Bloodborne Pathogens Training

University of Michigan-Flint.Environment, Health and Safety (EHS)

Course Information

This bloodborne pathogens training program is required annually for UM

employees who may reasonably anticipate contact with blood or other potentially infectious materials (OPIM), during the

performance of their duties.

Course Topics• Bloodborne Pathogens Standard (copy available from EHS and

online)

• Bloodborne Pathogens• Mode of Transmission• Exposure Control Plan• Methods of Prevention (Universal Precautions)

• UM Hepatitis B Immunization Program• Engineering Controls• Sharps Disposal• Personal Protective Clothing and Equipment (PPE) • Spill Response• BBP Waste• Communicable Diseases

Bloodborne Pathogens Standards and Regulations

This program was designed to meet the requirements of:

Occupational Safety and Health Administration (OSHA) Occupational Exposure to Bloodborne Pathogens

29 CFR 1910.1030 (1990).Michigan Occupational Safety and Health Administration

(MIOSHA) Bloodborne Infectious Diseases R 325.70001- R 325.70018 (1993). Needle stick Safety and Prevention Act (2000)Exposure Source Testing MI Act 368 of 1978

These standards apply to workers who are at risk of exposureto pathogenic microorganisms associated with human blood.

What are Bloodborne Pathogens

Pathogenic MicroorganismsBloodborne Pathogens: are pathogenic microorganisms that are present in human blood or other potentially infectious materials (OPIM) and can cause disease. Pathogenic microorganisms include, but are not limited to: oHBVoHCVoHIVoWest NileoMalariaoSyphilisoBrucellosis

Other Potentially Infectious Materials (OPIMs)

•Blood products, semen, vaginal secretions •Saliva in dental settings •Any body fluid that is contaminated with blood•Any body fluid of unknown source•Unfixed tissues or organs •HIV or HBV containing cells or cultures •Blood, organs or other tissues from

experimental animals infected with BBP• Introduction of human-derived materials (i.e.

tumor cells) into animals.

Mode of Transmission• Transmitted when infected blood or bodily fluid

enters the opening of mucosal membrane.• Mucous Membranes are wet, thin tissue found in

certain openings of the human body. These openings include the mouth, eyes and nose.

• Breaks in the skin are an ideal way for the contaminate to enter:

CutsPuncturesAbrasionsRashesAcneHang Nails

Bandage affected area and wear double gloves to prevent transmission through breaks in skin.

Hepatitis B (Hep B)

• Infection of the liver which may lead to liver disease, liver cancer and possibly death. It is the leading occupational disease in the United States.

•12,000 cases of HBV were identified annually (up to the year 1992). Numbers have decreased to approximately 800 cases annually since the introduction of the immunization.

HBV is extremely stable. It may survive 10 days outside of host!

Hepatitis B (cont’d)Approximately 10% of infected individuals may become "carriers“.

This means that they may suffer from infection at a later time. They can also be infectious to others for the rest of their lives while not demonstrating any symptoms of HBV.

Symptoms may occur 2-6 months after exposure and include:

Fever Vomiting Jaundice (yellowing) of the eyes and/or skin Loss of appetite Dark-colored urine Aches in muscles and joints

Hepatitis C (HCV)• Viral infection of the liver

that can be transmitted via blood or other potentially infected materials

• Symptoms similar to those caused by HBV

• Although 80% of individuals may have no symptoms, these infected individuals may be lifelong carriers. No vaccine is available.

• Very difficult for body’s immune system to recover from HCV infection

• Leading indication for liver transplants in the U.S.

Human Immunodeficiency Virus (HIV)

• Virus that causes Acquired Immunodeficiency Syndrome (AIDS)

• May be passed through infected blood or OPIMs that come in contact with broken skin or mucous membranes

• Some infected individuals will develop AIDS as a result of their HIV infection.

• Some individuals develop flu-like symptoms within 7-21 days after exposure.

• Recent studies suggest the best independent predictors of primary HIV infection are rash and fever among individuals recently exposed to HIV.

• HIV will not survive long outside host (~90-99% reduction within several hours).

Controlling the Risk of Exposure

Here are the ways to reduce your likelihood of exposure to blood or other potentially infectious materials: Universal Precautions Exposure Control plan (ECP) Hepatitis B Vaccination Engineering Controls Workplace Controls Safe Work Practices Personal Protective Equipment (PPE) Proper Hand-washing Technique Reporting exposures immediately and seeking medical follow-up

treatment as soon as possible

Universal Precautions

An infection control method where ALL human blood and other potentially infectious

materials are treated as if known to be infectious.

Exposure Control Plan (ECP)

•The ECP must be made available to all employees who are determined to be at risk.

•Employees must be familiar with the ECP and know where it is located.

•ECP reviewed/revised ANNUALLY with input from employees.

•ECP is readily available to employees.

