1. UF Bloodborne Pathogen Training Program 2011
*Biological Safety Office
Environmental Health & Safety
Sharon Judge, PhD
Assistant Biosafety Officer
*Portions of this presentation were edited and adapted for clinical dentistry applications at UFCD by the Office of Clinic Administration.
OSHA requires that printed copy of this training be maintained in the clinic.

2. Bloodborne Pathogens (BBPs) ?
Pathogenic microorganisms present in blood or other potentially infectious material (OPIM)that are able to cause disease in humans. These pathogens include:
Hepatitis B virus (HBV)
Human immunodeficiency virus (HIV)
Hepatitis C virus (HCV)
Less Common disease agents such as Epstein-Barr virus (EBV), human T cell lymphoma virus (HTLV-1), malaria, syphilis, babesiosis, brucellosis, leptospirosis, arboviral diseases (WNV, EEE), Creutzfeldt-jacob disease, rabies, etc

3. BBP Standard
Implemented in 1991 by the Occupational Safety & Health Administration (OSHA)
29 CFR
Revised in 2001 – Safe sharps devices, maintain a log of injuries from contaminated sharps.
UF follows OSHA requirement
General and workplace-specific training
Completed BEFORE individual is assigned to tasks with the potential for BBP exposure and ANNUALLY thereafter

4. BBP Standard: In addition to training, individuals with potential exposure must also have the following:
Access to the regulatory text – required to print a copy for the work (clinic) area
And an explanation of it’s contents
A copy of the training material is adequate
Access to a copy of the UF Exposure Control Plan
Access to any site-specific standard operating procedures (SOPs)

5. The OSHA BBP Standard Scope & application Definitions
Exposure control, exposure control plan, & exposure determination by jobs/tasks
Compliance
Engineering and work practice controls
Personal Protective Equipment (PPE)
Housekeeping
Regulated waste and sharps
HIV/HBV research labs – held to a higher standard
HBV vaccination and Post-exposure prophylaxis (PEP)
Communication to employees – signs, labels, training
Record keeping

6. UF BBP Program http://www.ehs.ufl.edu/Bio/BBP/default.htm
Chairs/Directors : ensure department’s compliance
Faculty/Supervisors : have an exposure control plan in place that is appropriate & being followed
Employees, students, volunteers, etc: follow exposure control plan, report problems/exposures
SHCC/Employee Health: immunizations & post-exposure follow-up
EH&S Biosafety: develop & coordinate UF program, track participants

7. Who at UF is enrolled in the program?
ALL employees, staff, students, volunteers, affiliates with potential exposure to bloodborne pathogens (BBP) from human blood / other potentially infectious material (OPIM)
Custodians, medical providers, dentists/dental staff, autopsy staff, clinical laboratory staff, research lab staff & students, biomedical engineers, athletic trainers, event staff, police, emergency responders, physical plant workers,…..etc

8. NO* unless visibly contaminated with blood
What constitutes OPIM?
YES
NO* unless visibly contaminated with blood
Cerebrospinal fluid
Tears
Synovial fluid
Feces
Peritoneal fluid
Urine
Pericardial fluid
Nasal secretions
Pleural fluid
Sputum
Semen/Vaginal secretions
Sweat
Saliva
Vomit
Breast milk
Amniotic fluid

9. How are BBPs commonly transmitted at work?
Cuts or punctures with contaminated sharp objects
Splashes to mucous membranes (linings of eyes, nose, & mouth)
Your mucous membranes are permeable, allow pathogens to pass through
Contamination of broken or non-intact or skin (wounds, chapped skin, rashes)

10. UF Exposures (2008-2010) Note: 2010 Increase in sharps and splash exposures

11. 2010 Reported Sharps Exposures by Department
Dentistry reported 10 exposures

12. Cornerstone of exposure prevention “STANDARD PRECAUTIONS”
Any and all human blood or other potentially infectious material (OPIM) is treated as INFECTIOUS
Use:
Safety equipment
Engineering Controls
Safe practices
Personal Protective Equipment (PPE)
To protect yourself & others in the work environment
“Standard Precautions” is an alternate, clinical / hospital term
= Universal Precautions + “body substance isolation” (standard of care for all patients, all body fluids)

13. What to treat with STANDARD PRECAUTIONS:
Any human blood or OPIM …..&…..
objects/items that may be contaminated by blood or OPIM
Any unfixed tissue or organ, other than intact skin, from a living or dead person
Cell or tissue cultures that may contain BBP agents
Blood/ tissues from animals infected with BBP agents

14. Research using human cell lines…
Use Universal Precautions for all human cell lines
ATCC started testing newly manufactured/deposited cell lines for common viral pathogens (HIV, HepB, HepC, HPV, EBV, and CMV) in January 2010
Many infectious agents yet to be discovered and for which there is no test
Remember HIV?
What about XMRV?

