Presentation on theme: "University of Connecticut Health Center Bloodborne Pathogen Training"— Presentation transcript:
1University of Connecticut Health Center Bloodborne Pathogen Training You will now begin the Bloodborne Pathogen Refresher Training.The following program will review your occupational risks and the steps that you and the UCONN Health Center must take to reduce your risks of exposure.
2Bloodborne Pathogen Training Employees must report any occupational accident, illness, or hazardous exposure to their supervisor AND by phone to Human Resources (x2204 or x4589).Contact Office of Research Safety x2723 if you have any questionsContact Employee Health Service for medical questions (x2893)Contact (JDH Staff) Epidemiology Department (x4376) for infection control issues.
3Bloodborne Pathogen Training Use Engineering Controls to Reduce Risk of Bloodborne Pathogen Exposures from NeedlesticksWhen feasible , “safety” syringe/needle systems will be used to reduce the risk of a contaminated needlestick exposure (when the needle will pierce human skin or be used with human blood, cells, body fluids, infectious agents, etc.) This requirement applies to clinical and laboratory (research) activities. When such contamination risk will not be present, ordinary syringe/needle systems should be used. The Health System has stressed that at this time safety syringes are only to be used for giving injections that pierce the patient’s skin or have the potential to become contaminated with human blood or body fluids.Ordering information on such “safety” syringe/needle systems (syringe has a safety shield) will be found in the “Safety” shared folder.
5Bloodborne Pathogen Training UCHC Bloodborne PathogenExposure Control ProgramA Written Plan – available from Office of Research Safety x2723 or website atIdentifying Those at RiskBBP TrainingOffering Hep. B ImmunizationsPreventing ExposuresEvaluating & Treating ExposuresProperly Disposing of Waste
6Bloodborne Pathogen Training In addition to blood, other fluids may also present aninfection risk. OSHA defines these as “Other PotentiallyInfectious Materials” or OPIM. These are listed below.Synovial Fluid Pleural FluidSemen Amniotic FluidPeritoneal Fluid Saliva in Dental ProceduresPericardial Fluid Vaginal SecretionsCerebraspinal Fluid HIV or HBV CulturesBloody Body Fluids Unfixed Tissue
7Bloodborne Pathogen Training Bloodborne Pathogens are micro-organisms that arepresent in human blood and cause diseases in humans.Commonly we emphasize Hepatitis B and HIV (HumanImmunodeficiency Virus) in the health care setting. Thereare others.
8Bloodborne Pathogen Training Employer Responsibilities Include Implementing a written plan.Enforcing good work practices that include disinfecting surfaces, following universal precautions, and proper waste disposal.Controlling exposures through the use of needle buckets, biosafety cabinets, needleless IV systems, and self-sheathing needles.Training employees initially and through annual updates.Providing Personal Protective Equipment (PPE): gloves, gowns/aprons, eye protection (i.e., goggles, faceshields, side shields) and surgical maskIdentifying hazards by proper labeling of: incubators, freezers and centrifugesManaging medical wastes
9Bloodborne Pathogen Training Individual Responsibilities Your Actions are key to good exposure control. Theseinclude:Attending training.Complying with and enforcing the UCHC Exposure Control Plan.Segregating medical waste properly.Properly selecting, wearing, removing, and disposing ofPersonal Protective Equipment (PPE).