Reporting an Exposure Incident• Is it work related?• Date and time of exposure• Details of the procedure being performed, including where

and how the exposure occurred. If related to a sharp device, the type and brand of device and how and when in the course of handling the device the exposure occurred must be included in the report

• Details of the exposure, including the type and amount of fluid or material and the severity of the exposure

• Details about the exposure source if known• Details about the exposed person… vaccinated?• May need to attach sheet of paper with details to work

connection form

Hepatitis B Vaccination• Available to Category A employees at no cost• Series of 3 injections:

1st: given at anytime2nd: 1 month after first injection3rd: 5 months after 2nd injection

• Provides protective levels of antibody in 97% of healthy individuals

• You cannot get HBV from the vaccine• No booster shot required (lifelong immunity)• According to the FDA, the current shot is one of the safest

available• Side effects may include: soreness, redness and swelling at

injection site• For further information, EHS encourages you to contact your

primary care physician/practitioner

Hepatitis B (cont’d)• Vaccination need not be offered if…

▫ Individuals have previously received the complete series

▫ Antibody testing has revealed the individual is immune

▫ The vaccine is contraindicated for medical reasons• The vaccine is NOT mandatory.• Employer must offer the vaccine, however, you do not

have to accept the vaccine.• You may decline the vaccination series, in which you

will be asked to sign a declination form.• To receive the Hepatitis B Vaccine, please contact:

UM-Flint EHS @ (810)766-6763

Hepatitis B Forms

No Vaccines for HCV and HIV

•There is no vaccine against HCV and no treatment after exposure that will prevent infection.

•There is no vaccine against HIV. •The Public Health Service, under

recommendations from the CDC, suggests a 4-week course of administration of the antiretroviral drugs depending upon the risk of transmission (exposures involving a larger volume of blood with larger amount of HIV). This should begin within hours after exposure.

Engineering ControlsAre used to isolate or remove the potential hazard from the workplace. Controls are used in combination with safe work practice controls. Sharps disposal containers Hand washing facilities &waterless soap dispensers Biohazard bags/waste containers Spill/clean-up kits Use tongs for picking up hazardous object

Sharps disposal

containers

Hand washing facilities

Biological Safety Cabinets

AutoclaveFacilities

Mechanical means to remove broken

sharps items

Sharps• Departments generating

sharp waste are responsible for proper disposal.

• Must use a puncture resistant plastic container

• Must be located in area where sharps are used

• Sharp containers can only be filled to indicator line or ¾ full. Call EHS (810)766-6763 for removal.

• Do NOT OVERFILL sharps container. Overfilled sharps container pose a risk to all workers.

Sharps (cont’d)Examples of sharps are:•Needles•Scalpels•Razor blades•Lancets•Contaminated glass Pasteur pipettes•Glass capillary tubes•Contaminated broken glass•Contaminated microscope slides and

cover slips•Exposed ends of dental wires

Workplace Controls

• Wash hands after contacting body fluids or contaminated surfaces

• Keep fingernails short• Scrub nail area• Clean surfaces regularly • Keep disinfectant

solution and waterless hand disinfectant nearby.

• Keep PPE in stock and readily available.

Safe Work Practices

•Personal Protective Equipment (PPE) must be removed before leaving the work area

•Clothing penetrated with blood or OPIM must be removed immediately

•Follow proper protocol for cleaning blood/bodily fluid spills

•Wash hands immediately after removing gloves or other protective clothing.

•Wash hands after contact with blood or OPIM.

ECDC Soiled Clothing

•Remove clothing immediately

•Place in a labeled plastic bag (To Be Washed) and separate from normal laundry and use proper laundering techniques. (Make sure water is hot, 82oC, and is on the hot cycle for at least 10 mins)

•Child’s clothing should be placed in a labeled plastic bag (Soiled) and should be sent home with parents

DPS/Medical Staff Soiled Clothing

•Remove clothing immediately

•Place in a labeled plastic bag (Biohazard)

•Have clothing be sent to proper laundering facilities that will decontaminate the uniform

BBP ExposuresEyes: Flush with water Skin: Wash thoroughly with

soap and water for 15 mins.

IMMEDIATELY notify Supervisor & EHS.Go to UM Medical Provider

for post-exposure follow-up ASAP

Protective Work Clothing and Equipment (PPE)

•PPE shall be provided at no cost to the employee.

•Examples: GLOVES, goggles, apron, “booties”

•Assure appropriate PPE is readily accessible and fits properly

•Supervisor will monitor and ensure employee uses PPE.

•Provide for cleaning, laundering, or disposal of PPE.

