Transcript UF Bloodborne Pathogen Training

Biological Safety Office
Environmental Health & Safety
352-392-1591
www.ehs.ufl.edu
[email protected]
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1990: Occupational Safety & Health Administration
(OSHA) estimates >200 deaths & 9000 infections/year
from occupational BBP exposure
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BBP standard implemented in 1991 to protect workers
from occupational exposure
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29 CFR 1910.1030
http://www.osha.gov/pls/oshaweb/owadisp.show_document?p_t
able=STANDARDS&p_id=10051
Revised in 2001 – safe sharps devices, maintain a log of
injuries from contaminated sharps
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UF follows OSHA requirement
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ALL employees, staff, students, volunteers, affiliates with
potential exposure to BBP from human blood/OPIM
General and workplace-specific training
Completed BEFORE individual is assigned to tasks with the
potential for BBP exposure and ANNUALLY thereafter
In addition to training, individuals with potential exposure
must also have:
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Access to the regulatory text and an explanation of its contents
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Access to a copy of the UF Exposure Control Plan
http://www.ehs.ufl.edu/Bio/BBP/ECP2012.pdf
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Access to site-specific Standard Operating Procedures (SOPs)
http://www.ehs.ufl.edu/Bio/BBP/BBPSOPS.pdf
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Pathogenic microorganisms present in blood and other
potentially infectious material (OPIM) that are able to
cause disease in humans
Hepatitis B virus (HBV, HepB)
 Hepatitis C virus (HCV, HepC)
 Human immunodeficiency virus (HIV)
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Less commonly, human T-lymphotropic virus (HTLV-1),
Epstein-Barr virus (EBV), malaria, brucellosis, rabies,
leptospirosis, babesiosis, syphilis, Creutzfeld-Jakob
disease, arboviral infections (WNV, EEE), etc.
YES
NO (unless visibly
contaminated with blood)
Cerebrospinal fluid
Tears
Synovial fluid
Feces
Peritoneal fluid
Urine
Pericardial fluid
Saliva
Pleural fluid
Nasal secretions
Semen/Vaginal secretions
Sputum
Breast milk
Sweat
Amniotic fluid
Vomit
Saliva from dental procedures
Unfixed human tissue or organs (other than intact skin)
Cell or tissue cultures that may contain BBP agents
Blood/tissues from animals infected with BBP agents
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Cell lines may be infected or become
infected/contaminated in subsequent handling/passaging
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ATCC started testing newly manufactured/deposited cell
lines for common viral pathogens (HIV, HepB, HepC, HPV,
EBV, and CMV) in January 2010
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Many infectious agents yet to be discovered and for which
there is no test
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Remember HIV?
Use Universal Precautions for all human cell lines
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More stringent control measures
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Work must be registered with EH&S
Biosafety Office (rDNA or BA
registration – forms online at
http://www.ehs.ufl.edu/Bio/Registration_
Forms.htm)
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Enrollment in medical surveillance
program
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Follow CDC/NIH BSL-2 containment
practices at a minimum
1. Cuts or punctures with contaminated sharp objects
(needles, glass, scalpels, etc)
2. Splashes to mucous membranes (eyes, nose, mouth)
3. Contamination of broken/non-intact skin
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All human blood or OPIM is
treated as infectious
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Standard precautions = universal
precautions + body substance
isolation. Applies to blood & all
other body fluids, secretions,
excretions (except sweat),
nonintact skin, and mucous
membranes
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Spread through direct contact with infected blood or
OPIM; 50-100 times more infectious than HIV
Infection may be acute or chronic
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5-10 % of infected adults will develop chronic infection; ~1.2 million
people with chronic HBV
15-25% develop cirrhosis, liver failure, or liver cancer (~ 3000
deaths/year)
Symptoms of acute infection can appear 6 wks - 6 mos
after exposure & include:
Fever
Abdominal pain Fatigue
Loss of appetite Nausea
Vomiting
Jaundice
Dark urine
Joint pain
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Needlestick/sharp injury from HepB contaminated source
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~30% of these exposures results in infection
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Mucosal exposure to blood/body fluids
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Exposure to nonintact skin from contaminated surfaces and
equipment
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HBV can remain infective in dried blood at RT for at least 1 week
(MacCannell et al., Clin Liver Dis 2010; 14:23-36)
What besides Universal Precautions &
appropriate cleaning & disinfection can be
used to prevent HepB infection….. ?
