Annual Blood Borne Pathogen Training (Healthcare

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Annual Blood Borne Pathogen Training (Healthcare
Research version)

• Environmental Health Safety Department
• Jay Abbt
• Daron White

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• Annual update for PVAMU employees with potential
  exposure to blood or other potentially infectious
  materials (OPIM)

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• 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

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Bloodborne Pathogens Standard

• 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

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What are Bloodborne Pathogens (BBP)?

• 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.

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• We know blood and blood products are included in
  this BBP scope, but what are Other Potentially
  Infectious Materials (OPIM)?

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OPIM includes the following

• Synovial, pleural, pericardial, and peritoneal
  fluid
• Cerebrospinal fluid
• Semen
• Vaginal secretions
• Amniotic fluid
• Saliva (in dental procedures)

• 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

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Lets look at each of the BBP of concern in detail

• HBV, HIV, HCV

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Hepatitis B Virus (HBV)

• 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.

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Hepatitis B Virus

• HBV infection is a well recognized occupational
  risk for healthcare personnel.
• The average volume of blood inoculated during a
  needlestick injury with a 22-gauge 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.

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Hepatitis B Virus

• 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
• jaundice abdominal discomfort
• dark urine clay-colored bowel movements
• joint pain fatigue
• loss of appetite nausea

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HBV IS PREVENTABLE!A safe effective vaccine
is available.

• 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

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What treatment is available for HBV?

• In the occupational setting, multiple doses of
  Hepatitis B Immune Globulin initiated within 1
  week following percutaneous exposure to hepatitis
  B surface antigen-positive 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.

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HIV

• 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 bodys immune
  system, gradually destroying the bodys ability
  to fight infection and certain cancers.

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HIV

• 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.

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HIV

• 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
• 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.

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HIV

• 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.

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HIV- no cure or vaccine available

• 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.
• The recommendations provide guidance to
  effectively suppress the virus on the basis of
  HIV transmission risk represented by the exposure.

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HIV

• 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.

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HCV

• 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.

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HCV

• 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

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HCV
80 of persons infected have no signs or symptoms
for HCV. When present, symptoms may include

• jaundice
• fatigue
• dark urine

• abdominal pain 
• loss of appetite
• nausea

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HCV

• 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.

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How does a bloodborne infection occur?

• How might I get exposed in the workplace?

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Chain of Infection
Infection Control Break any link in the chain
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Modes of transmission of BBP

• 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.

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Modes of transmission of BBP

• 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.

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Duties that might put you at risk for an
occupational exposure

• 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

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Duties that might put you at risk for an
occupational exposure

• 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

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Risk Factors for Infection

• 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

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• Now that we have reviewed how an exposure can
  occur, lets look at how to prevent exposure.

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Occupational Exposure Prevention

• 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.  

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Standard Precautions

• 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

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Employee Responsibilities

• 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

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Employee Responsibilities

• Reporting exposure incidents to their supervisor
  and assisting the supervisor in completing First
  Report of Injury Form
• Pursuing follow-up care after an occupational
  exposure

Failure to follow these policies could result in
disciplinary action.
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Exposure Control Plan

• Written plan provided to eliminate or minimize
  occupational exposure to BBP.
• PVAMU Safety Manual
• Can be obtained from EHS website.
• Reviewed annually.

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Exposure Control Plan

• 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

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Engineering Controls

• 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
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More Examples of Engineered Sharps Safety Devices
In use
After use
Retractable needle technology
Retractable lancets
Self-blunting needles
Add-ons (needle covers)
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Engineering Controls

• 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

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Work Practice Controls

• Contaminated needles/sharps shall not be bent,
  recapped or removed unless there is no feasible
  alternative or if required by a specific medical
  procedure
• Such bending, recapping, or removal must be done
  though use of mechanical device or a one-handed
  technique
• Use puncture-resistant sharps
• container for disposal of sharps

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Work Practice Controls

• 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
• No mouth pipetting
• Use secondary containment for transport,
  shipping, or storage of containers
• Decontaminate surfaces and equipment

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Handwashing

• 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

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Personal Protective Equipment (PPE)

• PPE is appropriate only if it does not permit
  blood/OPIM to pass through and/or reach the
  employees clothing, skin, eyes, mouth, or other
  mucous membranes under normal use.

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Personal Protective Equipment

• 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

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Latex Allergies

• 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

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Personal Protective Equipment

• Gowns, aprons, fluid-resistant clothing
• Face shields, eye protection (safety glasses,
  goggles)
• Respirators
• Surgical caps, shoe covers

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Even though the use of PPE is very important in
controlling exposure to BBPs, it is your last
line of defense against exposure if engineering
and work practice controls fail.

• Do not rely only on PPE for protection.

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Training

• 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.

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HBV Vaccination

• 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.

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Warning Signs and Labels

• 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.

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Housekeeping Sharps Disposal

• 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

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Housekeeping Decontamination
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.
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Where do I go and what must I do if I am exposed?
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What to Do Post-Exposure

• Wash exposed area with soap and water for 5
  minutes
• if eye or mucous membrane contact, flush with
  sterile water or saline for 5 minutes
• Report the incident to your supervisor, EHS AND
  Health Center immediately.
• Complete First Report of Injury Form
• Report to Health enter for medical evaluation

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Post-Exposure General Medical Surveillance

• 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.

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• Dont delay in reporting for medical care - early
  treatment can mean the difference between life
  and death!

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Recordkeeping

• Injury Log
• Maintained by Human Resources in cooperation with
  Environmental Health Safety Department.
• 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

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Recordkeeping

• Confidential medical records duration
• of employment 30 years
• EPINet (Exposure Prevention Information Network)
  forms
• helps to track trends, problem areas, types of
  medical devices, etc. related to BBP occupational
  exposure incidents and injuries
• First Report of Injury and Illness Form

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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. PVAMUs Workers
Compensation Specialist can be reached at (936)
261-1728
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Summary of Post-Exposure Employee Responsibilities

• Wash/flush exposed injury area for 5 minutes.
• 2. Promptly report the incident to your
  supervisor and the Bloodborne Pathogens
  Coordinator.
• 3. Complete the First Report of Injury forms.
• 4. Report to Health Clinic for medical
  evaluation.

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Reminder

• PVAMU encourages you to contact youre the Health
  Center, Environmental Health Safety or
  supervisor for questions, comments, or
  suggestions.

Health Center [phone] Env. Health
Safety [phone] or 1746 Workers
Compensation [phone]
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Why was this training so vital?

• Healthcare and research personnel are at a great
  risk for occupational exposure to bloodborne
  pathogens.
• Through information and awareness PVAMU aims to
  minimize any risk to our employees and continue
  the commitment to safety in the workplace.

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