1. Bloodborne Pathogen Training University of Colorado Colorado Springs Department of Environmental Health and Safety www.uccs.edu/~pusafety/environmental/index.shtml UNIVERSITY OF COLORADO AT COLORADO SPRINGS

2. The University of Colorado is an NIH funded institution and is required to follow the Occupational Safety and Health Administration (OSHA) Bloodborne Pathogen Standard, 29 CFR 1910.1030 http://www.osha.gov/pls/oshaweb/owadisp.show_document?p_table=STANDARDS&p_id=10051 This Standard recommends safeguards to protect workers against exposures to blood and other potentially infectious materials. 2 Bloodborne Pathogen Training Introduction

3. Course Overview  Institutional Biosafety Committee (IBC) approval  Training Requirements  Characteristics of bloodborne pathogens (BBPs) and other potentially infectious materials (OPIM)  Routes of transmission of infectious agents  Exposure control methods to prevent exposure  Infectious or biomedical waste disposal procedures  How to address accidents and injuries when working with BBPs and OPIMs  Managing Biohazardous Waste Bloodborne Pathogen Training 3

4. Institutional Biosafety Committee  The Institutional Biosafety Committee (IBC) must approve research, class instruction, and field work that includes bloodborne pathogens or other potentially infectious materials - An IBC application must be completed electronically and submitted to sberryIo@uccs.edusberryIo@uccs.edu -Approved applications are good for 3 years  For additional IBC information, applications, and forms: http://www.uccs.edu/~osp/compliance/ http://www.uccs.edu/~osp/compliance/ Bloodborne Pathogen Training 4

5. Who Must Receive This Training?  Employees who could be “reasonably anticipated” to have eye, mucous membrane, or parenteral contact with blood or other potentially infectious materials (OPIMs)  Health care workers, researchers, etc. Bloodborne Pathogen Training 5

6. Training shall be provided as follows: –At the time of initial assignment to tasks where occupational exposure may take place; –Annual training for all employees shall be provided within one year of their previous training. –Employers shall provide additional training when changes such as modification of tasks or procedures or institution of new tasks or procedures affect the employee's occupational exposure. The additional training may be limited to addressing the new exposures created. Training Requirements Bloodborne Pathogen Training 6

7. On-The-Job-Training ■On-the-job training (OJT) is recommended. ■Based upon a risk assessment of the specific materials you will handle and procedures you will perform in your lab related duties. ■The requirement to perform a risk assessment and OJT rests with the Principal Investigator/lab manager/supervisor. 7 Bloodborne Pathogen Training

8. Bloodborne Pathogens (BBP)  Bloodborne pathogens (BBP) are specific microorganisms transmitted in human blood or bodily fluids, which can cause disease in people.  There are three major BBPs:  Hepatitis B (HBV)  Hepatitis C (HCV)  Human Immunodeficiency Virus (HIV)  HIV is a human retrovirus that causes AIDS (Acquired Immune Deficiency Syndrome).  There is no vaccine to prevent HIV infection. Bloodborne Pathogen Training 8

9. Hepatitis B Virus  Very infectious Age dependent chronicity: -approx 90% of infants infected at birth develop chronic infections; -approx 90% of adults develop an acute infection but resolve infection and become life-long immune  Causes inflammation of the liver that might lead to liver failure  Completely preventable by a vaccine  Survives in dried blood > 1 week  Can be transmitted via blood exposures and sex Bloodborne Pathogen Training 9

10. HBV Infections are Preventable HBV vaccine series – necessary if working with human tissue  Series of three shots (0, 1 mo, 6 mo)  Approximately > 95% seroconvert  If did not convert after immunization, repeat series  Titers are recommended after series is complete to determine immunity  If unable to convert  Assigned different duties?  Hepatitis B Immune Globulin (HBIG) post exposure  Post-Exposure Prophylaxis is available Bloodborne Pathogen Training 10

