1	Bloodborne Pathogen Training Program
2	What are BBP diseases?
3	Where are BBPs found? Blood, cerebrospinal fluid, synovial fluid, peritoneal fluid, pericardial fluid, pleural fluid, semen, vaginal secretions, breast milk, amniotic fluid ALL potentially infectious Tears, feces, urine, saliva, nasal secretions, sputum, sweat, vomit not infectious unless visibly contaminated with blood
4	How are BBPs commonly transmitted at work? Cuts or puncture wounds with contaminated sharp objects or equipment Through broken, non-intact or chapped skin Contamination of cut, graze, lesion, or rash Splashes to mucous membranes (linings of eyes, nose, & mouth) Permeable, allow pathogens to pass through
5	Cornerstone of exposure prevention “UNIVERSAL PRECAUTIONS” An approach to infection control Treat Any human blood or other potentially infectious material (OPIM) as INFECTIOUS Use: Safety equipment Safe practices Personal Protective Equipment To protect yourself & others
6	What to treat with UNIVERSAL PRECAUTIONS – potentially infectious: Any human blood - OR cerebrospinal fluid, synovial fluid, peritoneal fluid, pericardial fluid, pleural fluid, semen, vaginal secretions, breast milk, amniotic fluid, other visibly bloody body fluids/secretions objects/items that may be contaminated by blood or any of the other fluids listed above Any unfixed tissue or organ, other than intact skin, from a living or dead person Cell or tissue cultures that may contain BBP agents Organ cultures and culture medium or other solutions that may contain BBP agents Blood/ tissues from animals infected with BBP agents
7	HIV
8	What is my risk of becoming infected with HIV at work? 1980 through 2001: only 57 occupational infections in US 48 were from needlesticks 8 were from splashes to eyes, nose, or mouth 1 unknown – worked w/concentrated HIV in a lab setting Among health care providers - risk of getting HIV after: Sharps injury estimated to be ~ 0.3% Mucous membrane exposure ~ 0.09% Risk of infection from splash onto non-intact skin unknown (low) Not transmitted by surface contact with dried blood Higher risk work: Work with AIDS patients HIV research lab Frequent use of needles to give injections, draw blood, etc.
9	If HIV is such low risk, why worry? No cure – eventually fatal No preventative vaccine Some HIV strains resistant to therapy Post-exposure therapy costly & not without side effects Reverse transcriptase inhibitors Fusion inhibitors Protease inhibitors
10	How to prevent HIV infections at work Universal precautions
11	Hepatitis viruses
12	Hepatitis B virus (HBV, Hep B) Can result in severe liver damage, liver cancer, & death if not treated. Some people only “carriers” (~30%) & show no symptoms. About 10% of infected adults will progress to chronic hepatitis. slow onset of symptoms (1.5 – 6 months): Jaundice (skin, eyes become yellow) Dark urine Abdominal pain Enlargement of the liver Flu-like symptoms Sometimes joint pain, rash, fever
13	What is my risk of becoming infected with Hepatitis B at work? Health care providers stuck with Hep B contaminated needle ~ 30% became infected with Hep B! Needlesticks not the only route – Can Be transmitted by surface contact with dried blood or OPIM! (lives > 1 week) Many people have no idea how they became infected Risk of infection from splash onto non-intact skin greater. Higher risk work: Hep B research lab Frequent use of needles to give injections, draw blood, etc.
14	How to prevent Hepatitis B infections at work Get vaccinated! OSHA BBP standard mandates employees with potential exposure be offered the vaccine at no cost. Vaccine safe, ~ 95% effective (more later) Universal precautions Housekeeping/disinfection important because virus can survive outside body Post-exposure prophylaxis in non-vaccinated person: HepB immune globulin/Hep B vaccine ~ 75% effective
15	Hepatitis C virus (HCV, Hep C) Can result in severe liver damage, liver cancer, & death if not treated. Many people asymptomatic (~75%). About 80% adults will progress to chronic hepatitis. slow onset of symptoms (> 6 months): Jaundice (skin, eyes become yellow) Dark urine Abdominal pain Enlargement of the liver Flu-like symptoms Sometimes joint pain, rash, fever
16	What is my risk of becoming infected with Hepatitis C at work? Health care providers stuck with Hep C contaminated needle ~ 2% became infected with Hep C Needlesticks (hollow bore) the primary route Transmitted by surface contact with dried blood or OPIM ?? Not much data. Risk of infection from splash onto non-intact skin: low Higher risk work: Hep C research lab Frequent use of needles to give injections, draw blood, etc.
