Transcript Document 7110511

Tulane University
Bloodborne Pathogens Training
Annual update for Tulane University
employees with potential exposure to
blood or other potentially infectious
materials (OPIM)
March 2011
Tulane University - Office of Environmental Health and Safety (OEHS)
The following program meets the training requirements
set forth by the OSHA Bloodborne Pathogens Standard.
This training module is a self-study designed to provide a
review of the following:
• Bloodborne pathogens (BBP)
• Modes of transmission of BBP
• Exposure control principles and practices as they
relate to bloodborne pathogens
Tulane University - Office of Environmental Health and Safety (OEHS)
Bloodborne Pathogens Standard
• OSHA (1991)- “Occupational Exposure to
Bloodborne Pathogens” (29 CFR 1910.1030)
• Revised in 2001 in response to the Needlestick
Safety and Prevention Act
Goal: eliminate or minimize occupational exposure
to Hepatitis B virus (HBV), Human
Immunodeficiency virus (HIV), Hepatitis C virus
(HCV), and other bloodborne pathogens
Tulane University - Office of Environmental Health and Safety (OEHS)
What are Bloodborne Pathogens (BBP)?
• Any pathogenic microorganisms or OPIM (other
potentially infectious materials) present in human
blood that can cause disease in humans.
• Primary focus in our setting is HBV, HCV, and
HIV- which will be detailed further in this
presentation.
• Other examples of BBP include microorganisms
that cause:
• malaria, syphilis, babesiosis, brucellosis, leptospirosis, arboviral
infections, relapsing fever, Creutzfeldt-Jakob disease, HTLV-1,
and viral hemorrhagic fever.
Tulane University - Office of Environmental Health and Safety (OEHS)
Working with Non-Human Primates?
• Any employees who work with non-human
primates (monkeys, monkey tissue, or
monkey specimens) may have the potential
for contracting B virus and/or SIV (Simian
Immunodeficiency Virus).
• Please contact the BBP Coordinator for
additional training more specific to your
occupational safety needs.
Tulane University - Office of Environmental Health and Safety (OEHS)
We know blood and blood products
are included in this BBP scope, but
what are Other Potentially Infectious
Materials (OPIM)?
Tulane University - Office of Environmental Health and Safety (OEHS)
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
Tulane University - Office of Environmental Health and Safety (OEHS)
Let’s look at each of
the BBP of concern in
detail…
HBV, HIV, HCV
Tulane University - Office of Environmental Health and Safety (OEHS)
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 2006, an estimated 46,000 people were
newly infected with HBV. It is estimated
that 1.25 million Americans are chronically
infected.
Tulane University - Office of Environmental Health and Safety (OEHS)
Hepatitis B Virus
• HBV infection is a well recognized occupational
risk for healthcare personnel.
• The average volume of blood inoculated during
a needlestick injury with a 22-gauge needle is
approximately 1 µl, a quantity sufficient to
contain up to 100 infectious doses of HBV.
• HBV can survive outside the body at least 7
days and still be capable of causing infection.
Tulane University - Office of Environmental Health and Safety (OEHS)
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
dark urine
joint pain
loss of appetite
•
•
•
•
abdominal discomfort
clay-colored bowel movements
fatigue
nausea
Tulane University - Office of Environmental Health and Safety (OEHS)
HBV IS PREVENTABLE!
A safe & effective vaccine is available.
• Hepatitis B vaccine prevents hepatitis B infection and its
serious consequences.
• 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
Tulane University - Office of Environmental Health and Safety (OEHS)
What treatment is available for HBV?
• In the occupational setting, multiple doses of
Hepatitis B Immune Globulin initiated within 1
week following percutaneous exposure to hepatitis
B surface antigen-positive blood provides an
estimated 75% protection from HBV infection.
• There is no cure available for acute HBV
infection. There are antiviral drugs available for
the treatment of chronic HBV infection.
Tulane University - Office of Environmental Health and Safety (OEHS)
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 body’s
immune system, gradually destroying the
body’s ability to fight infection and
certain cancers.
Tulane University - Office of Environmental Health and Safety (OEHS)
computer generated
art quality graphics of
HIV was done by
Russell Kightley of
Canberra, Australia.
HIV
As of December 2001, occupational exposure to
HIV has resulted in 57 documented cases of
HIV seroconversion among healthcare
personnel (HCP) in the United States.
At the end of 2003, an estimated 1,039,000 to
1,185,000 persons in the United States were
living with HIV/AIDS, with 24-27%
undiagnosed and unaware of their HIV
infection.
