BBP Training

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UWSP Bloodborne Pathogens Training
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EHS Officer

• Environmental Health and Safety Officer
• University of Wisconsin - Stevens Point
• 101 George Stien Building
• Stevens Point, WI 54481
• [phone]
• [phone] (fax)
• dbartosh_at_uwsp.edu
• www.uwsp.edu/ehs

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Introduction

• BLOODBORNE PATHOGENS AWARENESS
• Bacteria that cause disease are called
  pathogens.
• Bloodborne pathogens are pathogenic
  microorganisms such as viruses or bacteria that
  are carried in blood and can cause disease in
  people. Types of Bloodborne Pathogens include
• Malaria
• Hepatitis B (HBV)
• Hepatitis C (HCV)
• HIV
• OSHAs Bloodborne Pathogens standard prescribes
  safeguards to protect workers against the health
  hazards from exposure to blood and other
  potentially infectious materials, and to reduce
  their risk from this exposure

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Who is covered by the OSHA Bloodborne Pathogen
Standard?

• All employees who could be reasonably
  anticipated as the result of performing their
  job duties to face contact with blood and other
  potentially infectious materials -
• Medical, housekeeping/laundry, lab, bloodbank,
  emergency, medical waste, etc.
• Good Samaritan acts such as assisting a
  co-worker with a nosebleed would not be
  considered occupational exposure

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UWSP BLOODBORNE PATHOGENS EXPOSURE CONTROL PLAN

• Outlines specific procedures for UWSP.
• See http//www.uwsp.edu/ehs/policydownloads/expco
  n.doc

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What is Regulated Material?

• Human Blood , human blood components, and
  products made from human blood.
• OPIM (Other Potentially Infectious Materials)
• saliva in dental procedures, semen, vaginal
  secretion, internal body fluids (I.e.spinal,
  synovial,etc) other external body fluids visibly
  contaminated with blood along with all body
  fluids in situations where it is difficult or
  impossible to differentiate between body fluids

• Other
• unfixed human tissues or organs (other than
  intact skin) HIV-containing cell or tissue
  cultures, organ cultures, and HIV- or HBV-
  containing culture media or other solutions and
  blood, organs, or other tissues from experimental
  animals infected with HIV or HBV.

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/Saliva
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BBP TRANSMISSION

• BBP most commonly transmitted through
• Sexual Contact
• Sharing of needles
• From mothers to their babies at/before birth
• Accidental puncture from contaminated needles,
  broken glass, or other sharps
• Contact between broken or damaged skin and
  infected body fluids
• Contact between mucous membranes and infected
  body fluids

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How does exposure occur?

• Occupational Transmission of Bloodborne
  Pathogens
• Anytime there is blood-to-blood contact with
  infected blood or body fluids, there is a
  potential for transmission. Unbroken skin forms
  a generally good barrier against bloodborne
  pathogens. However, infected blood can enter your
  system through open sores, cuts, abrasions, acne,
  burns, and open blisters.
• Most common occupational exposure needlesticks
• Cuts from other contaminated sharps (scalpels,
  broken glass, etc.)
• Contact of mucous membranes (for example, the
  eye, nose, mouth) or broken (cut or abraded) skin
  with contaminated blood.

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HEPATITIS B (HBV)

• Hepatitis B (HBV) Disease caused by a virus that
  attacks the liver. Can cause lifelong infection,
  cirrhosis (scarring) of the liver, liver cancer,
  liver failure, and death. Acute Chronic Cases.
  Most serious.
• Signs Symptoms Jaundice, fatigue, abdominal
  pain, loss of appetite, nausea, vomiting, joint
  pain, flu.
• Transmission Occurs when blood or body fluids
  from an infected person enters the body of a
  person who is not immune.  Can be treated to
  overcome infection. More infectious than HIV.
• Prevention Hepatitis B vaccine Universal
  precautions.
• NOTE Number of new infections per year has
  declined from an average of 260,000 in the 1980s
  to about 79,000 in 1999.

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HEPATITIS C (HCV)

• Hepatitis C Causes chronic liver disease. Deaths
  lt3.
• Signs Symptoms Jaundice, fatigue, abdominal
  pain, loss of appetite, nausea, dark urine.
• Transmission Occurs when blood or body fluids
  from an infected person enters the body of a
  person who is not infected. Transfusions /
  Injection (prior to pre blood testing). NOTE
  Most infections are due to illegal injection drug
  use.
• Prevention No vaccine available. Use universal
  precautions. Post exposure medical care.

