Bloodborne Pathogens Training

1. Bloodborne Pathogens Training University of Michigan-Flint. Environment, Health and Safety (EHS)

2. Course Information This bloodborne pathogens training program is required annually for UM employees who may reasonably anticipate contact with blood or other potentially infectious materials (OPIM), during the performance of their duties.

3. Course Topics • Bloodborne Pathogens Standard (copy available from EHS and online) • Bloodborne Pathogens • Mode of Transmission • Exposure Control Plan • Methods of Prevention (Universal Precautions) • UM Hepatitis B Immunization Program • Engineering Controls • Sharps Disposal • Personal Protective Clothing and Equipment (PPE) • Spill Response • BBP Waste • Communicable Diseases

4. Bloodborne Pathogens Standards and Regulations This program was designed to meet the requirements of: • Occupational Safety and Health Administration (OSHA) Occupational Exposure to Bloodborne Pathogens 29 CFR 1910.1030 (1990). • Michigan Occupational Safety and Health Administration (MIOSHA) Bloodborne Infectious Diseases R 325.70001- R 325.70018 (1993). • Needle stick Safety and Prevention Act (2000) • Exposure Source Testing MI Act 368 of 1978 These standards apply to workers who are at risk of exposure to pathogenic microorganisms associated with human blood.

5. What are Bloodborne Pathogens

6. Pathogenic Microorganisms Bloodborne Pathogens: are pathogenic microorganisms that are present in human blood or other potentially infectious materials (OPIM) and can cause disease. Pathogenic microorganisms include, but are not limited to: • HBV • HCV • HIV • West Nile • Malaria • Syphilis • Brucellosis

7. Other Potentially Infectious Materials (OPIMs) • Blood products, semen, vaginal secretions • Saliva in dental settings • Any body fluid that is contaminated with blood • Any body fluid of unknown source • Unfixed tissues or organs • HIV or HBV containing cells or cultures • Blood, organs or other tissues from experimental animals infected with BBP • Introduction of human-derived materials (i.e. tumor cells) into animals.

8. Mode of Transmission • Transmitted when infected blood or bodily fluid enters the opening of mucosal membrane. • Mucous Membranes are wet, thin tissue found in certain openings of the human body. These openings include the mouth, eyes and nose. • Breaks in the skin are an ideal way for the contaminate to enter: • Cuts • Punctures • Abrasions • Rashes • Acne • Hang Nails Bandage affected area and wear double gloves to prevent transmission through breaks in skin.

9. Hepatitis B (Hep B) • Infection of the liver which may lead to liver disease, liver cancer and possibly death. It is the leading occupational disease in the United States. • 12,000 cases of HBV were identified annually (up to the year 1992). Numbers have decreased to approximately 800 cases annually since the introduction of the immunization. HBV is extremely stable. It may survive 10 days outside of host!

10. Hepatitis B (cont’d) Approximately 10% of infected individuals may become "carriers“. This means that they may suffer from infection at a later time. They can also be infectious to others for the rest of their lives while not demonstrating any symptoms of HBV. Symptoms may occur 2-6 months after exposure and include: • Fever • Vomiting • Jaundice (yellowing) of the eyes and/or skin • Loss of appetite • Dark-colored urine • Aches in muscles and joints

11. Hepatitis C (HCV) • Viral infection of the liver that can be transmitted via blood or other potentially infected materials • Symptoms similar to those caused by HBV • Although 80% of individuals may have no symptoms, these infected individuals may be lifelong carriers. No vaccine is available. • Very difficult for body’s immune system to recover from HCV infection • Leading indication for liver transplants in the U.S.

12. Human Immunodeficiency Virus (HIV) • Virus that causes Acquired Immunodeficiency Syndrome (AIDS) • May be passed through infected blood or OPIMs that come in contact with broken skin or mucous membranes • Some infected individuals will develop AIDS as a result of their HIV infection. • Some individuals develop flu-like symptoms within 7-21 days after exposure. • Recent studies suggest the best independent predictors of primary HIV infection are rash and fever among individuals recently exposed to HIV. • HIV will not survive long outside host (~90-99% reduction within several hours).

13. Controlling the Risk of Exposure Here are the ways to reduce your likelihood of exposure to blood or other potentially infectious materials: • Universal Precautions • Exposure Control plan (ECP) • Hepatitis B Vaccination • Engineering Controls • Workplace Controls • Safe Work Practices • Personal Protective Equipment (PPE) • Proper Hand-washing Technique • Reporting exposures immediately and seeking medical follow-up treatment as soon as possible

14. Universal Precautions An infection control method where ALL human blood and other potentially infectious materials are treated as if known to be infectious.