11. HBV Symptoms 1 to 6 month incubation 30% asymptomatic Symptoms may look like: - jaundice, dark colored urine -fatigue -abdominal pain -anorexia -nausea/vomiting -severe, life-threatening liver failure If symptoms resolved, life-long immunity Bloodborne Pathogen Training 11

12. Hepatitis C Virus HCV – infection of the liver; major cause of liver cancers - also causes inflammation of the liver - no vaccine to prevent infection - no post-exposure treatment - acute symptoms similar to HBV infection - most infected individuals have NO symptoms - survival outside the host up to 4d, possibly more - most infected individuals become chronically infected Bloodborne Pathogen Training 12

13. HIV Human Immunodeficiency Virus (HIV) - HIV is a human retrovirus that causes AIDS (Acquired Immune Deficiency Syndrome) -There is no vaccine or cure -Most occupational infections result from needlestick injuries -HIV can be isolated from almost all body tissues  Highest titer in blood, semen, vaginal secretions, breast milk -Does not survive long outside the body -Post-exposure prophylaxis: drug therapy ASAP to prevent likelihood of infection Bloodborne Pathogen Training 13

14. HIV Infection Symptoms Possibly – weight loss, dry cough, fever, night sweats, fatigue, swollen lymph glands, persistent diarrhea, white patches in oral cavity, pneumonia, unusual colored patches under the skin Non-descript symptoms, may be attributable to other illnesses. The only way to tell if you are infected is to get tested - Seroconversion may take up to 6 months Bloodborne Pathogen Training 14

15. Other Potentially Infectious Materials 15 Besides blood-borne pathogens, there are other potentially infectious materials (OPIM) found in the academic and research laboratory settings: –Bacteria, Fungi, Rickettsia, Parasites, Prions –Other Viruses, including oncogenic (cancer causing) viruses, Epstein Barr Virus (Mononucleosis) –Recombinant DNA from infectious agents –Cell or tissue cultures of human origin –Human bodily fluids, tissue and organs –Hepatitis D Bloodborne Pathogen Training

16. Other Potentially Infectious Materials Potentially infectious bodily fluids include: –Cerebral Spinal Fluid –Synovial Fluid –Pericardial Fluid –Peritoneal Fluid –Pleural Fluid –Amniotic Fluid –Vaginal Secretions –Semen –Saliva in Dental Procedures –Any Body Fluid with Blood Bloodborne Pathogen Training 16

17. Facts About Transmission  HIV, HBV, and HCV are all spread by contact with an infected person’s blood, body fluid containing visible blood, or through sexual transmission  To actually get HIV, HBV or HCV, the virus must get inside your body  In a school environment the chance of becoming infected is very small, but could happen Bloodborne Pathogen Training 17

18. Bloodborne Pathogens are NOT…  Spread through the air like a cold or the flu  Transmittable by working next to someone who is infected  Spread via drinking fountains, food, coughing or sneezing Bloodborne Pathogen Training 18

19. Risk of Contracting BBPs 19 HIV: from a contaminated needle = 0.3% HBV: from a contaminated needle = 30%, on average, depending upon state of infection of source patient HCV: from a contaminated needle = 1-2% Bloodborne Pathogen Training

20. Routes of exposure 20 Needlesticks or contaminated sharps injuries –Most common means of exposure –600,000 to 800,000 exposures occur in the U.S. BBPs may also be transmitted through mucous membranes of the –Eyes –Nose –Mouth –Broken skin Bloodborne Pathogen Training

21. Routes of exposure ■ Unbroken skin is a good barrier against BBPs. However, infectious materials can enter your system through skin openings such as: –Open sores –Cuts –Abrasions –Acne –Sunburn –Blisters Bloodborne Pathogen Training 21

