Environmental Health and Safety Offices BLOODBORNE PATHOGENS

Environmental Health and Safety Offices BLOODBORNE PATHOGENS

Purpose! Reduce / eliminate exposure potential Comply with Ohio s Public Employment Risk Reduction Act (reference OSHA) 2!

Exposure Determination! Employees in the following job classifications have reasonably anticipated occupational exposure: Physicians, nurses, and lab technicians at SHC; Nursing Faculty Trainers in Intercollegiate Athletics Employees with first aid responsibilities at the Ice Arena RSC: Lifeguards, Facility Managers, Outdoor Pursuit Center First aiders in Child Studies University Police Officers BSW / BRW who may clean-up blood/body fluid in a work area Chemistry/Biochemistry, Kinesiology who work with blood products 3"

Topics! Bloodborne diseases and their transmission Reducing exposure potential Exposure incidents Hepatitis B vaccine Spill cleanup 4"

Bloodborne diseases and their transmission Percutaneous, parenteral (i.e., through the skin layer) Contact with mucous membranes of eyes, nose, mouth (via splash, direct contact) Sex with infected partner Maternal-Neonatal (i.e., mother to unborn child/infant) Significant risk variables: volume, concentration, mode of transmission, immune status 5"

Bloodborne diseases and their transmission" Universal Precautions! A simple approach to infection control. A concept that assumes that all human blood and certain human body fluids are treated as if known to be infected by bloodborne pathogens. Always Presume Contamination 6"

Bloodborne diseases and their transmission" Terms! BBP (bloodborne pathogens) HIV (human immunodeficiency virus) AIDS (acquired immunodeficiency syndrome) HBV (hepatitis B virus)* OPIM (other potentially infectious materials) *or one of the other hepatitis viruses (e.g., HCV) 7"

Bloodborne diseases and their transmission" Other Potentially Infectious Materials! OPIM! Semen and vaginal secretions Saliva (in dental procedures) ANY body fluid visibly contaminated with blood ALL body fluids in situations where it is difficult or impossible to differentiate between body fluids Other internal fluids from the brain or spine, joints, lungs, around the heart or abdomen, or in the womb Any unfixed (not preserved) human tissue or organ 8"

Bloodborne diseases and their transmission" Not Considered OPIM! Vomit Perspiration Tears Urine Feces 9"

Human Immunodeficiency Virus! Target in Body Risk (contaminated needlestick) Risk (splash to mucous membrane) External viability Vaccine Available immune system 0.3% (1 in 300 chance) 0.1% (1 in 1000 chance) 3 to 5 hrs no H I V Time Span (?) AIDS Source: Centers for Disease Control and Prevention http://www.cdc.gov/oralhealth/infectioncontrol/faq/bloodborne_exposures.htm 10"

HIV Basics Statistics! About 50,000 people get infected in the US with HIV each year. About 1.2 million people in the US were living with HIV at the end of 2011, the most recent year this information was available. Worldwide, there were about 2.1 million new cases of HIV in 2013. About 35 million people are living with HIV around the world. Source: Centers for Disease Control and Prevention http://www.cdc.gov/hiv/statistics/basics.html 11"

Bloodborne diseases and their transmission" Hepatitis! Hepa = liver; titis = inflammation of 6 types = A, B, C, D, E, and G Types B (HBV) and C are bloodborne Type D and G only occurs in those already infected with type B Types A, E spread through fecal-oral mode of transmission Hepatitis B and C can be ACUTE or CHRONIC 12"

Bloodborne diseases and their transmission" Hepatitis B virus! Target in Body Risk from contaminated needlestick External viability Vaccine Available liver 6% - 30%* 7 days yes *depends on the hepatitis Be antigen (HBeAg) status of the source individual Source: Centers for Disease Control and Prevention http://www.cdc.gov/oralhealth/infectioncontrol/faq/bloodborne_exposures.htm 13"