Tulane University - Office of Environmental Health and Safety (OEHS)
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.
Tulane University - Office of Environmental Health and Safety (OEHS)
HIV
• 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.
Tulane University - Office of Environmental Health and Safety (OEHS)
HIV- no cure or vaccine available
• Treatment protocols from the U.S. Public Health
Service have been developed using antiretroviral agents
from five classes of drugs to treat HIV infection. These
include:
• the nucleoside reverse transcriptase inhibitors, nucleotide
reverse transcriptase inhibitors, nonnucleoside reverse
transcriptase inhibitors, protease inhibitors, and a single
fusion inhibitor.
• The recommendations provide guidance to effectively
suppress the virus on the basis of HIV transmission risk
represented by the exposure.
Tulane University - Office of Environmental Health and Safety (OEHS)
HIV
• Side effects associated with the use of antiviral drugs
can be severe.
• The drug regimen is not a cure for AIDS, but it has
greatly improved the health of many people with AIDS
and it reduces the amount of virus circulating in the
blood to nearly undetectable levels.
• Researchers, however, have shown that HIV remains
present in hiding places such as the lymph nodes even
in people who have been treated.
Tulane University - Office of Environmental Health and Safety (OEHS)
HCV
• Hepatitis C virus is a liver disease
• After a needlestick or sharps exposure to HCV
positive blood , about 1.8% healthcare workers
will get infected with HCV.
• Estimated 4.1 million (1.6%) Americans have
been infected with HCV, of whom 3.2 million
are chronically infected.
Tulane University - Office of Environmental Health and Safety (OEHS)
HCV
Long term effects of HCV:
• Chronic infection: 75%-85% of infected
persons
• Cirrhosis: 20% of chronically infected persons
• Deaths from chronic liver disease: 1%-5% of
infected persons may die
• Leading indication for liver transplant
Tulane University - Office of Environmental Health and Safety (OEHS)
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
Tulane University - Office of Environmental Health and Safety (OEHS)
HCV
• Currently, there is no cure for hepatitis C, and no
effective vaccine is currently available.
• National recommendations for the control of
occupational exposure to HCV rely more on the
prevention of transmission. In addition, several
blood tests that measure either antibodies to HCV
or HCV-RNA are available for hepatitis C
screening. These tests are useful in determining
current immune status and monitoring ongoing
infection.
Tulane University - Office of Environmental Health and Safety (OEHS)
How does a bloodborne
infection occur?
How might I get exposed in
the workplace?
Tulane University - Office of Environmental Health and Safety (OEHS)
Chain of Infection
Infection Control = Break any link in the chain
Tulane University - Office of Environmental Health and Safety (OEHS)
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)
Penetration by contaminated sharps is the most
common mode of transmission of bloodborne
pathogens in the workplace.
Tulane University - Office of Environmental Health and Safety (OEHS)
Modes of transmission of BBP
• 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 in clinical or laboratory
settings poses a genuine risk of infection.
Tulane University - Office of Environmental Health and Safety (OEHS)
Duties that might put you at risk for
an occupational exposure:
• Perform drawing of blood from human patients or
animals
• Process blood for experimentation
• Work with human or animal blood or body fluids
• Use unfixed tissue in preparations or experimentation
• Work in an area where HIV or HBV research is being
performed or produced
• Clean glassware contaminated with blood or OPIM
Tulane University - Office of Environmental Health and Safety (OEHS)
Duties that might put you at risk for
an occupational exposure:
• Dispose of waste contaminated with blood or OPIM
• Transport blood or OPIM
• Work in a laboratory where equipment or work
benches can become contaminated
• Handle containers of infectious wastes
• Clean blood spills, including dried blood
• Handle laundry that contains sharps or is soiled with
blood or OPIM
• Perform lifesaving procedures
Tulane University - Office of Environmental Health and Safety (OEHS)
Risk Factors for Infection
• Pathogenicity of organism
• Dose (how much blood or infectious agent)
• Route of entry (injection vs. contact with
mucous membrane or open wound)
• Host susceptibility
• Work practices
Tulane University - Office of Environmental Health and Safety (OEHS)
Now that we have reviewed how
an exposure can occur,
let’s look at how to prevent
exposure.
Tulane University - Office of Environmental Health and Safety (OEHS)
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, HBV
vaccination, warning signs or labels, and other
provisions described in this training section.
