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Tulane University Bloodborne Pathogens Training

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Title: Tulane University Bloodborne Pathogens Training


1
Tulane UniversityBloodborne Pathogens Training
  • Annual update for Tulane University employees
    with potential exposure to blood or other
    potentially infectious materials (OPIM)
  • March 2011

2
  • 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

3
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

4
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.

5
Working with Non-Human Primates?
  • Any employees who work with non-human primates
    (monkeys, monkey tissue, or monkey specimens) may
    have the potential for contracting B virus and/or
    SIV (Simian Immunodeficiency Virus).
  • Please contact the BBP Coordinator for additional
    training more specific to your occupational
    safety needs.

6
We know blood and blood products are included in
this BBP scope, but what are Other Potentially
Infectious Materials (OPIM)?
7
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

8
Lets look at each of the BBP of concern in
detail
  • HBV, HIV, HCV

9
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.

10
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.

11
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

12
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

13
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.

14
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.

computer generated art quality graphics of HIV
was done by Russell Kightley of Canberra,
Australia.
15
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.

16
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.

17
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.

18
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.

19
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.

20
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.

21
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

22
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

23
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.

24
How does a bloodborne infection occur?
  • How might I get exposed in the workplace?

25
Chain of Infection
Infection Control Break any link in the chain
26
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.

27
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.

28
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

29
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

30
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

31
Now that we have reviewed how an exposure can
occur, lets look at how to prevent exposure.
32
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.  

33
Standard (Universal) 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

34
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

35
Employee Responsibilities
  • Reporting exposure incidents to their supervisor
    and assisting the supervisor in completing First
    Report of Occupational Injury/Illness Form
  • Pursuing follow-up care after an occupational
    exposure

Failure to follow these policies could result in
disciplinary action.
36
Exposure Control Plan
  • Written plan provided to eliminate or minimize
    occupational exposure to BBP.
  • Section 40 of the Tulane University EHS
    Policies and Procedures Manual
  • Can be obtained from OEHS (11th Floor Tidewater)
    or on OEHS website listed above
  • Reviewed annually

37
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

38
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
39
More Examples of Engineered Sharps Safety Devices
In use
After use
Retractable needle technology
Retractable lancets
Self-blunting needles
Add-ons (needle covers)
40
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

41
Work Practice Controls
  • Contaminated needles/sharps shall not be bent,
    recapped or removed
  • Use puncture-resistant sharps
  • container for disposal of sharps
  • No mouth pipetting
  • Decontaminate surfaces and equipment

42
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
  • Use secondary containment for transport,
    shipping, or storage of containers

43
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

44
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.

45
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

46
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

47
Personal Protective Equipment
  • Gowns, aprons, fluid-resistant clothing
  • Face shields, eye protection (safety glasses,
    goggles)
  • Respirators
  • Surgical caps, shoe covers

48
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.

49
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

50
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.

51
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.

52
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

53
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.
54
Where do I go and what must I do if I am exposed?
55
What to Do Post-Exposure
  • Wash exposed area with soap and water for 5
    minutes
  • if at TNPRC or you have a possible B virus
    exposure, you must scrub 15 minutes
  • if eye or mucous membrane contact, flush with
    sterile water or saline for 5 minutes
  • Report the incident to your supervisor and the
    Bloodborne Pathogens Coordinator (504)419-1391.
  • Complete First Report of Occupational
    Injury/Illness Form
  • Report for medical evaluation (please review the
    next few slides for places to report)

56
Where to Go Post-Exposure General Medical
Surveillance for Tulane University Employees
  • 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.

57
Where to Go Post-Exposure Injuries Sustained
while on Rotation at Another Facility
  • If on rounds at another hospital, report there
    for initial visit but you must still notify the
    Tulane University Bloodborne Pathogens
    Coordinator at (504) 419-1391.

58
Where to Go Post-Exposure Injuries Sustained at
TNPRC (Tulane National Primate Research Center)
  • Go to the Occupational Health Trailer at TNPRC
    for medical evaluation during business hours.
  • Report to Occupational Health at TNPRC for
    follow-up visits
  • If an exposure incident occurs after hours or on
    the weekend, your supervisor will send you to St.
    Tammany Parish Hospital.

59
Where to Go Post-Exposure Tulane University
Health Sciences Center Students
  • Downtown Student Health Services
  • Elks Place Building (2nd Floor) Suite 261
  • Mon thru Fri 8A to 4P Call Downtown Student
    Health (504) 988-6929
  • All other times Page the on-call physician
  • (504) 538-7277
  • It does not matter where you are in the USA while
    engaged in a Tulane-sanctioned educational
    experience, students must notify the health
    center ASAP following an injury.

60
It is VERY important to bring the patients
source blood (if available) with you when you
report for initial evaluation. Your care is
dependant on the HIV, HBV, and HCV status of the
source patient to whom you were
exposed.Similarly, when dealing with nonhuman
primates it is important to note which monkey was
the source for the bite/scratch to allow for
proper evaluation of infection in the source
animal.
Failure to do this can result in delayed or
unnecessary treatment for you.
61
Tulane is required to provide this post-exposure
evaluation and follow-up after an exposure
incident.
  • Dont delay in reporting for medical care - early
    treatment can mean the difference between life
    and death!

62
Recordkeeping
  • Sharps Injury Log
  • Maintained by Office of Environmental Health
    Safety (OEHS) independently from OSHA 300 Log
  • 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

63
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

64
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. Tulanes Workers
Compensation Specialist can be reached at (504)
988-2869 or workcomp_at_tulane.edu
65
Summary of Post-Exposure Employee Responsibilities
  • Wash/flush exposed injury area for 5 minutes (15
    minutes if at TNPRC for possible B virus
    exposure).
  • 2. Promptly report the incident to your
    supervisor and the Bloodborne Pathogens
    Coordinator.
  • 3. Complete the First Report of Injury and EPINet
    forms.
  • 4. Report to appropriate clinic/emergency
    department (depending on your location) for
    medical evaluation.

66
Reminder
  • Tulane University encourages you to contact your
    Bloodborne Pathogens Coordinator or supervisor
    for questions, comments, or suggestions.

Bloodborne Pathogens Coordinator -
(504) 988-6608 Primate Center ext.
6653 Work Cell -
(504) 419-1391 Office of Env. Health Safety
(OEHS) - (504) 988-5486
67
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.
68
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.

69
Tulane UniversityOffice of Environmental Health
Safety (OEHS)Please contact the BBP
Coordinator Kellie C. Mayer(504)
419-1391kmayer_at_tulane.edufor questions and/or
interactive discussion.
70
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