Policy for Immune Compromised Personnel working in Research Settings

Transcription

1 Plicy fr Immune Cmprmised Persnnel wrking in Research Settings Plicy and Scpe It is the plicy f the University f Califrnia San Dieg (UCSD) that all persnnel wh wrk in research labratries r handle animals will receive educatin and training regarding risks specific fr their wrk area and jb duties. As part f this training, infrmatin will be given regarding causes and risk factrs fr immune cmprmise. It will be prvided befre starting wrk, with annual training updates thereafter. This plicy applies t all immune cmprmised labratry persnnel wh may be at increased risk fr develpment f infectius diseases as a result f research activities. Research activities include persnnel wh wrk directly with ptential pathgens as well as persnnel wh have expsure because they wrk in the same labratry space where infectius agents are studied. Examples frm this grup include ACP emplyees, research labratry staff, EH&S staff, facilities staff, and custdial wrkers. Educatin and Training f Labratry Wrkers and Trainees In additin t infrmatin and cunseling n specific labratry hazards, persnnel will be advised that individuals wh are immune cmprmised are mre susceptible t infectin by infectius agents that pse little risk fr healthy individuals. Individuals will be given an infrmatinal handut r webpage link with educatinal and cntact infrmatin in the event they have any questins. Persnnel with immune cmprmise will nt be asked t identify themselves during training, but will be referred t resurces cited in the handut/webpage in the event they have any questins r cncerns. Cunseling f Immune Cmprmised Labratry Wrkers and Trainees Regarding Risk At the time f hire: All persnnel will be advised during IIPP/Labratry and/r Orientatin t Animal Research training abut the increased risk f illness in immune cmprmised wrkers as a result f infectius disease expsure in the wrkplace Immune cmprmised persnnel will be encuraged t cntact the Bisafety fficer r EHS Occupatinal Health Nurse t develp a list f ptential pathgens in their wrk area. An individual risk assessment will be cmpleted based n the labratry BUA(s) and/r research animal envirnment. All persnnel wh receive a risk assessment will be encuraged t discuss the results f the risk assessment with their primary care physician and/r UCSD Center fr Occupatinal and Envirnmental Health (COEM).

2 In the event persnnel have persistent cncerns regarding risks f emplyment, they may be advised t make an appintment with COEM. COEM will assess risks and advise persnnel regarding resurces and ptins. The cst fr this appintment may be cvered either by the individual s department r wrkers cmpensatin, depending n the circumstances. Persnnel will be advised f the UCSD accmmdatin services available thrugh Accmmdatin Cunseling and Cnsulting Services (ACCES). During the curse f emplyment: Annual educatinal material regarding the risks fr immune cmprmised individuals will be prvided t all research persnnel (e.g., via Lab Ntes, ACP staff meetings, etc.). Emplyees are encuraged t seek advice regarding ptential infectius hazards frm the Bisafety Officer r EHS Occupatinal Health Nurse, in additin t cnfidential cunseling and/r risk assessment frm their Primary Care Prvider, COEM, and/r ACCES. Resurces: Bisafety Officer, Brenda Wng Envirnment Health and Safety Phne: bwng@ucsd.edu Occupatinal Health Nurse, Bbbi Sawtelle Envirnment Health and Safety Phne: bsawtelle@ucsd.edu UCSD Center fr Occupatinal and Envirnmental Medicine (COEM) La Jlla Clinic: Hillcrest Clinic: UCSD Accmmdatin and Cnsulting Services (ACCES) Phne:

3 Infrmatin fr Immune Cmprmised Persnnel in the Research Setting What is immune cmprmise? Immune cmprmise, als referred t as immuncmprmise r immunsuppressin, is a cnditin in which the immune system des nt wrk as well as it des in nrmal healthy wrkers. Immune cmprmised persnnel are at higher risk f illness and/r mre serius side effects f illness caused by an infectius disease. What cnditins cause immune cmprmise? There are many medical cnditins that cause immune cmprmise. In general, if yu have a medical cnditin that causes prblems with yur immune system, yur primary physician will have infrmed yu. Sme examples include: Infectin with Human Immundeficiency Virus (HIV) Prlnged use f crticsterid (crtisne) medicatins by muth r by injectin. These drugs are given fr a variety f diseases including asthma, allergies, and autimmune disrders such as lupus and rheumatid arthritis. Mnclnal antibdy therapy Medicatins used by peple wh have received rgan transplants Lng term diabetes mellitus, kidney r liver disease Bld diseases (diseases that affect the bne marrw r white bld cells, fr example leukemia r lymphma) Certain frms f cancer, leukemia, and lymphma. Cancer chemtherapy and radiatin therapy Chrnic under nutritin (malnutritin) Pregnancy will cause sme degree f immune cmprmise (i.e., Listeria, LCMV) Spleen remval If I am immune cmprmised, what infectins am I at increased risk fr? Almst any f the infectius disease agents that can infect healthy peple pse mre f a risk f infectin fr peple wh are immune cmprmised. Bacterial, viral, parasitic, and fungal agents may be present in research labs. A few examples include: Tuberculsis (TB) Human Immundeficiency Virus (HIV) Streptcccus pneumnia Herpes viruses Leishmania Enteric infectins such as salmnella, campylbacter and cryptspridium Many infectius agents that d nt nrmally cause serius health prblems in healthy peple can cause prblems in immune cmprmised individuals. A few examples include: Mycbacterium marinum (fund in fish tanks) Mycbacterium avium (fund in birds) Cryptspridium (fund in many animals in the research labratry) Giardia (fund in cats, dgs, and sheep) Salmnella (fund in many different research animals, especially reptiles/rdents)

