Transcript Personal Protective Equipment (PPE)

UF Bloodborne
Pathogen Training
Program 2011
*Biological Safety Office
Environmental Health & Safety
www.ehs.ufl.edu
352-392-1591
[email protected]
Sharon Judge, PhD
Assistant Biosafety Officer
*Portions of this presentation were
edited and adapted for clinical
dentistry applications at UFCD by the
Office of Clinic Administration.
OSHA requires that printed copy of
this training be maintained in the
clinic.
Bloodborne Pathogens (BBPs) ?
Pathogenic microorganisms present in blood or other potentially infectious
material (OPIM)that are able to cause disease in humans. These pathogens
include:
Hepatitis B virus (HBV)
Human immunodeficiency virus (HIV)
Hepatitis C virus (HCV)
Less Common disease agents such as Epstein-Barr virus (EBV), human T cell lymphoma
virus (HTLV-1), malaria, syphilis, babesiosis, brucellosis, leptospirosis, arboviral diseases
(WNV, EEE), Creutzfeldt-jacob disease, rabies, etc
2
BBP Standard
Implemented in 1991 by the Occupational Safety & Health
Administration (OSHA)

29 CFR1910.1030 http://www.osha.gov/pls/oshaweb/owadisp.show_document?p_table=STANDARDS&p_id=10051
Revised in 2001 – Safe sharps devices, maintain a log of
injuries from contaminated sharps.
UF follows OSHA requirement
General and workplace-specific training
Completed BEFORE individual is assigned to tasks with the potential for BBP exposure and
ANNUALLY thereafter
3
BBP Standard:
In addition to training, individuals with potential exposure must
also have the following:
Access to the regulatory text – required to print a copy for the work
(clinic) area
http://www.osha.gov/pls/oshaweb/owadisp.show_document?p_table=S
TANDARDS&p_id=10051
And an explanation of it’s contents
•
A copy of the training material is adequate
Access to a copy of the UF Exposure Control Plan
http://www.ehs.ufl.edu/Bio/BBP/ECP2010.pdf
Access to any site-specific standard operating procedures (SOPs)
http://www.ehs.ufl.edu/Bio/BBP/BBPSOPS.pdf
4
The OSHA BBP Standard
1. Scope & application
2. Definitions
3. Exposure control, exposure control plan, & exposure
4.
5.
6.
7.
8.
determination by jobs/tasks
Compliance
a. Engineering and work practice controls
b. Personal Protective Equipment (PPE)
c. Housekeeping
d. Regulated waste and sharps
HIV/HBV research labs – held to a higher standard
HBV vaccination and Post-exposure prophylaxis (PEP)
Communication to employees – signs, labels, training
Record keeping
5
UF BBP Program
http://www.ehs.ufl.edu/Bio/BBP/default.htm
 Chairs/Directors : ensure department’s compliance
 Faculty/Supervisors : have an exposure control plan in place that is
appropriate & being followed
 Employees, students, volunteers, etc: follow exposure control plan,
report problems/exposures
 SHCC/Employee Health: immunizations & post-exposure follow-up
 EH&S Biosafety: develop & coordinate UF program, track participants
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Who at UF is enrolled in the program?
ALL employees, staff, students, volunteers, affiliates with potential
exposure to bloodborne pathogens (BBP) from human blood / other
potentially infectious material (OPIM)
Custodians, medical providers, dentists/dental staff, autopsy staff, clinical laboratory
staff, research lab staff & students, biomedical engineers, athletic trainers, event staff,
police, emergency responders, physical plant workers,…..etc
7
What constitutes OPIM?
YES
NO* unless visibly
contaminated with blood
Cerebrospinal fluid
Tears
Synovial fluid
Feces
Peritoneal fluid
Urine
Pericardial fluid
Nasal secretions
Pleural fluid
Sputum
Semen/Vaginal secretions
Sweat
Saliva
Vomit
Breast milk
Amniotic fluid
How are BBPs commonly
transmitted at work?
Cuts or punctures with contaminated sharp objects
Splashes to mucous membranes (linings of eyes, nose, &
mouth)
Your mucous membranes are permeable, allow pathogens to pass
through
Contamination of broken or non-intact or skin (wounds,
chapped skin, rashes)
UF Exposures (2008-2010) Note: 2010
Increase in sharps and splash exposures
2010 Reported Sharps Exposures by Department
Dentistry reported 10 exposures
Cornerstone of exposure prevention
“STANDARD PRECAUTIONS”
Any and all human blood or other potentially
infectious material (OPIM) is treated as
INFECTIOUS
Use:

Safety equipment



Engineering Controls
Safe practices
Personal Protective Equipment (PPE)
To protect yourself & others in the work environment
“Standard Precautions” is an alternate, clinical / hospital term
= Universal Precautions + “body substance isolation” (standard of
care for all patients, all body fluids)
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What to treat with STANDARD
PRECAUTIONS:
Any human blood or OPIM …..&…..
objects/items that may be contaminated by blood
or OPIM
Any unfixed tissue or organ, other than intact skin,
from a living or dead person
Cell or tissue cultures that may contain BBP agents
Blood/ tissues from animals infected with BBP
agents
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Research using human cell lines…

Use Universal Precautions for all human cell lines

ATCC started testing newly manufactured/deposited cell
lines for common viral pathogens (HIV, HepB, HepC, HPV,
EBV, and CMV) in January 2010

Many infectious agents yet to be discovered and for which
there is no test


Remember HIV?
What about XMRV?
Hepatitis B (HepB, HBV)



Spread through direct contact with infected
fluids (blood, semen, vaginal fluids)
More transmissible than Hep C virus and HIV
Infection may be acute or chronic




body
~4.3-5.6% of Americans have been infected with HepB
5-10 % of adults will develop chronic infection; ~1.2 million people
with chronic HBV
15-25% develop cirrhosis , liver failure, or liver cancer (~ 3000
deaths/year)
Many people (~50%) are asymptomatic; if symptoms occur
they include: Fever
Abdominal pain Fatigue
Loss of appetite
Nausea
Vomiting
Jaundice
Joint pain
Dark urine
Occupational Hepatitis B Exposures
Needle sticks a real concern… 30% of susceptible/non-vaccinated
individuals exposed to infected blood this way became infected
Can be transmitted by surface contact with dried blood or OPIM!
HBV can remain infective in dried blood @ room temperature for at
least 1 week (MacCannell et al., Clin Liver Dis 2010; 14:23-26)
Many people have no idea how they became infected
Risk of infection from blood/OPIM splash onto non-intact skin or
mucous membranes… greater risk than other BBPs
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How to prevent Hepatitis B infections at work
 Get vaccinated!
•OSHA BBP standard requires that employees with
potential exposure be offered the vaccine at no cost.
•Occupational infections have decreased 95% since
HepB vaccine became available in 1982
 Use Standard Precautions
 Cleaning/disinfection is important because the virus
can survive on surfaces
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HepB Vaccine

Safe


Effective


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 months)
In Gainesville, free to employees
@UF SHCC (392-0627)


Bring completed Acceptance/Declination
statement with you
http://www.ehs.ufl.edu/Bio/BBP/TNV.pdf
If you decline, can change mind at any time
NOTE: Decline in children and adolescents
since implementation of childhood
vaccinations.
Post-vaccination testing

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

Performed 1-2 months after dose #3 for recently vaccinated
individuals




HepB surface antibody (anti-HBs) ≥ 10 mIU/mL - immune
Anti-HBs < 10 mIU/mL – revaccinate (3 doses) and retest anti-HBs
Still negative – non-responder, need HBIG after exposure
Previously vaccinated but not tested? Test for anti-HBs
after an exposure; if negative, treat as susceptible.
Hepatitis C (HepC, HCV)

