Designed to protect workers – In effect since 1992 – Goal: Prevent occupational transmission of diseases potentially present in blood and bodily fluids – Regulated in Calif. by Title 8

Some of the requirements:

• Written plan • Use of controls • Cleaning and decontamination program • Sharps injury prevention plan • Training & protective equipment • HBV vaccinations

Body fluids that can transmit infection:

• Blood • Semen • Vaginal secretions • Cerebrospinal fluid • Synovial fluid • Pleural fluid • Pericardial fluid • Peritoneal fluid • Amniotic fluid • Saliva (e.g. dental procedures) • Any unfixed human tissue or organ

PREVENTION: Universal precautions

• Treat all blood and other potentially infectious body fluids as if infected • Avoid direct contact with blood and body fluids & contaminated materials • Wear PPE appropriate for job • Practice good housekeeping and personal hygiene

Universal precautions – cont.

• Follow proper decontamination procedures • Dispose of all contaminated materials properly • Seek prompt medical attention in the event of exposure

Personal Protective Equipment

Provides a barrier

Examples: • Latex/PVC gloves • Goggles, safety glasses w/side shields • Plastic or rubberized gowns/aprons • Surgical masks/face shields • Pocket mouth-mouth resuscitation masks

Special PPE precautions

• Cover open cuts, rashes, and other broken skin.

• Check condition before using • Remove carefully to avoid contaminating yourself or anything around you • Dispose properly • Don’t mix contaminated clothing or laundry with other laundry • Wash hands thoroughly after removing gloves.

Hygiene

• Wash hands w/ soap and water • Don’t keep food or drink in work areas w/ exposure potential • Don’t eat, drink, smoke, apply make-up or lip balm, or handle contact lenses • Avoid splashing/spattering of potentially infectious materials • Don’t suction potentially infectious materials by mouth.

Housekeeping

• Clean up all spills immediately.

• Clean and decontaminate all equipment and surfaces after contact w/ blood and other potentially infectious materials.

• Clean and sanitize pails and other reusable waste containers regularly.

• Replace protective coverings, immediately upon obvious contamination, or at end of work day.

Cleaning vs. Sanitizing

• Cleaning: Removal of infectious agent via mechanical means using a cleaning agent.

• Sanitizing: Applying sanitizing agent, carefully following label instructions.

Contaminated surfaces and equipment must be sanitized!

Sharps Injury Prevention

• Evaluate and provide devices designed to prevent injury – Syringes w/ sliding sheath that engages after use – Needles that retract after use – Shielded or retracting catheters – IV delivery systems w/ catheter port/needle in protective covering • Provide training on new equipment • Keep a sharps injury log – which includes: – date and time of incident – type of sharp involved – description of incident • PI/Supervisor must immediately report all sharps incidents to EH&S

Proper Disposal Procedures

Contaminated materials • Dispose in red, plastic biohazard bag.

• Tie off bag tightly.

• Place bag in labeled, rigid container with close-fitting lid.

• All bags must be transported in labeled rigid containers with close-fitting lids.

– Note that this requirement is in effect whenever the waste leaves the point of generation.

Disposal - cont.

Potentially contaminated sharps • Dispose in rigid, labeled sharps containers.

• Never: – Break off needles or blades – Attempt to retrieve sharps from a sharps container

Disposal - cont.

• Bloodborne pathogen waste cannot remain on campus beyond one week.

– Waste is currently picked up by a licensed contractor every Tuesday.

• Contact EH&S at 8-7422 if you have bloodborne pathogen waste requiring disposal

HBV Vaccination

• HBV vaccination series will be made available to employees at risk of exposure at no cost.

• Employee may decline series by completing declination form.

• If employee declines series, may elect to have series at a later time.

Post exposure

• Wash needlesticks/cuts with soap & water.

• Flush splashes to nose, mouth, or skin with water.

• Irrigate eyes with clean water, saline, or sterile irrigants.

• Report the exposure promptly!

Post exposure – cont.

• After exposure incident; employee shall be offered post-exposure evaluation, including at no cost: – Medical exam – Blood testing

RISK OF INFECTION from Occupational Exposure Overall risk depends on:

• # infected individuals in patient population • Type and # of blood/fluid contacts

Risk factors following exposure:

• Pathogen involved • Type of exposure • Amount of blood/fluid involved • Amount of virus present in blood/fluid at exposure

Bloodborne Diseases

• HIV/Aids • HBV, HCV

Risk of infection cont.

• HIV needlestick/cut: 0.3% • HIV mouth/nose/eye: 0.1% • HIV skin: 0.1% • HBV w/ pre-vaccination: no risk • HBV w/o pre-vaccination: 6 ~ 30 % depending on HBV antigen status of source individual • HCV: 1.8 %

HIV/AIDS Stats cont.

• As of Dec. 2001: 57 documented cases of occupational HIV transmission to healthcare personnel Primarily from accidental “sticks”

AIDS: Advanced HIV

• Definition: – Fewer than 200 CD4-T cells/mm blood (vs. healthy: 1000+) – Clinical conditions, opportunistic infections and cancers generally not affecting health people

Diagnosis of HIV

• May take 1 ~ 6 months post infection for presence of sufficient # of antibodies using standard blood tests • Acute/recent exposures: screen for presence of HIV genetic mat’l • Depending on exposure circumstances, more tests may be necessary

Prompt disclosure of details re: suspected exposure

4

Proper diagnosis procedure

HIV: Post exposure treatment

• Determined on a case-by-case basis Treatment should be started within hours • Slows spread of HIV and delays start of opportunistic infections/conditions • Post Exposure Prophylaxis treatment 4 80% reduction infection risk

HEPATITIS – HBV, HCV

• Virus that can cause acute liver infections or chronic liver disease (cirrhosis, liver cancer) • Approx. 300,000 cases of acute HBV infection annually.

• 5 ~ 10% become chronically infected • Approx. one million chronic carriers • HBV: Highly effective vaccine available • No cure for HBV or HCV

HEPATITUS Routes of Exposure

• HBV, HCV: Entrance of infected blood into the body.

– Includes bodily fluids that could contain blood in amounts not visible to naked eye.

HBV Post Exposure Treatment

May include: Depends on several factors: • Whether source individual is positive for HBV • Whether you have been vaccinated • Whether the vaccine provided you w/ immunity.

No post exposure treatment for HCV

Comparison of HBV/HIV

HBV: • More “sturdy”, can survive outside the body up to a week vs. less than a day for HIV • Likely to be more concentrated in blood and bodily fluids • Much higher risk of transmission.

– One case of HBV transmission in athletics setting.

Summary…

• Use Universal Precautions when in contact with bodily fluids.

• Use PPE and use it properly • Sanitize – don’t just “clean”!

• Protect yourself from HBV infection – Complete your vaccination series – Get your titer checked