15. Hepatitis B (HepB, HBV)
Spread through direct contact with infected body fluids (blood, semen, vaginal fluids)
More transmissible than Hep C virus and HIV
Infection may be acute or chronic
~ % of Americans have been infected with HepB
5-10 % of adults will develop chronic infection; ~1.2 million people with chronic HBV
15-25% develop cirrhosis , liver failure, or liver cancer (~ 3000 deaths/year)
Many people (~50%) are asymptomatic; if symptoms occur they include:
Fever
Abdominal pain
Fatigue
Loss of appetite
Nausea
Vomiting
Jaundice
Joint pain
Dark urine

16. Occupational Hepatitis B Exposures
Needle sticks a real concern… 30% of susceptible/non-vaccinated individuals exposed to infected blood this way became infected
Can be transmitted by surface contact with dried blood or OPIM! HBV can remain infective in dried room temperature for at least 1 week (MacCannell et al., Clin Liver Dis 2010; 14:23-26)
Many people have no idea how they became infected
Risk of infection from blood/OPIM splash onto non-intact skin or mucous membranes… greater risk than other BBPs

17. How to prevent Hepatitis B infections at work
Get vaccinated!
Use Standard Precautions
Cleaning/disinfection is important because the virus can survive on surfaces
OSHA BBP standard requires that employees with potential exposure be offered the vaccine at no cost.
Occupational infections have decreased 95% since HepB vaccine became available in 1982

18. HepB Vaccine Safe Effective
Given to newborns, 120 million people in U.S. have received at least one dose
Effective
>95% develop immunity after full series (3 doses given at 0, 1, 6 months)
In Gainesville, free to SHCC ( )
Bring completed Acceptance/Declination statement with you
If you decline, can change mind at any time
NOTE: Decline in children and adolescents since implementation of childhood vaccinations.

19. Post-vaccination testing
Health-care workers or public safety workers at high risk for continued percutaneous or mucosal exposure to blood or body fluids, HBV research lab workers
Performed 1-2 months after dose #3 for recently vaccinated individuals
HepB surface antibody (anti-HBs) ≥ 10 mIU/mL - immune
Anti-HBs < 10 mIU/mL – revaccinate (3 doses) and retest anti-HBs
Still negative – non-responder, need HBIG after exposure
Previously vaccinated but not tested? Test for anti-HBs after an exposure; if negative, treat as susceptible.

20. Hepatitis C (HepC, HCV)
Transmitted primarily through contact with infected blood
Many people asymptomatic (symptoms similar to HepB)
~1.8 % of Americans have been infected with HepC, 3.2 million chronically infected
~ 12,000 deaths/year
Leading indication for liver transplant in U.S.

21. Occupational HepC Exposures
Percutaneous injury, esp. with deep punctures or extensive blood exposures
~2% develop infection
Mucosal/non-intact skin exposures rarely documented
Proper cleaning/disinfection of surfaces important
HCV in dried blood samples remains infective for at least 16 hours (Kamili et al., Infect Control Hosp Epidemiol 2007; 28: )

22. How to prevent Hepatitis C infections at work
Universal Precautions for Prevention!
NO VACCINE
Antivirals (interferon/ribavirin) can have serious side effects, treatment lasts weeks

23. HIV
CDC: Greater than 1 million people in the United States are currently infected.
At least one-fourth of them do not know they are infected, putting them at high risk for transmitting the virus to others.
The annual incidence rate of HIV/AIDS in Florida remains more than twice the national average.
In 2007, Florida reported 6235 cases HIV, 3896 cases AIDS (Florida DOH HIV/AIDS Annual Report 2007).

