IUSON - OSHA Bloodborne Pathogens Training 2010 Occupational Exposure to Bloodborne Pathogens Healthcare and research personnel are at the greatest risk for occupational exposure to disease causing agents collectively known as bloodborne pathogens. It has been well documented that employees with occupational exposure to blood and other potentially infectious materials containing bloodborne pathogens face a significant health risk. Exposures may occur through needlesticks or any other form of percutaneous injury, or from splashing potentially infectious material into existing skin cuts, abrasions, rashes, or unprotected eyes, nose, or mouth. In the event of an exposure incident, the actual risk of infection by a given agent is determined by the nature of the pathogen, the type of exposure, the amount of material involved, and the amount of the agent present in the material. While every exposure may not lead to an actual infection, the risk can be minimized or eliminated using a combination of engineering and work practice controls, personal protective clothing and equipment, training, medical surveillance, Hepatitis B vaccination, warning signs or labels, and other provisions described in this training. Please contact the Biological Safety Manager ([email protected]) if you have questions or concerns regarding infectious agents or bloodborne pathogens at your work site. What are Bloodborne Pathogens? Bloodborne Pathogens are causative agents of disease that are carried in blood, blood products and other potentially infectious materials. They can result in severe and deadly disease in healthcare or research personnel. While Hepatitis B (HBV), Hepatitis C (HCV), Human Immunodeficiency Virus (HIV), are of specific importance in the occupational setting, other bloodborne disease include malaria, syphilis, brucellosis, Creutzfeldt-Jacob disease, cytomegalovirus infection, and viral hemorrhagic fever. This section will focus primarily on HIV, HBV and HCV, but it is important to know which bloodborne pathogens (from humans or animals) you may be exposed to at work, especially in the laboratory or clinical setting. 1
Transcript
IUSON - OSHA Bloodborne Pathogens Training 2010Occupational Exposure to Bloodborne Pathogens Healthcare and research personnel are at the greatest risk for occupational exposure to disease causing agents collectively known as bloodborne pathogens. It has been well documented that employees with occupational exposure to blood and other potentially infectious materials containing bloodborne pathogens face a significant health risk. Exposures may occur through needlesticks or any other form of percutaneous injury, or from splashing potentially infectious material into existing skin cuts, abrasions, rashes, or unprotected eyes, nose, or mouth.
In the event of an exposure incident, the actual risk of infection by a given agent is determined by the nature of the pathogen, the type of exposure, the amount of material involved, and the amount of the agent present in the material. While every exposure may not lead to an actual infection, the risk can be minimized or eliminated using a combination of engineering and work practice controls, personal protective clothing and equipment, training, medical surveillance, Hepatitis B vaccination, warning signs or labels, and other provisions described in this training.
Please contact the Biological Safety Manager ([email protected]) if you have questions or concerns regarding infectious agents or bloodborne pathogens at your work site.
What are Bloodborne Pathogens? Bloodborne Pathogens are causative agents of disease that are carried in blood, blood products and other potentially infectious materials. They can result in severe and deadly disease in healthcare or research personnel.
While Hepatitis B (HBV), Hepatitis C (HCV), Human Immunodeficiency Virus (HIV), are of specific importance in the occupational setting, other bloodborne disease include malaria, syphilis, brucellosis, Creutzfeldt-Jacob disease, cytomegalovirus infection, and viral hemorrhagic fever.
This section will focus primarily on HIV, HBV and HCV, but it is important to know which bloodborne pathogens (from humans or animals) you may be exposed to at work, especially in the laboratory or clinical setting.
Please contact the Biological Safety Manager if you have questions or concerns regarding infectious agents or bloodborne pathogens at your work site.
HIV - Human Immunodeficiency Virus The human immunodeficiency virus (HIV) is the causative agent of acquired immunodeficiency syndrome (AIDS). Once infection progresses to AIDS, the immune system of the infected person gradually becomes less able to to fight off opportunistic infections and cancers. While usually well managed in individuals with a normal immune system, these may ultimately lead to and result in death for the HIV-infected individual.
HIV-infected persons may have no symptoms or may experience symptoms such as swollen lymph nodes (particularly in the neck, armpits, and groin areas), fatigue or listlessness, weight loss (>10%), diarrhea, persistent dry cough, night sweats and fever of at least 100°F.
HIV Infections
As of 2002, and according to the Centers for Disease Control and Prevention (CDC), there are over 816,000 reported cases of people with AIDS in the US, and an estimated 5 million people were infected with the human immunodeficiency virus (HIV) worldwide in 2002, including 2 million women and 800,000 children under 15. In the US, HIV-related illness was the leading cause of death among young adults between the ages of 25 and 44 years old in 1995. Today it is the sixth leading cause of death for this age group.
Medical treatment...
Significant advances have been made in recent years regarding HIV treatment. Several antiviral drugs, called protease inhibitors and reverse transcriptase inhibitors, have been found to slow the replication of the virus. However, they do NOT provide a cure.
