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Bloodborne Pathogens


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Title: Bloodborne Pathogens

Bloodborne Pathogens
  • For Tulane National Primate Research Center
    employees whose work involves a high risk of
    exposure to HIV/SIV/SHIV, HBV, or B-virus
  • February 2009

  • This training serves as a review of
  • Bloodborne Pathogens (BBP) in
  • relation to the specialized work at
  • TNPRC in working with nonhuman
  • primates (NHP).

Bloodborne Pathogens Standard
  • 1991- OSHAs Occupational Exposure to Bloodborne
    Pathogens (29 CFR 1910.1030)
  • Goal eliminate or minimize occupational
    exposure to bloodborne pathogens
  • Revised in 2001 in response to the Needlestick
    Safety and Prevention Act
  • Goal clarifies employer requirements to
    identify, evaluate, and make use of safer,
    effective medical devices.

How does animal blood fit into the Bloodborne
  • The standard covers animal blood only for those
    animals purposely infected with HIV or HBV.
  • Persons handling any animal blood should follow
    general precautions as recommended by the
    CDC/NIH, Biosafety in Microbiological and
    Biomedical Laboratories (BMBL) 5th edition

What are Bloodborne Pathogens (BBP)?
  • Pathogenic microorganisms that are present in
    blood or other potentially infectious materials
    (OPIM) that can cause disease in humans.
  • These pathogens include, but are not limited to
    HBV (hepatitis B virus) and HIV (human
    immunodeficiency virus).

Bloodborne Pathogens (BBP)
  • Other examples of BBP include micro-organisms
    that cause
  • hepatitis C virus, malaria, syphilis, babesiosis,
    brucellosis, leptospirosis, arboviral infections,
    relapsing fever, Creutzfeldt-Jakob disease,
    HTLV-1, and viral hemorrhagic fever.
  • It is important to know which pathogens (from
    humans or animals) you may be exposed to at work,
    especially in the laboratory or clinical setting.

  • Nonhuman primates, by virtue of their genetic,
    physiologic, and sometimes social similarities to
    humans, are particularly likely sources of
    infectious agents that pose a threat to humans.

What are we concerned about here at TNPRC?
  • HIV (human immunodeficiency virus)
  • SIV (simian immunodeficiency virus)
  • SHIV (simian-human immunodeficiency virus)
  • HBV (hepatitis B virus)
  • B-virus

HIV(Human Immunodeficiency Virus)
  • HIV 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.

computer generated art quality graphics of HIV
was done by Russell Kightley of Canberra,
  • 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.

  • 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.

  • The average risk for HIV transmission after a
    percutaneous (e.g., needlestick) 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.

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

  • 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
  • Researchers, however, have shown that HIV remains
    present in hiding places such as the lymph nodes
    even in people who have been treated.

SIV/SHIV(Simian Immunodeficiency
Virus/Simian-Human Immunodeficiency Virus)
  • Primate-borne retrovirus closely related to HIV-1
    and HIV-2
  • Infection in monkeys can lead to chronic wasting
    disease syndrome with depletion of CD4
    lymphocytes and lymphadenopathy
  • Can be complicated by various opportunistic
    complications similar to AIDS, making it an
    important animal study model.

  • Natural seroprevalence in captive rhesus monkeys
    appears to be low (0-1)
  • Found in variety of tissue and body fluids of
    infected nonhuman primates
  • -including blood, plasma, CSF, and
  • parenchyma tissue

  • Laboratory-made hybrid of the simian and human
    viruses created by wrapping the SIV core in the
    HIV envelope
  • Virus seems to affect monkeys much like HIV
    affects humans
  • Created to learn what genes are necessary to
    overcome the species barriers to pathogenesis

  • Risk of human infection has not been defined
  • Since SIV/SHIV shares many similar
    characteristics of HIV, many of the same
    biosafety precautions are indicated.
  • Specific precautions in handling SIV/SHIV are
  • based on recommendations developed
  • for HIV and other lentiviruses.