Protective Work Clothing and Equipment (PPE)

Hand Protection:• Ensure equipment is available• Non-latex products must be

available for individuals with latex allergies

• Disposable gloves should be replaced if they are peeling, cracked, discolored, or if they have punctures, tears, or other evidence of deterioration

• Gloves of appropriate size must be available

• Do not re-use disposable gloves• Remove gloves before leaving

the work area• Always wash hands after

removing gloves

Blood/Body Fluid Spills•All spills must be safely cleaned as soon as

possible.•Wear gloves, gowns or lab coats and eye

protection during clean up. •A solution of 1:10 bleach and water or an EPA-

approved disinfectant should be used. • If broken glass is involved, it should be carefully

removed using a mechanical device such as tongs or forceps and the broken glass placed in the sharps container.

Never pick up broken glass by hand!

http://www.youtube.com/watch?v=gnOtvAztKoQ

Spill Clean-up Procedure

Spill Clean-up Procedure

• Put on personal protective equipment

• Remove sharp objects carefully with forceps/tongs

• Circle spill with disinfectant. Use bleach (1:10 dilution), Lysol, Virex, or EPA registered tuberculocidal disinfectant

• Cover and saturate with disinfectant. Let stand 15 - 20 minutes. Clean and Dispose of Paper Towel

• Re-spray area with disinfectant

• Re-wipe with paper towel

• Decontaminate materials used to clean spill

Disinfectant Procedure Information

• Take the necessary precautions when handling disinfectants because of them are caustic and hazardous chemicals

• Always prepare all disinfectants daily. Some prepared diluted mixtures, like bleach and water, are not stable and lose it’s efficacy as a disinfectant when not made daily

• When using, spray on and allow to air dry• If area is heavily soiled, clean with detergent and

water first• Impervious (waterproof) surfaces are cleaned

differently than porous/fabric surfaces. • Do not use commercially pre-saturated wipes to

sanitize surfaces as their efficacy has not been tested

• The contamination of the wipe during use may not be sufficiently controlled by the bleach solution in the wipe

Hand-washing• First line of defense against infectious

disease• Hands and other skin surfaces must be

washed immediately, and thoroughly, after handling potentially infectious materials

• Wash hands and lather, rubbing front and back for at least 20 seconds with soap

• Rinse under running warm water from wrists to fingertips

• Dry with paper towel and turn faucet off with paper towel

http://www.youtube.com/watch?v=vYwypSLiaTUD

Employee Responsibilities• Know and understand your department’s ECP

What PPE should be worn? When?What do you do if you are not sure if a substance is a BBP or

not?Who in your department is authorized to clean up blood?

Category A or B? What are you?• ALWAYS Follow SAFE Work Practices… maintain a clean

and sanitary environment.• Wash hands. • Get HBV Vaccine . . . or sign declination form. Discuss other

vaccinations that are available for you with your family physician.

• Report all exposure incidents immediately• Participate in your department’s annual ECP review.

Other Communicable Diseases

West NileMeningitisNorovirus

H1N1 Tuberculosis (TB)

West Nile• Derived from being bitten by an infected mosquitoThe most serious form of WNV is FatalEncephalitis: inflammation of the brain

• Incubation period is 2-15 days

Symptoms include: High fever Neck stiffness Disorientation Coma Tremors Convulsions Muscle weakness Paralysis

According to the CDC, 1 in 150 people get infected, however, 4 out of 5people infected with the virus express asymptomatic infections. This means that they do not show any signs of sickness.

West NileAccording to the CDC, 1 in 150 people get infected, however, 4 out of 5

people infected with thevirus express asymptomatic infections. This means that they do not show

any signs of sickness.

There are 3 possible outcomes from beinginfected with WNV: Asymptomatic: you do not show any signs of infection (most people fall

into this category) Develop West Nile Fever: experience symptoms (expressed in 20% of

infected individuals) Severe West Nile Disease, West Nile Meningitis, West Nile Encephalitis:

experience severe symptoms and possibly die (expressed in 1% of infected individuals)

Meningitis• Inflammation of the membrane (meninges) that

covers the brain and spinal cord

• Caused by either:Viral Meningitis(Aseptic) Bacterial Meningitis

Viral Meningitis• Caused by Enteroviruses• Less severe and is healed without any specific treatment• Symptoms include:

▫High fever▫Severe Headache▫Stiff neck▫Sensitivity to bright light▫Sleepiness or trouble waking up▫Nausea, vomiting ▫Lack of appetite

• Symptoms last between 7-10days with full recovery• No specific treatment

Bacterial Meningitis• Highly severe and some

forms are contagious

• 2 strains of the leading cause of Bacterial Meningitis are Streptococcus pneumoniae and Neisseria meningitis

• Symptoms include:▫ High fever▫ Headache▫ Stiff neck▫ Discomfort looking into bright

lights▫ Nausea▫ Vomiting▫ Confusion▫ Sleepiness▫ Brain damage▫ Hearing loss▫ Learning disability▫ Disability