15. Exposure Control Plan (ECP) • The ECP must be made available to all employees who are determined to be at risk. • Employees must be familiar with the ECP and know where it is located. • ECP reviewed/revised ANNUALLY with input from employees. • ECP is readily available to employees.

16. Reporting an Exposure Incident • Is it work related? • Date and time of exposure • Details of the procedure being performed, including where and how the exposure occurred. If related to a sharp device, the type and brand of device and how and when in the course of handling the device the exposure occurred must be included in the report • Details of the exposure, including the type and amount of fluid or material and the severity of the exposure • Details about the exposure source if known • Details about the exposed person… vaccinated? • May need to attach sheet of paper with details to work connection form

17. Hepatitis B Vaccination • Available to Category A employees at no cost • Series of 3 injections: 1st: given at anytime 2nd: 1 month after first injection 3rd: 5 months after 2nd injection • Provides protective levels of antibody in 97% of healthy individuals • You cannot get HBV from the vaccine • No booster shot required (lifelong immunity) • According to the FDA, the current shot is one of the safest available • Side effects may include: soreness, redness and swelling at injection site • For further information, EHS encourages you to contact your primary care physician/practitioner

18. Hepatitis B (cont’d) • Vaccination need not be offered if… • Individuals have previously received the complete series • Antibody testing has revealed the individual is immune • The vaccine is contraindicated for medical reasons • The vaccine is NOT mandatory. • Employer must offer the vaccine, however, you do not have to accept the vaccine. • You may decline the vaccination series, in which you will be asked to sign a declination form. • To receive the Hepatitis B Vaccine, please contact:UM-Flint EHS @ (810)766-6763

19. Hepatitis B Forms

20. No Vaccines for HCV and HIV • There is no vaccine against HCV and no treatment after exposure that will prevent infection. • There is no vaccine against HIV. • The Public Health Service, under recommendations from the CDC, suggests a 4-week course of administration of the antiretroviral drugs depending upon the risk of transmission (exposures involving a larger volume of blood with larger amount of HIV). This should begin within hours after exposure.

21. Engineering Controls Are used to isolate or remove the potential hazard from the workplace. Controls are used in combination with safe work practice controls. • Sharps disposal containers • Hand washing facilities &waterless soap dispensers • Biohazard bags/waste containers • Spill/clean-up kits • Use tongs for picking up hazardous object

22. Sharps • Departments generating sharp waste are responsible for proper disposal. • Must use a puncture resistant plastic container • Must be located in area where sharps are used • Sharp containers can only be filled to indicator line or ¾ full. Call EHS (810)766-6763 for removal. • Do NOT OVERFILL sharps container. Overfilled sharps container pose a risk to all workers.

23. Sharps (cont’d) Examples of sharps are: • Needles • Scalpels • Razor blades • Lancets • Contaminated glass Pasteur pipettes • Glass capillary tubes • Contaminated broken glass • Contaminated microscope slides and cover slips • Exposed ends of dental wires

24. Workplace Controls • Wash hands after contacting body fluids or contaminated surfaces • Keep fingernails short • Scrub nail area • Clean surfaces regularly • Keep disinfectant solution and waterless hand disinfectant nearby. • Keep PPE in stock and readily available.

25. Safe Work Practices • Personal Protective Equipment (PPE) must be removed before leaving the work area • Clothing penetrated with blood or OPIM must be removed immediately • Follow proper protocol for cleaning blood/bodily fluid spills • Wash hands immediately after removing gloves or other protective clothing. • Wash hands after contact with blood or OPIM.

26. ECDC Soiled Clothing • Remove clothing immediately • Place in a labeled plastic bag (To Be Washed) and separate from normal laundry and use proper laundering techniques. (Make sure water is hot, 82oC, and is on the hot cycle for at least 10 mins) • Child’s clothing should be placed in a labeled plastic bag (Soiled) and should be sent home with parents

27. DPS/Medical Staff Soiled Clothing • Remove clothing immediately • Place in a labeled plastic bag (Biohazard) • Have clothing be sent to proper laundering facilities that will decontaminate the uniform

28. BBP Exposures Eyes: Flush with water Skin: Wash thoroughly with soap and water for 15 mins. IMMEDIATELY notify Supervisor & EHS. Go to UM Medical Provider for post-exposure follow-up ASAP

29. Protective Work Clothing and Equipment (PPE) • PPE shall be provided at no cost to the employee. • Examples: GLOVES, goggles, apron, “booties” • Assure appropriate PPE is readily accessible and fits properly • Supervisor will monitor and ensure employee uses PPE. • Provide for cleaning, laundering, or disposal of PPE.

