Bloodborne Pathogens Training USC Environmental Health and Safety

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Bloodborne Pathogens TrainingUSC Environmental
Health and Safety
University of Southern California
For annual refresher training ONLY (initial
training must be taken in class)
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Outline

• Objective
• Introduction to Bloodborne Pathogens
• Epidemiology and Symptoms
• Modes of transmission
• Case Reports
• Preventive methods
• Summary

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Objective

• To inform USC healthcare workers (HCW), students,
  staff and other personnel about
• Occupational risk, vaccination program, exposure
  control plan, etc.
• Comply with OSHA Bloodborne Pathogen Standard
• 29 CFR 1910.1030 CCR Title 8, section 5193
• Cal-OSHA BBP Std. Guide
• Comply with CA Medical Waste Management Act
• Safety Code, Sections 117600-118360

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Bloodborne Pathogens

• Microorganisms that are present in human and
  non-human primate blood and can cause disease in
  human
• HBV, HCV, HIV most prevalent (Herpes B, Malaria
  Syphilis)
• Transmitted by blood or other bodily
  fluids/tissue via
• contaminated sharps,
• mucosal exposure,
• or exposure with non-intact skin
• Needlestick HBV 30 risk of transmission, HCV
  1-10, HIV .3
• Hepatitis B has been the most frequent
  laboratory-acquired viral infection, with a rate
  of 3.54.6 cases per 1000 workers. Any laboratory
  personnel who collects or handles tubes of blood
  is vulnerable
• Exposure to Blood What Healthcare Personnel Need
  to Know, http//www.cdc.gov/ncidod/dhqp/pdf/bbp/Ex
  p_to_Blood.pdf

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Disease characteristics

• Hep B Acute liver inflammation, cold/flu-like
  symptoms and vomiting. Chronic cirrhosis, liver
  cancer, death
• Hep C many cases asymptomatic, mostly chronic
  infection, liver transplant
• HIV once immunocompromised, succumb to
  opportunistic infections(CMV, Pneumocystis
  pneumonia)

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Occupationally acquired HIV among healthcare
personnel 1981-2006
Occupation Documented Possible
Nurse 24 35
Clinical Laboratory Worker 16 17
Nonsurgical Physician 6 12
Non-Clinical Laboratory Technician 3 -
Housekeeping or Maintenance 2 13
Dentist or Dental Worker - 6
Other healthcare occupation - 6
Surveillance of Occupationally Acquired HIV/AIDS
in Healthcare Personnel, as of December 2006,
http//www.cdc.gov/ncidod/dhqp/bp_hcp_w_hiv.html
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Needlesticks

• 85 occupationally acquired HIV
• 600K-800K injuries annually
• Half are estimated to be unreported.
• Most needlesticks due to poor work practices
• Preventable
• Panlilio AL, et al. Infect Control Hosp
  Epidemiol, 2004

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Tasks that may put you at risk

• Phlebotomy
• Handling containers of blood, fluid, tissue, or
  cultures
• Pipetting, mixing, or handling blood, fluid,
  tissue
• Using finger stick device for blood testing
• Using capillary tube
• Providing injections
• Cleaning blood or broken contaminated glass
• Handling medical waste
• Assisting diabetic patient with blood glucose
  monitoring
• Performing first aid or CPR
• Finding improperly discarded needle
• An introduction to Bloodborne Pathogens in the
  Pharmacy, https//webapp.walgreens.com/cePharmacy/
  viewpdf?fileNameblood_borne_pathogens.pdf

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Case Report
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Controlling Risk

• Risk Assessment
• Universal precautions
• Engineering controls, work practice controls,
  personal protective equipment
• Proper Waste Disposal
• Disinfection

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Risk Assessment Process

• What is Risk?
• A measure of the likelihood that a loss will
  occur (probability) and its potential seriousness
  (severity)
• Risk Assessment Process (I.A.M)
• Identify the hazards
• Assess the potential impact of the hazards
• Manage the potential impact of the hazards
  through risk reduction strategies
• (Engineering, Administrative, PPE)

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Engineering controls

• Biosafety Cabinet (BSC)
• Safety-engineered sharps must be used, such as
  self-retracting needle, hinged cap needle
• Proven to reduce number of needlestick injuries
• Plastic capillary tubes/ aspirating pipettes

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Biosafety Cabinets(Engineering Controls)

• BSC work practices
• Disinfect working area with appropriate
  disinfectant and contact time.
• Do not block front or back grilles
• Divide BSCs working area into clean, working
  and dirty areas.
• Work from clean to dirty area
• Have only items needed for procedures
• Do not overcrowd BSC
• Minimize rapid movements inside BSC
• Move arms in and out slowly (minimize sweeping
  motion)
• Disinfect thoroughly at the end of experiment.
• UV light is not recommended