22. Other routes of exposure ■ Other types of potentially infectious material (OPIM) can be transmitted by the following routes: –Inhalation/aerosol exposures –Ingestion, especially of contaminated food or drink –Vector-borne transmission, by mosquito or other biting insects 22 Bloodborne Pathogen Training

23. Control Measures 23 Bloodborne Pathogen Training Universal Precautions Work Practices Administrative Controls Engineering Controls Sharps Safety Personal Protective Equipment Exposure Controls consist of those policies and practices that prevent occupational exposures to infectious materials, including:

24. Universal (Standard) Precautions 24 “Precautions to protect against exposure must be taken when there is any potential for exposure to bodily fluids. It is assumed that all bodily fluids have the potential to transmit disease” The Universal Precaution Rule: Treat all human blood, bodily fluids and other potentially infectious materials as if they are infectious. Bloodborne Pathogen Training

25. Exposure control plan (ECP) The OSHA BBP Standard requires employers to develop written documents to explain how they will implement the standard, provide training to employees, and to eliminate or minimize occupational exposure to blood-borne pathogens to protect the health and safety of their workers. The ECP must be tailored to the specific requirements of the institution; plans must be accessible to all employees, either on-line or in an area where they are available for review on all shifts. 25 Bloodborne Pathogen Training

26. Exposure Control Plan (ECP)  The ECP includes: –Determination of employee exposure and –Implementation of various methods of exposure control, including:  Universal (Standard) precautions  Engineering and work practice controls  Personal protective equipment  Waste segregation, treatment and disposal, including sharps  Hepatitis B vaccination  Post-exposure evaluation and follow-up  Communication of hazards to employees and training  Recordkeeping: Training records, employee health records, exposure/incident records  Procedures for evaluating circumstances surrounding exposure incidents 26 Bloodborne Pathogen Training

27. Exposure Control Plan (ECP) cont…  Administrative Controls –Administrative controls, including risk assessments, are steps taken by supervisors and individual employees, including:  Conducting a risk assessment of the materials in use  Adhering to vaccination schedules and training schedules  Training personnel to handle specific infectious materials and their hazards  Promoting individual awareness of personal protective equipment use and engineering controls (sample containers) to minimize or eliminate potential exposure Bloodborne Pathogen Training 27

28. Exposure Control Plan (ECP) cont…  Sharps Precautions –You must exercise care when using needles, scalpels, glass pipettes and other sharp instruments or devices. Follow these rules of thumb when handling sharps:  Do not recap, bend, break, or otherwise manipulate used needles by hand  Do not remove used needles from disposable syringes  Place used sharps in labeled or color-coded puncture- resistant, leak-proof, closable, sharps containers for disposal  Do not overfill sharps containers  Consider the use of alternative, non-sharps equipment whenever possible 28 Bloodborne Pathogen Training

29. Sharps disposal containers are: -Closable -Puncture-resistant -Leak-proof -Labeled or color-coded -Upright, conveniently placed in area where sharps used DO NOT OVERFILL! Equipment and Safer Medical Devices Bloodborne Pathogen Training 29

30. Exposure Control Plan (ECP) cont…  Personal Protective Equipment (PPE) –Whenever you may be exposed to infectious materials you must wear the appropriate personal protective equipment. PPE places a barrier between you and potentially infectious material. –Here are some basic rules to follow:  PPE should be readily accessible  Always wear PPE in exposure situations-Wear a lab coat, gloves and eye protection whenever splashing is imminent  Remove and replace PPE that is torn or punctured, or that loses its ability to function as a barrier to potentially infectious materials  Remove PPE before leaving the work area  Dispose of contaminated PPE properly in biohazard waste container – must have a lid, preferably a step- activated trash can lid 30 Bloodborne Pathogen Training

31. Exposure Control Plan (ECP) cont…  Types of Personal Protective Equipment (PPE) –Gloves –Protective clothing such as, but not limited to, gowns, aprons, lab coats, clinic jackets, or similar outer garments –Eye protection devices, such as masks, goggles or glasses with solid side shields, or chin-length face shields 31 Bloodborne Pathogen Training