Bloodborne diseases and their transmission" HBV Confirmed Transmission! Percutaneous (i.e., puncture through skin) or mucosal contact with infectious blood or body fluids (e.g., seman, saliva), including: Sex with an infected partner Contaminated needles (esp. I.V. drug use) Birth to an infected mother Contact with blood or open sores of an infected person Sharing items such as razors or toothbrushes with an infected person Source: Centers for Disease Control and Prevention http://www.cdc.gov/hepatitis/hbv/hbvfaq.htm#b1 14"

HBV Symptoms! 30% to 50% of people have initial signs and symptoms. When present, they can include: Nausea, vomiting, fever, abdominal or joint pain Loss of appetite Fatigue Yellowing of the skin or eyes Dark Urine Bloodborne diseases and their transmission" Clay-colored bowel movements Source: Centers for Disease Control and Prevention http://www.cdc.gov/hepatitis/hbv/hbvfaq.htm#b6 15"

Bloodborne diseases and their transmission" HBV facts (U.S.)! About 95% of adults who are exposed to HBV fully recover within 6 months (acute HBV) without medication. About 5% have HBV all their lives (chronic HBV) unless they are successfully treated with medications. The rate of new HBV infections has declined by 82% since 1991 when vaccination of children was first recommended. Source: Centers for Disease Control and Prevention http://www.cdc.gov/hepatitis/hbv/hbvfaq.htm#overview 16"

Exposure Control Methods 1. Signs and Labels 2. Exposure Control Plan 3. Engineering Controls 4. Personal Protective Equipment 5. First Aid Situations 6. Contaminated waste disposal 7. Contaminated laundry 17"

Exposure Control Methods" 1. Signs and Labels! Medical Waste Infectious Waste Infectious Biohazard 18"

Exposure Control Methods" 2. Exposure Control Plan! Covers: Spill response Housekeeping HBV program Exposure incidents Infectious waste disposal PPE Work practices Availability - BBP Trainer or ESRM at: http://http://www.units.miamioh.edu/esrm/training/bloodborne-pathogen-training pathogen-training 19"

Exposure Control Methods" 3. Engineering Controls! Examples: Sharps Containers Biohazard waste bags & boxes One-way valves on resuscitation devices Hand washing facilities 20"

Exposure Control Methods" 4. Personal Protective Equipment! Types Limitations 21"

Exposure Control Methods" 5. First Aid Situations! University Police are designated first responders Encourage self-care if possible Avoid bare-hand pressure without barrier Glove accessibility 22"

Exposure Control Methods" 6. Contaminated Waste Disposal! Infectious Waste Red bags Labeling requirements Biohazard boxes Drop-off sites Sharps disposal 23"

Exposure Control Methods" 7. Contaminated Laundry! Wear gloves for handling and thoroughly wash hands afterwards If blood or OPIM gets on personal clothing, remove it and wash the clothing as soon as feasible following the detergent manufacturer s directions. 24"

Exposure Incidents Blood or OPIM Contacts: 1. Mucous membranes Eyes Mouth Nose 2. Non-intact skin 3. Contaminated Sharp 25"

Exposure Incidents" Exposure Incident Examples! Blood/OPIM splash on non-healthy or non-intact skin (e.g., rash, a recent cut, chapped skin, broken cuticles, skin that is chafed, scraped, etc.) Blood/OPIM splash to eyes, nose, or mouth Puncture injuries with potentially contaminated object (e.g., needlesticks, contaminated glass, etc.) Rubbing eyes or nose with contaminated gloves or clothing 26"

Exposure Incidents" Post-exposure evaluation and follow-up! Confidential medical evaluation and blood testing offered at no cost to employee Voluntary 28"

Exposure Incidents" What is involved in an exposure evaluation?! Report to Miami s Student Health Service Medical personnel will document how the exposure occurred and the route of entry They will request the identity of the source individual and seek consent to test their blood for hepatitis and HIV (you will be given the results of these tests) 29"

Voluntary blood tests Recordkeeping Exposure Incidents" Post-exposure testing! HIV antibody test requires several blood tests over a period of time If medically indicated, you will be offered a vaccine for Hepatitis B 30"

