1. BLOODBORNE PATHOGENS Presented by Office of Environmental Health and Safety

2. Goals of training: Knowledge of regulatory requirements Increase awareness of diseases Provide information regarding: –Routes of exposure –Risk of transmission –Prevention

3. Regulated requirements OSHA Bloodborne Pathogens standard –Designed to protect workers –In effect since 1992 –Goal: Prevent occupational transmission of diseases potentially present in blood and bodily fluids –Regulated in Calif. by Title 8

4. Some of the requirements: Written plan Use of controls Cleaning and decontamination program Sharps injury prevention plan Training & protective equipment HBV vaccinations

5. Body fluids that can transmit infection: Blood Semen Vaginal secretions Cerebrospinal fluid Synovial fluid Pleural fluid Pericardial fluid Peritoneal fluid Amniotic fluid Saliva (e.g. dental procedures) Any unfixed human tissue or organ

6. PREVENTION: Universal precautions Treat all blood and other potentially infectious body fluids as if infected Avoid direct contact with blood and body fluids & contaminated materials Wear PPE appropriate for job Practice good housekeeping and personal hygiene

7. Universal precautions – cont. Follow proper decontamination procedures Dispose of all contaminated materials properly Seek prompt medical attention in the event of exposure

8. Personal Protective Equipment Provides a barrier Examples: Latex/PVC gloves Goggles, safety glasses w/side shields Plastic or rubberized gowns/aprons Surgical masks/face shields Pocket mouth-mouth resuscitation masks

9. Special PPE precautions Cover open cuts, rashes, and other broken skin. Check condition before using Remove carefully to avoid contaminating yourself or anything around you Dispose properly Don’t mix contaminated clothing or laundry with other laundry Wash hands thoroughly after removing gloves.

10. Hygiene Wash hands w/ soap and water Don’t keep food or drink in work areas w/ exposure potential Don’t eat, drink, smoke, apply make-up or lip balm, or handle contact lenses Avoid splashing/spattering of potentially infectious materials Don’t suction potentially infectious materials by mouth.

11. Housekeeping Clean up all spills immediately. Clean and decontaminate all equipment and surfaces after contact w/ blood and other potentially infectious materials. Clean and sanitize pails and other reusable waste containers regularly. Replace protective coverings, immediately upon obvious contamination, or at end of work day.

12. Cleaning vs. Sanitizing Cleaning: Removal of infectious agent via mechanical means using a cleaning agent. Sanitizing: Applying sanitizing agent, carefully following label instructions. Contaminated surfaces and equipment must be sanitized!

13. Sharps Injury Prevention Evaluate and provide devices designed to prevent injury –Syringes w/ sliding sheath that engages after use –Needles that retract after use –Shielded or retracting catheters –IV delivery systems w/ catheter port/needle in protective covering Provide training on new equipment Keep a sharps injury log – which includes: –date and time of incident –type of sharp involved –description of incident PI/Supervisor must immediately report all sharps incidents to EH&S

14. Proper Disposal Procedures Contaminated materials Dispose in red, plastic biohazard bag. Tie off bag tightly. Place bag in labeled, rigid container with close-fitting lid. All bags must be transported in labeled rigid containers with close-fitting lids. –Note that this requirement is in effect whenever the waste leaves the point of generation.

15. Disposal - cont. Potentially contaminated sharps Dispose in rigid, labeled sharps containers. Never: –Break off needles or blades –Attempt to retrieve sharps from a sharps container

16. Disposal - cont. Bloodborne pathogen waste cannot remain on campus beyond one week. –Waste is currently picked up by a licensed contractor every Tuesday. Contact EH&S at 8-7422 if you have bloodborne pathogen waste requiring disposal

17. HBV Vaccination HBV vaccination series will be made available to employees at risk of exposure at no cost. Employee may decline series by completing declination form. If employee declines series, may elect to have series at a later time.

18. Post exposure Wash needlesticks/cuts with soap & water. Flush splashes to nose, mouth, or skin with water. Irrigate eyes with clean water, saline, or sterile irrigants. Report the exposure promptly!

19. After exposure incident; employee shall be offered post-exposure evaluation, including at no cost: –Medical exam –Blood testing Post exposure – cont.

20. RISK OF INFECTION from Occupational Exposure Overall risk depends on: # infected individuals in patient population Type and # of blood/fluid contacts Risk factors following exposure: Pathogen involved Type of exposure Amount of blood/fluid involved Amount of virus present in blood/fluid at exposure

21. Bloodborne Diseases HIV/Aids HBV, HCV

22. Risk of infection cont. HIV needlestick/cut: 0.3% HIV mouth/nose/eye: 0.1% HIV skin: 0.1% HBV w/ pre-vaccination: no risk HBV w/o pre-vaccination: 6 ~ 30 % depending on HBV antigen status of source individual HCV: 1.8 %

23. HIV/AIDS Stats cont. As of Dec. 2001: 57 documented cases of occupational HIV transmission to healthcare personnel Primarily from accidental “sticks”

24. AIDS: Advanced HIV Definition: –Fewer than 200 CD4-T cells/mm blood (vs. healthy: 1000+) –Clinical conditions, opportunistic infections and cancers generally not affecting health people

25. Diagnosis of HIV May take 1 ~ 6 months post infection for presence of sufficient # of antibodies using standard blood tests Acute/recent exposures: screen for presence of HIV genetic mat’l Depending on exposure circumstances, more tests may be necessary Prompt disclosure of details re: suspected exposure  Proper diagnosis procedure

26. HIV: Post exposure treatment Determined on a case-by-case basis Treatment should be started within hours Slows spread of HIV and delays start of opportunistic infections/conditions Post Exposure Prophylaxis treatment  80% reduction infection risk

27. HEPATITIS – HBV, HCV Virus that can cause acute liver infections or chronic liver disease (cirrhosis, liver cancer) Approx. 300,000 cases of acute HBV infection annually. 5 ~ 10% become chronically infected Approx. one million chronic carriers HBV: Highly effective vaccine available No cure for HBV or HCV

28. HEPATITUS Routes of Exposure HBV, HCV: Entrance of infected blood into the body. –Includes bodily fluids that could contain blood in amounts not visible to naked eye.

29. HBV Post Exposure Treatment May include: Depends on several factors: Whether source individual is positive for HBV Whether you have been vaccinated Whether the vaccine provided you w/ immunity. No post exposure treatment for HCV

30. Comparison of HBV/HIV HBV: More “sturdy”, can survive outside the body up to a week vs. less than a day for HIV Likely to be more concentrated in blood and bodily fluids Much higher risk of transmission. –One case of HBV transmission in athletics setting.

31. Summary… Use Universal Precautions when in contact with bodily fluids. Use PPE and use it properly Sanitize – don’t just “clean”! Protect yourself from HBV infection –Complete your vaccination series –Get your titer checked