32. Remove gloves safely and properly  Grasp near cuff of glove and turn it inside out. Hold in the gloved hand.  Place fingers of bare hand inside cuff of gloved hand and also turn inside out and over the first glove.  Dispose gloves into proper waste container.  Clean hands thoroughly with soap and water (or antiseptic hand rub product if handwashing facilities are not available). Bloodborne Pathogen Training 32

33. 33 PPE Guidelines: Gloves Wear gloves when contact with potentially infectious materials is anticipated. Check gloves before use (no small holes, tears, cracks). Remove contaminated gloves before leaving the work area. Wash hands after removing gloves. Never reuse disposable gloves. Types of gloves than can be used include vinyl, latex, neoprene or utility gloves. Bloodborne Pathogen Training

34. Exposure Control Plan (ECP) cont…  Hand Hygiene –Most common mode of transmission of pathogens is via hands! –Often infections acquired in healthcare and research settings are due to not washing your hands –Employees must wash their hands with soap and water:  immediately, or as soon as feasible, after removal of gloves or other PPE  whenever they leave the work area, go on break, or before eating  following contact with blood or other potentially infectious materials 34 Bloodborne Pathogen Training

35. 35 Hand Washing Wash hands before: –Eating. Wash hands after: –Any contact with blood, body fluids or soiled objects. –Using the toilet. –Assisting with personal hygiene. This is the single most important technique for preventing the spread of infectious diseases. Bloodborne Pathogen Training

36. 36 Hand Washing Technique Bloodborne Pathogen Training

37. 37 Alcohol-based Hand Sanitizers Procedure: 1.Apply to palm of one hand. 2.Rub hands together. 3.Rub the product over all surfaces of hands and fingers until hands are dry. Remember: if hands are visibly soiled, wash with soap & water! Bloodborne Pathogen Training

38. Hand Hygiene – Alcohol Rubs  Infection control products including waterless antiseptic hand cleaners, such as alcohol-based hand rub, allow you to cleanse your hands when soap and water are not readily available  These simple methods of infection control can help prevent bacteria or germs that may come in contact with the skin from transmitting an infectious disease  When these types of alternatives are used, you must wash your hands (or other affected areas) with soap and running water as soon as possible Bloodborne Pathogen Training 38

39. Exposure Control Plan (ECP) cont…  Engineering controls –Containment is the concept of managing materials to reduce or eliminate potential exposures to personnel, the general public and the outside environment  Primary containment consists of good microbiological techniques, appropriate vaccinations or immunizations, appropriate PPE and safety equipment 39 Bloodborne Pathogen Training

40. Communication of Hazards Must have biohazard symbol Labels attached securely to any containers or items containing blood/OPIM Red bags/containers may substitute for labels Signs posted at entrance to specified work areas Bloodborne Pathogen Training 40

41. Exposure Control Plan (ECP) cont…  Engineering Controls –Needlestick Prevention:  Sharps disposal containers, self-sheathing needles, safer medical devices, such as sharps with engineered sharps injury protections and needleless systems are used to isolate or remove certain blood-borne pathogens hazards from the workplace 41 Bloodborne Pathogen Training

42. Spills  Always wear PPE when cleaning spills  Always disinfect spills first – then use absorbent material to wipe up  - must use disinfectant and contact time that is specific to the pathogen  Always be aware of sharps  Always dispose of waste properly 42 Bloodborne Pathogen Training

43. During clean-up of spills and broken glassware/sharps contaminated with blood or OPIM, do the following:  Wear protective eyewear and mask if splashing is anticipated.  Remove glass and other sharps materials using a brush and dust pan, forceps, hemostat, etc. Do not use your hands.  Properly discard all materials into a sharps or puncture-resistant biohazardous waste container.  Use paper/absorbent towels to soak up the spilled materials. Safe Work Practices Bloodborne Pathogen Training 43