  • In the lab, SIV/SHIV must be presumed to be
    present in all SIV/SHIV cultures, in all
    materials derived from such cultures, in all
    specimens from SIV/SHIV antibody-positive
    nonhuman primates, and in/on all equipment coming
    in contact with these materials.
  • Skin and mucous membranes should be considered a
    pathway for virus entry.
  • Contact with these sites should be considered an
    exposure to SIV/SHIV.

HBV(Hepatitis B Virus)
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 2003, an estimated 73,000 people were infected
    with HBV. People of all ages get hepatitis B and
    about 5,000 die per year of sickness caused by

Hepatitis B Virus
  • 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.

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

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

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.

What is B-Virus?
  • Other names Cercopithecine herpesvirus-1, Herpes
    B virus, Monkey B virus, Herpes Virus Simiae
  • Herpes group of viruses that occurs naturally in
    macaques and produces very mild disease in the
    monkey but can cause fatal encephalitis in humans.

How Do I get B-Virus?
  • Exposure to contaminated monkey saliva,
    secretions, or tissues most commonly through
  • Bites or scratches
  • Splashes
  • Needlesticks
  • Indirectly (contact with contaminated cage, etc)

What are the chances that I will get B-Virus?
  • The risk of actually acquiring B-Virus infections
    from macaques is very low. The approximate
    proportion of people who work with primates have
    historically become ill with Herpes B is much
    fewer that 1.
  • Only 22 cases of human infection have been
    described. Of these cases, 20 infected developed
    encephalitis and 15 of these patients died as a
    result of their infection.

Who Is Most at Risk for B-Virus?
  • animal caretakers
  • laboratory personnel
  • anyone who is exposed to monkeys or monkey
  • immune-suppressed individuals may also face a
    higher risk for infection

B-virusSigns and Symptoms (for monkeys)
  • Most have no obvious sign of infection.
  • Some have ulcerations on the mouth, face, lips
    genitals, and/or eye.
  • Virus resides permanently in the monkey and can
    be periodically reactivated (usually if stressed
    or immunosuppressed). The virus can be shed by
    monkeys without visible lesions or symptoms.

B-Virus Signs and Symptoms (for humans)
These generally occur within one month of
  • Vesicular (small blister) skin lesions at or near
    the site of injury
  • Localized neurological symptoms such as pain,
    numbness or itching near the wound site
  • Flu-like aches and pains
  • Fever and chills
  • Headaches lasting more than 24 hours
  • Fatigue
  • Lack of muscular coordination
  • Shortness of breath

Precautions to Consider
  • Exercise caution at all times. Nonhuman primates
    can and will bite.
  • Wear appropriate, protective clothing.
  • Work together with at least one other person when
    handling nonhuman primates. Minimize direct
  • Report any observed facial, lip or oral lesions
    in the nonhuman primates to a veterinarian.
  • For bite or scratch injuries involving a monkey,
    or scratches with cages or equipment that might
    be contaminated with their secretions, wash
    thoroughly and seek medical care immediately.

How can I protect myself from B-virus infection?
  • Read TNPRC Procedure on Herpes B virus
  • Follow all standard procedures for your area
  • Wash Hands!!!!

How could I be exposed to these pathogens at work?
Chain of Infection
Infection Control Break any link in the chain
Modes of transmission of BBP
  • Percutaneous - the direct inoculation of
    infectious material by piercing through the skin
    barrier (needlestick, bites, scratches from
    animals or cages)
  • Non-intact skin - exposure of infectious material
    to pre-existing lesions, cuts, abrasions, or
    rashes provides a route of entry into the body.
  • Mucous membrane contact splashes of infectious
    material to an individual's unprotected eyes,
    nose, or mouth in clinical or laboratory

What can I do to prevent occupational exposure
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.  

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.