A treatment protocol (Zidovudine (AZT) plus lamivudine (3TC) for 28 days) has been developed by the U.S. Public Health Service (UPHS) and is to be administered following a high-risk exposure to a known HIV-infected source. The series of drugs does reduce the likelihood that the exposed person will become HIV-infected. In fact, post-exposure prophylaxis for HIV has been shown to reduce the risk of HIV transmission by 81%. However, the discovery of HIV strains resistant to antiretroviral drugs exacerbates the concerns regarding the efficacy of future post-prophylaxis regimens and demonstrates how preventing occupational exposure to HIV should be the primary focus of all affected IUB & IUPUI staff and students.
Remember: No vaccine is available for HIV!
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HIV - Human Immunodeficiency Virus Occupational exposure Risks
HIV is a bloodborne pathogen and healthcare workers are generally considered to have the highest risk of having an occupational exposure to blood or other potentially infectious materials. Therefore, the primary focus in preventing occupational HIV transmission in healthcare and research settings is to prevent exposure to blood or OPIM.
As of 2001, CDC was aware of 57 health-care workers in the United States who had been documented as having seroconverted to HIV following occupational exposures with 26 of them developing AIDS. Exposure to HIV-infected blood accounted for 49 seropositive healthcare workers, while 3 were exposed to concentrated virus in the laboratory
The majority of individuals (88%) who seroconverted had percutaneous exposures to HIV-infected blood typically by needle stick accidents, although any exposure through a break in the skin is considered percutaneous. The overall risk of transmission for percutaneous is approximately 0.3%. The risk of transmission for muco-cutaneous exposures is 0.1%
Factors such as virus titer, amount of exposure material involved, and type of exposure can result in differences for risk transmission in an exposure incident. Some factors that have been shown to increase the risk of HIV transmission include the involvement of a deep injury, a source patient in the final stages of AIDS, and if the needle was within a blood vessel in the source patient (phlebotomy needle). Gloves are able to reduce exposure to skin but are unable to prevent penetrating injuries caused by contaminated needles or other sharps.
Ability to Survive in the Environment
Various studies have been completed regarding the survival of HIV and the statements below represent some of the key findings.
According to previous reports from the CDC, HIV does not survive well outside the body. The number of infectious HIV particles is reduced by 90 to 99 percent within several hours.
However, this natural inactivation can take up to 8 hours. Virus in high concentrations, and in liquid form, can survive for 1-2 weeks at room temperature.
Dried out HIV suspensions of 2-3 log amounts can survive for several days and remain potentially infectious.
HIV is susceptible to most common disinfectants including bleach or 70% ethanol.
HBV - Hepatitis B Virus
What is Hepatitis B? Hepatitis B is a serious public health problem that affects people of all ages in the United
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States and around the world. Each year, approximately 78,000 people become infected with hepatitis B in the United States. Of those, approximately 22,000 result in acute clinical disease. The disease is caused by a highly infectious virus that attacks the liver.
Clinical symptoms associated with acute hepatitis B infection occur in 30-50% of infected adults and might include:
Jaundice (yellowing of the skin or eyes). Extreme fatigue and unable to work for weeks or months.
Loss of appetite, nausea, or vomiting.
Abdominal or joint pain.
Is Hepatitis B serious?
Approximately 2-10% of infected adults develop a chronic Hepatitis B infection. While they may remain asymptomatic, it is this group that is at high risk for developing cirrhosis (scarring of the liver), liver cancer, or liver failure. Approximately 5000 people in the US die each year from HBV infections.
How common are HBV infections?
CDC estimates that between 78,000 and 81,000 people become infected every year in the U.S. Most primary infections in adults are self-limiting and completely resolve within 6 months of onset. Many infections also appear to be subclinical and are detected only by serologic testing and other methods.
Approximately 30% of all people who become infected do not have any symptoms of infection.
Between 2% and 10% of all people who become infected may become "chronic carriers" of HBV. Although they might be without symptoms, they carry the virus and can infect others.
There are an estimated 1.25 million chronically infected persons in the United States.
It is estimated that 4.9% of all Americans have been infected with HBV.
Is there a treatment for Hepatitis B infections?
There is no cure for acute hepatitis B infections. However, three drugs currently licensed as a treatment for chronically infected persons are Adefovir dipivoxil, alpha interferon, and lamivudine. Without a "cure" available for new infections, efforts have been to focus on the prevention of the disease. As a result, a highly effective vaccine is
In 1983 there were 17,000 new cases (386/100,000) among healthcare workers, while in 1995 there were only 400 occupationally acquired infections (9.1/100,000). With the introduction of the HBV vaccine to healthcare workers, the period from 1983 to 1995 had a 95% decrease in new cases among healthcare workers.
PROTECT YOURSELF!!!! GET VACCINATED!!!