10Bloodborne Pathogen Training Hepatitis B Virus (HBV),Hepatitis C Virus (HCV), andHuman Immunodeficiency Virus (HIV)Bloodborne virusesCan produce chronic infectionTransmissible in healthcare settingsData from multiple sources (e.g., surveillance, observational studies, serosurveys) used to assess risk of occupational transmission
11Bloodborne Pathogen Training Frequency of Percutaneous Injury in Healthcare PersonnelBased on CDC estimates, 384,325 (95% CI 311, ,922) percutaneous injuries are sustained by healthcare personnel in US hospitals annuallyFrequency of percutaneous injury varies by occupational group and healthcare settingAt UCHC campus we had 56 high-risk percutaneous sharp injuries requiring PEP in 5 years ( ); no conversions documented
12Bloodborne Pathogen Training Risk of Bloodborne Virus Transmission after Occupational Percutaneous ExposureSourceHBVHBeAg +HBeAg -HCVHIVRisk%%1.8%0.3%
13Bloodborne Pathogen Training Preventing Transmission of Bloodborne Viruses in Healthcare SettingsPromote hepatitis B vaccinationTreat all blood as potentially infectiousUse barriers to prevent blood contactPrevent percutaneous injuriesSafely dispose of sharps and blood-contaminated materials
14Bloodborne Pathogen Training Factors Influencing OccupationalRisk of Bloodborne Virus InfectionPrevalence of infection among patientsRisk of infection transmission after a blood exposureNature and frequency of blood exposures, for example splash to mucous membranes, cut, needlestick, skin contamination, quantity of blood involved and concentration of organism in the blood
15Bloodborne Pathogen Training Hepatitis B - SymptomsOnly a small portion of acute Hepatitis B infections may be clinically recognized.Symptoms include:Anorexia or loss of appetiteVague abdominal discomfortNausea and vomitingSometimes arthralgias and rashJaundice or yellowing of the skinFever which may be absent or mild
16Bloodborne Pathogen Training Hepatitis B – Modes of Transmission Hepatitis B can be transmitted in three ways:Sexual transmissionEither homosexual or heterosexualParenteralSuch as an injury with needles and sharpsPerinatal- Virus can be transmitted from a mother to her infant during pregnancy
17Bloodborne Pathogen Training Hepatitis B – Vaccine Available A safe and effective vaccine against Hepatitis B isavailable to all “potentially at risk” UCHC individuals.You are “potentially at risk” if you have direct contact with blood and other potentially infectious body fluids. It doesn’t matter how frequently you have contact or that you take precautions when you do.The vaccine is free and available through Employee Health Service (x-2893).
18Bloodborne Pathogen Training Hepatitis C VirusMost common chronic bloodborne infection in U.S.3.9 million Americans (1.8%) have current or past infection with HCV40% of chronic liver disease HCV-related, leading to 8-10,000 deaths annuallyHCV-associated end-stage liver disease most common indication for liver transplants in U.S. adults
19Bloodborne Pathogen Training HCV Transmission in Healthcare Settings Risk factors for occupational transmission not well definedEnvironmental transmission not believed to be important - HCV rapidly degrades at room temperatureNeither presence of antibody nor HCV RNA is a direct measure of infectivity
20Bloodborne Pathogen Training Patient-to-HCW Transmission of HCVafter Exposures to HCV-Positive BloodNo. (Range) SeroconvertedType of Exposure Tested No. (%)Needlestick/sharps (50-436) (1.8)Hollowbore (1.2)OtherMucous membrane (29-85) *Nonintact skin (40-125)* Two case reports of transmission from blood splashes to the eye
21Bloodborne Pathogen Training Prevalence of HCV Infection in HCW United StatesGroup % InfectionHospital-based (pre-1980) 1-2Oral surgeons (1992) 2General surgeons ( ) 1Orthopedic surgeons (1991) 1General dentists (1992) 1Emergency response ( ) 1-3General population of adults
22Bloodborne Pathogen Training Postexposure Prophylaxis for HCV Not recommended after exposureImmunoglobulin not effectiveNo data on use of antivirals (e.g., interferon), which may be effective only with established infectionAntivirals not FDA approved for this useNo guidelines for therapy during acute infectionWhen HCV infection identified early, refer to a specialist for proper management
23Bloodborne Pathogen Training Postexposure Management: Follow-up HCV Testing of HCWIf HCV-positive source, test for anti-HCV andALT 3-6 months after exposurePerform HCV-RNA at 4-6 weeks for earlier diagnosis of HCV infection, if symptoms appear or if ALT increasesConfirm anti-HCV results with supplemental test (RIBA)
24Bloodborne Pathogen Training HIV – Symptoms“Within several weeks to several months after infectionwith the human immunodeficiency virus (HIV), manypeople develop an acute self-limiting mononucleosis-likeillness lasting for a week or two.Infected people may then be free of clinical signs forMany months to years before clinical manifestations,Including opportunistic infections and constitutional andneurological symptoms appear”.American Public Health Association Acquired Immunodeficiency Virus, Benenson, AS, ed, Control of Communicable Diseases Manual, Washington, 1995.