30. Protective Work Clothing and Equipment (PPE) Hand Protection: • Ensure equipment is available • Non-latex products must be available for individuals with latex allergies • Disposable gloves should be replaced if they are peeling, cracked, discolored, or if they have punctures, tears, or other evidence of deterioration • Gloves of appropriate size must be available • Do not re-use disposable gloves • Remove gloves before leaving the work area • Always wash hands after removing gloves

31. Blood/Body Fluid Spills • All spills must be safely cleaned as soon as possible. • Wear gloves, gowns or lab coats and eye protection during clean up. • A solution of 1:10 bleach and water or an EPA-approved disinfectant should be used. • If broken glass is involved, it should be carefully removed using a mechanical device such as tongs or forceps and the broken glass placed in the sharps container. Never pick up broken glass by hand!

32. Spill Clean-up Procedure http://www.youtube.com/watch?v=gnOtvAztKoQ

33. Spill Clean-up Procedure • Put on personal protective equipment • Remove sharp objects carefully with forceps/tongs • Circle spill with disinfectant. Use bleach (1:10 dilution), Lysol, Virex, or EPA registered tuberculocidal disinfectant • Cover and saturate with disinfectant. Let stand 15 - 20 minutes. Clean and Dispose of Paper Towel • Re-spray area with disinfectant • Re-wipe with paper towel • Decontaminate materials used to clean spill

34. Disinfectant Procedure Information • Take the necessary precautions when handling disinfectants because of them are caustic and hazardous chemicals • Always prepare all disinfectants daily. Some prepared diluted mixtures, like bleach and water, are not stable and lose it’s efficacy as a disinfectant when not made daily • When using, spray on and allow to air dry • If area is heavily soiled, clean with detergent and water first • Impervious (waterproof) surfaces are cleaned differently than porous/fabric surfaces. • Do not use commercially pre-saturated wipes to sanitize surfaces as their efficacy has not been tested • The contamination of the wipe during use may not be sufficiently controlled by the bleach solution in the wipe

35. Hand-washing • First line of defense against infectious disease • Hands and other skin surfaces must be washed immediately, and thoroughly, after handling potentially infectious materials • Wash hands and lather, rubbing front and back for at least 20 seconds with soap • Rinse under running warm water from wrists to fingertips • Dry with paper towel and turn faucet off with paper towel http://www.youtube.com/watch?v=vYwypSLiaTUD

36. Employee Responsibilities • Know and understand your department’s ECP • What PPE should be worn? When? • What do you do if you are not sure if a substance is a BBP or not? • Who in your department is authorized to clean up blood? Category A or B? What are you? • ALWAYS Follow SAFE Work Practices… maintain a clean and sanitary environment. • Wash hands. • Get HBV Vaccine . . . or sign declination form. Discuss other vaccinations that are available for you with your family physician. • Report all exposure incidents immediately • Participate in your department’s annual ECP review.

37. Other Communicable Diseases West Nile Meningitis Norovirus H1N1 Tuberculosis (TB)

38. West Nile • Derived from being bitten by an infected mosquito The most serious form of WNV is Fatal Encephalitis: inflammation of the brain • Incubation period is 2-15 days Symptoms include: • High fever • Neck stiffness • Disorientation • Coma • Tremors • Convulsions • Muscle weakness • Paralysis According to the CDC, 1 in 150 people get infected, however, 4 out of 5 people infected with the virus express asymptomatic infections. This means that they do not show any signs of sickness.

39. West Nile According to the CDC, 1 in 150 people get infected, however, 4 out of 5 people infected with the virus express asymptomatic infections. This means that they do not show any signs of sickness. There are 3 possible outcomes from being infected with WNV: • Asymptomatic: you do not show any signs of infection (most people fall into this category) • Develop West Nile Fever: experience symptoms (expressed in 20% of infected individuals) • Severe West Nile Disease, West Nile Meningitis, West Nile Encephalitis: experience severe symptoms and possibly die (expressed in 1% of infected individuals)

40. Meningitis • Inflammation of the membrane (meninges) that covers the brain and spinal cord • Caused by either: Viral Meningitis(Aseptic) Bacterial Meningitis

41. Viral Meningitis • Caused by Enteroviruses • Less severe and is healed without any specific treatment • Symptoms include: • High fever • Severe Headache • Stiff neck • Sensitivity to bright light • Sleepiness or trouble waking up • Nausea, vomiting • Lack of appetite • Symptoms last between 7-10days with full recovery • No specific treatment

42. Bacterial Meningitis • Highly severe and some forms are contagious • 2 strains of the leading cause of Bacterial Meningitis are Streptococcus pneumoniae and Neisseria meningitis • Symptoms include: • High fever • Headache • Stiff neck • Discomfort looking into bright lights • Nausea • Vomiting • Confusion • Sleepiness • Brain damage • Hearing loss • Learning disability • Disability