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HEPATITIS A (HAV)

• Hepatitis A is a liver disease caused by the
  hepatitis A virus. Hepatitis A can affect anyone.
  
• Signs Symptoms Jaundice, fatigue, abdominal
  pain, loss of appetite, nausea, diarrhea, fever.
• Transmission HAV is usually spread from person
  to person by putting something in the mouth (even
  though it may look clean) that has been
  contaminated with the stool of a person with
  hepatitis A. 
• Prevention Always wash your hands with soap and
  water after using the bathroom, changing a
  diaper, before preparing and eating food. Good
  personal hygiene and proper sanitation.
• Hepatitis A vaccine.

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HIV/AIDS

• What is HIV and how can I get it? HIV - the human
  immuno deficiency virus - virus that kills bodys
  "CD4 cells." CD4 cells (T-helper cells) help body
  fight infection disease.
• What is AIDS - the acquired immunodeficiency
  syndrome - is a disease where HIV destroys bodys
  immune system. Deadly No Cure.
• HIV is found in varying concentrations or amounts
  in blood, semen, vaginal fluid, breast milk,
  spinal, synovial, saliva, sweat and tears, other
  bodily fluids.

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HIV/AIDS

• Signs Symptoms The only way to determine
  infection is to test. Many people infected with
  HIV do not have symptoms at all for many years.
• The following may be warning signs of infection
  with HIV rapid weight loss dry coughrecurring
  fever or profuse night sweats profound and
  unexplained fatigue swollen lymph glands in the
  armpits, groin, or neck diarrhea gt week white
  spots or unusual blemishes on the tongue, in the
  mouth, or in the throat pneumonia red, brown,
  pink, or purplish blotches on or under the skin
  or inside the mouth, nose, or eyelids memory
  loss, depression, and other neurological
  disorders.
• Do not assume infection. Each symptoms can be
  related to other illnesses. Testing must be
  accomplished.

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HIV/AIDS

• Transmission General Sexual contact with
  infected individual sharing needles blood
  transfusions mother to baby breast feeding.
• Occupational Transmission Needle Sticks/Sharps,
  Infected blood/fluid into open cut or a mucous
  membrane (for example, the eyes or inside of the
  nose).
• Only one case of doctor to patient.
• No additional routes of transmission have been
  recorded.

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HIV/AIDS

• You cannot get HIV
• By working with or being around someone who has
  HIV.
• From sweat, spit, tears, clothes, drinking
  fountains, phones, toilet seats, or through
  everyday things like sharing a meal.
• From insect bites or stings.
• From donating blood properly.
• From a closed-mouth kiss (but there is a very
  small chance of getting it from open-mouthed
  kissing with an infected person because of
  possible blood contact).

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HIV/AIDS

• PREVENTION
• Personal abstinence, safe sex, dont shoot
  drugs, needle/razor safety, dont share other
  personal hygiene items, tattoo/body piercing,
  pregnancy issues.
• Occupational Follow Universal Precautions
  Proper Work Practices. See slide 23.

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TUBERCULOSIS (TB) NOT A BBP

• TB is a disease caused by bacteria that can
  attack any part of your body, but usually attack
  lungs. TB disease once leading cause of death in
  the U.S.
• TB, can be fatal if not treated. However, several
  antibiotics are available that are very
  effective.
• NOTE TB is not a bloodborne pathogen, but we
  would like to discuss it in todays session.

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TB Types

• Latent TB Breathe in TB bacteria and become
  infected, but able to fight bacteria and stop
  growth. The bacteria become inactive, but remain
  alive and can become active later. Many latent TB
  infections never develop into disease. But in
  other people, especially with weak immune
  systems, bacteria become active and cause TB
  disease.
• TB Disease Active bacteria - the body is not
  able to fight and the individual becomes sick.

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TB - Transmission

• Transmission spread through air from person to
  person when the bacteria is aerosolized by
  someone with TB disease. When a person breathes
  in TB bacteria, the bacteria can settle in the
  lungs and grow. From there, can move through the
  blood to other body parts, such as kidney, spine,
  and brain. TB in the lungs or throat can be
  infectious. TB in other parts of the body, such
  as the kidney or spine, usually not infectious.
• Cannot get TB from touching someones clothes,
  drinking glass, handshake, or toilet.
• Most likely to spread it to people they spend
  time with every day and are in close contact.

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TB Prevention

• Prevention Testing, Medical Treatment,
  Isolation, Notification, Medical Clearance.
• TB patients are no longer considered infectious
  if they 1) are on adequate therapy 2) had
  favorable clinical response to therapy and 3)
  have three consecutive negative test results.