25Bloodborne Pathogen Training HIV – Modes of Transmission Blood Contacts – needlesticks and exposure of skin and mucous membranesSexual Contact – exchange of vaginal secretions and semenMother to Infant – transmission can occur throughout the perinatal period – during pregnancy, at delivery & through breastfeedingAlthough other modes of transmission (i.e., mosquitoes and kissing) have been suggested, none have been substantiated as distinctly different as those mentioned above.
26Bloodborne Pathogen Training HIV – No Vaccine Available Research continues toward the development of an “AIDS” vaccine.There is no vaccine available for the prevention of HIV infection.
27Bloodborne Pathogen Training Segregating Medical Waste
28Bloodborne Pathogen Training Protective EquipmentHow do I choose appropriate protective equipment?First, determine the potential for contact with blood andother potentially infectious materials or OPIM. Then select the items that will prevent your skin, mucous membranes, and clothing from becoming contaminated.
29Bloodborne Pathogen Training I’ve Been Stuck!!Promptly wash or flush the affected area and notify your supervisor! The CDC currently recommends treatment within 2 hours of exposure.
30Bloodborne Pathogen Training Where do I go to be evaluated and treated?Employee Health Service is open Monday – Friday from 8:00 AM – 5:00 PM for occupational exposures to blood and body fluids. They are located at the Exchange, 2nd floor, suite 262Phone: (option #1 for prompt response).A shuttle bus can bring you to the Exchange. Response times are generally within 10 minutes of the request. Please call for shuttle bus transportation at x2143.Employee Health Servicex2893
31Bloodborne Pathogen Training Where do I go to be evaluated and treated?The Emergency Department will provide post-exposure treatment for occupational exposures when Employee Health Service is not open. Generally, this would include evenings, nights, weekends and major holidays. The Emergency Department will assess the exposure and administer appropriate therapy. Employee Health Service will then follow-up on the next working day.The Emergency Department is located in the “C” building on the main floor of the Health Center.Emergency Departmentx2588
32Bloodborne Pathogen Training When should I be evaluated? Promptly! You need to be evaluated as soon as possible after the exposure so that the severity of the injury can be assessed.Serious exposures will require the initiation of drug therapies that are believed to be most effective when given within a few hours of the exposure.
33Bloodborne Pathogen Training Must I do anything else?YES! UCHC employees, after appropriate medical evaluation, need to call Human resources (x2204 or x4589) and complete an Occupational Injury/Illness report over the phone. Non-UCHC employees should file their employer’s required form.
34Bloodborne Pathogen Training Signs & LabelsThe biohazard symbol is reserved for indicating material with potential infection risks.At UCHC universal precautions are used – all samples with blood/body fluids are considered infectious.
35Bloodborne Pathogen Training Signs & LabelsThe biohazard symbol is not needed for specimens of human materials remaining in the Health Center that are easily recognized as requiring bloodborne pathogen controls.
36Bloodborne Pathogen Training Signs & LabelsRefrigerators, incubators, and freezers containing or contaminated with biohazardous materials require a biohazard symbol and be stored in a secure/restricted area or kept locked at all times.
38Bloodborne Pathogen Training Shipping Specimens & Infectious Agents Human specimens or infectious agents sent from the Health Center or sent here, must be labeled and packaged according to DOT regulations. These regulations also require that you be trained. Contact the Office of Research Safety to arrange for shipping.
39Bloodborne Pathogen Training Other IssuesRemember to remove all sharps before disposing of IV tubing.IV tubing and bags should be disposed of in Regulated Medical Waste (RMW).