Tulane University - Office of Environmental Health and Safety (OEHS)
Standard (Universal) 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
Tulane University - Office of Environmental Health and Safety (OEHS)
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
Tulane University - Office of Environmental Health and Safety (OEHS)
Employee Responsibilities
• Reporting exposure incidents to their supervisor
and assisting the supervisor in completing First
Report of Occupational Injury/Illness Form
• Pursuing follow-up care after an occupational
exposure
Failure to follow these policies could result
in disciplinary action.
Tulane University - Office of Environmental Health and Safety (OEHS)
Exposure Control Plan
• Written plan provided to eliminate or minimize
occupational exposure to BBP.
• Section 40 of the Tulane University EH&S
Policies and Procedures Manual
• Can be obtained from OEHS (11th Floor
Tidewater) or on OEHS website listed above
• Reviewed annually
Tulane University - Office of Environmental Health and Safety (OEHS)
Exposure Control Plan
Updates include:
• Changes in technology that reduce/eliminate
exposure (engineering controls)
• Annual documentation of consideration and
implementation of safer medical devices
• Input from non-managerial employees (who
are responsible for direct patient care) in
selecting and evaluating safer medical
devices
Tulane University - Office of Environmental Health and Safety (OEHS)
Engineering Controls
• Sharps with Engineered Sharps Injury
Protection (SESIP)– a non-needle sharp or
needle with a built-in safety feature or
mechanism that effectively reduces the risk of
an exposure incident
Examples include:
Self-sheathing syringe
Tulane University - Office of Environmental Health and Safety (OEHS)
More Examples of Engineered
Sharps Safety Devices
In use
After use
Retractable needle technology
Add-ons (needle covers)
Retractable lancets
Self-blunting needles
Engineering Controls
• Needleless Systems = Device
that does not use a needle for:
• collection of body fluids
• administration of
medication/fluids
• any other procedure with
potential percutaneous
exposure to a contaminated
sharp
Tulane University - Office of Environmental Health and Safety (OEHS)
Work Practice Controls
• Contaminated needles/sharps shall not
be bent, recapped or removed
• Use puncture-resistant sharps
container for disposal of sharps
• No mouth pipetting
• Decontaminate surfaces and equipment
Tulane University - Office of Environmental Health and Safety (OEHS)
Work Practice Controls
• No food/drink/smoking, handling of contact
lenses, or application of cosmetics in work area
where there is potential for exposure
• Minimize splashing, spraying, spattering, and
generation of droplets
• Use secondary containment for transport,
shipping, or storage of containers
Tulane University - Office of Environmental Health and Safety (OEHS)
Handwashing
• Employees must wash their hands
immediately or as soon as feasible after
removal of gloves or other personal
protective equipment.
• Wash as soon as possible if gross
contamination occurs
• Alternate methods:
– Antiseptic towelettes
– Waterless handwashing gels
Tulane University - Office of Environmental Health and Safety (OEHS)
Personal Protective Equipment (PPE)
PPE is appropriate only if it does not
permit blood/OPIM to pass through
and/or reach the employee’s clothing,
skin, eyes, mouth, or other mucous
membranes under normal use.
Tulane University - Office of Environmental Health and Safety (OEHS)
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 performing vascular access procedures
• when handling or touching contaminated surfaces or
items.
– Remove prior to leaving the work area and discard
as biohazard waste
Tulane University - Office of Environmental Health and Safety (OEHS)
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
Tulane University - Office of Environmental Health and Safety (OEHS)
Personal Protective Equipment
• Gowns, aprons, fluid-resistant clothing
• Face shields, eye protection (safety
glasses, goggles)
• Respirators
• Surgical caps, shoe covers
Tulane University - Office of Environmental Health and Safety (OEHS)
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.
Tulane University - Office of Environmental Health and Safety (OEHS)
Training
• Training is required:
– at the time of initial employment and assignment
(or transfer) to job tasks where occupational exposure may
occur
– within one year of the employee's previous training and
annually thereafter (if the employee remains in an at-risk
position)
– when changes such as modification of tasks or procedures
or institution of new tasks or procedures affect the
employee's potential for occupational exposures, and as
new standards for safe work practices evolve
Tulane University - Office of Environmental Health and Safety (OEHS)
HBV Vaccination
• FREE to employee - paid for by your department
if you are at high-risk for exposure
• If you initially refuse the vaccine, you may
change your mind later and still receive it.
Tulane University - Office of Environmental Health and Safety (OEHS)
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.
Tulane University - Office of Environmental Health and Safety (OEHS)
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
Tulane University - Office of Environmental Health and Safety (OEHS)
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.