HBV - Hepatitis B Virus
Occupational Exposure to Hepatitis B Virus
Hepatitis B virus is well recognized as an occupational hazard to healthcare and research workers. The level of risk is also directly related to the degree of contact with infectious materials. Individuals whose jobs involve handling blood and other OPIM (Other Potentially Infectious Material) are at a much greater risk of becoming infected with HBV than other employees. In unvaccinated healthcare and research personnel sustaining needlestick injuries involving HBV positive blood, the risk of developing acute hepatitis B is between 22 and 31%.
Why is the risk of transmission of HBV from occupational exposures so high?
It is directly related to the amount of virus present in an infected person. A single milliliter (ml) of blood from a hepatitis B-infected person may contain more than 100 million infectious viral particles. A mere 10 microliters (µl) can contain as much as 1 million infectious HBV particles. Capillary action will quickly allow the injection of 10 µl during a percutaneous accident. Recalling the information from the previous pages on HIV, the concentrations of HIV in the blood of infected persons are much lower. Estimates of the number of infectious viral particles range from a few hundred to approximately 10,000 per ml in HIV infected persons. However, the consequences of occupational exposure to HIV can be more serious than those for HBV.
The most common mode of transmission of HBV to healthcare workers in the work place is by accidental needle sticks or other contaminated sharps injuries. An unimmunized individual has a 6 to 30% chance of becoming infected following a hepatitis B-positive needle stick injury. The rate is high because hepatitis B virus is much more infectious than HIV and present in greater numbers in infected individuals. As such, IUPUI offers HBV vaccinations and post-exposure management in order to maximize workplace safety and to prevent infection after occupational exposure to HBV.
HBV particles cannot reproduce outside the human body, and must infect specific human or primate cells to make copies of themselves.
Studies have demonstrated that even in dried blood, HBV remains viable on environmental surfaces for at least 1 week, and likely remains infectious for several weeks. Because HBV is quite stable, infection of personnel (without any known percutaneous injury) can occur through direct or indirect exposure of dried blood into cuts, abrasions, lesions, burns, or other mucosal surfaces. Fortunately, the virus is susceptible to a variety of common disinfectants including bleach, and routine disinfection should be standard practice in designated work areas.CV - Hepatitis C Virus
What is Hepatitis C?
Hepatitis C virus (HCV), also known as non-A, non-B hepatitis (NANB), has become a serious public health problem and represents the most common chronic bloodborne infection in the United States. According to the CDC, 75-85% of infected individuals become chronically infected, 70% develop chronic liver disease, 10-20% may develop cirrhosis of the liver, and 1-5% of infected individuals die from complications (liver cancer or cirrhosis). Hepatitis C infection is the leading cause for liver transplants.
Hepatitis C infection in occupational settings can easily be prevented with proper precautions. Taking the same precautions that protect you from HBV and HIV will help prevent transmission of HCV in the workplace.
The typical symptoms seen in an acute hepatitis C infection are similar to acute HBV infections and may include:
Jaundice (yellowed eyes or skin).
Loss of appetite, nausea, or vomiting.
Extreme fatigue and unable to
work.
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Abdominal pain
Is Hepatitis C serious?
In the United States, approximately 8000 to 10,000 persons die each year of chronic liver disease due to hepatitis C infection. Some studies indicate that as many as 85% of individuals who become infected with hepatitis C never fully recover and can carry the virus for the rest of their lives. These persons have chronic hepatitis C, and some may eventually develop cirrhosis (scarring) of the liver and liver failure.
How common are HCV infections?
CDC estimates that 25,000 people become infected every year in the U.S., with about 4000 of the infections being symptomatic for an annual incidence rate of <1/100,000. While the number of new cases is lower than that for hepatitis B infections, and has dramatically decreased over the last 20 years (about 90%), approximately 2.7 million people in the US are chronically infected. In the US, the number ever infected with hepatitis C is 1.8% of the population.
Is there a treatment for Hepatitis C infections?
Currently, there is no cure for hepatitis C, and no effective vaccine is currently available. However, clinical trials are being proposed for an experimental HCV vaccine. As such, national recommendations for the control of occupational exposure to HCV rely more on the prevention of transmission through engineering and work practice controls. In addition, several blood tests that qualitatively (or quantitatively) measure either antibodies to HCV or HCV-RNA are available for hepatitis C screening. These are useful in determining current immune status and the presence of infectious particles in an ongoing infection.
In the event a person has anti-HCV antibodies but develops an elevation in liver enzyme levels, there is a combination therapy of pegylated interferon and ribavirin thas has been shown to sustain response rates in 40-80% of chronic cases. Currently, there are no guidelines for the treatment of acute infections. Individuals are advised to consult with a physician familiar with hepatitis C.
Question 1:
If you have the potential for occupational exposure to Bloodborne Pathogens, you may request a vaccine for which infectious disease or agent?
HIV
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Hepatitis B
Syphilis
Question 2:
How much has the incidence of Hepatitis B virus infection among research and health care personnel decreased due to the use of the Hepatitis B vaccine?
50%
75%
95%
Question 3:
Of the bloodborne pathogens below, which of these agents has the highest risk of disease transmission following a percutaneous exposure in a non-immune
individual?