40Bloodborne Pathogen Training Other IssuesSharps containers must be changed frequently enough so that they never become overfilled. To reduce the potential of injury due to an overfilled container, replace the sharps container when it is ¾ full.
41Bloodborne Pathogen Training Other IssuesOne of the best techniques for infection control is using plenty of soap and water when washing your hands!
42Bloodborne Pathogen Training ConclusionYou are at risk for occupational exposure to Bloodborne Pathogens.The UCHC Exposure Control Plan outlines the steps necessary to reduce infection risk. Copy available from Office of Research Safety, x-2723.When accidents occur, prompt medical attention is necessary. The CDC recommends treatment within 2 hours.Prevention is the key.
43Bloodborne Pathogen Training Review the following slides if you work in research.If you are a healthcare worker,go to the last slide.
44Bloodborne Pathogen (BBP) Training for Research Staff Biosafety Level 2 (BSL-2) – Introduction BSL-2 is required for research involving agents of moderate* potential hazard to personnel and the environment.At the UCHC, BSL-2 containment is considered equal to or better than Universal Precautions; many of the same principles apply.At the UCHC, the 5th Edition (2007) of Biosafety in Microbiological and Biomedical Laboratories (BMBL; CDC/NIH) and any lab-specific safety protocols are considered the “Biosafety Manual” for research laboratories. BSL-2 requirements may be found in Section IV of the BMBL online.The UCHC has it’s own Biosafety Webpage (http://ors.uchc.edu/bio/biosaf1.html) which is meant to be a comprehensive and UCHC specific resource.* Immunization or antibiotic treatment is often available. Extreme precaution with contaminated needles or sharp instruments.
45Bloodborne Pathogen Training for Research Staff Requirements* under the law for research staff who are potentially exposed to human blood and “other potentially infectious [human] material” are identical to those for Health Care Workers:Initial BBP Training and Annual BBP Training annually thereafter. (The Office of Research Safety has records of this; x2723.)Medical Surveillance, including the HBV vaccination or documented declination. (The Employee Health Service has records of this; x2893.)* A detailed explanation of all necessary institutional training requirements for researchers can be found at .
46Bloodborne Pathogen Training for Research Staff Examples of agents frequently assigned to BSL-2:Bloodborne Pathogens as defined above (except in strict HIV or HBV research, which requires higher containment)Other Potentially Infectious [Human] Material (OPIM):Human body fluids/particularly when visibly contaminated with bloodHuman primary cultures and established cell lines.Herpes, EBV, Hepatitis C virusesListeria monocytogenes, Salmonella spp.Toxoplasma spp., Brugia spp., Plasmodium spp.Non-Human Primate cell lines, primary cells, body fluids or tissues.
47Bloodborne Pathogen Training for Research Staff There is a clarification in the OSHA documentation* about established cell line cultures:If they are capable of propagating viruses, they are considered OPIM under the law unless:They have been tested, shown to be free of human pathogens and documented as such by the institution.They should be manipulated at BSL-2. (Cell lines, to protect the culture are already usually manipulated in biosafety cabinets. To achieve BSL-2, add the operator-protective aspects of BSL-2 containment.)ATCC BSL classifications and the fact that human (or non-human primate) cell lines come from ATCC does not assure that the cell lines have been tested and are free of pathogens. See* See the OSHA letter of interpretation at: . See the double asterisk at the bottom of the letter.
48Bloodborne Pathogen Training for Research Staff Your first defense at BSL-2 containment is standard microbiological practices, including:Limited access to BSL-2 containment. Post a biohazard sign when manipulating biohazardous materials.Wash hands after handling viable material (even with gloves).No eating, drinking, handling contact lenses, applying cosmetics, food storage, in containment. For contacts, wear goggles.No mouth pipetting. Use mechanical pipettes.Follow safe handling rules for sharps.Be careful to minimize aerosols. For techniques that cause aerosols, e.g., centrifugation, the aerosols are contained in a biological safety cabinet.Decontaminate work surfaces after use and after spills.Disinfect cultures before they go into regulated medical waste.Lab directors provide adequate training, have evidence of staff proficiency and require medical surveillance for staff.