Transmitted primarily through contact with
infected blood

Many people asymptomatic (symptoms similar
to HepB)

~1.8 % of Americans have been infected with
HepC, 3.2 million chronically infected


~ 12,000 deaths/year
Leading indication for liver transplant in U.S.
Occupational HepC Exposures

Percutaneous injury, esp. with deep punctures or extensive
blood exposures

~2% develop infection

Mucosal/non-intact skin exposures rarely documented

Proper cleaning/disinfection of surfaces important

HCV in dried blood samples remains infective for at least 16 hours
(Kamili et al., Infect Control Hosp Epidemiol 2007; 28:519-524)
How to prevent Hepatitis C infections at work

Universal Precautions for Prevention!


NO VACCINE
Antivirals (interferon/ribavirin) can have serious side effects,
treatment lasts 24-48 weeks
22
HIV
 CDC: Greater than 1 million people in the United States are currently
infected.
 At least one-fourth of them do not know they are infected, putting
them at high risk for transmitting the virus to others.
 The annual incidence rate of HIV/AIDS in Florida remains more than
twice the national average.
 In 2007, Florida reported 6235 cases HIV, 3896 cases AIDS (Florida DOH
HIV/AIDS Annual Report 2007).
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HIV/AIDS - U.S. and Florida
 > 1 million living with HIV/AIDS
 ~56,000 new infections/year
 ~20% don’t know they are infected
 Florida ranks 3rd among states
in the number of reported
HIV/AIDS cases
HIV
Attacks immune system
destroys white blood cells (CD4+ T cells)
Leaves patient immune suppressed & susceptible to
infections & certain tumors
Many people show no symptoms for a long time (years)
Eventually leads to development of AIDS
(acquired immune deficiency syndrome)
Early symptoms very similar to flu:
Fever
Headache
Tiredness
Enlarged lymph nodes
Treatment focuses on ways to lower blood levels of virus
Occupational HIV Exposures

Risk for HIV transmission after:



Percutaneous injury – 0.3%
Mucous membrane exposure – 0.09%
Non-intact skin exposure – low risk (< 0.09%)
57 documented occupational
infections in U.S. (139 possible
infections)
84% resulted from percutaneous
exposure!
If HIV is such low risk, why worry?
No cure – eventually fatal
NO VACCINE
Some HIV strains resistant to therapy
Post-exposure therapy costly & has side effects.
Cocktails of three or more antiretroviral drugs given
27
How to prevent HIV infections at work
Standard precautions ONLY!
28
BBPs – comparing the risk of infection
Risks of becoming infected with (one of the below listed
BBPs) from a needle stick accident:
HepB: 30% or 300 people per 1000 needle sticks,
if unvaccinated
HepC :2% or 20 people per 1000 needle sticks
HIV : 0.3% or 3 people per 1000 needle sticks
29
Workplace-specific controls to protect against BBP
exposure
 Engineering controls(Safety
Equipment )
 Work Practices
 Personal protective equipment
(PPE)
Maximum protection when these
controls overlap
30
Engineering Controls (Safety Equipment)
Task specific - Examples:

Sharps box

Non-slip floors

Cleanable Work Surfaces
& Dental Chairs

Leak-proof transport
containers

Safety devices including
needles/syringes and
scalpels
SAFETY Sharps DEVICES as available at
http://www.healthsystem.virginia.edu/internet/epinet/safetydevice.cfm#1
Work practices Controls
Safer ways of doing things:
Pre-plan your work (unit dose)
Decontamination/Disinfection of
equipment and surfaces
Minimize splashes
 Barrier covers on equipment and
surfaces
 Proper handling of spills
 Hand Hygiene
No food or drink in areas where blood
or OPIM is generated/handled/ stored
Needle Safety: NEVER RECAP NEEDLES USING BOTH HANDS
• Do Place needles directly into the Sharps Box
• Close & replace Sharps Box when it is ¾ full
•
Do not overfill the sharps box.
• Never attempt to re-open a closed Sharps Box
Needle Safety:
Know where your needles and other
sharps are—AT ALL TIMES!!!!!!!
**Never leave a needle uncapped
anywhere in your operating field.
When possible retract tissue with
another instrument (mouth mirror)
Recapping Needles
•Use a scoop technique
•Use a cap holder if supplied on the
tray
Never use two hands when recapping
- use the one-handed scoop method.
34
Circumstances Associated with Hollow-Bore Needle Injuries
NaSH June 1995—December 2003 (n=10,239)
35%
Clean-up
and
disposal
related
Decontamination/Disinfection of
equipment & surfaces: Disinfectants
 EPA listed tuberculocidal disinfectant
http://www.epa.gov/oppad001/chemregindex.htm
 Cavicide or Opticide
 Follow manufacturers recommendation for contact time of
surface exposure to disinfectant
 A FRESHLY MADE (w/in 24 hr) solution of household
bleach diluted 1:10 with water
 Ethanol; isopropyl alcohol products evaporate too quickly
to be effective. Do not use.
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Indications for Hand Hygiene
 When hands are visibly dirty, contaminated or
soiled, wash with non-antimicrobial or antimicrobial soap and water.
 Should be washed for at least 20 seconds and dried
thoroughly before donning gloves. Pay attention to areas
between fingers and around nails.
 If hands are not visibly soiled, use an alcohol based
hand sanitizer for routinely decontaminating
hands.
 Use enough sanitizer to moisten all surfaces of the hands
and rub until dry.
 Less damaging to skin than soap
 Use before and after wearing gloves or patient contact.
Note residue around cuticles
& under watchband after
thorough hand washing
(using “Glo-Germ” )
37
Personal Protective Equipment (PPE)
 Procedure driven - Wear it when & where you’re
supposed to
 PPE must not be worn in any common area, hallway
or office = OSHA BBP rule
Employer responsibilities for PPE:
Supplied by employer It must be available
It must fit
It must be suitable to the task
Cleaned or disposed of properly
38
Personal Protective Equipment (PPE)
Site specific & appropriate to the task - Refer to area’s site specific written
standard operating procedures
•Face and Eyes
Mask
Glasses (with side shields)
Goggles
Face Shield
With mask
Body – Examples
 Coats
 Gowns
 Aprons
 Sleeves
 Head
 Shoe Covers
According to the CDC, the correct order for
donning personal protective equipment is:
1. Cover gown
•
Fully cover torso from neck to knees , arms to end of wrist
2. Mask
•
•
Fit flexible band to nose bridge
Fit snug to face and over chin, covering nose
3. Goggles, safety glasses with side shield or face shield
4. Gloves
•
Extend to cover wrist of cover gown
40
According to the CDC, the correct order for
removing personal protective equipment is:
1. Gloves
•
•
Outside of glove is contaminated!
When removing, grasp outside of glove with opposite gloved hand and peel off
2. Goggles, safety glasses with side shield or face shield
•
•
Outside of goggles is contaminated!
Remove by grasping ear piece
3. Cover gown
•
•
•
•
Gown front and sleeves are contaminated!
Unfasten ties
Pull away from neck and shoulders, touching inside of gown only
Turn gown inside out and roll into a ball then discard
4. Mask
•
•
Front of mask is contaminated – DO NOT TOUCH!
Grasp bottom, then elastics and remove
41
Pay attention to how you remove your gloves
 Grasp the top or wrist of one glove, being careful not to touch anything
but the glove.
 Pull the glove off, turning it inside out. Continue holding the glove.
 Go under the cuff of the other glove, being careful not to touch its
outside surface.
 Pull the glove off, turning it inside out and pulling it over the first
glove. Both gloves should now be inside out, one inside the other.
 Discard both gloves into an approved waste container.
Then wash hands or use hand sanitizer!
REMEMBER TO USE SAFE WORK PRACTICES TO
PROTECT YOURSELF AND LIMIT THE SPREAD
OF CONTAMINATION
 Keep hands away from face
Limit surfaces touched
Change gloves between patients, when worn/torn or heavily
contaminated
Perform hand hygiene
43
Personal protective equipment (PPE)Other Considerations:
Store, Dispose of, or Clean
PPE appropriately
…Wear closed toe
shoes !
 Do not take PPE home to
wash
 Do not wear it out of the
clinic area
Acid + Flip flops
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GLOVES
 Latex
 Nitrile
 Vinyl – Not recommended - DO NOT hold up
well
Do not re-use gloves
Do not wash gloves
Some chemicals (soaps, lotions, & hand sanitizers)
you use may breakdown the gloves – use glove
compatibility chart
45
No gloves outside of the clinic!
Be aware that the general public does not if know gloves are
clean and assumes they are contaminated.
46
Site specific Exposure Control Plan (ECP) & Standard
Operating Procedures (SOPs)
 Equipment, practices, and personal protective
equipment used AT YOUR SITE to protect you & others
 Written down, reviewed, & updated on a regular basis –
at least annually
 Accessible to all
 See EH&S website for a template to make your SOPs
http://www.ehs.ufl.edu/Bio/BBP/BBPSOPS.pdf
47
HIV & Hepatitis research labs…..
 More stringent control measures
 Registration of work with EH&S
 Documented enrollment in a medical surveillance
program
 CDC/NIH BSL2 guidelines at a minimum
48
Steps to Take If An Exposure Occurs