Employee Responsibilities
  • Completing training/orientation as required
  • Following the Standard Precautions Policy and the
    Exposure Control Plan (Written plan provided to
    eliminate or minimize occupational exposure to
  • Using work practices, engineering controls, and
    personal protective equipment as outlined in the
    Exposure Control Plan

Employee Responsibilities
  • Reporting exposure incidents to your supervisor
    and assisting the supervisor in completing First
    Report of Injury/Illness Form
  • Knowing in advance what to do if an exposure
    incident occurs
  • Pursuing follow-up care at after an exposure
    incident with Employee Health in B-building, Room
    112 (Nurse Janey)

Failure to follow these policies could result in
disciplinary action.
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
  • Examples include

Self-sheathing syringe
More Examples of Engineered Sharps Safety Devices
In use
After use
Retractable needle technology
Retractable lancets
Self-blunting needles
Add-ons (needle covers)
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
  • Squeeze cages
  • Transfer boxes

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
  • Such bending, recapping, or removal must be done
    through use of mechanical device or a one-handed
  • Use puncture-resistant sharps
  • container for disposal of sharps

Work Practice Controls
  • No food/drink/smoking, handling of contacts, 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
  • Decontaminate surfaces and equipment

Personal Protective Equipment
  • Gloves (latex or nonlatex)
  • When to use them
  • when there is reasonable anticipation
  • of employee hand contact with blood, mucous
    membranes, non-intact skin, or other potentially
    infectious materials
  • 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

  • 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
  • Alternate methods
  • Antiseptic towelettes
  • Waterless handwashing gels

Personal Protective Equipment (PPE)
  • Gowns, aprons, fluid-resistant clothing
  • Face shields, eye protection (safety glasses,
  • Surgical mask and/or N-95 respirator
  • Surgical caps, shoe covers

  • 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
  • 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

HBV Vaccination
  • FREE to employee - paid for by your department
    (available from Employee Health) for high-risk
  • If you initially refuse the vaccine, you may
    change your mind later and still receive it.

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
  • Contaminated equipment
  • Red bags may be substituted for biohazard labels
    on biohazardous waste bags.

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
  • Do not overfill - dispose of sharps container as
    biohazard waste when it is 2/3 full

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.
Where do I go and what must I do if I am exposed?
What to Do Post-Exposure
  • Wash exposed area with soap and water for 15
    minutes if eye or mucous membrane contact, flush
    with water or saline for 15 minutes
  • Report the incident to your supervisor so the
    veterinarian can be notified to examine the
    source monkey to see if it is shedding virus.
  • Complete First Report of Injury/Illness Form
  • Report to Employee Health (Bldg B) for evaluation
    and follow-up visits

  • Sharps Injury Log
  • Maintained by Office of Environmental Health
    Safety (OEHS) independently from OSHA 300 Log
  • Training records 3 years
  • Confidential medical records duration
  • of employment 30 years

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.
Summary of Post-Exposure Employee Responsibilities
  • Perform 15 minute scrub procedure using soap and
    water. If mucous membrane contact, flush injured
    area with sterile saline or water for 15 minutes.
  • 2. Promptly report the incident to your
  • Report to Employee Health during business hours
    for medical evaluation or page the nurse at (985)
    966-6515 after hours for instructions.
  • Complete the First Report of Injury forms.

  • Tulane University encourages you to contact your
    Bloodborne Pathogens Coordinator or supervisor
    for questions, comments, or suggestions.

TNPRC Employee Health
(985)871-6596 Bloodborne Pathogens Coordinator
(985)892-2040 ext. 6653 Office
of Env. Health Safety (OEHS) (504)988-5486
You can always reach the Bloodborne Pathogens
Coordinator 24 hours a dayby work cell phone
(504)419-1391 or call (504)988-5486 and press 1.
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 Tulane
  • University aims to minimize any risk to our
  • employees and continue the commitment to
  • safety in the workplace.

  • http//
  • http//
  • http//
  • HBV
  • http//
  • B virus
  • http//
  • http//
  • http//
  • BBP
  • http//
  • http//

Tulane UniversityOffice of Environmental Health
Safety (OEHS)Kellie C. MayerBloodborne
Pathogens Coordinator(504) 419-1391kmayer_at_tulane
  • Thank you for completing the self-study review
    session. Please click below to assess your
    learning and receive credit for participation.

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