49Bloodborne Pathogen Training for Research Staff Biosafety Level 2 –Facility Design (Secondary Barriers)
50Bloodborne Pathogen Training for Research Staff Biosafety Level 2 –Facility Design (Secondary Barriers)Requirements including:Laboratories have lockable doorsSink for hand washingWork surfaces easily cleaned/disinfectedBench tops are impervious to waterBiological safety cabinets installed as needed (certified annually)Adequate illuminationEyewash readily availableAir flows into lab without re-circulation to non-lab areas
51Bloodborne Pathogen Training for Research Staff Biosafety Level 2 –Facility Design (Secondary Barriers)Restricted access when work in progress.
52Bloodborne Pathogen Training for Research Staff Biosafety Level 2 –Laboratory Facilities (Secondary Barriers)BSL – 1 Facilities PLUS:Autoclave availableEyewash station available
53Bloodborne Pathogen Training for Research Staff Biosafety Level 2 –Safety Equipment (Primary Barriers)Personal Protective Equipment (PPE) and Engineering Controls including:Dermal protection: gloves, labcoat, eye/face shieldingRespiratory protection:Use certified (annually) Class II biosafety cabinets (BSC) for work with infectious agents involving:Aerosols and splashesLarge volumesHigh concentrationsRespirators do not replace BSCs; BSC’s are first choice for protection. Respirators may be added.
54Bloodborne Pathogen Training for Research Staff Biosafety Level 2 –Safety Equipment (Primary Barriers)Class II Biosafety CabinetAirflowEquipment/workflow layout:CLEAN>>>>>>>>>>>>>>>>>>>>>>>>>>>>DIRTY
55Bloodborne Pathogen Training for Research Staff Biosafety Level 2 – Special PracticesSupervisionSupervisor is a competent scientist with increased responsibilities and authorization to use agentLimits access to persons with proper training andmedical surveillance, e.g., immunizations.Lab PersonnelHave proper training & medical surveillanceAware of potential hazardsProficient in practices/techniques
56Bloodborne Pathogen Training for Research Staff Biosafety Level 2 – Special PracticesPolicies and procedures for entryBiohazard warning signsBiosafety manual specific to labTraining with annual updates
57Bloodborne Pathogen Training for Research Staff Biosafety Level 2 – Special PracticesBiological Safety Officer (x3781)Answer questionsEnsure complianceAssist with hazard/risk assessmentReview protocols
58Bloodborne Pathogen Training for Research Staff Biosafety Level 2 – Special PracticesNeedles & Sharps PrecautionsUse sharps containersDON’T break, bend, re-sheath or reuse syringes or needlesDON’T place needles or sharps in office waste containers
59Bloodborne Pathogen Training for Research Staff Biosafety Level 2 – Special PracticesNeedles & Sharps Precautions (con’t.)DON’T touch broken glass with hands
60Bloodborne Pathogen Training for Research Staff Biosafety Level 2 – Special PracticesUse leak-proof transport containersImmunizationsBaseline serum samplesProtocol approvals
61Bloodborne Pathogen Training for Research Staff Biosafety Level 2 – Special PracticesDecontaminate work surfacesReport spills and accidents, Research Safety x-2723,For emergencies, x-7777Disinfectants do not replace standard microbiological practices or good hygiene!
62Bloodborne Pathogen Training for Research Staff Select AgentsThe Federal Government restricts the possession, use or shipping of certain “Select Agents” and prosecutes those not complying. Go to the CDC website or call the Biological Safety Officer (x-3781)
63Bloodborne Pathogen Training for Research Staff You have now completed your annual Bloodborne Pathogen Refresher training. To receive credit, please print out the Training Certification document, complete, sign and mail to the Office of Research Safety, MC3930.THANK YOU!