HBV vaccine Noninfectious Produced in yeast cells Developed free of human blood or blood products Used to promote immunity to HB infection in individuals considered at high risk of potentially being exposed to the virus 31"

HBV vaccine" HBV program at Miami University! Eligibility requirements* Administration site (Student Health Services) Schedule (Call SHS for appointment) Consent / Declination procedures * Employees determined to have a reasonably anticipated high risk of occupational exposure 32"

HBV vaccine" Pre- vs. Post-exposure vaccination! Preventive / pre-exposure vaccination protects against unidentified exposure incidents Vaccine series may be initiated following exposure incident Best started within 48-72 hours Student Health Services suggests initiation no later than 7 days after exposure 70 to 75% effective in preventing HBV infection 33"

HBV vaccine" Side Effects! Local effects: redness, soreness, swelling, firmness at site! of injection Generalized effects: slight fever, nausea, vomiting, diarrhea, headache, chills, mild muscle aches and/or joint pain Allergic / hypersensitivity reaction: rash, itching, swelling not limited to injection site No known harmful effects if previously infected or positive for HBV antibody 34"

Contraindications! (Conditions suggesting treatment! should not be administered)! Yeast allergy HBV vaccine" Serious allergic reaction to a prior dose of Hepatitis B vaccine Serious allergic reaction to a component of the Hepatitis B Vaccine Source: Centers for Disease Control and Prevention http://http://www.cdc.gov/hepatitis/hbv/hbvfaq.htm#overview 35"

HBV vaccine" Efficacy! (Vaccine s effectiveness)! Active immunity in greater than 95% of persons completing the series of three injections Immunity projected to last indefinitely Positive immunity protects against all modes of transmission May donate blood if vaccine given as a preventive measure 36"

Spill cleanup Kits Decontamination Precautions Procedure 37"

Spill cleanup" Spill cleanup kits! Accessibility requirements Know the locations of the kits in your work area and make sure you have easy access to them Know how to use your department s kit Follow directions included with the kit and use all personal protective equipment provided in it 38"

Spill cleanup" Decontamination! Use 10% bleach solution for 15-minute soak time* Undiluted bleach for a minimum exposure of 30 seconds EPA-registered TUBERCULOCIDAL disinfectants Check the label of the disinfectant you are using. HIV-Effective does NOT necessarily mean it is effective against hepatitis viruses. *mix solution and use within 24 hours 39"

Spill cleanup" Spill cleanup precautions! Minimize spread of spill Avoid splashing or spraying Assume gloved hands are contaminated Avoid using brushes or brooms Dispose of sharps appropriately 40"

Spill cleanup" Spill cleanup procedure! 1. 2. 3. 4. Secure the site (keep others away) Inspect and put on appropriate PPE In an area free of contamination, position red bag so materials can be dropped in without soiling outside of bag Carefully use only as much decontaminant as you need to saturate the spill area, cover with paper towels, and allow to soak 41"

Spill cleanup" Spill cleanup procedure! 5. 6. 7. 8. For non-level surfaces (e.g., walls), thoroughly clean area with 10% bleach solution (or other EPA-approved disinfectant) and allow to air dry Dispose of sharp objects in a sharps container or a sturdy puncture-resistant container Place all materials in red bag Remove disposable PPE and place in red bag 42"

Spill cleanup" Spill cleanup procedure! 9. 10. 11. 12. Touching outside of red bag only, close and secure with twist tie or knot Decontaminate area again and allow to air dry Arrange for pickup and disposal of red bag Wash your hands with soap and water! 43"

BLOODBORNE PATHOGENS Course Revision 2016 Miami University Environmental Health and Safety Offices! 44"

Information You are encouraged to contact your BBP Trainer or the Environmental Health & Safety Offices to discuss questions you may have regarding this program. Refer to the following websites for more information: http://www.units.miamioh.edu/esrm/training/bloodborne-pathogen-training http://www.liverfoundation.org http://www.cdc.gov 45"