Environmental Health and Safety Offices BLOODBORNE PATHOGENS

Environmental Health and Safety Offices BLOODBORNE PATHOGENS

Purpose! Reduce / eliminate exposure potential Comply with Ohio s Public Employment Risk Reduction Act (reference OSHA) 2!

Exposure Determination! Employees in the following job classifications have reasonably anticipated occupational exposure: Physicians, nurses, and lab technicians at SHC; Nursing Faculty Trainers in Intercollegiate Athletics Employees with first aid responsibilities at the Ice Arena RSC: Lifeguards, Facility Managers, Outdoor Pursuit Center First aiders in Child Studies University Police Officers BSW / BRW who may clean-up blood/body fluid in a work area Chemistry/Biochemistry, Kinesiology who work with blood products 3"

Topics! Bloodborne diseases and their transmission Reducing exposure potential Exposure incidents Hepatitis B vaccine Spill cleanup 4"

Bloodborne diseases and their transmission Percutaneous, parenteral (i.e., through the skin layer) Contact with mucous membranes of eyes, nose, mouth (via splash, direct contact) Sex with infected partner Maternal-Neonatal (i.e., mother to unborn child/infant) Significant risk variables: volume, concentration, mode of transmission, immune status 5"

Bloodborne diseases and their transmission" Universal Precautions! A simple approach to infection control. A concept that assumes that all human blood and certain human body fluids are treated as if known to be infected by bloodborne pathogens. Always Presume Contamination 6"

Bloodborne diseases and their transmission" Terms! BBP (bloodborne pathogens) HIV (human immunodeficiency virus) AIDS (acquired immunodeficiency syndrome) HBV (hepatitis B virus)* OPIM (other potentially infectious materials) *or one of the other hepatitis viruses (e.g., HCV) 7"

Bloodborne diseases and their transmission" Other Potentially Infectious Materials! OPIM! semen and vaginal secretions saliva (in dental procedures) ANY body fluid visibly contaminated with blood ALL body fluids in situations where it is difficult or impossible to differentiate between body fluids Other internal fluids from the brain or spine, joints, lungs, around the heart or abdomen, or in the womb Any unfixed (not preserved) human tissue or organ 8"

Bloodborne diseases and their transmission" Not Considered OPIM! Vomit Perspiration Tears Urine Feces 9"

Human Immunodeficiency Virus! Target in Body Virus Concentration Risk (contaminated needlestick) External viability Vaccine Available immune system low (5-10)* 1 in 200 chance 3 to 5 hrs no *measured in viral bodies / milliliter of blood H I V Time Span (?) AIDS 10"

HIV/AIDS Epidemiology (U.S.)! Cases Reported Deaths Persons living With diagnosis of HIV Infection 1994 1996 2002 2004 2006 2008 2010 2013 71,874 59,347 38,132 38,726 25,551 23,049 18,926 49,095 36,510 16,948 17,154 15,679 16,276 15,529 492,673 601,741 762,084 872,990 1.1 million Source: Centers for Disease Control and Prevention http://www.cdc.gov/hiv/statistics/basics/index.html 11"

Bloodborne diseases and their transmission" Hepatitis! Hepa = liver; titis = inflammation of 6 types = A, B, C, D, E, and G Types B (HBV) and C are bloodborne Type D and G only occurs in those already infected with type B Types A, E spread through fecal-oral mode of transmission Hepatitis B and C can be ACUTE or CHRONIC 12"

Bloodborne diseases and their transmission" Hepatitis B virus! Target in Body Virus Concentration (one tsp. of blood) Risk from contaminated needlestick External viability Vaccine Available liver 500M* 1 in 2.5 chance 7 days yes *measured in viral bodies / milliliter of blood Source: American Liver Foundation 13"

Bloodborne diseases and their transmission" HBV Confirmed Transmission! Sexual contact (includes anal & oral sex) Contaminated needles (esp. I.V. drug use) Maternal-Neonatal Blood transfusions (negligible) Other: intra-family, -institutional, hemodialysis, oral (rare), household Approximately 1/3 unknown sources Source: American Liver Foundation 14"

Bloodborne diseases and their transmission" HBV Symptoms! Loss of appetite Nausea, vomiting, fever, stomach or joint pain Extreme fatigue Yellowing of the skin or eyes Dark Urine 30-40% with acute HBV show no symptoms Source: American Liver Foundation 15"

Bloodborne diseases and their transmission" HBV facts (U.S.)! Approximately 5,000 deaths annually 140-320K new infections annually Young adults account for 90% of reported cases 1.25 million Americans are HBV carriers 90-95% of adults recover from HBV Chronic carriers have 100% greater chance of developing liver cancer Source: American Liver Foundation 16"

Exposure Control Methods 1. Signs and Labels 2. Exposure Control Plan 3. Engineering Controls 4. Personal Protective Equipment 5. First Aid Situations 6. Contaminated waste disposal 7. Contaminated laundry 17"

Exposure Control Methods" 1. Signs and Labels! Medical Waste Infectious Waste Infectious Biohazard 18"

Exposure Control Methods" 2. Exposure Control Plan! Covers: Spill response Housekeeping HBV program Exposure incidents Infectious waste disposal PPE Work practices Availability - BBP Trainer or ESRM at: http://www.units.miamioh.edu/esrm/training/bloodborne-pathogen-training 19"

Exposure Control Methods" 3. Engineering Controls! Examples: Sharps Containers Biohazard waste bags & boxes One-way valves on resuscitation devices Hand washing facilities 20"

Exposure Control Methods" 4. Personal Protective Equipment! Types Limitations 21"

