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Bloodborne Pathogens Training USC Environmental Health and Safety

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... (CMV, Pneumocystis pneumonia) ... Samples are tested for Samples are NOT tested for Eastern Equine encephalitis virus (EEEV) St. Louis encephalitis virus ... – PowerPoint PPT presentation

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Title: Bloodborne Pathogens Training USC Environmental Health and Safety


1
Bloodborne Pathogens TrainingUSC Environmental
Health and Safety
University of Southern California
For annual refresher training ONLY (initial
training must be taken in class)
2
Outline
  • Objective
  • Introduction to Bloodborne Pathogens
  • Epidemiology and Symptoms
  • Modes of transmission
  • Case Reports
  • Preventive methods
  • Summary

3
Objective
  • To inform USC healthcare workers (HCW), students,
    staff and other personnel about
  • Occupational risk, vaccination program, exposure
    control plan, etc.
  • Comply with OSHA Bloodborne Pathogen Standard
  • 29 CFR 1910.1030 CCR Title 8, section 5193
  • Cal-OSHA BBP Std. Guide
  • Comply with CA Medical Waste Management Act
  • Safety Code, Sections 117600-118360

4
Bloodborne Pathogens
  • Microorganisms that are present in human and
    non-human primate blood and can cause disease in
    human
  • HBV, HCV, HIV most prevalent (Herpes B, Malaria
    Syphilis)
  • Transmitted by blood or other bodily
    fluids/tissue via
  • contaminated sharps,
  • mucosal exposure,
  • or exposure with non-intact skin
  • Needlestick HBV 30 risk of transmission, HCV
    1-10, HIV .3
  • Hepatitis B has been the most frequent
    laboratory-acquired viral infection, with a rate
    of 3.54.6 cases per 1000 workers. Any laboratory
    personnel who collects or handles tubes of blood
    is vulnerable
  • Exposure to Blood What Healthcare Personnel Need
    to Know, http//www.cdc.gov/ncidod/dhqp/pdf/bbp/Ex
    p_to_Blood.pdf

5
Disease characteristics
  • Hep B Acute liver inflammation, cold/flu-like
    symptoms and vomiting. Chronic cirrhosis, liver
    cancer, death
  • Hep C many cases asymptomatic, mostly chronic
    infection, liver transplant
  • HIV once immunocompromised, succumb to
    opportunistic infections(CMV, Pneumocystis
    pneumonia)

6
Occupationally acquired HIV among healthcare
personnel 1981-2006
Occupation Documented Possible
Nurse 24 35
Clinical Laboratory Worker 16 17
Nonsurgical Physician 6 12
Non-Clinical Laboratory Technician 3 -
Housekeeping or Maintenance 2 13
Dentist or Dental Worker - 6
Other healthcare occupation - 6
Surveillance of Occupationally Acquired HIV/AIDS
in Healthcare Personnel, as of December 2006,
http//www.cdc.gov/ncidod/dhqp/bp_hcp_w_hiv.html
7
Needlesticks
  • 85 occupationally acquired HIV
  • 600K-800K injuries annually
  • Half are estimated to be unreported.
  • Most needlesticks due to poor work practices
  • Preventable
  • Panlilio AL, et al. Infect Control Hosp
    Epidemiol, 2004

8
Tasks that may put you at risk
  • Phlebotomy
  • Handling containers of blood, fluid, tissue, or
    cultures
  • Pipetting, mixing, or handling blood, fluid,
    tissue
  • Using finger stick device for blood testing
  • Using capillary tube
  • Providing injections
  • Cleaning blood or broken contaminated glass
  • Handling medical waste
  • Assisting diabetic patient with blood glucose
    monitoring
  • Performing first aid or CPR
  • Finding improperly discarded needle
  • An introduction to Bloodborne Pathogens in the
    Pharmacy, https//webapp.walgreens.com/cePharmacy/
    viewpdf?fileNameblood_borne_pathogens.pdf

9
Case Report
10
Controlling Risk
  • Risk Assessment
  • Universal precautions
  • Engineering controls, work practice controls,
    personal protective equipment
  • Proper Waste Disposal
  • Disinfection

11
Risk Assessment Process
  • What is Risk?
  • A measure of the likelihood that a loss will
    occur (probability) and its potential seriousness
    (severity)
  • Risk Assessment Process (I.A.M)
  • Identify the hazards
  • Assess the potential impact of the hazards
  • Manage the potential impact of the hazards
    through risk reduction strategies
  • (Engineering, Administrative, PPE)

12
Engineering controls
  • Biosafety Cabinet (BSC)
  • Safety-engineered sharps must be used, such as
    self-retracting needle, hinged cap needle
  • Proven to reduce number of needlestick injuries
  • Plastic capillary tubes/ aspirating pipettes

13
Biosafety Cabinets(Engineering Controls)
  • BSC work practices
  • Disinfect working area with appropriate
    disinfectant and contact time.
  • Do not block front or back grilles
  • Divide BSCs working area into clean, working
    and dirty areas.
  • Work from clean to dirty area
  • Have only items needed for procedures
  • Do not overcrowd BSC
  • Minimize rapid movements inside BSC
  • Move arms in and out slowly (minimize sweeping
    motion)
  • Disinfect thoroughly at the end of experiment.
  • UV light is not recommended