HIV
Hepatitis B
Hepatitis C
Hepatitis C Virus (HCV)
What are the risks associated with occupational exposure to HCV?
While the overall risk is lower than it is for HBV, the most common mode of occupational transmission of HCV to healthcare workers is by accidental needle stick or sharps exposure to HCV positive blood. Approximately 1.8% of healthcare and research personnel will become infected with HCV after percutaneous exposure to contaminated blood. Transmission of HCV through exposure to mucosal membranes is rare and there are no
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known cases of occupationally acquired HCV through exposure to intact or non-intact skin. In order to prevent HCV transmission in healthcare or research personnel, IUPUI requires all staff exposed to blood or OPIM potentially contaminated with HCV to use appropriate engineering and work practice controls.
Can HCV survive in the environment?
Similar to HBV, HCV cannot reproduce outside the human body and is susceptible to a variety of common disinfectants, including bleach. There is minimal information available regarding the ability of HCV to survive in the environment. Some studies suggest that HCV may only remain infectious for several days while others draw analogies to HBV and propose HCV may survive for weeks in dried blood. Epidemiological studies tend to agree that environmental exposure to HCV is not a significant risk for healthcare or research workers. Even needle stick accidents have a relatively low risk of infection (1.8%), but remember that HCV is the leading cause of chronic liver infections and diseases. As stated for HBV, routine disinfection and housekeeping should be standard practice in your work areas.
Isn't Hepatitis A (HAV) the same as HBV or HCV?
Hepatitis A virus is responsible for 20-25% of all cases of infectious hepatitis worldwide and the annual number of acute cases is twice that of HBV and ten times that of HCV. While HAV does not result in chronic infections or liver diseases, it is estimated that almost one third of the US has been infected at some time. This sounds like an important occupational hazard, but the reason it is not discussed in detail is that HAV is NOT a bloodborne pathogen. The virus is primarily transmitted through the fecal-oral route as a result of ingesting food or water contaminated with fecal material from an infected person or animal.
There is an effective vaccine available and is usually recommended for travelers into certain regions where HAV is endemic. Occupational hazards do exist for persons who work with HAV-infected nonhuman primates and the vaccine may be a worthwhile preventative measure.
If you have questions about hepatitis A, contact the Biological Safety Officer for more information.
Taking into account both prevalence in the population and risk of transmission from an exposure, which of the following represents the greatest risk at the
present time to research and health care workers?
HIV
HBV
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HCV
Occupational Exposure to Bloodborne Pathogens
Preventing occupational exposure to bloodborne pathogens is an important aspect of the Biosafety Program at Indiana University-Purdue University Indianapolis. In order to protect all affected staff and personnel, we have developed an Exposure Control Plan that outlines the requirements of the Bloodborne Pathogen Standard and details standard procedures and protocols for the safe handling and disposal of human blood and Other Potentially Infectious Materials (OPIM).
The Exposure Control Plan is available online at the Environmental Health & Safety web page. Likewise the IUPUI Biosafety Manual contains additional information on work practices and controls as well as agent specific information.
Preventing and eliminating potential exposures to blood and OPIM in your work site is the most effective way of reducing infections by bloodborne pathogens. The IUPUI Exposure Control Plan applies to all employees of IUPUI with potential exposure to bloodborne pathogens in the workplace. Employees must comply with all elements of the Exposure Control Plan, especially those that apply to work-related tasks and procedures that may involve any potential exposure to bloodborne pathogens.
Specific controls, equipment, and preventive measures are used to control exposures. The specifics of these will be reviewed shortly. However, to better understand how these controls work, let's review the basics on how bloodborne pathogen infections can occur.There are several ways in which a bloodborne pathogen can be transmitted. The most efficient and common means of occupational transmission is percutaneous, or the direct inoculation of infectious material by piercing through the skin barrier.
In the workplace this might occur as a result of needle stick or other accidental injury with a sharp, contaminated object, which is capable of penetrating the skin. Direct inoculation is also possible when exposure of blood or OPIM to preexisting lesions, cuts, abrasions, or rashes (dermatitis) provides a route of entry into the body.
A second mode of transmission is for infected blood or OPIM to contact the mucous membranes of the eyes, nose, or mouth. Therefore, splashing blood or serum into an individual's unprotected eyes, nose, or mouth in clinical or laboratory settings poses a genuine risk of infection.
It has been well documented that employees with occupational exposure to blood and other potentially infectious materials containing bloodborne pathogens face a significant health risk. This risk can be minimized or eliminated using a combination of administrative, 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.
The following safety principles shall be followed by all personnel when working with materials potentially contaminated with bloodborne pathogens:
Always consider the risk of exposure to bloodborne pathogens to be present. An underestimation of the risk will increase the risk of exposure.
Universal Precautions are to be used at all times when working with blood or OPIM.