17	How to prevent Hepatitis C infections at work Universal precautions Housekeeping/disinfection important because virus may be able survive outside body for some time Post-exposure prophylaxis – immune globulin & antiviral agents not usually recommended. Hep C status of exposed & source person monitored.
18	Hepatitis D Depends on Hepatitis B for replication Vaccination against Hep B is therefore protective against Hep D
19	The Hepatitis B vaccine Safe – even given to newborns -10 million Americans vaccinated Three doses required (0, 1, 6 months) other vaccination schedules available Very effective (~95%) Given at the UF SHCC Infirmary: 392-1161 x 4212 HSC Satellite Clinic (D2-52): 392-0627 Boosters generally not required Check w/SHCC if working in a high risk environment Vaccine titer checks sometimes done for workers at high risk You can decline vaccination, but can change your mind at any time Given at no cost to the employee Acceptance/Declination form http://www.ehs.ufl.edu/Bio/BBP/tnv.pdf
20	Workplace-specific ways to protect against BBP exposure Safety Equipment (engineering controls) Work Practices Personal protective equipment/wear (PPE)
21	Safety Equipment
22	Work practices
23	Housekeeping Routine cleaning Use and apply an EPA registered tuberculocidal disinfectant or an EPA registered disinfectant that is labeled as effective against HIV and HBV. Freshly diluted bleach is also effective. Pour the disinfectant onto contaminated surfaces - allow 10 minutes before wiping. When using any commercial disinfectant, read the directions – some are chemical hazards. Your ECP should have a schedule for routine cleaning of potentially contaminated surfaces or equipment in the workplace. Keep the area clutter & hazard free Make sure safety equipment in place & functional
24	Cleaning spills or contaminated surfaces Put on appropriate PPE (gloves, safety glasses) Place absorbent material on spill Apply EPA-listed tuberculocidal disinfectant or freshly diluted bleach – let sit Pick up material – watch for glass (use tongs or dust pan) Properly dispose of material to biowaste Reapply disinfectant – let sit
25	Disinfectants A solution of household bleach diluted 1:10 with water or ~ 1/2 cup of bleach to a gallon of water EPA listed tuberculocidal disinfectant http://www.epa.gov/oppad001/chemregindex.htm Chlorox, amphyl, lysol, sporocidin, etc 70% Ethanol evaporates too quickly to be effective. 100% ethanol can be a preservative, not a disinfectant.
26	Hand washing Wash hands after removing gloves & when you leave the work area In emergency situations, no hand washing facilities in the area: use antiseptic cleanser or antiseptic towelettes for immediate hand cleansing. Thorough washing with soap and water at a handwashing station to follow as soon as possible.
27	Personal Protective Equipment (PPE)
28	Pay attention to how you remove your gloves
29	Latex glove allergy For some individuals, repeated exposures to latex proteins may result in allergic reactions. Symptoms may include flushing, skin rashes, hives, runny nose, sneezing, itchy eyes, scratchy throat and wheezing. Rarely and over time, with repeated exposures, symptoms may escalate to anaphylactic shock. Minimizing the Risk of Latex Use non-latex gloves for activities involving contact with infectious materials. When using latex gloves, use powder-free gloves with reduced protein content. When wearing latex gloves, do not use oil-based creams or lotions. After removing latex gloves, wash hands with mild soap and dry thoroughly. Frequently clean areas and equipment contaminated with latex-containing dust
30	Personal Protective Equipment (PPE)
31	Personal Protective Equipment (PPE) - Employer responsibilities:
32	HIV & Hepatitis research labs
33	Steps to Take When Exposure Occurs
34	If material has splashed into your eyes
35	Needle Stick? Call Immediately
36	The Latest Post-Exposure Prophylaxis (PEP) Guidelines
37	What factors must qualified health care professionals consider when assessing the need for follow-up of occupational exposures?
38	The BBP standard requires that a labeling system be in place to warn people about the potential for BBPs
39	Chemical Inactivation of Biowaste
40	Segregate Sharps