Wash the area very thoroughly with soap & water: flush
mucous membranes for 15 minutes
Notify supervisor/faculty
Call 1-866-477-6824, the Needle Stick Hotline, for
exposures within 1 hour of Gainesville. Go to nearest
medical facility outside of Gainesville area.
Get immediate medical attention (1-2 hr max)
Allow Medical to follow up with the appropriate testing &
the required written opinion
In Gainesville Vicinity:
Also for scalpel cuts, glass cuts, splashes, etc
If material has splashed into your eyes,
immediately use an emergency eyewash
or another source of clean running
water or saline irrigation to flush them
for at least 15 minutes. Hold the eyes
open and roll them around to make
certain that water reaches their entire
surface.
Know where the closest eyewash station is
located. Staff check to verify station is in
working order on a regular basis and
maintain a log sheet.
UFCD OCCUPATIONAL EXPOSURE FLOWCHART
Stop the procedure, cleanse the skin with antibacterial soap or flush eyes with clean
water.
Injured health care worker (HCW); faculty, resident, staff or student calls the Student
Health Care Center (SHCC) Needlestick Hotline at 9-1-866-477-6824. Identify
yourself as UFCD employee or student and that you’ve had an exposure. Provide
information about the event as requested by SHCC.
Attending dental faculty confirms permission from source patient to test for Hepatitis B,
Hepatitis C and HIV at no expense to them. A written consent is signed by source patient
and scanned into in dental electronic record to acknowledge that consent was obtained
for testing related to occupational exposure. No further details are included.
HCW and source patient go to Shands lab on 3rd floor, room 3152 for lab tests. (Lab
forms will be completed by SHCC and faxed to the Shands lab.)
The source patient may be verbally informed of their test results by the exposed dental
HCW or attending faculty. SHCC must provide the results – as SHCC originally ordered
the tests.
NOTE: If HCW is faculty or paid resident, they should contact Workers Compensation at
392-4940 to open a claim so expenses will be covered by Workers Comp. Follow-up
visits for HCW are scheduled according to SHCC guidelines.
NOTE: Exposed HCWs may contact SHCC with any questions or concerns at 392-0627.
52
Ask for Mr. Tony Mennella.
The Latest Post-Exposure Prophylaxis (PEP) Guidelines for
Occupational Exposures to BBP are at:
http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5409a1.htm - HIV
http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5011a1.htm - HIV, HBV, HCV
Post-exposure follow up must be offered by the employer, confidential, &
offered at no cost to the employee
53
Factors considered in assessing need for PEP
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
Record Keeping Requirements
 Training records:
 Retain a minimum of 3 years
 Medical records for immunization or post-exposure follow
up:
 Retain for duration of employment + 30 yrs (includes HepB
vaccination records, vaccination declination statement)
 Confidential sharps injury log (type of device involved,
where and how injury occurred):
 Retain for 5 years from date of exposure
“Thank you for your continued
efforts to comply with the OSHA
and BBP standards in your daily
work practices. This is the
cornerstone for protecting you,
your colleagues and your patients
in the work place.”
Questions may be directed to the
Office of Clinic Administration:
352.273.6820
56
Changing Topics…
 Biomedical Waste Training
57
*Biological Safety Office
Environmental Health & Safety
352.392.1591
www.ehs.ufl.edu
[email protected]
*Portions of this presentation were
edited for clinical dentistry and sitespecific applications by the UFCD Office
of Clinic Administration
Phone: 352.273.6820
Biomedical Waste Training
• State regulations require that all employees who may have contact
with BMW receive:
– initial training at time of hire
– annual refresher training
• Training shall cover:
– Identification, handling, use of protective clothing, segregation, storage,
labeling, transport, procedures for decontaminating BMW spills,
contingency plan for emergency transport, and procedure for containment
and treatment of BMW.
• Training must be facility and site specific
– Training Log/roster must be kept for a minimum of 3 years
– Documentation of individual employee training is to be kept in their
department.
What is Biomedical Waste (BMW)?
 Any solid or liquid waste which may present a threat of
infection to humans
 Includes but is not limited to:




Non-liquid human tissue and body parts
Blood, blood products and OPIM (as defined in OSHA BBP standard) from
humans and other primates
Laboratory/clinical waste containing/contaminated with blood, tissue, cell
cultures & other potentially infectious body fluids
Laboratory/veterinary wastes containing human disease-causing agents
 Discarded sharps (medical items intended to cut or puncture skin, e.g.
needles, syringe/needle combinations, burs, scalpels)
Biomedical vs. Biological vs.
Hazardous Waste
 Biomedical waste – specifically regulated by the State of
Florida Dept. of Health
 BMW is infectious for humans & a subset of biological waste
 Various regulations affect biological waste (NIH, USDA, etc)
 Biological waste includes rDNA, animal, & plant pathogens
 Hazardous waste is a non-specific term. At UF, most often
used to describe chemical waste or chemically-contaminated
waste (pharmaceutical waste also handled as chemical waste).
Examples of BMW?
 Used, absorbent materials saturated with blood, body fluids, or
secretions/excretions contaminated with blood & absorbent
materials saturated with blood or blood products that have dried
(bandages, gauze, sponges, wound care material).
 Non-absorbent disposable devices (needles, carpules, disposable gloves,
intact glass and hard plastic, etc) contaminated with blood, body fluids,
or secretions/excretions contaminated with blood but have not been
sterilized or disinfected by an approved method.
 Extracted teeth and biopsy specimens
 Other contaminated solid waste which represents a significant risk
of infection b/c they are generated in medical facilities which care
for persons suffering from diseases requiring isolation criteria.
State of Florida Requirements
• Described in Chapter 64E-16 FL Administrative Code
http://www.doh.state.fl.us/environment/community/biomedical/pdfs/64E16_1.pdf
• Segregation, handling, labeling, storage, transport & treatment
are regulated. Prescribe specific:
– Sanitary practices
– Training
– Biomedical waste plan – provides guidance & describes requirements
for proper management of biomedical waste at the generating site or
facility
• Permits required to generate, store, treat, & transport BMW – UF
has permit
• Inspections by the state – has ability to levy fines
• Enforcement
Biomedical Waste Plan
 Content of this presentation closely follows the UF Biomedical
Waste Plan which is located in EH&S Biosafety Office.
Contact 352-392-1591.
 The BMW plan for Shands UF is located in the Environmental
Services Dept., Room G137 (South Tower) and Room B301.8
(North Tower). Contact 352-265-0480.
 Other departments at UF/Shands may create and maintain a
BMW plan for their area using the following template:
http://www.doh.state.fl.us/environment/community/biomedical/index.html
How is BMW identified?
• International biological hazard symbol on the
container
• The phrase “Biomedical Waste”, “Infectious Waste”
or “Biohazardous” must be on the container
• Bagged waste must be in red bags.
Segregation of BMW at UF/Shands
 Segregated at point of origin into its proper container
 “Point of origin” is the operatory, lab, patient/exam/procedure room
or other area where the BMW is generated
 Choices for proper BMW container:
 Red biowaste bag
 Labeled fiberboard box lined with a biowaste bag
 Sharps container – puncture resistant container specifically
designed for sharps
Biowaste Waste Minimization
 Cost savings can be significant!
 New policy for “clean” labware – see
http://www.ehs.ufl.edu/HMM/labware.htm - cardboard box labeled
“clean lab ware”
 The following should not be put into
the biowaste box unless
contaminated:
*Paper
*Disposable cover gowns
*Packaging / wrappings *Paper towels
67
For biowaste items that can cut, but are not
intended to do so…
(broken glass, Pasteur pipettes, pipettes, cotton tip applicators, etc)
Dispose of in a way that they can’t do harm
Options:
Sharps box
Sturdy box in a biohazard bag