Institute as many engineering controls and work practice procedures as possible to eliminate or minimize exposure to bloodborne pathogens. This includes the Solicitation of Input from Non-Managerial Employees (discussed later) and utilization of safer medical devices.
The primary strategy for reducing or eliminating occupational bloodborne pathogen infections remains to be exposure prevention. However, occupational exposures will continue to occur and organizations like IUPUI make available to staff a system that includes written protocols for the prompt reporting, evaluation, counseling, treatment, and follow-up of all occupational exposures that may place IUPUI staff at risk for infection. There needs to be available training on the risk and the prevention of bloodborne infections, including the availability of the vaccine for hepatitis B. Employers are required to allow for the Solicitation of Input from Non-Managerial Employees and promote the use of safer medical devices where feasible.
In addition to being well informed regarding the hazards associated with bloodborne pathogens, IUPUI employees have additional responsibilities.
All IUPUI employees working with bloodborne pathogens or having the potential for occupational exposure must accept a shared responsibility for conducting their job-related duties in a safe manner. Ultimately each individual is responsible for his/her own safety by:
adhering to Universal Precautions when working with blood or OPIM;
utilizing the the facility Biosafety Manual as a resource and applying all applicable biosafety guidelines to their specific work practices;
recognizing which tasks demonstrate the potential for occupational exposure to bloodborne pathogens;
preplanning and conducting all research in accordance with approved protocol procedures and by following all exposure control and site specific safety procedures;
remaining compliant with the OSHA Bloodborne Pathogen Training requirement (initial and annual refresher training);
reporting all hazardous conditions to the supervisor and promoting ways to eliminate occupational exposure to bloodborne pathogens (Solicitation of Input from Non-Managerial Employees);
reporting any job-related injuries or illnesses to your supervisor and Employee Health Services and seek treatment immediately ;
requesting information and training when unsure how to work with blood and OPIM;
paying particular attention when sharps are used;
and by using all available engineering and work practice controls, PPE, and safer medical devices properly.
Question 7:
Where can you get a copy of the IUPUI Exposure Control Plan?
ELVIS
Safety Coordinator
Environmental Health and Safety
More than one of the above
Applying Universal Precautions to the Workplace
According to the CDC, Universal precautions are intended to prevent parenteral, mucous membrane, and nonintact skin exposures of health-care workers to bloodborne pathogens. In addition, immunization with HBV vaccine is recommended as an important adjunct to universal precautions for health-care workers who have exposures to blood. At IUB & IUPUI, this includes research personnel who may not have direct patient contact, but work with potentially infectious material while performing their assigned tasks and duties.
Since August 1987, the Centers for Disease Control and Prevention have defined Universal Precautions as:
"Since medical history and examination cannot reliably identify all patients infected with HIV or other blood-borne pathogens, blood and body- fluid
precautions should be consistently used for ALL patients."
Furthermore, Universal Precautions apply not only to human blood and body fluids
containing visible amounts of blood, but also to Other Potentially Infectious Material. OPIM or Other Potentially Infectious Materials include for example:
unfixed human tissues, cell lines and cultures of human origin, semen, vaginal secretions, cerebrospinal, synovial, pleural, peritoneal, pericardial, and amniotic fluids.
It is important to note that Universal Precautions also include continuous human cell cultures as well as other human derived materials capable of carrying bloodborne pathogens (e.g., serum). In addition, animals infected with bloodborne pathogens are also covered under the Bloodborne Pathogen Standard and Universal Precautions.
The following materials and fluids (excreta and secreta) are considered to be at low risk of transmitting bloodborne pathogens:
feces, nasal secretions, sputum, sweat, tears, urine, vomit, or saliva unless they contain visible blood. However, there may be instances when a staff member finds it difficult or impossible to differentiate between body fluid types. In those cases a conservative approach is warranted and all fluids should be treated as if potentially infectious.
Question 8:
Which of the following is NOT a component of Universal Precautions?
Hepatitis B vaccination
Personal protective equipment
Isolation of any patient suspected of having HIV, HBV, or HCV
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Handwashing
Question 9:
Which of the following material could potentially contain bloodborne pathogens and is covered under Universal Precautions?
Bloody saliva
Semen
Human cell cultures
Vaginal secretions
All of the above
Exposure Control at IU Bloomington
The following categories represent various exposure control methods that shall be utilized by IUB personnel covered under the Bloodborne Pathogen Standard. The general concept is to place a barrier between you and potentially infected materials.
Administrative Controls
Engineering and Work Practice Controls
Personal Protective Equipment (PPE)
Housekeeping
Administrative Controls include the Bloodborne Pathogen Standard, the IUB/IUPUI Exposure Control Plan, the IUB/IUPUI Biosafety Manual, research only performed according to approved protocols, and any lab specific procedures that ensure a safe work environment.
According to the new definition from the CDC, Engineering Controls ... means controls (e.g., sharps disposal containers, safer medical devices, such as sharps with engineered sharps injury protections and needleless systems) that isolate or remove the bloodborne pathogens hazard from the workplace. They also include facility design, containment and safety equipment such as biological safety cabinets (BSCs), sealed centrifuge rotors, covered incubator shakers, eyewash stations, autoclaves, and mechanical pipets.