4 Shigella and campylbacter (fund in many mammalian research animals) Ectparasites such as mites (fund in many research animals including birds, rdents and ther mammals) Brdetella species (dgs, cats, pigs and ther mammals) Bartnella species (cats and cat fleas) Which vaccines are safe fr immune cmprmised peple? Befre receiving any live bacterial r viral vaccines, yur persnal physician/prvider shuld be cnsulted since these medicatins may pse risks f severe side effects: MMR (mumps, measles and rubella) Yellw fever vaccine Varicella (chicken px and shingles vaccines) In general, ther vaccines that d nt cntain live bacteria r viruses are safe, but may be less effective and supply less prtectin in the case f labratry expsure: Hepatitis vaccines Inactivated pli vaccine Tetanus, diphtheria and pertussis vaccines In general, the tuberculin skin test is cnsidered safe fr individuals with immune cmprmise but may be less accurate than in a healthy individual. If I am immune cmprmised, what can I d t reduce my risk f infectin? It is imprtant t ask fr help in evaluating yur risks. The fllwing resurces are available: Knw yur wrkplace: UCSD Envirnment Health and Safety (EH&S) in cnjunctin with the Institutinal Bisafety Cmmittee (IBC) cnduct risk assessments f research prjects and prcedures t identify and minimize the ptential risk f expsure t research-related hazards fr all emplyees. In additin t identifying pssible hazards in the wrkplace, EH&S/Research Safety can help t evaluate engineering cntrls and safety practices which minimize yur risk f expsure. In general, safety practices in the research setting are designed t minimize all persnnel s expsure t hazards. Fr specific infrmatin abut animal research settings, refer t Appendix A. Talk t yur Prvider: A primary care physician/prvider wh is aware f yur medical cnditin and has a list f infectius agents present at wrk can help yu make imprtant decisins regarding whether yu shuld ask fr wrk place accmmdatin. In additin t discussing the infectius agents present in yur wrkplace with yur dctr, yu shuld als discuss with the dctr yur wrk activity, frequency and duratin f cntact with infectius agents, and the nrmal safety practices and equipment present in yur wrkplace. Cnsult with the EHS Occupatinal Health Nurse: After talking t yur physician t discuss infectius agents present in yur wrkplace and yur health cnditin, if medical recmmendatins r restrictins are necessary t minimize expsure, the EHS Occupatinal Health Nurse can assist in dcumenting medical recmmendatins.

5 Cntact UCSD Accmmdatin and Cnsulting Services (ACCES): If jb mdificatins r accmmdatins are needed t avid pssible wrkplace expsures, cntact ACCES fr assistance. What else can I d t reduce my risk? Always use the recmmended engineering cntrls (such as bisafety cabinets) Always wear the recmmended persnal prtective equipment Always wash yur hands after cntact with animals, ptential hazards, and after taking ff glves. Ask fr help in requesting accmmdatins in the wrkplace t avid pssible expsures What shuld I d if I have symptms that suggest a wrk related infectin, illness r injury? If yu have any symptms suggestive f infectin frm yur wrkplace, yu shuld seek medical evaluatin as sn as pssible. If yur cnditin requires emergency treatment, yu shuld g t the clsest Emergency Department fr evaluatin. Ntify yur supervisr and fllw the UCSD incident reprting prcess per the BLINK webpage: UCSD emplyees shuld cntact COEM t schedule an appintment fr evaluatin and treatment. Where can I get mre infrmatin? Fr a persnalized evaluatin f wrkplace hazards, cntact EHS/Research Safety: Bisafety Officer, Brenda Wng, bwng@ucsd.edu, Occupatinal Health Nurse, Bbbi Sawtelle, bsawtelle@ucsd.edu, Fr respiratr evaluatin, cntact EHS: Occupatinal Health & Hygiene Services (OHHS), ehsih@ucsd.edu, Fr Cnfidential Medical Assessment r Medical Treatment f Suspected Occupatinal Infectius Disease, cntact: EHS/Occupatinal Health Nurse, Bbbi Sawtelle, bsawtelle@ucsd.edu, Center fr Occupatinal and Envirnmental Medicine (COEM) La Jlla lcatin: Hillcrest lcatin: Fr Cnfidential Cunseling and Accmmdatin Assistance, cntact UCSD Accmmdatin and Cnsulting Services (ACCES):

