Bloodborne Pathogens

1. Bloodborne Pathogens Training for BIOL 1020 Human Physiology Liston Campus

2. Sources • Oklahoma State University • http://www.pp.okstate.edu/ehs/Training.htm • Wisconsin Department of Health and Family Services • http://dhfs.wisconsin.gov/webcast/dph/bbp.htm • Dr. Denise Yordy • http://faculty.ccri.edu/dyordy

3. Bloodborne Pathogens • Bloodborne pathogens are microorganisms (“small living things”) carried in blood (or other body fluids) that can cause disease in humans • Usually bacteria and viruses “Germ”

4. Diseases • Malaria • Syphilis • Brucellosis • Hepatitis B (HBV) • Human Immunodeficiency Virus (HIV) • Hepatitis C (HCV) All of these are examples of diseases caused by bloodborne pathogens. We are primarily concerned with HBV, HIV and HCV.

5. Hepatitis B (HBV) • “Hepato” = “liver” and “itis” = inflammation, so hepatitis is an inflammation of the liver • HBV, therefore, is a virus that infects the liver

6. Hepatitis B • Given what you already know about the specialization and functions of the liver, do you think that hepatitis B is potentially a major problem or a just minor nuisance? MAJOR PROBLEM! Inflammation of the liver can interfere with normal liver function. Cirrhosis of the liver and liver cancer are potential consequences of HBV infections.

7. Hepatitis B Symptoms • May feel like you have something like the flu • fatigue • abdominal pain • decreased appetite • nausea • jaundice (yellow discoloration of the skin and whites of the eyes) • dark-colored urine Note: Symptoms are highly variable and can even be absent! Symptoms may occur right after exposure or it might take as long as 1-9 months for them to develop.

8. Treatment of Hepatitis B • No cure • No specific treatment • Vaccine available for prevention of disease

9. Hepatitis C (HCV) • Infection of the liver caused by exposure to the hepatitis C virus (HCV), a virus that is not related to HBV

10. Hepatitis C Symptoms Note: Though initial symptoms are often mild and can even be absent, one-half of patients infected with HCV go on to develop chronic disease. Cirrhosis of the liver and liver cancer are possible consequences. • Asymptomatic (no symptoms) • Jaundice • Malaise (a nonspecific sensation of just not feeling well)

11. Treatment of Hepatitis C • No cure • No vaccine available for prevention of disease • Available treatment for chronic hepatitis C is effective only 50% of the time

12. Human Immunodeficiency Virus (HIV) • AIDS or Acquired Immune Deficiency Syndrome • Weakens body’s immune system leaving it incapable of fighting off other diseases • Fatal

13. HIV Infection Stages/ Symptoms • Initial flu-like illness may occur shortly after exposure • Later • Weakness • Fever • Sore throat • Nausea • Headaches • Diarrhea • Weight loss • Swollen lymph nodes • Full-blown AIDS

14. Treatment of AIDS • No cure • No vaccine available for prevention of disease • Available treatment focuses on slowing progression of disease and managing complications

15. Risks of HBV, HCV and HIV • It should now be obvious that people may be infected with HBV, HCV, and/or HIV without being aware of it. These viruses cause diseases that can be fatal, and since there are no cures, we need to focus on _______________. PREVENTION

16. Transmission of Pathogens • Semen • Vaginal secretions • Serous fluid • Pleural fluid • Pericardial fluid • Peritoneal fluid • Amniotic fluid (fluid surrounding developing fetus) While it is obvious that HBV, HCV and HIV can be transmitted by exposure to contaminated blood, other body fluids also pose a risk…

17. Transmission of Pathogens • Cerebrospinal fluid (surrounding brain and spinal cord) • Synovial fluid (in joints) • Saliva (in dental procedures) • Any body fluid that is visibly contaminated with blood. While it is obvious that HBV, HCV and HIV can be transmitted by exposure to contaminated blood, other body fluids also pose a risk…

18. Questions • What body fluids are not considered to be infected with bloodborne pathogen unless they contain visible blood? • sweat • tears • urine • vomitus • feces • nasal secretions • saliva (except in dental settings) • sputum

19. Questions • Why is saliva considered to be contaminated during dental procedures? • When would urine be considered contaminated? There is a risk of bleeding during dental procedures so saliva would be contaminated with blood. Urine is considered to be risky if it is visibly contaminated with blood.

20. Modes of Transmission • HBV, HCV and HIV can be transmitted: • Throughsexual contact • Remember that pathogens can be found in semen and in vaginal secretions • Through shared hypodermic needles • A used needle is contaminated with blood • From mothers to babies before birth or at the time of delivery

21. Modes of Transmission • In the laboratory setting, we must be concerned about possible: • Broken or damaged skin exposed to infected body fluids • Mucous membranes exposed to infected body fluids • Accidental punctures from contaminated needles, broken glass, or other sharps

22. Therefore….. • Our goals in the laboratory setting will be to: • Prevent body fluids from coming into contact with skin • Prevent body fluids from coming into contact with mucous membranes • Dispose of all laboratory wastes in the appropriate ways so that no one is accidentally punctured. If this is not done, we risk injuring students, instructors, custodial staff, and laboratory staff.

23. Body Defenses • The body has many defenses in place to protect it against infection. The immune system is a complex defense system. Simpler defenses include physical barriers such as the skin and mucous membranes. Intact skin essentially shields the body from pathogens, but if the skin is broken, that physical barrier is lost.

24. Skin at Risk • Cuts • Open wounds • Abrasions or scrapes • Acne • Blisters • Basically, anywhere that the skin is not perfectly intact, pathogens can gain entry into the body.

25. Mucous Membranes at Risk • In the lab, we are at risk if body fluids are splashed into the face because pathogens can enter through the mucus membranes of the • Mouth • Nose • Eyes

26. You are likely starting to think of ways that you can protect your skin and mucous membranes when you are in lab. What are your ideas?