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Safe
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Effective
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Given to newborns, 120 million people in
U.S. have received at least one dose
>95% develop immunity after full series (3
doses given at 0, 1, 6 mos)
In Gainesville, free to UF employees
@SHCC (392-0627)
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Bring completed Acceptance/Declination
statement
http://www.ehs.ufl.edu/Bio/BBP/TNV.pdf
If you decline, can change mind at any
time
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Health-care workers or public safety workers at high risk
for continued percutaneous or mucosal exposure to blood
or body fluids, HBV research lab workers
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Performed 1-2 months after dose #3
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HepB surface antibody (anti-HBs) ≥ 10 mIU/mL - immune
Anti-HBs < 10 mIU/mL – revaccinate (3 doses) and retest anti-HBs
Still negative – nonresponder, need HBIG after exposure
Previously vaccinated but not tested? Test for anti-HBs
after an exposure; if negative, treat as susceptible.
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Transmitted primarily through contact with
infected blood
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~3.2 million Americans chronically infected;
many do not know they are infected b/c they
are asymptomatic (if symptoms do occur,
similar to HepB)
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~ 12,000 deaths/year
Leading indication for liver transplant in U.S.
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Percutaneous injury, esp. with deep punctures or extensive
blood exposures
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~2% develop infection
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Mucosal/nonintact skin exposures rarely documented
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Proper cleaning/disinfection of surfaces important
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HCV in dried blood samples remains infective for at least 16 hours
(Kamili et al., Infect Control Hosp Epidemiol 2007; 28:519-524)
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Universal Precautions for Prevention!
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NO VACCINE
Antivirals (peginterferon/ribavirin) can have serious side effects,
treatment lasts 24-48 weeks
New HCV protease inhibitors – boceprevir & telaprevir (approved
5/11). Given in combination with traditional therapy, many side
effects, drug resistance, only effective for genotype 1
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Transmitted through contact with infected blood/OPIM
Attacks & destroys CD4+ T cells
Can be asymptomatic for many years
AIDS - occurrence of opportunistic infections or HIV-related
cancers & a decline in CD4+ T cell (<200/µl blood)
 1.2 million Americans living with HIV
 135,000 (11%) in FL (ranks 3rd among
states in # of reported infections)
 20% don’t know they are infected
 ~50,000 new infections/year
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Risk for HIV transmission after:
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Percutaneous injury – 0.3%
Mucous membrane exposure – 0.09%
Nonintact skin exposure – low risk (< 0.09%)
57 documented occupational
infections in U.S. (139 possible infections)
84% resulted from percutaneous exposure!
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No cure
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No vaccine
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Antiretroviral therapy – cocktail of 3 or more drugs,
costly, side effects, drug resistance
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Always use Universal Precautions!
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Risks of becoming infected after a needle stick injury:
35%
30%
30%
25%
20%
15%
10%
5%
2%
0.3%
0%
HepB
*If unvaccinated*
HepC
HIV
200
174
Number of exposures
180
160
150
144
140
140
120
Sharps Exposures
100
Splash Exposures
80
60
40
34
33
19
20
15
0
2008
2009
2010
2011
Neurology
OB/GYN
2%
2%
SHCC
All others
Pathology 3%
5%
3%
Orthopaedics
3%
Dentistry
21%
Otolaryngology
4%
Emergency Medicine
4%
Radiology
4%
Anesthesiology
16%
Surgery
5%
Pediatrics
6%
Neurosurgery
7%
Medicine
15%
All others includes 1 exposure
each in the following departments:
o ACS
o EH&S
o Nursing
o Pharmacy
o Psychiatry
o Rec Sports
Radiology
5%
All others
10%
Anesthesiology
5%
Surgery
32%
Pathology
7%
Orthopedics
7%
Emergency Medicine
17%
OB/GYN
7%
Medicine
10%
All others includes 1 exposure
each in the following
departments:
o Cardiology
o CMFM
o IM
o Neurology
Engineering Controls
- Safety needles, sharps containers, BSC’s
Work Practices
- Waste disposal, spill cleanup
Administrative Controls
- Training, vaccinations
Personal Protective Equipment
- Gloves, lab coat, eye protection
Sharps container
 Biosafety cabinet
 Cleanable work surfaces/chairs
 Leak-proof transport containers
 Safety needles/syringes
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List of safety sharps devices available can be found at:
http://www.healthsystem.virginia.edu/internet/epinet/safetydevice.cfm#1
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Know what they are and follow them!