Bacterial Meningitis (cont’d)• Transmitted via respiratory and throat secretions• Modes of transmission include:

▫ Coughing▫ Kissing▫ Sneezing

• Not as contagious as the flu, therefore, you cannot become infected through casual contact

• Example: You will not become infected if you breathe in the same air that someone with meningitis breathed

• Incubation period ranges from several hours to 2 days• There are vaccines against some forms of meningitis.• According to the CDC, the current vaccines available are

safe and effective

Norovirus•A type of Gastroenteritis: inflammation of the

stomach and small and large intestines

•Caused by a host of viruses that produces the outcome of vomiting and diarrhea

•According to the CDC, it is the leading cause of foodborne-disease outbreaks in the United States

•Common name: Stomach Flu, but not caused by Influenza

Norovirus

•Symptoms: ▫Watery diarrhea▫Vomiting▫Headache▫Fever▫Abdominal cramps

•Symptoms begin 1 to 2 days after infection and lasts for 1 to 10 days depending on the strain of virus.

•Transmitted through contaminated food and beverages via the oral-fecal pathway

H1N1 (Variant Influenza Virus)• Respiratory disease

normally affecting pigs, caused by a specific strain that affects human beings

• Spread through the direct contact of infected pig or infected person

• According to the CDC, human to human transmission is not as easily spread

• Symptoms are similar to those of the human flu

Tuberculosis (TB)• It is an airborne disease caused by bacterium,

Mycobacterium tuberculosis, which attacks the lungs. It can also attack the kidneys, spine and brain. If untreated it can be fatal.

There are 2 forms of TB:Latent TB: when the bacteria lives in the host’s

body without making the person sick. They test positive for the TB skin test, however, they are not infectious

Active TB: when the bacteria is active in the host’s body and makes the person sick and is infectious.

•People can become infected if some one with active TB sings, speaks, coughs or sneezes in the nearby area.

Tuberculosis (TB)If infectious, there is a treatment.• TB disease can be treated by taking several

drugs for 6 to 9 months. There are 10 drugs currently approved by the U.S. Food and Drug Administration (FDA) for treating TB. Of the approved drugs, the first-line anti-TB agents that form the core of treatment regimens include: isoniazid (INH) rifampin (RIF) ethambutol (EMB) pyrazinamide (PZA)

• Regimens for treating TB disease have an initial phase of 2 months, followed by a choice of several options for the continuation phase of either 4 or 7 months (total of 6 to 9 months for treatment).

• Treatment regimen must be fully completed to fully cured. If not taken as prescribed and correctly, infected person’s TB bacteria will become resistant to medication and would require a stronger and expensive medication.

Questions

Bibliography• http://rlv.zcache.com.au/bio_hazard_or_biohazard_sign_symbol_warning_purple_postcard-p239192129277273011

z74oh_125.jpg (Purple Biohazard Sign)

• http://www.papermasters.com/Images/bloodborne-pathogens.jpg (Bloodborne Pathogens Sign)• http://i.telegraph.co.uk/multimedia/archive/01487/hiv_1487944c.jpg (HIV)• http://www.nature.com/nprot/journal/v2/n3/covers/largecover.gif (HBV)• http://srxa.files.wordpress.com/2011/06/hepatitis_c1.gif (HCV)• http://scienceray.com/biology/ecology/managing-jaundice/ (Jaundice Hands)• http://www.fronine.com.au/images/mixmate05.jpg (Vortex Machine)• http://blogs.palmbeachpost.com/becoming-a-doctor/files/2009/07/pipetting.jpg (Pipet)• http://www.servoprax.com/images/5000/00249_1.jpg (Centrifuge Machine)• http://www.torranceca.gov/Images/Mosquito_rdax_400x277.jpg (WNV)• http://www.cdc.gov/ncidod/dvbid/westnile/images/WNV_03_a.gif (WNV Map)• http://www.doctortipster.com/wp-content/uploads/2011/04/Aseptic-Meningitis11.jpg (Viral Meningitis)• http://nchistorytube2.wikispaces.com/file/view/viral-meningitis.jpg/213342706/viral-meningitis.jpg (Viral

Meningitis microscopic)• http://www.about-child.com/wp-content/uploads/2011/07/Bacterial-Meningitis-In-Children-3.jpg (Bacterial

Meningitis)• http://feww.files.wordpress.com/2010/01/bacterial-meningitis-lg.jpg?w=711 (Bacterial Meningitis microscopic)• http://www.defendingfoodsafety.com/uploads/image/Norovirus.jpg (Norovirus)• http://knol.google.com/k/-/-/30e8n4orj1dsd/1ubdd7/fig2-allflu.jpg (H1N1)• http://

img.webmd.com/dtmcms/live/webmd/consumer_assets/site_images/articles/health_and_medical_reference/infectious_disease/understanding_tuberculosis_basics.jpg (TB)