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!

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

Post exposure – cont.

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

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

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