Exposure Control Methods" 5. First Aid Situations! University Police are designated first responders Encourage self-care if possible Avoid bare-hand pressure without barrier Glove accessibility 22"

Exposure Control Methods" 6. Contaminated Waste Disposal! Infectious Waste Red bags Labeling requirements Biohazard boxes Drop-off sites Sharps disposal 23"

Exposure Control Methods" 7. Contaminated Laundry! Wear gloves for handling and thoroughly wash hands afterwards If blood or OPIM gets on personal clothing, remove it and wash the clothing as soon as feasible following the detergent manufacturer s directions. 24"

Exposure Incidents Blood or OPIM Contacts: 1. Mucous membranes Eyes Mouth Nose 2. Non-intact skin 3. Contaminated Sharp 25"

Exposure Incidents" Exposure Incident Examples! Blood/OPIM splash on non-healthy or non-intact skin (e.g., rash, a recent cut, chapped skin, broken cuticles, skin that is chafed, scraped, etc.) Blood/OPIM splash to eyes, nose, or mouth Puncture injuries with potentially contaminated object (e.g., needlesticks, contaminated glass, etc.) Rubbing eyes or nose with contaminated gloves or clothing 26"

Exposure Incidents" Post-exposure evaluation and follow-up! Confidential medical evaluation and blood testing offered at no cost to employee Voluntary 28"

Exposure Incidents" What is involved in an exposure evaluation?! Report to Miami s Convenient Care Clinic or the Nursing Supervisor at Student Health Services Medical personnel will document how the exposure occurred and the route of entry They will request the identity of the source individual and seek consent to test their blood for hepatitis and HIV (you will be given the results of these tests) 29"

Voluntary blood tests HIV antibody test requires several blood tests over a period of time If medically indicated, you will be offered a vaccine for Hepatitis B Recordkeeping Exposure Incidents" Post-exposure testing! 30"

HBV vaccine Noninfectious Produced in yeast cells Developed free of human blood or blood products Used to promote immunity to HB infection in individuals considered at high risk of potentially being exposed to the virus 31"

HBV vaccine" HBV program at Miami University! Eligibility requirements* Administration site (Student Health Services) Schedule (Call SHS for appointment) Consent / Declination procedures * Employees determined to have a reasonably anticipated high risk of occupational exposure 32"

HBV vaccine" Pre- vs. Post-exposure vaccination! Preventive / pre-exposure vaccination protects against unidentified exposure incidents Vaccine series may be initiated following exposure incident Best started within 48-72 hours Student Health Services suggests initiation no later than 7 days after exposure 70 to 75% effective in preventing HBV infection 33"

HBV vaccine" Side Effects! Local effects: redness, soreness, swelling, firmness at site! of injection Generalized effects: slight fever, nausea, vomiting, diarrhea, headache, chills, mild muscle aches and/or joint pain Allergic / hypersensitivity reaction: rash, itching, swelling not limited to injection site No known harmful effects if previously infected or positive for HBV antibody 34"

Contraindications! (Conditions suggesting treatment! should not be administered)! Yeast allergy Immunodeficiency disease Recent febrile illness / infection Pregnancy Lactation HBV vaccine" 35"

HBV vaccine" Efficacy! (Vaccine s effectiveness)! Active immunity in 80 to 95 percent of persons completing the series of three injections Immunity projected to last indefinitely Positive immunity protects against all modes of transmission May donate blood if vaccine given as a preventive measure 36"

Spill cleanup Kits Decontamination Precautions Procedure 37"

Spill cleanup" Spill cleanup kits! Accessibility requirements Know the locations of the kits in your work area and make sure you have easy access to them Know how to use your department s kit Follow directions included with the kit and use all personal protective equipment provided in it 38"

Spill cleanup" Decontamination! Use 10% bleach solution for 15-minute soak time* Undiluted bleach for a minimum exposure of 30 seconds EPA-registered TUBERCULOCIDAL disinfectants Check the label of the disinfectant you are using. HIV-Effective does NOT necessarily mean it is effective against hepatitis viruses. *mix solution and use within 24 hours 39"

Spill cleanup" Spill cleanup precautions! Minimize spread of spill Avoid splashing or spraying Assume gloved hands are contaminated Avoid using brushes or brooms Dispose of sharps appropriately 40"

Spill cleanup" Spill cleanup procedure! 1. 2. 3. 4. Secure the site (keep others away) Inspect and put on appropriate PPE In an area free of contamination, position red bag so materials can be dropped in without soiling outside of bag Carefully use only as much decontaminant as you need to saturate the spill area, cover with paper towels, and allow to soak 41"

Spill cleanup" Spill cleanup procedure! 5. 6. 7. 8. For non-level surfaces (e.g., walls), thoroughly clean area with 10% bleach solution (or other EPA-approved disinfectant) and allow to air dry Dispose of sharp objects in a sharps container or a sturdy puncture-resistant container Place all materials in red bag Remove disposable PPE and place in red bag 42"

9. 10. 11. 12. Spill cleanup" Spill cleanup procedure! Touching outside of red bag only, close and secure with twist tie or knot Decontaminate area again and allow to air dry Arrange for pickup and disposal of red bag Wash your hands with soap and water! 43"

BLOODBORNE PATHOGENS Course Revision 2014 Miami University Environmental Health and Safety Offices! 44"

Information You are encouraged to contact your BBP Trainer or the Environmental Safety & Risk Management Offices to discussquestions you may have regarding this program. Refer to the following websites for more information: http://www.units.muohio.edu/ehso/bbp.html http://www.cdc.gov/hiv/hivinfo.htm Information in English and Información en Español http://www.liverfoundation.org/ 45"