Sleeve/bundle pipettes & place in biohazard bag
68
Segregation: Do not mix BMW with
radioactive or chemical waste!
 Chemically or radiologically contaminated gloves, tubes, etc.
do not go into a biomedical waste box. They go into their
appropriate waste container.
 Call EH&S (352-392-1591) before putting hazardous (chemical)
or radioactive warning stickers on biomedical waste
containers.
 Remember – the biomedical waste box is not a universal
disposal container! It is more expensive to dispose of than
regular trash.
Segregate medical sharps into sharps
containers
 Do Not Bend or Break Needles or Scalpels
 Discard directly into a leak-proof,
puncture resistant container
 Replace container when ¾ full
 Label sharps container with facility’s name
and address prior to offsite transport
 UF lab or UFCD Clinic, date, Faculty or
Principal Investigator (PI) name, room and
phone #
Sharps
 Container should be located where the sharps are used:
patient operatories, procedure areas, exam rooms, lab, etc.
◦ UF uses disposable containers transported for disposal by Stericycle
 Only sharps should go into sharps containers
◦ Soft items quickly overfill containers and may cause sharps to stick
out of the top of the box. Sharps boxes containing items other than
sharps and syringes need to be replaced ASAP, but definitely within
the 30 days of first use
What do we do with non-sharp BMW?
 RED autoclave bags – must meet certain documented standards of
State of FL, BBP & DOT
◦ e.g. Fisher #01-828E (Medical Action Industries)
 Red bags are to be available where needed
 No liquid waste in red bags!
 Once sealed, containers must stay sealed. If container breaks or is
punctured, put the whole broken container in a new one.
◦ Infectious/potentially infectious waste must be stored in a covered,
leak-proof container
BMW Storage
 BMW must be staged in an area away from general traffic & accessible only
to authorized personnel. Storage area must be:
◦ Labeled with biohazard sticker
◦ Secure (locked/non-accessible)
◦ Easily cleanable & tidy
 Waste cannot be stored > 30 days
◦ “The 30 day period shall commence when the first non-sharps item of biomedical
waste is placed into a red bag or sharps container, or when a sharps container
containing only sharps is sealed.”
 Packages must be labeled as biomedical waste with the biohazard symbol,
lab name, location, phone & date
 Some locations stage the waste & then transport it to outdoor containers
removed for disposal by a designated hauler
Handling BMW
 Wear appropriate PPE (gloves, clothing cover, safety
glasses) when handling non-inactivated waste
 Use Universal Precautions – assume all BMW is infectious
 Transport waste in leak-proof containers
 Know how to handle spills
Supplies for Handling and Containing BMW
 At UF: Includes UFCD
 Labs must furnish their own PPE and red bags (Fisher #01-828E)
 Sharps containers and BMW boxes are available from Building
Services custodians or from AG133 at the Health Science Center (call
392-5775) or from Physical Plant Stores, Bldg 705 near the Motor
Pool (call 392-1115)
 At Shands, staff may obtain any of the supplies by:
 Contacting Environmental Services at 352-265-0480 or
 Speaking to an Environmental Services staff associate on the unit
they are working
Who Picks Up/Transports BMW for
Shands/UF?
 Transportation of BMW is provided by the following
registered BMW transporter:
Stericycle, Inc.
4245 Maine Ave
Eaton Park, FL 33840
407-361-5454
State of Florida Permit # 53-64-00911
Contingency Plan
 Stericycle has a number of other sites in the state that they
can pull transport equipment from to facilitate emergency
situations
Treatment of BMW
 BMW shall be treated by heat, incineration, or other
equivalent method suitable for hazard inactivation
acceptable to the State of Florida.
 Shands/UF BMW is treated by Stericycle, Inc.
 Autoclave which sterilizes the waste or
 Incineration which destroys the waste

