1. BLOODBORNE PATHOGENS

2. Purpose Reduce / eliminate exposure potential Comply with Ohio’s Public Employment Risk Reduction Act (reference OSHA) 2

3. Exposure Determination Employees in the following job classifications have reasonably anticipated occupational exposure: –Physicians, nurses, and lab technicians at SHC; Nursing Faculty –Trainers in Intercollegiate Athletics –Employees with first aid responsibilities at the Ice Arena –RSC: Lifeguards, Facility Managers, Outdoor Pursuit Center –First aiders in Child Studies –University Police Officers –BSW / BRW who may clean-up blood/body fluid in a work area –Chemistry/Biochemistry, Kinesiology who work with blood products 3

4. Topics Bloodborne diseases and their transmission Reducing exposure potential Exposure incidents Hepatitis B vaccine Spill cleanup 4

5. Bloodborne diseases and their transmission Percutaneous, parenteral (i.e., through the skin layer) Contact with mucous membranes of eyes, nose, mouth (via splash, direct contact) Sex with infected partner Maternal-Neonatal (i.e., mother to unborn child/infant) Significant risk variables: volume, concentration, mode of transmission, immune status 5

6. Universal Precautions A simple approach to infection control. A concept that assumes that all human blood and certain human body fluids are treated as if known to be infected by bloodborne pathogens. Always Presume Contamination Bloodborne diseases and their transmission 6

7. Terms BBP (bloodborne pathogens) HIV (human immunodeficiency virus) AIDS (acquired immunodeficiency syndrome) HBV (hepatitis B virus)* OPIM (other potentially infectious materials) Bloodborne diseases and their transmission 7 * or one of the other hepatitis viruses (e.g., HCV)

8. semen and vaginal secretions saliva (in dental procedures) ANY body fluid visibly contaminated with blood ALL body fluids in situations where it is difficult or impossible to differentiate between body fluids Other internal fluids from the brain or spine, joints, lungs, around the heart or abdomen, or in the womb Any unfixed (not preserved) human tissue or organ Other Potentially Infectious Materials OPIM Bloodborne diseases and their transmission 8

9. Not Considered OPIM Vomit Perspiration Tears Urine Feces Bloodborne diseases and their transmission 9

10. Human Immunodeficiency Virus Target in Body Virus Concentration Risk (contaminated needlestick) External viability Vaccine Available low (5 - 10)* immune system 1 in 200 chance 3 to 5 hrs no 10 AIDS H I V Time Span (?) *measured in viral bodies / milliliter of blood

11. HIV/AIDS Epidemiology (U.S.) Source: Centers for Disease Control and Prevention http://www.cdc.gov/hiv/statistics/basics/index.html 11 1994 1996 2002 2004 2006 2008 2010 2013 Cases ReportedDeaths Persons living With diagnosis of HIV Infection 71,874 59,347 38,132 38,726 25,551 23,049 18,926 49,095 36,510 16,948 17,154 15,679 16,276 15,529 492,673 601,741 762,084 872,990 1.1 million

12. Hepatitis “Hepa” = liver; “titis” = inflammation of 6 types = A, B, C, D, E, and G Types B (HBV) and C are bloodborne Type D and G only occurs in those already infected with type B Types A, E spread through fecal-oral mode of transmission Hepatitis B and C can be ACUTE or CHRONIC Bloodborne diseases and their transmission 12

13. Target in Body Virus Concentration (one tsp. of blood) Risk from contaminated needlestick External viability Vaccine Available 500M* liver 1 in 2.5 chance 7 days yes Source: American Liver Foundation Hepatitis B virus Bloodborne diseases and their transmission 13 *measured in viral bodies / milliliter of blood

14. HBV Confirmed Transmission Sexual contact (includes anal & oral sex) Contaminated needles (esp. I.V. drug use) Maternal-Neonatal Blood transfusions (negligible) Other: intra-family, -institutional, hemodialysis, oral (rare), household Approximately 1/3 unknown sources Source: American Liver Foundation Bloodborne diseases and their transmission 14

15. HBV Symptoms Loss of appetite Nausea, vomiting, fever, stomach or joint pain Extreme fatigue Yellowing of the skin or eyes Dark Urine 30 - 40% with acute HBV show no symptoms Source: American Liver Foundation Bloodborne diseases and their transmission 15

16. HBV facts (U.S.) Approximately 5,000 deaths annually 140 - 320K new infections annually Young adults account for 90% of reported cases 1.25 million Americans are HBV carriers 90 - 95% of adults recover from HBV Chronic carriers have 100% greater chance of developing liver cancer Source: American Liver Foundation Bloodborne diseases and their transmission 16

17. Exposure Control Methods 1. Signs and Labels 2. Exposure Control Plan 3. Engineering Controls 4. Personal Protective Equipment 5. First Aid Situations 6. Contaminated waste disposal 7. Contaminated laundry 17

18. 1. Signs and Labels Exposure Control Methods “Medical Waste” “Infectious Waste” “Infectious” “Biohazard” 18

19. Spill response Housekeeping HBV program Exposure incidents Infectious waste disposal PPE Work practices Covers: Availability - BBP Trainer or ESRM at: 2. Exposure Control Plan Exposure Control Methods 19 http://www.units.miamioh.edu/esrm/training/bloodborne-pathogen-training

20. 3. Engineering Controls Sharps Containers Biohazard waste bags & boxes One-way valves on resuscitation devices Hand washing facilities Examples: Exposure Control Methods 20

21. Types Limitations 4. Personal Protective Equipment Exposure Control Methods 21

22. 5. First Aid Situations University Police are designated first responders Encourage self-care if possible Avoid bare-hand pressure without barrier Glove accessibility Exposure Control Methods 22