14
Potential Risk of Using Glass Pasteur Pipettes
15
Work practice controls
  • No recapping of needles
  • Place sharps container as close to you as
    possible, dont exceed fill line
  • Immediately dispose of medical waste
  • When using sharps, focus on task at hand
  • Practice before using device on patients
  • Practice good hand hygiene (soap and water,
    alcohol based hand sanitizer)

16
Hand HygieneFrequently missed areas
17
Personal Protective Equipment
  • Gloves for any vascular access(latex
    alternatives), remove carefully to minimize
    contamination of hands, wash hands afterwards
  • Lab coat/scrubs
  • Eye and face protection
  • when splash potential
  • Closed-toe shoes

18
Working with commercial blood bank samples?
Samples are tested for
  • Hepatitis B core antigen
  • Hepatitis B surface antigen
  • Hepatitis C virus
  • HIV 1 2
  • A, B, O and Rh

Samples are NOT tested for
  • Eastern Equine encephalitis virus (EEEV)
  • St. Louis encephalitis virus (SLEV)
  • West Nile Virus (WNV)
  • Brucellosis
  • Others

19
Hazardous Waste Disposal - Biomed
PATHOLOGICAL
SOLID
PHARMACEUTICAL
Chemotherapy
SHARPS
20
(No Transcript)
21
Decontamination of Biohazardous Liquid Waste
  • Decontaminate tissue and media with 10 bleach
    solution with a 30 minute contact time
  • Flasks must be emptied and surfaces must be
    decontaminated at the end of a shift

22
Disinfection
  • 1-10 household bleach
  • Make 10 solution weekly for effectiveness
  • 70 Ethanol
  • Not suitable for non-enveloped viruses
  • Sani-wipes
  • Must be EPA approved

23
Labeling
  • Place International biohazard symbol on
  • Biohazardous waste
  • Door signs
  • Incubators
  • Freezers
  • Refrigerators
  • Shipping boxes
  • Any equipment use for biological samples

24
Handling, storage, transport procedures
  • Specimens must be placed in a container which
    prevents leakage during collection, handling,
    processing, storage, transport, or shipping (use
    secondary container), container must be labeled
    with biohazard symbol

25
Hep B Vaccination
  • Recombinant vaccine
  • Anti-cancer
  • Anaphylaxis rare

Contact EHS for more information and
forms 323-442-2200 or IBC_at_admin.usc.edu In-cla
ss training required to obtained vaccination form
26
Handling Exposures
  • Wash affected area with soap and water, if
    mucosal exposure, rinse with water/saline
  • Report immediately and seek medical evaluation
    (Internal Medicine, White Memorial after-hours)
  • Counseling, baseline testing, test source if
    possible, possibly initiate PEP, schedule
    follow-up testing various timepoints up to 1 year

27
Post exposure prophylaxis
  • HBV HBIG vaccine if unvaccinated
  • HIV Standard Antiretroviral Therapy (ART)
  • antiretrovirals, 2 or 3 drug expanded regimen
    depending on type of exposure (percutaneous vs.
    mucosal), status of the source, bodily fluid
  • HCV Rivavirin pegylated-interferon alpha-2b.

28
In summary
  • Practice safe techniques
  • Use safety-engineered sharps
  • Dispose of needles into sharps containers
  • Dont recap needles
  • Wear gloves, lab coat/scrubs, closed-toe shoes
  • Good hand hygiene
  • Follow post-exposure procedures

29
Exposure control plan
Cal-OSHA BBP Exposure Control Plan
info http//www.dir.ca.gov/dosh/dosh_publications
/bbpbest1.pdf
30
Internal Medicine (HCC II) and White Memorial
Hospital
31
References
  • Cal OSHA Bloodborne Pathogen Standard,
    http//www.dir.ca.gov/title8/5193.HTML
  • Surveillance of Occupationally Acquired HIV/AIDS
    in Healthcare Personnel, as of December 2006,
    http//www.cdc.gov/ncidod/dhqp/bp_hcp_w_hiv.html
  • Panlilio AL, et al. Infect Control Hosp
    Epidemiol, 2004
  • Exposure to Blood What Healthcare Personnel Need
    to Know, http//www.cdc.gov/ncidod/dhqp/pdf/bbp/Ex
    p_to_Blood.pdf
  • An introduction to Bloodborne Pathogens in the
    Pharmacy, https//webapp.walgreens.com/cePharmacy/
    viewpdf?fileNameblood_borne_pathogens.pdf
  • Aoun, H. When a house officer gets AIDS. N Eng J
    Med 321(10)693-696, 1989.
  • FDA Safety Alert Hepatitis B Transmission via
    Spring-loaded Lancet Devices
  • http//www.fda.gov/downloads/MedicalDevices/Safety
    /AlertsandNotices/PublicHealthNotifications/ucm063
    124.pdf
  • NIOSH Alert Preventing Needlestick Injuries in
    Health Care Settings, 1999
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