University of Louisiana - MonroeBloodborne Pathogens Training

Annual Training for High Risk Occupations

July 2011

University of Louisiana at Monroe - Office of Environmental Health and

Safety (EHS)

University of Louisiana at Monroe - Office of Environmental Health and

Safety (EHS)

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

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

University of Louisiana at Monroe - Office of Environmental Health and

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Bloodborne Pathogens Standard

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.

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What are Bloodborne Pathogens (BBP)?

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

University of Louisiana at Monroe - Office of Environmental Health and

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University of Louisiana at Monroe - Office of Environmental Health and

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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

Synovial, pleural, pericardial, and peritoneal fluid

Cerebrospinal fluid

Semen Vaginal secretions Amniotic fluid Saliva (in dental

procedures)

OPIM includes the following:

Let’s look at each of the BBP of

concern in detail…

HBV, HIV, HCV

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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.

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Hepatitis B Virus (HBV)

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.

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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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Hepatitis B Virus

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

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HBV IS PREVENTABLE!A safe & effective vaccine is available.

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.

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What treatment is available for HBV?

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.

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HIV

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

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.

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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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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.

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HIV

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.

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HIV- no cure or vaccine available

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.

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HIV

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.

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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

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HCV

fatigue dark urine jaundice

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HCV

abdominal pain  loss of appetite nausea

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

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.

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HCV

How does a bloodborne infection occur?

How might I get exposed in the

workplace?

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University of Louisiana at Monroe - Office of Environmental Health and

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Chain of Infection

Infection Control = Break any link in the chain

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.

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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.

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Modes of transmission of BBP

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

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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

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Duties that might put you at risk for an occupational exposure:

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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

Now that we have reviewed how an

exposure can occur, let’s look at how to

prevent exposure.

University of Louisiana at Monroe - Office of Environmental Health and

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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.  

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Occupational Exposure Prevention

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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Standard (Universal) Precautions

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

University of Louisiana at Monroe - Office of Environmental Health and

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Employee Responsibilities

Reporting exposure incidents to their supervisor and assisting the supervisor in completing Accident/Incident Forms.

Pursuing follow-up care after an occupational exposure

University of Louisiana at Monroe - Office of Environmental Health and

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Employee Responsibilities

Failure to follow these policies could result in disciplinary action.

Written plan provided to eliminate or minimize occupational exposure to BBP.

ULM BBP Policy Can be obtained from EHS (501 Warhawk

Way, room 206) or on EHS website link above Reviewed annually

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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

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Exposure Control Plan

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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

More Examples of Engineered Sharps Safety Devices

In use

Retractable lancets

Self-blunting needles

Retractable needle technology

Add-ons (needle covers)

After use

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

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Engineering Controls

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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

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

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Work Practice Controls

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

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Handwashing

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.

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Personal Protective Equipment (PPE)

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

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Personal Protective Equipment

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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Latex Allergies

• Gowns, aprons, fluid-resistant clothing• Face shields, eye protection (safety

glasses, goggles)• Respirators• Surgical caps, shoe covers

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Personal Protective Equipment

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.

University of Louisiana at Monroe - Office of Environmental Health and

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University of Louisiana at Monroe - Office of Environmental Health and

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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

University of Louisiana at Monroe - Office of Environmental Health and

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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.

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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: 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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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.

Where do I go and what must I do if I

am exposed?

University of Louisiana at Monroe - Office of Environmental Health and

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University of Louisiana at Monroe - Office of Environmental Health and

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What to Do: Post-Exposure • Wash exposed area with soap and water for 5 minutes

– if at the Vivarium 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 Office of Environmental Health and Safety (318) 342-5177.

• Complete appropriate Accident/Incident Forms• Report for medical evaluation (please review the next

few slides for places to report)

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.

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Where to Go Post-Exposure: General Medical Surveillance for University of Louisiana at Monroe Employees

If on rounds at another hospital, report there for initial visit but you must still notify the Office of Environmental Health and Safety at (318) 342-5177.

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

Go to the Student Health Services on the main campus for medical evaluation during business hours.

Student Health will direct you to the nearest emergency facility should it be necessary.

If an exposure incident occurs after hours or on the weekend, your supervisor will send you to the nearest emergency facility.

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Where to Go Post-Exposure: Injuries Sustained at ULM

Student Health Services 1140 University Ave. (corner of LaSalle and University

Ave)◦ Mon thru Thu 7:30AM to 5PM (closed for lunch noon-1PM)◦ Friday 7:30-11:30A

It does not matter where you are in the USA while engaged in a ULM-sanctioned educational experience, students must notify their department head and EHS ASAP following an injury.

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Where to Go Post-Exposure: University of Louisiana at Monroe Student Health Services

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 animals, it is important to note which animal was the

source for the bite/scratch to allow for proper evaluation of infection in the source animal.

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Failure to do this can result in delayed or unnecessary treatment for you.

ULM is required to provide this post-exposure

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!

University of Louisiana at Monroe - Office of Environmental Health and

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University of Louisiana at Monroe - Office of Environmental Health and

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Recordkeeping• Sharps Injury Log

– Maintained by Office of Environmental Health & Safety (EHS) 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• Accident/Incident forms (DA2000 for employees and

DA3000 for students, patients, vendors, etc)– helps to track trends, problem areas, types of

medical devices, etc. related to BBP occupational exposure incidents and injuries

• Accident/Incident Forms

University of Louisiana at Monroe - Office of Environmental Health and

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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.

ULM’s Workers’ Compensation Specialist can be reached at (318) 342-5140.

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 accident/incident forms

4. Report to appropriate clinic/emergency department (depending on your location) for medical evaluation.

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Summary of Post-Exposure Employee Responsibilities

University of Louisiana at Monroe - Office of Environmental Health and

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*Reminder* University of Louisiana at Monroe

encourages you to contact Environmental Health and Safety or or supervisor for questions, comments, or suggestions.

Environmental Health and Safety - (318) 342-5177

Student Health Services - (318)-342-1651

Healthcare and research personnel are at a great risk for occupational exposure to bloodborne pathogens.

Through information and awareness ULM aims to minimize any risk to our employees and continue the commitment to safety in the workplace.

University of Louisiana at Monroe - Office of Environmental Health and

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Why was this training so vital?

University of Louisiana at MonroeOffice of Environmental Health & Safety (EHS)(318) 342-5177nugent@ulm.edu for questions and/or interactive discussion.

Thank you for completing the self-study review session. Please be sure to sign attendance sheet and forward to EHS

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