23. 6. Contaminated Waste Disposal Infectious Waste Red bags Labeling requirements Biohazard boxes Drop-off sites Sharps disposal Exposure Control Methods 23

24. 7. Contaminated Laundry Wear gloves for handling and thoroughly wash hands afterwards If blood or OPIM gets on personal clothing, remove it and wash the clothing as soon as feasible following the detergent manufacturer’s directions. Exposure Control Methods 24

25. Exposure Incidents Blood or OPIM Contacts: 1.Mucous membranes Eyes Mouth Nose 2.Non-intact skin 3. Contaminated Sharp 25

26. Exposure Incident Examples Blood/OPIM splash on non-healthy or non-intact skin (e.g., rash, a recent cut, chapped skin, broken cuticles, skin that is chafed, scraped, etc.) Blood/OPIM splash to eyes, nose, or mouth Puncture injuries with potentially contaminated object (e.g., needlesticks, contaminated glass, etc.) Rubbing eyes or nose with contaminated gloves or clothing Exposure Incidents 26

28. Post-exposure evaluation and follow-up Confidential medical evaluation and blood testing offered at no cost to employee Voluntary Exposure Incidents 28

29. Report to Miami’s Convenient Care Clinic or the Nursing Supervisor at Student Health Services Medical personnel will document how the exposure occurred and the route of entry They will request the identity of the source individual and seek consent to test their blood for hepatitis and HIV (you will be given the results of these tests) What is involved in an exposure evaluation? Exposure Incidents 29

30. Voluntary blood tests HIV antibody test requires several blood tests over a period of time If medically indicated, you will be offered a vaccine for Hepatitis B Recordkeeping Post-exposure testing Exposure Incidents 30

31. HBV vaccine Noninfectious Produced in yeast cells Developed free of human blood or blood products Used to promote immunity to HB infection in individuals considered at high risk of potentially being exposed to the virus 31

32. Eligibility requirements* Administration site (Student Health Services) Schedule (Call SHS for appointment) Consent / Declination procedures HBV program at Miami University HBV vaccine 32 * Employees determined to have a reasonably anticipated high risk of occupational exposure

33. Pre- vs. Post-exposure vaccination Preventive / pre-exposure vaccination protects against unidentified exposure incidents Vaccine series may be initiated following exposure incident –Best started within 48 - 72 hours –Student Health Services suggests initiation no later than 7 days after exposure –70 to 75% effective in preventing HBV infection HBV vaccine 33

34. Side Effects Local effects: redness, soreness, swelling, firmness at site of injection Generalized effects: slight fever, nausea, vomiting, diarrhea, headache, chills, mild muscle aches and/or joint pain Allergic / hypersensitivity reaction: rash, itching, swelling not limited to injection site No known harmful effects if previously infected or positive for HBV antibody HBV vaccine 34

35. Contraindications (Conditions suggesting treatment should not be administered) Yeast allergy Immunodeficiency disease Recent febrile illness / infection Pregnancy Lactation HBV vaccine 35

36. Efficacy ( Vaccine’s effectiveness) Active immunity in 80 to 95 percent of persons completing the series of three injections Immunity projected to last indefinitely Positive immunity protects against all modes of transmission May donate blood if vaccine given as a preventive measure HBV vaccine 36

37. Spill cleanup 37 Kits Decontamination Precautions Procedure

38. Spill cleanup kits Accessibility requirements Know the locations of the kits in your work area and make sure you have easy access to them Know how to use your department’s kit Follow directions included with the kit and use all personal protective equipment provided in it Spill cleanup 38

39. Decontamination Use 10% bleach solution for 15-minute soak time* Undiluted bleach for a minimum exposure of 30 seconds EPA-registered TUBERCULOCIDAL disinfectants Check the label of the disinfectant you are using. “HIV-Effective” does NOT necessarily mean it is effective against hepatitis viruses. Spill cleanup 39 * mix solution and use within 24 hours

40. Spill cleanup precautions Minimize spread of spill Avoid splashing or spraying Assume gloved hands are contaminated Avoid using brushes or brooms Dispose of sharps appropriately Spill cleanup 40

41. Spill cleanup procedure Secure the site (keep others away) Inspect and put on appropriate PPE In an area free of contamination, position red bag so materials can be dropped in without soiling outside of bag Carefully use only as much decontaminant as you need to saturate the spill area, cover with paper towels, and allow to soak 1. 2. 3. 4. Spill cleanup 41

42. For non-level surfaces (e.g., walls), thoroughly clean area with 10% bleach solution (or other EPA-approved disinfectant) and allow to air dry Dispose of sharp objects in a sharps container or a sturdy puncture-resistant container Place all materials in red bag Remove disposable PPE and place in red bag 5. 6. 7. 8. Spill cleanup procedure Spill cleanup 42

43. Touching outside of red bag only, close and secure with twist tie or knot Decontaminate area again and allow to air dry Arrange for pickup and disposal of red bag Wash your hands with soap and water! 9. 10. 11. 12. Spill cleanup procedure Spill cleanup 43

44. BLOODBORNE PATHOGENS Course Revision 2014 Miami University Environmental Health and Safety Offices 44

45. Information You are encouraged to contact your BBP Trainer or the Environmental Safety & Risk Management Offices to discussquestions you may have regarding this program. Refer to the following websites for more information: http://www.units.muohio.edu/ehso/bbp.html http://www.cdc.gov/hiv/hivinfo.htm Information in English and Información en Español http://www.liverfoundation.org/ 45