24. HIV/AIDS - U.S. and Florida
> 1 million living with HIV/AIDS
~56,000 new infections/year
~20% don’t know they are infected
Florida ranks 3rd among states in the number of reported HIV/AIDS cases

25. HIV Attacks immune system destroys white blood cells (CD4+ T cells)
Leaves patient immune suppressed & susceptible to infections & certain tumors
Many people show no symptoms for a long time (years)
Eventually leads to development of AIDS
(acquired immune deficiency syndrome)
Early symptoms very similar to flu:
Fever
Headache
Tiredness
Enlarged lymph nodes
Treatment focuses on ways to lower blood levels of virus

26. Occupational HIV Exposures
Risk for HIV transmission after:
Percutaneous injury – 0.3%
Mucous membrane exposure – 0.09%
Non-intact skin exposure – low risk (< 0.09%)
57 documented occupational
infections in U.S. (139 possible infections)
84% resulted from percutaneous exposure!

27. If HIV is such low risk, why worry?
No cure – eventually fatal
NO VACCINE
Some HIV strains resistant to therapy
Post-exposure therapy costly & has side effects.
Cocktails of three or more antiretroviral drugs given

28. How to prevent HIV infections at work
Standard precautions ONLY!

29. BBPs – comparing the risk of infection
Risks of becoming infected with (one of the below listed BBPs) from a needle stick accident:
HepB: 30% or 300 people per 1000 needle sticks, if unvaccinated
HepC :2% or 20 people per 1000 needle sticks
HIV : 0.3% or 3 people per 1000 needle sticks

30. Workplace-specific controls to protect against BBP exposure
Engineering controls(Safety Equipment )
Work Practices
Personal protective equipment (PPE)
Maximum protection when these controls overlap

31. Engineering Controls (Safety Equipment)
Task specific - Examples:
Sharps box
Non-slip floors
Cleanable Work Surfaces & Dental Chairs
Leak-proof transport containers
Safety devices including needles/syringes and scalpels
SAFETY Sharps DEVICES as available at

32. Work practices Controls
Safer ways of doing things:
Pre-plan your work (unit dose)
Decontamination/Disinfection of equipment and surfaces
Minimize splashes
Barrier covers on equipment and surfaces
Proper handling of spills
Hand Hygiene
No food or drink in areas where blood or OPIM is generated/handled/ stored

33. Needle Safety: NEVER RECAP NEEDLES USING BOTH HANDS
Do Place needles directly into the Sharps Box
Close & replace Sharps Box when it is ¾ full
Do not overfill the sharps box.
Never attempt to re-open a closed Sharps Box

34. Needle Safety:
Know where your needles and other sharps are—AT ALL TIMES!!!!!!!
**Never leave a needle uncapped anywhere in your operating field.
When possible retract tissue with another instrument (mouth mirror)
Recapping Needles
Use a scoop technique
Use a cap holder if supplied on the tray
Never use two hands when recapping - use the one-handed scoop method.

35. Circumstances Associated with Hollow-Bore Needle Injuries
NaSH June 1995—December 2003 (n=10,239)
35% Clean-up and disposal
related

36. Decontamination/Disinfection of equipment & surfaces: Disinfectants
EPA listed tuberculocidal disinfectant
Cavicide or Opticide
Follow manufacturers recommendation for contact time of surface exposure to disinfectant
A FRESHLY MADE (w/in 24 hr) solution of household bleach diluted 1:10 with water
Ethanol; isopropyl alcohol products evaporate too quickly to be effective. Do not use.

37. Indications for Hand Hygiene
When hands are visibly dirty, contaminated or soiled, wash with non-antimicrobial or anti-microbial soap and water.
Should be washed for at least 20 seconds and dried thoroughly before donning gloves. Pay attention to areas between fingers and around nails.
If hands are not visibly soiled, use an alcohol based hand sanitizer for routinely decontaminating hands.
Use enough sanitizer to moisten all surfaces of the hands and rub until dry.
Less damaging to skin than soap
Use before and after wearing gloves or patient contact.
Note residue around cuticles & under watchband after thorough hand washing (using “Glo-Germ” )

38. Personal Protective Equipment (PPE)
Procedure driven - Wear it when & where you’re supposed to
PPE must not be worn in any common area, hallway or office = OSHA BBP rule
Employer responsibilities for PPE: Supplied by employer It must be available It must fit It must be suitable to the task Cleaned or disposed of properly

