Transcript Tulane University Bloodborne Pathogens Training

Annual Training for High Risk
Occupations
July 2011
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
University of Louisiana at Monroe Office of Environmental Health and
Safety (EHS)
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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
Safety (EHS)
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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.
University of Louisiana at Monroe Office of Environmental Health and
Safety (EHS)
University of Louisiana at Monroe Office of Environmental Health and
Safety (EHS)
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Synovial, pleural,
pericardial, and
peritoneal fluid
Cerebrospinal
fluid
Semen
Vaginal secretions
Amniotic fluid
Saliva (in dental
procedures)
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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
University of Louisiana at Monroe Office of Environmental Health and
Safety (EHS)
HBV, HIV, HCV
University of Louisiana at Monroe Office of Environmental Health and
Safety (EHS)
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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.
University of Louisiana at Monroe Office of Environmental Health and
Safety (EHS)
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HBV infection is a well recognized
occupational risk for healthcare personnel.
The average volume of blood inoculated
during a needlestick injury with a 22gauge 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.
University of Louisiana at Monroe Office of Environmental Health and
Safety (EHS)
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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:
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jaundice
abdominal discomfort
dark urine
clay-colored bowel movements
joint pain
fatigue
loss of appetite
nausea
University of Louisiana at Monroe Office of Environmental Health and
Safety (EHS)
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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
University of Louisiana at Monroe Office of Environmental Health and
Safety (EHS)
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In the occupational setting, multiple doses
of Hepatitis B Immune Globulin initiated
within 1 week following percutaneous
exposure to hepatitis B surface antigenpositive 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.
University of Louisiana at Monroe Office of Environmental Health and
Safety (EHS)
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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.
University of Louisiana at Monroe Office of Environmental Health and
Safety (EHS)
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.
University of Louisiana at Monroe Office of Environmental Health and
Safety (EHS)
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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
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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.
University of Louisiana at Monroe Office of Environmental Health and
Safety (EHS)
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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.
University of Louisiana at Monroe Office of Environmental Health and
Safety (EHS)
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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.
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The recommendations provide guidance to
effectively suppress the virus on the basis of
HIV transmission risk represented by the
exposure.
University of Louisiana at Monroe Office of Environmental Health and
Safety (EHS)
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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.
University of Louisiana at Monroe Office of Environmental Health and
Safety (EHS)
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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.
University of Louisiana at Monroe Office of Environmental Health and
Safety (EHS)
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
University of Louisiana at Monroe Office of Environmental Health and
Safety (EHS)
80% of persons infected have no signs or
symptoms for HCV. When present, symptoms
may include:
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fatigue
dark urine
jaundice
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abdominal pain
loss of appetite
nausea
University of Louisiana at Monroe Office of Environmental Health and
Safety (EHS)
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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.
University of Louisiana at Monroe Office of Environmental Health and
Safety (EHS)
How might I get exposed
in the workplace?
University of Louisiana at Monroe Office of Environmental Health and
Safety (EHS)
Chain of Infection
Infection Control = Break any link in the chain
University of Louisiana at Monroe Office of Environmental Health and
Safety (EHS)
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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.
University of Louisiana at Monroe Office of Environmental Health and
Safety (EHS)
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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.
University of Louisiana at Monroe Office of Environmental Health and
Safety (EHS)
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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
University of Louisiana at Monroe Office of Environmental Health and
Safety (EHS)
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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
University of Louisiana at Monroe Office of Environmental Health and
Safety (EHS)
• 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
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 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.
University of Louisiana at Monroe Office of Environmental Health and
Safety (EHS)
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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
University of Louisiana at Monroe Office of Environmental Health and
Safety (EHS)
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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
Safety (EHS)
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Reporting exposure incidents to their
supervisor and assisting the supervisor in
completing Accident/Incident Forms.
Pursuing follow-up care after an
occupational exposure
Failure to follow these policies could result
in disciplinary action.
University of Louisiana at Monroe Office of Environmental Health and
Safety (EHS)
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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
University of Louisiana at Monroe Office of Environmental Health and
Safety (EHS)
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
University of Louisiana at Monroe Office of Environmental Health and
Safety (EHS)
• 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
University of Louisiana at Monroe Office of Environmental Health and
Safety (EHS)
In use
After use
Retractable needle technology
Retractable lancets
Add-ons (needle covers)
Self-blunting needles
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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
University of Louisiana at Monroe Office of Environmental Health and
Safety (EHS)
• 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
University of Louisiana at Monroe Office of Environmental Health and
Safety (EHS)
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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
University of Louisiana at Monroe Office of Environmental Health and
Safety (EHS)
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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
University of Louisiana at Monroe Office of Environmental Health and
Safety (EHS)
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.
University of Louisiana at Monroe Office of Environmental Health and
Safety (EHS)
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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
University of Louisiana at Monroe Office of Environmental Health and
Safety (EHS)
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
University of Louisiana at Monroe Office of Environmental Health and
Safety (EHS)
• Gowns, aprons, fluid-resistant clothing
• Face shields, eye protection (safety
glasses, goggles)
• Respirators
• Surgical caps, shoe covers
University of Louisiana at Monroe Office of Environmental Health and
Safety (EHS)
Do not rely only on PPE for
protection.
University of Louisiana at Monroe Office of Environmental Health and
Safety (EHS)
• 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
Safety (EHS)
• 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.
University of Louisiana at Monroe Office of Environmental Health and
Safety (EHS)
• 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.
University of Louisiana at Monroe Office of Environmental Health and
Safety (EHS)
• 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
University of Louisiana at Monroe Office of Environmental Health and
Safety (EHS)
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.
University of Louisiana at Monroe Office of Environmental Health and
Safety (EHS)
University of Louisiana at Monroe Office of Environmental Health and
Safety (EHS)
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)
University of Louisiana at Monroe Office of Environmental Health and
Safety (EHS)
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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.
University of Louisiana at Monroe Office of Environmental Health and
Safety (EHS)
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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.
University of Louisiana at Monroe Office of Environmental Health and
Safety (EHS)
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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.
University of Louisiana at Monroe Office of Environmental Health and
Safety (EHS)
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
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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.
University of Louisiana at Monroe Office of Environmental Health and
Safety (EHS)
Failure to do this can result in delayed or
unnecessary treatment for you.
University of Louisiana at Monroe Office of Environmental Health and
Safety (EHS)
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
Safety (EHS)
• 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
University of Louisiana at Monroe Office of Environmental Health and
Safety (EHS)
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
Safety (EHS)
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.
University of Louisiana at Monroe Office of Environmental Health and
Safety (EHS)
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.
University of Louisiana at Monroe Office of Environmental Health and
Safety (EHS)
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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
University of Louisiana at Monroe Office of Environmental Health and
Safety (EHS)
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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
Safety (EHS)
University of Louisiana at Monroe Office of Environmental Health and
Safety (EHS)