BLOODBORNE PATHOGENS

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BLOODBORNE PATHOGENS
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Purpose

• Reduce / eliminate exposure potential
• Comply with Ohios Public Employment
• Risk Reduction Act (reference OSHA)

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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
• Recycling Center staff
• First aiders in Child Studies
• BSW / BRW who may clean-up blood/body fluid in a
  work area

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Topics
Bloodborne diseases and their transmission Reducin
g exposure potential Exposure incidents Hepatitis
B vaccine Spill cleanup
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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
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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
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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)
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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

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Bloodborne diseases and their transmission
Not Considered OPIM

• Vomit
• Perspiration
• Tears
• Urine
• Feces

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Bloodborne diseases and their transmission
Human Immunodeficiency Virus

• Target in Body
• Virus Concentration
• Risk (crossing skin barrier)
• External viability
• Vaccine Available

immune system
low (5 - 10)
0.3 to 0.5
3 to 5 hrs
no
measured in viral bodies / milliliter of blood
AIDS
H I V
Time Span (?)
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Bloodborne diseases and their transmission
AIDS Epidemiology (U.S.)
Source Centers for Disease Control and
Prevention HIV/AIDS Surveillance Report.. 1998.
v10, n2.
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Bloodborne diseases and their transmission
U.S. AIDS cases reported through 1998
Number ()

• Men who have sex with men
• Injected drug use
• Heterosexual contact
• Hemophilia / coagulation disorder
• Receipt of transfusion
• Other / Multiple modes of exposure
• Not reported or identified
• TOTAL

312,148 46 138,503 20 64,844 10 3,969 1
8,369 1 95,321 14 56,425 8
679,739
Source Centers for Disease Control and
Prevention HIV/AIDS Surveillance Report.. 1998.
v10, n2.
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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

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Bloodborne diseases and their transmission
Hepatitis B virus
measured in viral bodies / milliliter of blood
Source American Liver Foundation
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Bloodborne diseases and their transmission
HBV Confirmed Transmission

• Sexual contact (includes anal oral sex)
• Contaminated needles (esp. I.V. drug use)
• Maternal-Neonatal
• Blood transfusions (negligible)
• Other intra-family, -institutional,
  hemodialysis, oral (rare), household
• Approximately 1/3 unknown sources

Source American Liver Foundation
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Bloodborne diseases and their transmission
HBV facts (U.S.)

• Approximately 5,000 deaths annually
• 200 - 250K new infections annually
• Young adults account for 90 of reported cases
• 30 - 40 with acute HBV show no symptoms
• Chronic carriers have 100 greater chance of
  developing liver cancer

Source American Liver Foundation
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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
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Exposure Control Methods
1. Signs and Labels

• Medical Waste
• Infectious Waste
• Infectious
• Biohazard

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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 EHSO
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Exposure Control Methods
3. Engineering Controls

• Sharps Containers
• Biohazard waste bags boxes
• One-way valves on resuscitation devices
• Hand washing facilities

Examples
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Exposure Control Methods
4. Personal Protective Equipment

• Types
• Limitations

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Exposure Control Methods
5. First Aid Situations

• Designated first aider, University Police
• Encourage self-care if possible
• Avoid bare-hand pressure without barrier
• Glove accessibility

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Exposure Control Methods
6. Contaminated Waste Disposal

• Infectious Waste
• Red bags
• Labeling requirements
• Biohazard boxes
• Drop-off sites
• Sharps disposal

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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
• manufacturers directions.

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Exposure Incidents
A specific eye, mouth, other mucous membrane,
non-intact skin, or parenteral (across the skin
barrier) contact with blood or other potentially
infectious materials that results from the
performance of an employees duties
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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

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(No Transcript)
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Exposure Incidents
Contact with Blood / OPIM

• Needlestick / puncture injury
• Mucous membrane contact

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Exposure Incidents
Post-exposure evaluationand follow-up

• Confidential medical evaluation and blood
  testing offered at no cost to employee
• Voluntary

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Exposure Incidents
What is involved in an exposure evaluation?

• Report to the Student Health Center
• Medical personnel will document and 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)

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Exposure Incidents
Post-exposure testing

• Voluntary blood tests
• HIV antibody test requires several blood tests
  over a period of time
• If medically indicated, you will be offered a
  vaccine for Hepatitis B
• Recordkeeping

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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

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HBV vaccine
HBV program at Miami University

• Eligibility requirements
• Administration site
• Schedule
• Consent / Declination procedures

Employees determined to have a reasonably
anticipated high risk of occupational exposure
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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 hours
• Student Health Services suggests initiation no
  later than 7 days after exposure
• Projected conversion rate 70 to 88 percent

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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

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HBV vaccine
Contraindications (Conditions suggesting
treatment should not be administered)

• Yeast allergy
• Immunodeficiency disease
• Recent febrile illness / infection
• Pregnancy
• Lactation

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HBV vaccine
Efficacy (Vaccines effectiveness)

• Active immunity in 80 to 95 percent of persons
  completing the series of three injections
• Immunity projected to last about 10 years
• Positive immunity protects against all modes of
  transmission
• May donate blood if vaccine given as a preventive
  measure

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Spill cleanup

• Kits
• Decontamination
• Precautions
• Procedure

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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 departments kit
• Follow directions included with the kit and use
  all personal protective equipment provided in
  it

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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
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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

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Spill cleanup
Spill cleanup procedure
Inspect and put on appropriate PPE Keep others
away Position red bag so materials can be dropped
in without contaminating outside of
bag Carefully pour only as much decontaminant as
you need to cover the spill area, cover with
paper towels, and allow to soak
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Spill cleanup
Spill cleanup procedure
For non-level surfaces (e.g., walls), thoroughly
clean area with 10 bleach solution (or other
approved) and allow to air dry Disposing of
sharp objects Place all materials in red bag
Decontaminate area again and allow to air dry
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Spill cleanup
Spill cleanup procedure
Remove PPE and place in red bag Touching outside
of red bag only, close and secure with twist
tie Arrange for pickup and disposal of red
bag Wash your hands with soap and water! Complete
Cleanup Fact Card and return to
supervisor Supervisor signs completed card and
forwards to EHSO
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BLOODBORNE PATHOGENS Course Revision 1999 Miami
University Environmental Health and Safety Offices
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Information
You are encouraged to contact your BBP Trainer
or the Environmental Health and Safety Offices to
discuss questions you may have regarding this
program. Viral Hepatitis Everybodys
Problem? Hepatitis B A disease in need of
prevention Hepatitis B Reduce your risk and
find out how American Liver Foundation fact
sheet What every Miami student should know
about AIDS Voluntary HIV Counseling and
Testing CDC fact sheet HIV and its
transmission
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