39. Personal Protective Equipment (PPE)
Site specific & appropriate to the task - Refer to area’s site specific written standard operating procedures
Face and Eyes
Mask
Glasses (with side shields)
Goggles
Face Shield
With mask
Body – Examples
Coats
Gowns
Aprons
Sleeves
Head
Shoe Covers

40. According to the CDC, the correct order for
donning personal protective equipment is:
Cover gown
Fully cover torso from neck to knees , arms to end of wrist
Mask
Fit flexible band to nose bridge
Fit snug to face and over chin, covering nose
Goggles, safety glasses with side shield or face shield
Gloves
Extend to cover wrist of cover gown

41. According to the CDC, the correct order for removing personal protective equipment is:
Gloves
Outside of glove is contaminated!
When removing, grasp outside of glove with opposite gloved hand and peel off
Goggles, safety glasses with side shield or face shield
Outside of goggles is contaminated!
Remove by grasping ear piece
Cover gown
Gown front and sleeves are contaminated!
Unfasten ties
Pull away from neck and shoulders, touching inside of gown only
Turn gown inside out and roll into a ball then discard
Mask
Front of mask is contaminated – DO NOT TOUCH!
Grasp bottom, then elastics and remove

42. Pay attention to how you remove your gloves
Grasp the top or wrist of one glove, being careful not to touch anything but the glove.
Pull the glove off, turning it inside out. Continue holding the glove.
Go under the cuff of the other glove, being careful not to touch its outside surface.
Pull the glove off, turning it inside out and pulling it over the first glove. Both gloves should now be inside out, one inside the other.
Discard both gloves into an approved waste container.
Then wash hands or use hand sanitizer!

43. REMEMBER TO USE SAFE WORK PRACTICES TO PROTECT YOURSELF AND LIMIT THE SPREAD OF CONTAMINATION
Keep hands away from face
Limit surfaces touched
Change gloves between patients, when worn/torn or heavily contaminated
Perform hand hygiene

44. Personal protective equipment (PPE)-Other Considerations:
Store, Dispose of, or Clean PPE appropriately
Do not take PPE home to wash
Do not wear it out of the clinic area
…Wear closed toe shoes !
Acid + Flip flops

45. GLOVES Latex Nitrile Vinyl – Not recommended - DO NOT hold up well
Do not re-use gloves
Do not wash gloves
Some chemicals (soaps, lotions, & hand sanitizers) you use may breakdown the gloves – use glove compatibility chart

46. No gloves outside of the clinic
No gloves outside of the clinic! Be aware that the general public does not if know gloves are clean and assumes they are contaminated.
These photos should be scary! The potentially contaminated gloves have touched all sorts of things that others may touch without gloves. Anything transferred from the contaminated gloves to the item, may be picked up by the unsuspecting individual! 46

47. Site specific Exposure Control Plan (ECP) & Standard Operating Procedures (SOPs)
Equipment, practices, and personal protective equipment used AT YOUR SITE to protect you & others
Written down, reviewed, & updated on a regular basis – at least annually
Accessible to all
See EH&S website for a template to make your SOPs

48. HIV & Hepatitis research labs…..
More stringent control measures
Registration of work with EH&S
Documented enrollment in a medical surveillance program
CDC/NIH BSL2 guidelines at a minimum

49. Steps to Take If An Exposure Occurs
Wash the area very thoroughly with soap & water: flush mucous membranes for 15 minutes
Notify supervisor/faculty
Call , the Needle Stick Hotline, for exposures within 1 hour of Gainesville. Go to nearest medical facility outside of Gainesville area.
Get immediate medical attention (1-2 hr max)
Allow Medical to follow up with the appropriate testing & the required written opinion

50. In Gainesville Vicinity:
Also for scalpel cuts, glass cuts, splashes, etc

51. If material has splashed into your eyes, immediately use an emergency eyewash or another source of clean running water or saline irrigation to flush them for at least 15 minutes. Hold the eyes open and roll them around to make certain that water reaches their entire surface.
Know where the closest eyewash station is located. Staff check to verify station is in working order on a regular basis and maintain a log sheet.