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BBP Universal Precautions / Work Practices

• Treat all human blood and Other Potentially
  Infectious Materials as if they are infectious
• Observed in all situations where there is a
  potential for contact with blood or other
  potentially infectious materials
• To protect yourself, it is essential to have a
  barrier between you and the potentially
  infectious material.
• PPE and BBP Containers (i.e. Sharps containers).
• Report any suspected exposure to your Supervisor
  and/or Employee Health Services.

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Personal Protective Equipment

• Specialized clothing or equipment worn by an
  employee for protection against infectious
  materials in all possible exposure situation.
• Gloves, masks, eye protection, coveralls, face
  shield, mouthpiece, etc. Ensure Readily
  Available!
• Must be properly cleaned, laundered, repaired,
  and disposed of.
• Must be removed when leaving area or upon
  contamination asap.

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Specific Universal Precautions

• Gloves must be worn during contact with blood or
  other body fluids that could possibly contain
  visible blood, such as urine, feces, or vomit.
  Inspect, Replace, Do not Reuse, Remove
  Properly.Wash Hands.
• Safety glasses, goggles, face shields, masks, and
  other barriers if risk of splash, spray, or
  vaporization.
• Cuts, sores, or breaks on both the care givers
  and patients exposed skin should be completely
  covered with bandages or other barriers.

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Specific Universal Precautions

• Hands and other parts of the body should be
  washed immediately after contact with blood or
  other body fluids, and surfaces soiled with blood
  should be disinfected appropriately.
• Practices that increase the likelihood of blood
  contact, such as sharing of razors and
  toothbrushes, should be prevented.
• Needles and other sharp instruments should be
  used only when medically necessary. More.

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NEEDLES/SHARPS

• Handle with extreme care!
• Needles, broken glass, razors, or other sharp
  objects must be disposed of in labeled sharp
  containers.
• Needles should never be recapped.
• Needles/Sharps should be moved by using a
  mechanical device or tool such as forceps,
  pliers, or broom and dust pan NOT BY HAND.
• Never break or shear needles.
• Broken glassware that has been visibly
  contaminated with blood must be sterilized with
  an approved disinfectant solution before it is
  disturbed or cleaned up.
• Glassware that has been decontaminated may be
  disposed of in an appropriate sharps container.
• Uncontaminated broken glassware may be disposed
  of in a closable, puncture resistant container
  such as a coffee can.

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Work Practice Controls
Examples

• PPE!!!
• Proper Housekeeping Decontaminated.
• Wash hands after removing gloves and as soon as
  possible after task or exposure.
• Do not bend or break sharps.
• Place sharps in containers ASAP.
• Do not eat, drink, smoke, apply cosmetics, or
  handle contacts in any potential exposure area.
• Prevent splashing, spraying, or aerosolizing
  bodily fluids.
• Safer medical devices
• Needle less systems
• Sharps with engineered protections

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Hand Washing

• Use warm running water and nonabrasive soap.
  Premoisten towels / lotions should not take the
  place of hand washing.
• Wet the hands apply liquid soap to hands.
• Rub hands together vigorously for at least 15
  seconds. Be sure to scrub between fingers, under
  fingernails, and around the tops and palms of the
  hands, and up to wrist or other affected areas.
• Rinse hands under warm running water. Leave the
  water running while drying hands.
• Dry hands with clean, disposable (or single use)
  towel, avoid touching the faucet handles or towel
  holder with clean hands.
• Turn the faucet off using the towel as a barrier
  between your hands and the faucet handle.
• Discard the used towel.
• Consider using hand lotion to prevent chapping of
  hands.
• Assist children as needed.
• Wash hands frequently before and after tasks,
  eating, drinking, applying makeup, washroom,
  contact, handling items, etc.

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Clean Up Small Spills

• Bloodborne pathogens biohazard kits are available
  to clean small amounts of bodily fluids. The
  kits are available from Central Stores (item
  8102104, 8.40). Contain items to protect
  responders such as gloves, protective clothing,
  and disinfectants.
• A solution of household bleach (Clorox) diluted
  between 110 and 120 with water.
• Other Check the label of all disinfectants to
  make sure they meet EPA disinfection requirement.
  
• Entire area must be cleaned (including any
  affected equipment).
• Use proper PPE.
• Proper tools to clean up sharps (tongs, dustpan,
  puncture resistant gloves, etc).

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Clean Up

• All regulated waste must be disposed in the
  proper biohazard waste "stream".
• All regulated waste must be disposed in properly
  labeled containers or red biohazard bags, sealed,
  and stored correctly.
• Large spills beyond supplies or ability require
  contacting Protective Services at 3456 (custodial
  services).
• EHS for waste pickup at extension 2320.