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Work Practice Controls includes personal activities such as frequent hand washing, good microbiological practices, and no mouth pipetting. It also involves altering the way a task is performed in order to reduce or eliminate exposure.
Personal Protective Equipment includes eye and face protection (safety glasses, goggles, face shield), gloves, lab coats, and all other equipment worn to prevent exposure to bloodborne pathogens.
Housekeeping does not refer to routine waste disposal from your work area. What it 16
involves is the routine cleaning and disinfection of all equipment and work surfaces.
Each of these exposure control methods will be discussed in more detail in the following pages.Engineering and Work Practice Controls
Employers must select and implement appropriate engineering and work practice controls to reduce or eliminate employee exposure. The selection of these engineering and work practice controls is dependent on the employer's exposure determination.
Some important Work Practice Controls are as follows.
Hand washing is very important in order to reduce the possibility of spreading infectious agents through contact contamination. Hands must be washed immediately after removal of gloves or other personal protective equipment prior to leaving your work area.
Never bend, recap, shear or remove contaminated needles if at all feasible. Dispose of them in a sharps container immediately.
If you must recap sharps (e.g., needle), use a one-handed scoop or mechanical device designed for that purpose. IUPUI prohibits recapping by a two-handed technique.
One important warning is to NEVER recap by pressing down on the cap end itself. The possibility of the needle coming through the end warrants utmost care when handling contaminated sharps.
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Ideally, sharps shouldn't be recapped and should be disposed of immediately after use.
Rollover the following images to better view the inappropriate activity.
Do not eat, drink, apply cosmetics or lip balm, or handle contacts in your work area where there is a potential for exposure to BBPs. Additionally, extra care should be taken to avoid contact of contaminated materials with open lesions, including new skin or ear piercings.
Remember: the work area is distinct from a clean area. Most departments have a designated area where food may be stored and eaten and this does NOT include a desk in a laboratory. Absolutely no lab materials are to be brought into these areas, including gloves and lab coats.
Do not store food or drink in laboratory refrigerators, freezers, on countertops, or in any other laboratory storage area.Engineering Practice Controls
Devices designed to reduce the potential for contact with contaminated materials help to create a barrier between IUPUI staff and bloodborne pathogens.
Keep in mind, if you have questions about these procedures or engineering controls, please contact your supervisor, safety coordinator or the Biosafety Manager.
IUPUI staff shall use mechanical pipetting devices at all times. Mouth pipetting/suctioning of any material is strictly prohibited.
It's amazing to think that 30 years ago, techs in a blood bank would use a cannula to mouth pipet blood samples for ABO-typing on slides.
When procedures involving the use of blood or OPIM that has the potential to result in splashing, spraying, or the generation of droplets of these substances, the best engineering device available is the Biosafety Cabinet (BSC), also known as a laminar flow hood or a tissue culture hood. All activities involving potentially infectious materials capable of producing droplets, splashes, spills, or aerosols must be conducted in BSCs or other physical containment devices.
Examples include vortexing samples or opening blood collection vacuum tubes.
Sharps Containers are used for the disposal of contaminated sharps. Sharps containers must be closable, puncture resistant, leakproof, accessible, and replaced routinely.
One of the most common causes for an accidental needlestick is due to overfilling a sharps container.
Contaminated sharps must never be pushed into a sharps container.
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Place specimens of blood or OPIM in containers which prevent leakage during collection, handling, transport and storage
Engineering Practice Controls - continued
Following passage of the Needlestick Safety and Prevention Act, P.L. 106-430, OSHA revised the Bloodborne Pathogen Standard to now require that employers incorporate safer medical devices in the workplace. These are referred to as sharps with engineered sharps injury protections and needleless systems that effectively reduce the risk of an exposure incident.
Keep in mind, if you have an idea on how to make your workplace safer, the Solicitation of Input from Non-Managerial Employees requires that employers consider the ideas, implement any appropriate engineering controls/devices, and train employees on their safe use. Any staff with questions regarding these new engineering controls, are encouraged to contact their supervisor, safety coordinator or the Biosafety Manager.
One example of these new safer medical devices is the "self-sheathing" feature on hypodermic syringes.
Another hypodermic syringe with a built in feature involves a "retractable technology" for removing the needle hazard.
"Add-on" safety features are also commercially available.
There are even "blunt-tipped" technologies that remove the needle hazard by obscuring the point from within the needle lumen itself.
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Other examples include "gliding mechanisms" that effectively remove the needle hazard after their use.
Scalpel blades are also addressed and available with "built-in" safety features or intended as single use and disposable.
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Needleless Systems are devices that do not use a needle for the collection of body fluids, administering fluids or medications, or any other procedure with the potential for a percutaneous exposure. Here is an example of a needleless IV connector.
Personal Protective Equipment
The use of Personal Protective Equipment (PPE) is a very important aspect of exposure control.