44.  Clean the area with 10% bleach or EPA-registered disinfectant.  Saturate the spill area with disinfectant. Leave for 10 minutes (or as specified by product manufacturer) or allow to air dry.  Properly dispose of paper towels and cleaning materials into proper waste containers. Safe Work Practices Clean-up of spills and broken glassware/sharps (cont.) Bloodborne Pathogen Training 44

45. Accidents and Injuries  If you are exposed to blood or other potentially infectious or hazardous materials, follow these steps: –If you experience a needlestick or sharps injury, immediately wash needlesticks or cuts with soap and water –Splashes to the nose, mouth, or skin should be flushed with water –Irrigate eyes using eyewash, for 15 minutes –Report the incident to your supervisor. Colorado State law requires you to notify your supervisor in writing within 4 days of an accident, injury or exposure –Immediately seek medical treatmentImmediately seek medical treatment 45 Bloodborne Pathogen Training

46. Where Should I Go for Medical Treatment?  Incidents involving worker exposure to infectious material are covered under Worker's Compensation for initial medical care at: -Concentra Medical Center (719)592-1584 [5320 Mark Dabling Blvd, Bldg 7, Suite 100] or -Centura Centers for Occupational Medicine (719)475- 9496 [Union Medical Campus, 1633 Medical Center Point, #100]  For after-hours treatment, go to the nearest emergency room or urgent care facility  Workers have the right to confidential medical evaluation, follow-up, and counseling. 46 Bloodborne Pathogen Training

47. What Must I Do After the Accident? “Accidents” happen even when all precautions are taken The IBC and Risk Management (255-3525) must be notified immediately of the incident, even if there is a “perceived” exposure Call 255-3111 or 9-911 if it is after University hours A Risk Management “Employee Injury Report Form” must be completed for all injuries http://www.cu.edu/risk/services/workers-compensation http://www.cu.edu/risk/services/workers-compensation And a “Needle Stick or Bodily Fluid Exposure Report Form” for these types of injuries/exposures, http://www.cu.edu/sites/default/files/WC_MH_CUDenverNeedlestickBod yFluidExposureProcess.pdf http://www.cu.edu/sites/default/files/WC_MH_CUDenverNeedlestickBod yFluidExposureProcess.pdf 47 Bloodborne Pathogen Training

48. Managing Biohazardous Waste 48 All waste generated from working with BBP or OPIM must be processed through an approved biohazardous waste vendor Solid waste must be placed in an autoclave bag that is in a secured, labeled, and covered biowaste container – preferably with a step-activated trash can lid Both solid and liquid biohazardous waste must be autoclaved or use chemical disinfection before disposal Wear proper PPE whenever handing or processing biohazardous waste Bloodborne Pathogen Training

49. Liquid or semi-liquid blood or OPIM Contaminated items that would release blood or OPIM in a liquid or semi-liquid state if compressed Items caked with dried blood or OPIM that are capable of releasing these materials during handling Contaminated sharps Pathological and microbiological wastes containing blood or OPIM Regulated Waste Bloodborne Pathogen Training 49

50. Easily accessible Labeled or color-coded Leak-proof, closeable Puncture-resistant for sharps Replaced routinely (do no overfill!) Regulated Waste - Containers Bloodborne Pathogen Training 50

51. Close immediately before removing or replacing Place in second container if leaking possible or if outside contamination of primary container occurs If reusable - open, empty, and clean it in a manner that will not expose you and other employees Regulated Waste - Containers Bloodborne Pathogen Training 51

52. Contact Information Cynthia Norton Institutional Biosafety Officer Department of Environmental Health and Safety cnorton@uccs.edu (719)255-3212 52 QUESTIONS ? Bloodborne Pathogen Training

53. THANK YOU You are now ready to take the required BBP Quiz 53 Bloodborne Pathogen Training