52. UFCD OCCUPATIONAL EXPOSURE FLOWCHART
Stop the procedure, cleanse the skin with antibacterial soap or flush eyes with clean water.
Injured health care worker (HCW); faculty, resident, staff or student calls the Student Health Care Center (SHCC) Needlestick Hotline at Identify yourself as UFCD employee or student and that you’ve had an exposure. Provide information about the event as requested by SHCC.
Attending dental faculty confirms permission from source patient to test for Hepatitis B, Hepatitis C and HIV at no expense to them. A written consent is signed by source patient and scanned into in dental electronic record to acknowledge that consent was obtained for testing related to occupational exposure. No further details are included.
HCW and source patient go to Shands lab on 3rd floor, room 3152 for lab tests. (Lab forms will be completed by SHCC and faxed to the Shands lab.)
The source patient may be verbally informed of their test results by the exposed dental HCW or attending faculty. SHCC must provide the results – as SHCC originally ordered the tests.
NOTE: If HCW is faculty or paid resident, they should contact Workers Compensation at to open a claim so expenses will be covered by Workers Comp. Follow-up visits for HCW are scheduled according to SHCC guidelines.
NOTE: Exposed HCWs may contact SHCC with any questions or concerns at Ask for Mr. Tony Mennella.

53. The Latest Post-Exposure Prophylaxis (PEP) Guidelines for Occupational Exposures to BBP are at:
- HIV - HIV, HBV, HCV
Post-exposure follow up must be offered by the employer, confidential, & offered at no cost to the employee

54. Factors considered in assessing need for PEP
Type of exposure
Type/amount of fluid/tissue
Infectious status of source
Susceptibility of exposed person
Percutaneous injury (depth, extent, device)
Blood
Presence of HepB surface antigen (HBsAg) and HepB e antigen (HBeAg)
HepB vaccine and vaccine response status
Mucous membrane exposure
Fluids containing blood
Presence of HepC antibody
Immune status
Non-intact skin exposure
Presence of HIV antibody
Bites resulting in blood exposure to either person
CDC PEP Guidelines:

55. Record Keeping Requirements
Training records:
Retain a minimum of 3 years
Medical records for immunization or post-exposure follow up:
Retain for duration of employment + 30 yrs (includes HepB vaccination records, vaccination declination statement)
Confidential sharps injury log (type of device involved, where and how injury occurred):
Retain for 5 years from date of exposure

56. “Thank you for your continued efforts to comply with the OSHA and BBP standards in your daily work practices. This is the cornerstone for protecting you, your colleagues and your patients in the work place.”
Questions may be directed to the Office of Clinic Administration:

57. Changing Topics…
Biomedical Waste Training

58. 2011 UF Biomedical Waste Training
*Biological Safety Office
Environmental Health & Safety
*Portions of this presentation were edited for clinical dentistry and site-specific applications by the UFCD Office of Clinic Administration
Phone:

59. Biomedical Waste Training
State regulations require that all employees who may have contact with BMW receive:
initial training at time of hire
annual refresher training
Training shall cover:
Identification, handling, use of protective clothing, segregation, storage, labeling, transport, procedures for decontaminating BMW spills, contingency plan for emergency transport, and procedure for containment and treatment of BMW.
Training must be facility and site specific
Training Log/roster must be kept for a minimum of 3 years
Documentation of individual employee training is to be kept in their department.

60. What is Biomedical Waste (BMW)?
Any solid or liquid waste which may present a threat of infection to humans
Includes but is not limited to:
Non-liquid human tissue and body parts
Blood, blood products and OPIM (as defined in OSHA BBP standard) from humans and other primates
Laboratory/clinical waste containing/contaminated with blood, tissue, cell cultures & other potentially infectious body fluids
Laboratory/veterinary wastes containing human disease-causing agents
Discarded sharps (medical items intended to cut or puncture skin, e.g. needles, syringe/needle combinations, burs, scalpels)

61. Biomedical vs. Biological vs. Hazardous Waste
Biomedical waste – specifically regulated by the State of Florida Dept. of Health
BMW is infectious for humans & a subset of biological waste
Various regulations affect biological waste (NIH, USDA, etc)
Biological waste includes rDNA, animal, & plant pathogens
Hazardous waste is a non-specific term. At UF, most often used to describe chemical waste or chemically-contaminated waste (pharmaceutical waste also handled as chemical waste).