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Minimize splashes/aerosols
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Safe handling of sharps
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Proper hand washing
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Decontaminate work surfaces daily and after spills
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Know how to handle spills (covered in BMW training)
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Proper disposal of contaminated items
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No eating, drinking, smoking, handling contacts or applying
cosmetics in areas where blood/OPIM is handled or stored
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Hand transmission important route of infection
◦ Hands easily contaminated during lab procedures
◦ Usually no barrier between hands and face
◦ Hand-to-face contact common → 15-27 times/half hour
(Collins & Kennedy, 1999)
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Wash hands frequently & thoroughly
◦ After handling infectious/potentially infectious materials
◦ After removing gloves
◦ Before leaving the lab
Pay attention to frequently missed
areas – fingertips, between fingers,
under jewelry
NO!!
NO!!
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Discard needles directly into sharps
container
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Do not overfill the sharps box – close and
replace when ¾ full
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Never attempt to re-open a closed sharps box
Circumstances Associated with Hollow-Bore
Needle Injuries
NaSH June 1995—December 2003 (n=10,239)
Access IV Line
5%
Transfer/Process
Specimens
5%
Handle/Pass
Equipment
6%
Recap Needle
6%
Collision
W/Worker or
Sharp
10%
Other
5%
During Sharps
Disposal
13%
Improper
Disposal
9%
During Clean Up
9%
In Transit to
Disposal
4%
Manipulate
Needle in Patient
28%
35% disposal
related
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FRESHLY DILUTED (w/in 24 hrs) 1:10 solution of
household bleach
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EPA listed tuberculocidal disinfectant
◦ http://www.epa.gov/oppad001/chemregindex.htm
◦ Clorox, amphyl, lysol, sporicidin
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Ethanol evaporates too quickly to be an effective
disinfectant!
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Must be supplied by the employer
Wear it WHEN and WHERE you are supposed to
◦ Do not wear in common areas (offices, hallways, bathrooms, cafeterias, etc) or
when handling common-use items (doorknobs, elevator buttons, telephones)
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It must fit, be suitable to the task (use common sense), and be
cleaned or disposed of properly (this does not mean taking it
home to wash!)
◦ Gloves
 Latex or nitrile – vinyl does not hold up well!
◦ Face and Eye Protection
 Surgical mask, goggles, glasses w/side shield, face shield
◦ Body
 Gowns, aprons, lab coats, shoe covers
Absolutely no open toed
shoes in the lab!
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BBP standard requires that warning labels are placed
on:
◦ Containers of regulated waste
◦ Refrigerators & freezers containing blood or OPIM
◦ Containers used to store, transport, or ship blood or OPIM
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Use red bags for waste containers
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Wash wound with soap & water for 5 minutes; flush mucous
membranes for 15 minutes
Seek immediate medical attention (1-2 hrs max)
◦ In Gainesville, call 1-866-477-6824 (Needle Stick Hotline)
◦ In Jacksonville, 7am-4pm, go to Employee Health Suite 505 in Tower
1; Other hours, go to ER
◦ Other areas, go to the nearest medical facility
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Notify supervisor
Contact UF Worker’s Compensation Office, 352-392-4940
Allow medical to follow-up with appropriate testing & required
written opinion
Type/amount of
fluid/tissue
Infectious status
of source
Susceptibility of
exposed person
Percutaneous
injury (depth,
extent, device)
Blood
Presence of HepB
surface antigen
(HBsAg) and HepB
e antigen (HBeAg)
HepB vaccine and
vaccine response
status
Mucous membrane
exposure
Fluids containing
blood
Presence of HepC
antibody
Immune status
Type of exposure
Non-intact skin
exposure
Presence of HIV
antibody
Bites resulting in
blood exposure to
either person
CDC PEP Guidelines:
http://www.cdc.gov/mmwr/PDF/rr/rr5409.pdf
http://www.cdc.gov/mmwr/PDF/rr/rr5011.pdf
Please exit the session and click on the link for Tests &
Quizzes on the left hand side of the screen. You must
take the quiz & score at least 75% to fulfill the training
requirement.