6 Appendix A Animal Care Prgram Risk Assessment Infrmatin fr Immune Cmprmised Individuals UCSD Envirnment Health and Safety (EH&S) in cnjunctin with the Institutinal Animal Care and Use Cmmittee (IACUC) and the Animal Care Prgram (ACP) cnduct risk assessments f research prtcls and prcedures t identify risk mdificatins that will minimize the ptential risk f expsure t hazards fr all emplyees. Safety cnsideratin meetings are held with essential persnnel prir t the start f animal research wrk invlving BSL2 agents t review all safety practices, engineering cntrls, persnal prtective equipment, and bimedical waste practices. In the animal care facilities, this risk assessment has resulted in implementatin f the fllwing safety practices and risk mdificatins: Engineering Cntrls Use f Bisafety Cabinets, Fume Hds, Dwndraft tables, and/r ther engineering cntrls are the primary methd in use t minimize ptential fr expsure t animal allergens, infectius agents, and chemicals. Dispsable cages t minimize handling f cntaminated bedding/waste. When engineering cntrls are nt an ptin, apprpriate wrk practices r persnal prtective equipment are required t prtect all wrkers frm ptential expsure. Administrative Cntrls/Wrk Practices Hand hygiene: washing hands after glve remval N fd, beverage, smking, handling f cntacts, applying csmetics, r taking medicatins in research wrk areas Prmpt sanitatin f bisafety cabinets r wrk surfaces after cmpletin f prcedures r if spills ccur. When high risk infectius agents (e.g., risk grup 2) are used in a prject, a safety cnsideratins meeting is held with essential persnnel t review safe wrk practices and equipment use. Persnal Prtective Equipment Persnal prtective equipment in animal facilities includes: Scrubs, gwn, glves, hair and she cvers. Additinal persnal prtective equipment may be available upn request (e.g., sleeve cvers, aprns, masks, safety glasses/gggles). If risk f aerslizatin r ther airbrne expsure is present when engineering cntrls are nt available, apprpriate respiratry prtectin is required, including medical clearance, training and fit testing. As in the health care setting, an N95 mask is generally apprpriate fr prtectin frm aerslized r airbrne infectius agents in the animal use areas. Hwever, it shuld be nted that despite fit testing, the N95 mask may nt prvide 100% prtective factr in the actual wrk setting due t multiple factrs, such as emplyee technique in dnning and/r adjusting the mask and type f wrk activity r level f exertin. Alternate respiratr ptins such as half and fullface cartridge respiratrs and pwered-air purifying respiratrs (PAPR) may be discussed with EHS/OHHS.

7 General Vivarium Hazards and Risks fr immune cmprmised individuals: Research invlving experimentally r naturally infected research animals des present recgnized risks f ccupatinally acquired infectin. In the largest survey f labratry-acquired infectins cnducted t date, research animals r their ectparasites were assciated with abut 17% f the reprted infectins 1. Hwever, it is imprtant t nte that the Natinal Research Cuncil reprts Transmissin f zntic disease in an animal facility that is nt invlved with infectius disease research is rare. 2 Zntic disease risk is variable, depending upn the species, surce f the animal, and the duratin and type f cntact. Risk frm infectius agents used in research animals als varies depending n the species, infectius agent, dsage, rute f administratin, and the duratin and type f cntact. Research animals in use at UCSD are primarily labratry-raised clnies specifically bred fr research purpses and are received frm vendrs wh breed disease-free animals. These clnies f lab research animals pse a very minimal zntic disease risk because they underg regular health mnitring, including a sentinel prgram t detect early signs f infectin within the research animal clnies. There is limited wrk with large animals r wild animals that pse zntic disease risks, but fr this type f research the risk assessment prcess identifies apprpriate safety practices and prcedures t minimize risk f expsure. When infectius agents are in use fr the research, animal care persnnel generally have minimal direct cntact with the infectius agents. They d nt directly handle r administer the infectius agents, as this is dne by trained lab researchers. Direct handling f animals invlved in research using infectius disease agents is generally limited t very shrt duratin tasks, such as: mving the animal int a clean cage placing dirty cages int bihazard bags (reusable and dispsable) autclaving bagged dirty cages, when apprpriate dumping dirty bedding sanitizing equipment and rm These tasks are dne using apprpriate engineering cntrls (e.g., bisafety cabinet, bedding dump statin), administrative/wrk practices, and/r persnal prtective equipment. T minimize the ptential fr animal bites r scratches, persnnel are trained in handling techniques t reduce animal stress. Additinal prtective equipment such as sleeve cvers, duble glving r gauntlet glves may be required fr certain animals psing mre risk f biting r scratching. Fr small animals, ther transfer ptins may be available. Persnnel are trained in prmpt reprting f any wrk-related injuries r expsures s that apprpriate medical evaluatin can be prvided immediately, if needed. 1 Pike, R.M Labratry-assciated infectins: summary and analysis f 3,921 cases. Health Lab. Sci. 13; Natinal Research Cuncil, Occupatinal Health and Safety in the Care and Use f Research Animals, Natinal Academy Press, 1997.