However, keep in mind that PPE is the last line of defense if everything else fails. Please do not rely on PPE alone and make sure that the appropriate engineering and work practice controls are used.
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The selection of PPE should be made based on the anticipated exposure to potentially contaminated blood or OPIM.
Gloves should be:
The type appropriate for the task. Available in appropriate sizes.
Available in hypo-allergenic materials if needed.
PPE is considered appropriate only if it does not permit blood or OPIM to come in contact with skin, eyes, mouth, or other mucous membranes under normal working conditions. Safety glasses are a minimum and face shields or masks may be required.
Clothing (scrubs, lab coats) should be fluid-resistant and worn when the potential for splashing or soak through exists. Contaminated clothing should be laundered through IUPUI services and not taken home.
You are required to routinely use appropriate barrier precautions to prevent skin and mucous membrane exposure when working with human blood or OPIM.
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This might include:
Gloves Protective Clothing
Eye and Face Protection
Respiratory Protection
REMEMBER - Potentially contaminated PPE MUST be removed and hands washed prior to leaving the area where it was used!Gloves deserve a few additional comments
It is important to keep in mind that disposable gloves are by name, intent, and function exactly that: Disposable.
Don't wash or attempt to disinfect them for reuse. Don't save money by reusing them after removal. In the event they become visibly soiled, torn or punctured, or potentially compromised in their ability to function as a barrier.... dispose of them immediately.
If you are, or become allergic to latex gloves, your employer is responsible for supplying alternatives to you. These include options such as nitrile gloves,
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hypoallergenic gloves, glove liners, and powderless gloves.
Can I use utility gloves in the lab?
Utility gloves (e.g., rubber household gloves) can only be used for housekeeping chores such as when cleaning equipment or during decontamination procedures. They can be decontaminated and reused, but must be discarded and replaced if they are peeling, cracked, discolored, or if they have punctures, tears, or show any other evidence of deterioration.
If I'm only touching frozen samples, gloves aren't really necessary...right?
A technician working in the anthrax reference lab in Texas gave himself cutaneous anthrax after handling frozen vials. Because he was not wearing gloves, contact contamination from the vials infected a fresh shaving cut on his jaw. Always wear gloves when han
Biohazard Waste Segregation
Sharps are disposed of by placing them in puncture-resistant sharps containers.
Sharps include items that are sharp in their original form or can become sharp upon bending or breaking.
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Non-sharp items, including disposable gloves, gowns, and barrier materials are placed in an infectious waste bag for disposal.
Biohazard Waste TreatmentBiohazardous waste treatment is accomplished by following these steps.
Autoclave biohazardous waste within your department or building. Assure that the treated waste is marked as "treated".
Dispose as ordinary trash in the normal waste stream.
Emergency Procedures
IN CASE OF AN EMERGENCY (Fire, Medical and Major Spills)
CONTACT HELP IMMEDIATELY:
For Police, Fire, or Medical Emergencies call: 911
GIVE THE OPERATOR THE FOLLOWING INFORMATION: A. Emergency location, name and phone number. B. Assistance needed.
C. Stay on the line for further instructions.
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For Non-Emergency Situations, Contact the IUPUI Police Dispatcher at 274-7911 (4-7911)
Refer to Site or Local Emergency Procedures for useful information on chemical, biological and radiological spills, fire, evacuations and tornadoes. Additional Information Resources
IUPUI Emergency Information at www.iupui.edu/~iupuiemg Recorded Announcements on the Operating Status of the Campus - 278-1600
IUPUI Radio Station AM 1610
IUPUI Emergency Alert Radio - Contact EHS at 274-2005, or order online at http://www.ehs.iupui.edu/ehs/radio_order_new.asp
Hepatitis B Vaccine
An important reminder: For a susceptible person, the risk of infection from a single needlestick of HBV-infected blood can be as high as 1 in 3. Meanwhile, personnel that have received the HBV vaccine and seroconverted are at virtually no risk of infection.
This vaccine is required at the time of your initial entry into the nursing program, The vaccine is a safe, recombinant product administered as 3 injections over a six month period. It is very effective, giving the recipient long-lasting immunity, and is HIGHLY RECOMMENDED.
The vaccine is voluntary. If you choose, you can decline the hepatitis B vaccine, however you will need to sign the Acceptance/Refusal Form for HBV vaccination.
Note!
You can change your mind at any time and receive the vaccine.
The waiver is not permanent and may be rescinded at any time.
When, and if, a safe and effective vaccine for any other bloodborne pathogen becomes available, IUPUI will make every effort to offer it to you. If you work with non-bloodborne pathogens, contact Occupational Health Services or the Biological Manager for the availability of other vaccines.
Exposure Incident Reporting An exposure incident is defined as any contact with potentially infectious materials that can result in the transmission of disease and requires medical treatment.