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Potential Risk of Using Glass Pasteur Pipettes
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Work practice controls

• No recapping of needles
• Place sharps container as close to you as
  possible, dont exceed fill line
• Immediately dispose of medical waste
• When using sharps, focus on task at hand
• Practice before using device on patients
• Practice good hand hygiene (soap and water,
  alcohol based hand sanitizer)

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Hand HygieneFrequently missed areas
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Personal Protective Equipment

• Gloves for any vascular access(latex
  alternatives), remove carefully to minimize
  contamination of hands, wash hands afterwards
• Lab coat/scrubs
• Eye and face protection
• when splash potential
• Closed-toe shoes

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Working with commercial blood bank samples?
Samples are tested for

• Hepatitis B core antigen
• Hepatitis B surface antigen
• Hepatitis C virus
• HIV 1 2
• A, B, O and Rh

Samples are NOT tested for

• Eastern Equine encephalitis virus (EEEV)
• St. Louis encephalitis virus (SLEV)
• West Nile Virus (WNV)
• Brucellosis
• Others

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Hazardous Waste Disposal - Biomed
PATHOLOGICAL
SOLID
PHARMACEUTICAL
Chemotherapy
SHARPS
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(No Transcript)
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Decontamination of Biohazardous Liquid Waste

• Decontaminate tissue and media with 10 bleach
  solution with a 30 minute contact time
• Flasks must be emptied and surfaces must be
  decontaminated at the end of a shift

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Disinfection

• 1-10 household bleach
• Make 10 solution weekly for effectiveness
• 70 Ethanol
• Not suitable for non-enveloped viruses
• Sani-wipes
• Must be EPA approved

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Labeling

• Place International biohazard symbol on
• Biohazardous waste
• Door signs
• Incubators
• Freezers
• Refrigerators
• Shipping boxes
• Any equipment use for biological samples

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Handling, storage, transport procedures

• Specimens must be placed in a container which
  prevents leakage during collection, handling,
  processing, storage, transport, or shipping (use
  secondary container), container must be labeled
  with biohazard symbol

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Hep B Vaccination

• Recombinant vaccine
• Anti-cancer
• Anaphylaxis rare

Contact EHS for more information and
forms 323-442-2200 or IBC_at_admin.usc.edu In-cla
ss training required to obtained vaccination form
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Handling Exposures

• Wash affected area with soap and water, if
  mucosal exposure, rinse with water/saline
• Report immediately and seek medical evaluation
  (Internal Medicine, White Memorial after-hours)
• Counseling, baseline testing, test source if
  possible, possibly initiate PEP, schedule
  follow-up testing various timepoints up to 1 year

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Post exposure prophylaxis

• HBV HBIG vaccine if unvaccinated
• HIV Standard Antiretroviral Therapy (ART)
• antiretrovirals, 2 or 3 drug expanded regimen
  depending on type of exposure (percutaneous vs.
  mucosal), status of the source, bodily fluid
• HCV Rivavirin pegylated-interferon alpha-2b.

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In summary

• Practice safe techniques
• Use safety-engineered sharps
• Dispose of needles into sharps containers
• Dont recap needles
• Wear gloves, lab coat/scrubs, closed-toe shoes
• Good hand hygiene
• Follow post-exposure procedures

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Exposure control plan
Cal-OSHA BBP Exposure Control Plan
info http//www.dir.ca.gov/dosh/dosh_publications
/bbpbest1.pdf
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Internal Medicine (HCC II) and White Memorial
Hospital
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References

• Cal OSHA Bloodborne Pathogen Standard,
  http//www.dir.ca.gov/title8/5193.HTML
• Surveillance of Occupationally Acquired HIV/AIDS
  in Healthcare Personnel, as of December 2006,
  http//www.cdc.gov/ncidod/dhqp/bp_hcp_w_hiv.html
• Panlilio AL, et al. Infect Control Hosp
  Epidemiol, 2004
• Exposure to Blood What Healthcare Personnel Need
  to Know, http//www.cdc.gov/ncidod/dhqp/pdf/bbp/Ex
  p_to_Blood.pdf
• An introduction to Bloodborne Pathogens in the
  Pharmacy, https//webapp.walgreens.com/cePharmacy/
  viewpdf?fileNameblood_borne_pathogens.pdf
• Aoun, H. When a house officer gets AIDS. N Eng J
  Med 321(10)693-696, 1989.
• FDA Safety Alert Hepatitis B Transmission via
  Spring-loaded Lancet Devices
• http//www.fda.gov/downloads/MedicalDevices/Safety
  /AlertsandNotices/PublicHealthNotifications/ucm063
  124.pdf
• NIOSH Alert Preventing Needlestick Injuries in
  Health Care Settings, 1999