62. Examples of BMW?
Used, absorbent materials saturated with blood, body fluids, or secretions/excretions contaminated with blood & absorbent materials saturated with blood or blood products that have dried (bandages, gauze, sponges, wound care material).
Non-absorbent disposable devices (needles, carpules, disposable gloves, intact glass and hard plastic, etc) contaminated with blood, body fluids, or secretions/excretions contaminated with blood but have not been sterilized or disinfected by an approved method.
Extracted teeth and biopsy specimens
Other contaminated solid waste which represents a significant risk of infection b/c they are generated in medical facilities which care for persons suffering from diseases requiring isolation criteria.

63. State of Florida Requirements
Described in Chapter 64E-16 FL Administrative Code
Segregation, handling, labeling, storage, transport & treatment are regulated. Prescribe specific:
Sanitary practices
Training
Biomedical waste plan – provides guidance & describes requirements for proper management of biomedical waste at the generating site or facility
Permits required to generate, store, treat, & transport BMW – UF has permit
Inspections by the state – has ability to levy fines
Enforcement

64. Biomedical Waste Plan
Content of this presentation closely follows the UF Biomedical Waste Plan which is located in EH&S Biosafety Office. Contact
The BMW plan for Shands UF is located in the Environmental Services Dept., Room G137 (South Tower) and Room B301.8 (North Tower). Contact
Other departments at UF/Shands may create and maintain a BMW plan for their area using the following template:

65. How is BMW identified?
International biological hazard symbol on the container
The phrase “Biomedical Waste”, “Infectious Waste” or “Biohazardous” must be on the container
Bagged waste must be in red bags.

66. Segregation of BMW at UF/Shands
Segregated at point of origin into its proper container
“Point of origin” is the operatory, lab, patient/exam/procedure room or other area where the BMW is generated
Choices for proper BMW container:
Red biowaste bag
Labeled fiberboard box lined with a biowaste bag
Sharps container – puncture resistant container specifically designed for sharps

67. Biowaste Waste Minimization
Cost savings can be significant!
New policy for “clean” labware – see - cardboard box labeled “clean lab ware”
The following should not be put into the biowaste box unless contaminated:
*Paper *Disposable cover gowns *Packaging / wrappings *Paper towels

68. For biowaste items that can cut, but are not intended to do so…
(broken glass, Pasteur pipettes, pipettes, cotton tip applicators, etc)
Dispose of in a way that they can’t do harm
Options:
Sharps box
Sturdy box in a biohazard bag
Sleeve/bundle pipettes & place in biohazard bag

69. Segregation: Do not mix BMW with radioactive or chemical waste!
Chemically or radiologically contaminated gloves, tubes, etc. do not go into a biomedical waste box. They go into their appropriate waste container.
Call EH&S ( ) before putting hazardous (chemical) or radioactive warning stickers on biomedical waste containers.
Remember – the biomedical waste box is not a universal disposal container! It is more expensive to dispose of than regular trash.

70. Segregate medical sharps into sharps containers
Do Not Bend or Break Needles or Scalpels
Discard directly into a leak-proof, puncture resistant container
Replace container when ¾ full
Label sharps container with facility’s name and address prior to offsite transport
UF lab or UFCD Clinic, date, Faculty or Principal Investigator (PI) name, room and phone #

71. Sharps
Container should be located where the sharps are used: patient operatories, procedure areas, exam rooms, lab, etc.
UF uses disposable containers transported for disposal by Stericycle
Only sharps should go into sharps containers
Soft items quickly overfill containers and may cause sharps to stick out of the top of the box. Sharps boxes containing items other than sharps and syringes need to be replaced ASAP, but definitely within the 30 days of first use

72. What do we do with non-sharp BMW?
RED autoclave bags – must meet certain documented standards of State of FL, BBP & DOT
e.g. Fisher #01-828E (Medical Action Industries)
Red bags are to be available where needed
No liquid waste in red bags!
Once sealed, containers must stay sealed. If container breaks or is punctured, put the whole broken container in a new one.
Infectious/potentially infectious waste must be stored in a covered, leak-proof container

73. Recommend posting a laminated copy of these instructions near biomedical waste box. Write phone number to request additional boxes and red bag liners on copy:

74. BMW Storage
BMW must be staged in an area away from general traffic & accessible only to authorized personnel. Storage area must be:
Labeled with biohazard sticker
Secure (locked/non-accessible)
Easily cleanable & tidy
Waste cannot be stored > 30 days
“The 30 day period shall commence when the first non-sharps item of biomedical waste is placed into a red bag or sharps container, or when a sharps container containing only sharps is sealed.”
Packages must be labeled as biomedical waste with the biohazard symbol, lab name, location, phone & date
Some locations stage the waste & then transport it to outdoor containers removed for disposal by a designated hauler

75. Handling BMW
Wear appropriate PPE (gloves, clothing cover, safety glasses) when handling non-inactivated waste
Use Universal Precautions – assume all BMW is infectious
Transport waste in leak-proof containers
Know how to handle spills

76. Supplies for Handling and Containing BMW
At UF: Includes UFCD
Labs must furnish their own PPE and red bags (Fisher #01-828E)
Sharps containers and BMW boxes are available from Building Services custodians or from AG133 at the Health Science Center (call ) or from Physical Plant Stores, Bldg 705 near the Motor Pool (call )
At Shands, staff may obtain any of the supplies by:
Contacting Environmental Services at or
Speaking to an Environmental Services staff associate on the unit they are working

77. Who Picks Up/Transports BMW for Shands/UF?
Transportation of BMW is provided by the following registered BMW transporter:
Stericycle, Inc.
4245 Maine Ave
Eaton Park, FL 33840
State of Florida Permit #

78. Contingency Plan
Stericycle has a number of other sites in the state that they can pull transport equipment from to facilitate emergency situations

79. Treatment of BMW
BMW shall be treated by heat, incineration, or other equivalent method suitable for hazard inactivation acceptable to the State of Florida.
Shands/UF BMW is treated by Stericycle, Inc.
Autoclave which sterilizes the waste or
Incineration which destroys the waste
Note: CJD BMW must be marked for incineration per hospital policy by the area that has filled the container. See ICP 03-15, Guideline for the Management of Patients with Suspected or Confirmed Creutzfeldt-Jakob Disease (CJD) or other prion disease

80. Pretreatment of biological waste from UF labs prior to disposal by Stericycle
At UF, all lab waste handled by UF custodial staff
UF Policy:
Laboratory waste containing infectious, potentially infectious, or rDNA organisms must be inactivated prior to disposal
Properly performed autoclave or bleach treatment is acceptable
Storage of all non-inactivated waste in this category is restricted to within the generating laboratory
Specific requirements apply for waste containing biological toxins. Contact the Biological Safety Office at

81. Autoclaving Requirements:
Biological indicator testing every 40 hrs of use (every 6 mos if autoclaving non-infectious material exclusively)
Log book
Regular maintenance
250°F/121°C, lb pressure
Large loads/resistant pathogens need more time
Typical bag of Biohazardous Waste = 60 min
Transport BMW to autoclave in closed bag and leak-proof container

82. Bleach Inactivation of BMW
Acceptable for liquid material if done correctly
Add full strength household bleach to final concentration of 10% (5000 ppm available chlorine).
Mix. Contact time should be at least 30 minutes.
Pour down drain to sanitary sewer.
Beware of other disinfectants = “hazardous chemicals”, harmful work with and can’t go down drain, must be picked up by EH&S

83. BMW Spills & Surface Disinfection
Proper spill handling:
Notify people in the area
Don appropriate PPE
Place absorbent material on spill
Apply appropriate disinfectant – allow sufficient contact time (30 min)
Pick up material (watch for glass – use tongs or dust pan); dispose of material into biomedical waste
Reapply disinfectant and wipe
For large/high hazard spills, call the Biosafety Office ( )
For routine disinfection of surfaces where BMW is handled, use a 1:10 solution of freshly diluted bleach or a tuberculocidal disinfectant (ethanol products evaporate too quickly!)
UFCD uses Opticide or Cavicide, disinfectant to clean and disinfect surfaces. Utilize spray,wipe,spray method. If using disinfectant wipes: use wipe, discard, wipe method. Surface must remain wet for the length of time recommended by manufacturer in order for effective disinfection.

84. Questions? Contact: The UF Biological Safety Office 352-392-1591