43. Bacterial Meningitis (cont’d) • Transmitted via respiratory and throat secretions • Modes of transmission include: • Coughing • Kissing • Sneezing • Not as contagious as the flu, therefore, you cannot become infected through casual contact • Example: You will not become infected if you breathe in the same air that someone with meningitis breathed • Incubation period ranges from several hours to 2 days • There are vaccines against some forms of meningitis. • According to the CDC, the current vaccines available are safe and effective

44. Norovirus • A type of Gastroenteritis: inflammation of the stomach and small and large intestines • Caused by a host of viruses that produces the outcome of vomiting and diarrhea • According to the CDC, it is the leading cause of foodborne-disease outbreaks in the United States • Common name: Stomach Flu, but not caused by Influenza

45. Norovirus • Symptoms: • Watery diarrhea • Vomiting • Headache • Fever • Abdominal cramps • Symptoms begin 1 to 2 days after infection and lasts for 1 to 10 days depending on the strain of virus. • Transmitted through contaminated food and beverages via the oral-fecal pathway

46. H1N1 (Variant Influenza Virus) • Respiratory disease normally affecting pigs, caused by a specific strain that affects human beings • Spread through the direct contact of infected pig or infected person • According to the CDC, human to human transmission is not as easily spread • Symptoms are similar to those of the human flu

47. Tuberculosis (TB) • It is an airborne disease caused by bacterium, Mycobacterium tuberculosis, which attacks the lungs. It can also attack the kidneys, spine and brain. If untreated it can be fatal. There are 2 forms of TB: • Latent TB: when the bacteria lives in the host’s body without making the person sick. They test positive for the TB skin test, however, they are not infectious • Active TB: when the bacteria is active in the host’s body and makes the person sick and is infectious. • People can become infected if some one with active TB sings, speaks, coughs or sneezes in the nearby area.

48. Tuberculosis (TB) If infectious, there is a treatment. • TB disease can be treated by taking several drugs for 6 to 9 months. There are 10 drugs currently approved by the U.S. Food and Drug Administration (FDA) for treating TB. Of the approved drugs, the first-line anti-TB agents that form the core of treatment regimens include: • isoniazid (INH) • rifampin (RIF) • ethambutol (EMB) • pyrazinamide (PZA) • Regimens for treating TB disease have an initial phase of 2 months, followed by a choice of several options for the continuation phase of either 4 or 7 months (total of 6 to 9 months for treatment). • Treatment regimen must be fully completed to fully cured. If not taken as prescribed and correctly, infected person’s TB bacteria will become resistant to medication and would require a stronger and expensive medication.

49. Questions

50. Bibliography • http://rlv.zcache.com.au/bio_hazard_or_biohazard_sign_symbol_warning_purple_postcard-p239192129277273011z74oh_125.jpg (Purple Biohazard Sign) • http://www.papermasters.com/Images/bloodborne-pathogens.jpg (Bloodborne Pathogens Sign) • http://i.telegraph.co.uk/multimedia/archive/01487/hiv_1487944c.jpg (HIV) • http://www.nature.com/nprot/journal/v2/n3/covers/largecover.gif (HBV) • http://srxa.files.wordpress.com/2011/06/hepatitis_c1.gif (HCV) • http://scienceray.com/biology/ecology/managing-jaundice/ (Jaundice Hands) • http://www.fronine.com.au/images/mixmate05.jpg (Vortex Machine) • http://blogs.palmbeachpost.com/becoming-a-doctor/files/2009/07/pipetting.jpg (Pipet) • http://www.servoprax.com/images/5000/00249_1.jpg (Centrifuge Machine) • http://www.torranceca.gov/Images/Mosquito_rdax_400x277.jpg (WNV) • http://www.cdc.gov/ncidod/dvbid/westnile/images/WNV_03_a.gif (WNV Map) • http://www.doctortipster.com/wp-content/uploads/2011/04/Aseptic-Meningitis11.jpg (Viral Meningitis) • http://nchistorytube2.wikispaces.com/file/view/viral-meningitis.jpg/213342706/viral-meningitis.jpg (Viral Meningitis microscopic) • http://www.about-child.com/wp-content/uploads/2011/07/Bacterial-Meningitis-In-Children-3.jpg (Bacterial Meningitis) • http://feww.files.wordpress.com/2010/01/bacterial-meningitis-lg.jpg?w=711 (Bacterial Meningitis microscopic) • http://www.defendingfoodsafety.com/uploads/image/Norovirus.jpg (Norovirus) • http://knol.google.com/k/-/-/30e8n4orj1dsd/1ubdd7/fig2-allflu.jpg (H1N1) • http://img.webmd.com/dtmcms/live/webmd/consumer_assets/site_images/articles/health_and_medical_reference/infectious_disease/understanding_tuberculosis_basics.jpg (TB)