Note: CJD BMW must be marked for incineration per hospital
policy by the area that has filled the container. See ICP 03-15,
Guideline for the Management of Patients with Suspected or
Confirmed Creutzfeldt-Jakob Disease (CJD) or other prion
disease
Pretreatment of biological waste from UF labs
prior to disposal by Stericycle
 At UF, all lab waste handled by UF custodial
staff
 UF Policy:
 Laboratory waste containing infectious, potentially
infectious, or rDNA organisms must be inactivated prior to
disposal
 Properly performed autoclave or bleach treatment is
acceptable
 Storage of all non-inactivated waste in this category is
restricted to within the generating laboratory
 Specific requirements apply for waste containing biological
toxins. Contact the Biological Safety Office at 352-392-1591
Autoclaving
 Requirements:
 Biological indicator testing every 40
hrs of use (every 6 mos if autoclaving
non-infectious material exclusively)
 Log book
 Regular maintenance
 250°F/121°C, 15-20 lb pressure
 Large loads/resistant pathogens
need more time
 Typical bag of Biohazardous Waste =
60 min
 Transport BMW to autoclave in
closed bag and leak-proof
container
Bleach Inactivation of BMW
 Acceptable for liquid material if done correctly
 Add full strength household bleach to final concentration of 10%
(5000 ppm available chlorine).
 Mix. Contact time should be at least 30 minutes.
 Pour down drain to sanitary sewer.
 Beware of other disinfectants = “hazardous chemicals”,
harmful work with and can’t go down drain, must be picked
up by EH&S
BMW Spills & Surface Disinfection
 Proper spill handling:
◦
◦
◦
◦
◦
Notify people in the area
Don appropriate PPE
Place absorbent material on spill
Apply appropriate disinfectant – allow sufficient contact time (30 min)
Pick up material (watch for glass – use tongs or dust pan); dispose of
material into biomedical waste
◦ Reapply disinfectant and wipe
◦ For large/high hazard spills, call the Biosafety Office (352-392-1591)
 For routine disinfection of surfaces where BMW is handled, use a 1:10
solution of freshly diluted bleach or a tuberculocidal disinfectant (ethanol
products evaporate too quickly!)
◦ UFCD uses Opticide or Cavicide, disinfectant to clean and disinfect surfaces.
Utilize spray,wipe,spray method. If using disinfectant wipes: use wipe, discard,
wipe method. Surface must remain wet for the length of time recommended by
manufacturer in order for effective disinfection.
Contact: The UF Biological Safety Office
352-392-1591
[email protected]
www.ehs.ufl.edu