Tulane University - Office of Environmental Health and Safety (OEHS)
Where do I go and what
must I do if I am
exposed?
Tulane University - Office of Environmental Health and Safety (OEHS)
What to Do: Post-Exposure
• Wash exposed area with soap and water for 5 minutes
– if at TNPRC or you have a possible B virus exposure, you must scrub
15 minutes
– if eye or mucous membrane contact, flush with sterile water or saline
for 5 minutes
• Report the incident to your supervisor and the
Bloodborne Pathogens Coordinator (504)419-1391.
• Complete First Report of Occupational Injury/Illness
Form
• Report for medical evaluation (please review the next
few slides for places to report)
Tulane University - Office of Environmental Health and Safety (OEHS)
Where to Go Post-Exposure:
General Medical Surveillance for
Tulane University Employees
• 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). You should not
use your personal insurance when receiving care for an
occupational injury/exposure.
Tulane University - Office of Environmental Health and Safety (OEHS)
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 Tulane University Bloodborne
Pathogens Coordinator at (504) 419-1391.
Tulane University - Office of Environmental Health and Safety (OEHS)
Where to Go Post-Exposure:
Injuries Sustained at TNPRC
(Tulane National Primate Research Center)
• Go to the Occupational Health Trailer at TNPRC
for medical evaluation during business hours.
• Report to Occupational Health at TNPRC for
follow-up visits
• If an exposure incident occurs after hours or on the
weekend, your supervisor will send you to St.
Tammany Parish Hospital.
Tulane University - Office of Environmental Health and Safety (OEHS)
Where to Go Post-Exposure:
Tulane University
Health Sciences Center Students
Downtown Student Health Services
Elk’s Place Building (2nd Floor) Suite 261
• Mon thru Fri 8A to 4P: Call Downtown Student Health
(504) 988-6929
• All other times: Page the on-call physician
(504) 538-7277
• It does not matter where you are in the USA while engaged in
a Tulane-sanctioned educational experience, students must
notify the health center ASAP following an injury.
Tulane University - Office of Environmental Health and Safety (OEHS)
It is VERY important to bring the patient’s 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.
Tulane University - Office of Environmental Health and Safety (OEHS)
Tulane is required to provide this postexposure evaluation and follow-up after
an exposure incident.
Don’t delay in reporting for medical
care - early treatment can mean the
difference between life and death!
Tulane University - Office of Environmental Health and Safety (OEHS)
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
Tulane University - Office of Environmental Health and Safety (OEHS)
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
Tulane University - Office of Environmental Health and Safety (OEHS)
REMEMBER:
Don't wait.
Immediately report all exposures.
You may have to make a quick decision about
starting an antiretroviral agent as prophylaxis. The
time frame for beginning this treatment is critical.
Reporting is also essential for establishing a claim
for Workers' Compensation benefits.
Tulane’s Workers’ Compensation Specialist can be
reached at (504) 988-2869 or [email protected]
Tulane University - Office of Environmental Health and Safety (OEHS)
Summary of Post-Exposure
Employee Responsibilities
1.
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 and
the Bloodborne Pathogens Coordinator.
3.
Complete the First Report of Injury and EPINet
forms.
4.
Report to appropriate clinic/emergency department
(depending on your location) for medical evaluation.
Tulane University - Office of Environmental Health and Safety (OEHS)
*Reminder*
Tulane University encourages you to
contact your Bloodborne Pathogens
Coordinator or supervisor for
questions, comments, or suggestions.
Bloodborne Pathogens Coordinator
Primate Center
Work Cell
- (504) 988-6608
ext. 6653
- (504) 419-1391
Office of Env. Health & Safety (OEHS) - (504) 988-5486
Tulane University - Office of Environmental Health and Safety (OEHS)
You can always reach the
Bloodborne Pathogens Coordinator
24 hours a day
by work cell phone (504)419-1391
or call (504)988-5486 and press 1.
Tulane University - Office of Environmental Health and Safety (OEHS)
Why was this training so vital?
Healthcare and research personnel are at a great
risk for occupational exposure to bloodborne
pathogens.
Through information and awareness Tulane
University aims to minimize any risk to our
employees and continue the commitment to
safety in the workplace.
Tulane University - Office of Environmental Health and Safety (OEHS)
Tulane University
Office of Environmental Health & Safety (OEHS)
Please contact the BBP Coordinator
Kellie C. Mayer
(504) 419-1391
[email protected]
for questions and/or interactive discussion.
Thank you for completing the self-study
review session. Please click below to assess
your learning and receive credit for
participation.
Take Quiz
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