27. Universal Precautions • The first thing you need to do is to assume that all of the body fluids we listed before are potentially infectious, no matter who they came from. • Remember that people: • May not be aware that they are infected or • May be embarrassed to admit that they are infected.

28. Personal Protective Equipment (PPE) • Needed in an environment where exposure to body fluids is possible • Protective equipment made of nonporous material so that fluids cannot soak through • Protect clothing, skin, eyes, nose and mouth

29. Rules for Using PPE • Always use the appropriate PPE in situations that put you at risk for exposure. • Do not use PPE that has in any way lost its ability to function as a barrier. Torn and/or punctured equipment is not effective. • If PPE becomes torn or punctured during use, it must be replaced. • PPE must be removed before leaving the laboratory.

30. Gloves • Made of rubber, latex, vinyl, nitrile, etc. • Check them before wearing to make sure that they are not damaged. A torn glove does not provide protection! • Remove them carefully to avoid having the contaminated outside of the glove come into contact with your skin.

31. Goggles • Protect the mucous membranes of the eyes from splashed or vaporized fluids

32. Face Shield • Protect the mucous membranes of the nose and mouth from splashed or vaporized fluids

33. Apron • Protect clothing • Help to prevent fluids from soaking through clothes and reaching skin • Should be made of a nonporous material. A standard kitchen apron is not going to provide protection.

34. Hand Washing • Hands should be thoroughly washed after any exposure to body fluids and immediately after protective equipment is removed. • Use a hand sanitizer if hand washing facilities are not immediately available, then wash hands at the earliest opportunity.

35. You should now understand why CCRI’s laboratory policy prohibits the following activities: • Eating • Drinking • Smoking • Gum chewing • Should you apply cosmetics in lab? • Should you put in contact lenses or take them out? No! No!

36. When Bad Things Happen • We live in an imperfect world, and accidents will happen. • If you have a skin exposure, wash the area thoroughly with an antibacterial soap and running water. • If you have an eye splash, use the eyewash station and flush the affected eye for 15 minutes. • If you have any other mucous membrane splash, flush the affected area with running water for 15 minutes.

37. When Bad Things Happen • Notify your instructor immediately! • File an incident report with Campus Police and send a copy to CCRI’s Chemical Safety Coordinator. • Get a post exposure medical evaluation.

38. Decontamination • All surfaces, tools, equipment and other objects that come in contact with potentially infectious materials must be decontaminated and sterilized as soon as possible. • Equipment being decontaminated should be soaked in disinfectant for at least 10 minutes before continuing the cleaning process. • Equipment used to clean up a spill of potentially infectious material, i.e. mops, sponges, etc., must be decontaminated immediately.

39. Disinfectants • A 10% solution of household bleach can be used for decontamination. The usual recommendation is to use at least ¼ cup of bleach per 1 gallon of water. • Lysol • Other EPA-registered disinfectant. http://www.mediacampaign.org/mg/images/bleach_full.jpg

40. Clean Up of Potentially Infectious Spills • Carefully cover the spill with paper towels, then gently pour 10% bleach solution over the towels. Leave it for at least 10 minutes before you begin wiping the material up. • Wear appropriate PPE when cleaning up spills.

41. Cleanup • Remember that accidental punctures from contaminated needles, glass and other sharps can be a way that pathogens are transmitted. • Inappropriate cleanup, therefore jeopardizes the health of students, instructors, custodial staff and laboratory staff.

42. Handling of Sharps & Regulated Wastes • Sharps are NEVER disposed of in ordinary trash receptacles. • Regulated wastes are NEVER disposed of in ordinary trash receptacles.

43. Sharps • According to OSHA, contaminated sharps are "any contaminated object that can penetrate the skin, including but not limited to, needles, scalpels, broken glass, broken capillary tubes, and exposed ends of dental wires,“ • In our lab, sharps can include glass slides, cover slips and lancets.

44. Regulated Waste • Any liquid or semi-liquid blood or other potentially infectious materials • Contaminated items that would release blood or other potentially infectious materials in a liquid or semi-liquid state if compressed • Items that are caked with dried blood or other potentially infectious materials and are capable of releasing these materials during handling • Contaminated sharps

45. Handling of Sharps • Needles and other sharps should not be bent, broken or recapped • Needles and other sharps should be moved only by using forceps, pliers, or broom and dust pan. • Needles shall be disposed of only in labeled sharps containers.

46. Sharps Disposal • Sharps containers must be closable, puncture-resistant, and leak-proof on sides and bottom. The container must be labeled and/or color-coded. http://web.princeton.edu/sites/ehs/biosafety/livevirusworker/21-Sharpscontainer.jpg

47. Biohazard Labels • Sharps containers display the biohazard symbol • Bags for regulated waste also display the biohazard symbol and are orange or red in color. Double-bagging should be used. • Other containers used to store or transport hazardous wastes must also display this symbol

48. Biohazard Labels • Refrigerators/freezers used to store blood, body fluids or other potentially infectious material display the biohazard symbol. • Food and drinks are NEVER stored in a biohazard refrigerator or in cupboards or on counters where specimens are located.

49. Summary • To protect yourself and prevent transmission of bloodborne pathogens • Use Universal Precautions • Follow the appropriate practice recommendations and clean up procedures • When in doubt, ASK!

50. Quiz • Remember that in order to take participate in laboratory, you must pass the following quiz with a grade of 80% or better. • Print, complete, sign the quiz, and return it to your lab instructor. • QUIZ • If this hyperlink does not work for you, copy and paste this address into your browser. • http://faculty.ccri.edu/chansen1/Physiology/Bloodborne_Pathogens_Quiz.doc