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What is Regulated Waste?

• The Bloodborne Pathogens Standard defines
• (1) liquid or semi-liquid blood or OPIM
• (2) items contaminated with blood or OPIM and
  which would release these substances in a liquid
  or semi-liquid state if compressed
• (3) items that are caked with dried blood or OPIM
  and are capable of releasing these materials
  during handling
• (4) contaminated sharps and
• (5) pathological and microbiological wastes
  containing blood or OPIM.

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Regulated Waste

• Must be placed in closeable, leak-proof
  containers built to contain all contents during
  handling, storing, transporting or shipping and
  be appropriately labeled or color-coded.
• Contact UWSP EHS at Extension 2320 or 4464 with
  questions regarding Bloodborne Pathogens and for
  waste pickup and disposal.

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Laundry

• Handle contaminated laundry as little as possible
  and use PPE
• Must be bagged or containerized at location where
  used
• No sorting or rinsing at location where used
• Must be placed and transported in labeled or
  color-coded containers
• Contact EHS 2320 for details.

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Biohazard Warning Labels

• Warning labels required on
• Containers of regulated waste
• Refrigerators and freezers containing blood and
  other potentially infectious materials
• Other containers used to store, transport, or
  ship blood or other potentially infectious
  materials
• Red bags or containers may be substituted for
  labels if marked properly.

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Hepatitis B Vaccination Requirements

• Hepatitis B vaccine is an additional protective
  measure offered to all employees who receive
  occupational exposure.
• Must make available to all employees at risk of
  exposure
• The vaccination must be performed by a licensed
  healthcare professional
• Declination form signed for those who do not wish
  to have vaccination.

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UWSP Hepatitis B Vaccination

• The cost of the vaccination is the responsibility
  of the employee's department. Cost for three
  doses 108.00.
• Vaccinations provided by the Portage County
  Health Department, 817 Whiting Avenue, 345-5350.
  Series of three.
• Contact EHS at 2320 to coordinate vaccination
  arrangements.

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What to do if an exposure occurs?

• Wash exposed area with soap and water. Use
  non-abrasive, antibacterial soap
• Flush splashes to nose, mouth, or skin with water
  for minimum of 15 minutes.
• Irrigate eyes with water or saline for 15
  minutes.
• Report the exposure to your Supervisor
• Direct the worker to a healthcare professional
  for immediate follow-up care. (i.e. post Hep. B
  vaccine, HIV inhibitors).

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Post-Exposure Follow-Up

• Document routes of exposure and how exposure
  occurred with accident investigation. For
  work-related incidents, the exposed employee and
  Supervisor must complete, (in 24 hrs)
  Employees Work Injury and Illness Report
  (UWS/OSLP-1Emp) "Employer's First Report of
  Injury" form (WKC-12) and "Supervisor's Accident
  Analysis and Prevention" form (UWS/OSLP-2). For
  non-employees, complete the UWSP Accident Report
  for Non Employees.
• Also completed Determination of Exposure to
  Blood/Body Fluids (WKC-8165). It should be
  presented to the attending physician when seeking
  medical assistance. Health care providers
  equivalent form may be used in place of WKC-8165.
  The evaluating physician should provide the
  employee with a written opinion within 15 days
  after completion of the evaluation. Contact your
  supervisor or the Safety and Loss Control
  Department, X2618, to obtain and assistance in
  completing the forms.
• If the attending physician determines that source
  testing is warranted, he/she will contact the
  source individual for consent. If consent is
  obtained, the source individuals blood will be
  tested and those results will, upon consent, be
  made available to the exposed employee.
• Provide risk counseling and offer post-exposure
  protective treatment for disease when medically
  indicated.
• Provide written opinion of findings to employer
  and copy to employee within 15 days of the
  evaluation.
• If the injury was from a contaminated sharp, it
  must be entered into the sharps injury log.
  Contact EHS at 2320 to complete.

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Summary

• Beware of your surroundings and potential for
  exposure.
• Follow Universal Precautions Proper Work
  Practices. MAINTAIN A BARRIER!!!
• Clean up and dispose of waste properly.
• Continue to educate yourself.
• Annual Refresher Training.

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More Info / Resources

• UWSP EHS www.uwsp.edu/ehs/ or Contact EHS
  Department, Dick Bartosh, 346-2320
• www.osha.gov
• www.cdc.gov
• www.nih.gov
• www.ncaa.org
• ?? Questions ??