In the rare situation that human blood or OPIM comes in direct contact with the mucous membranes of your eyes, nose or mouth (e.g. splash), or blood or OPIM enter through your skin because of a cut, needlestick, or break in your skin, or comes in contact with non-intact skin (rashes, cuts, and abrasions) that's when - You have an exposure!
The following action is necessary for exposure incident follow-up:
In the event of a needlestick, make the site bleed.
Wash or flush the affected area(s) with running water for at least 15 minutes. Don't hesitate!
Your prompt (re)action in flushing will significantly decrease your chance of infection. Contact your supervisor and report the incident IMMEDIATELY!
Complete an Incident Report.
Go to Student Health Services at the corner of 10th and Jordan for a medical evaluation.
During evenings or weekends, report directly to the Bloomington Hospital Em. Dept.
By the way, getting blood or OPIM on your gloves or lab coat is NOT an exposure, because it has not penetrated your skin. Just change gloves or coats, wash hands and you are ready to go. Splashing blood on your shirt sleeve could be considered an exposure incident, especially if non-intact skin is involved - but because you always wear your lab coat in your work area this shouldn't be an issue...right?
Biohazard Warning Signs
Labels are required in the following instances:
Biowaste containers; Refrigerators or freezers used to store blood or other infectious materials;
Containers for sorting, transporting, or shipping blood or other infectious materials;
Contaminated equipment requiring handling for service, repair, or shipping.
Equipment
All equipment that is used for blood or other potentially infectious materials needs to be labeled with the biohazard symbol.
NO... you don't have to label each tube...
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YES... the incubator needs to be labeled...
For more information on labeling refer also to the Biosafety Manual, as it addresses other biosafety related containment procedures.
If equipment is potentially contaminated and needs to be serviced, be sure to clean and decontaminate it thoroughly. However, sometimes there is no way to clean inside and out. The service technician must be made aware of the situation and the equipment shall have a biohazard label affixed to it.
What should I use???
Housekeeping
Within the context of the Bloodborne Pathogen Standard, remember that housekeeping refers to how you treat your work area and is not related to routine, non-biohazardous waste disposal. Because you expect your work environment to be safe and clean, all work areas shall be maintained in a clean and sanitary condition. Frequency and methods of decontamination should be based on the location within the facility, the type of surface to be cleaned, type of contamination present, and the tasks or procedures currently performed in the work area. The schedule and decontamination procedures are based on the following elements.
1. Work Surfaces
All equipment and working surfaces must be cleaned, then decontaminated after contact with blood or OPIM. Contaminated work surfaces must be decontaminated with an appropriate disinfectant at the following times:
after completion of your procedures; immediately, or as soon as possible, after surfaces are overtly contaminated or after
any spill of blood or OPIM; and
at the end of the work shift if the surface may have become contaminated since the last cleaning.
Don't put yourself at risk, but wear the appropriate protective equipment like gloves, gowns or lab coats, eye protection during clean up.
2. Equipment
If equipment needs decontaminated, be sure to do so thoroughly and appropriately. However, sometimes there is no way to clean inside and out and electrical components can be easily damaged. Consult the manufacturer or the Biosafety Manager for additional guidance.
What should I use???
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EPA registered tuberculocidal disinfectants are the best. How do you know if they are registered? Look at the label and as always use them according to the manufacturers guidelines.
Bleach is also very good. Keep in mind that commercial bleach contains approximately 5% sodium hypochlorite (the active ingredient). Dilute it with water to 0.5 %. That's a 1:10 dilution of commercial bleach with water. Make it fresh, i.e., every 24 hours because it is not very stable and can easily lose its disinfection properties.
Bleach is caustic and considered a hazardous chemical!
Don't use bleach on sensitive equipment, as it will cause corrosion. Contact the Biosafety Manager or refer to the Biosafety Manual for more information on appropriate disinfectants.
Decontamination and Spill Cleanup
If a surface becomes overtly contaminated with blood, OPIM, or any other infectious material, IUPUI has established procedures that shall be followed.
For cleaning up small (specimen-size, less than 100 ml or 4 oz.) spills.
Wear gloves and safety glasses during spill cleanup. Pick up sharp items with tongs or other mechanical means and not with hands.
Dispose of all sharps in an appropriate sharps container.
Absorb spill by covering the spill with paper towels.
Apply a disinfectant, such as a fresh 1:10 dilution of bleach, onto the paper towels left in place.
Allow decontamination to proceed for 15 minutes.
Apply a final treatment of disinfectant to the spill area and cleanup with paper towels.
Dispose of all residue and paper towels in a biohazardous waste container.
Don't put yourself at risk, but wear the appropriate protective equipment like gloves, gowns or lab coats, eye protection during clean up.
Larger spills are the responsibility of Environmental Health & Safety. However, if you are uncertain about cleaning up a smaller spill please contact the Biosafety Manager. Contact the Biosafety Manager or refer to the Biosafety Manual for more information on appropriate disinfectants.
Question 10:
How long do you have to wait until you can request Hepatitis B vaccination after signing a waiver stating that you don't want the vaccination?
