1. Department of University Safety and Assurances www.safety.uwm.edu

2. US&A (v. 2/07) 2 Bloodborne Pathogens Bloodborne Pathogens are microorganisms (such as viruses) transmitted through blood, or other potentially infectious material such as certain bodily fluids (semen, breast milk, etc.) or tissues.Bloodborne Pathogens are microorganisms (such as viruses) transmitted through blood, or other potentially infectious material such as certain bodily fluids (semen, breast milk, etc.) or tissues.

3. US&A (v. 2/07) 3 Bodily fluids, especially those visibly contaminated with blood, are capable of causing disease.Bodily fluids, especially those visibly contaminated with blood, are capable of causing disease. Pathogens can enter your body through a cut in the skin, through your eyes or mouth.Pathogens can enter your body through a cut in the skin, through your eyes or mouth. Can also be transmitted sexuallyCan also be transmitted sexually Main diseases of concern are Hepatitis B (and C) virus, and HIV (AIDS virus).Main diseases of concern are Hepatitis B (and C) virus, and HIV (AIDS virus). Bloodborne Pathogens

4. US&A (v. 2/07) 4

5. 5HIV HIV attacks your body’s ability to protect itself against disease Initially no visible signs of having the virus Most people with HIV develop AIDS (acquired immune deficiency syndrome) There is no vaccination for HIV

6. US&A (v. 2/07) 6 HIV attacks your body’s ability to protect itself against disease Initially no visible signs of having the virus Most people with HIV develop AIDS (acquired immune deficiency syndrome) There is no vaccination for HIV Human Immunodeficiency Virus (HIV) Immature HIV Virus

7. US&A (v. 2/07) 7HIV Virus lives outside the body only a few hours 4 modes of transfer: 1. Blood 2. Semen 3. Vaginal secretions 4. Breast milk

8. US&A (v. 2/07) 8HIV 10-50 virus particles per ml of blood

9. US&A (v. 2/07) 9 Aids Statistics from CDC

10. US&A (v. 2/07) 10 Persons Diagnosed With AIDS

11. US&A (v. 2/07) 11 Adults & Adolescents Living with AIDS

12. US&A (v. 2/07) 12 Adults & Adolescents Living with AIDS

13. US&A (v. 2/07) 13 Proportion of AIDS Cases Among Females

14. US&A (v. 2/07) 14 CDC HIV Prevention Program CDC directs largest portion of its HIV prevention effort to the African American communities AIDS is the leading cause of death among African Americans ages 25-44

15. US&A (v. 2/07) 15 HIV Risk Growing Among Women and Teens

16. US&A (v. 2/07) 16HIV Newsweek Special Edition Summer, 2005

17. US&A (v. 2/07) 17

18. US&A (v. 2/07) 18 What is Hepatitis? Hepatitis means inflammation of the liver. Viral hepatitis is inflammation of the liver caused by a virus.Hepatitis means inflammation of the liver. Viral hepatitis is inflammation of the liver caused by a virus. There are five identified types of viral hepatitis and each one is caused by a different virus.There are five identified types of viral hepatitis and each one is caused by a different virus. In the United States, Hepatitis A, Hepatitis B and Hepatitis C are the most common types.In the United States, Hepatitis A, Hepatitis B and Hepatitis C are the most common types.

19. US&A (v. 2/07) 19 Types of Hepatitis Hepatitis A Hepatitis B Hepatitis C Hepatitis D Hepatitis E Hepatitis G

20. US&A (v. 2/07) 20 Hepatitis A Hepatitis A continues to be one of the most frequently reported vaccine-preventable diseases in the US. Although hepatitis A occurs in virtually every area of the United States, certain states and counties have higher rates than others.

21. US&A (v. 2/07) 21 Up to 100 times easier to catch than HIV Unlike HIV, can live outside of body for several days Schematic of Hepatitis B Virus Hepatitis B

22. US&A (v. 2/07) 22 Is Hepatitis B a Serious Problem? Yes. Each year thousands of people of all ages get Hepatitis B and about 5,000 dies of chronic liver problems caused by HBV virus infection. If you have had other types of Hepatitis, such as Hepatitis A or C, you can still get HBV. HBV is spread by: –Having sex with an infected person –Direct contact with the blood of an infected person.

23. US&A (v. 2/07) 23 Hepatitis B Hepatitis B virus (HBV) is 100 more infectious than HIVHepatitis B virus (HBV) is 100 more infectious than HIV About 5% of Americans have been infected with HBV at some point during their lifetimeAbout 5% of Americans have been infected with HBV at some point during their lifetime People who get infected with HBV can also get infected with Hepatitis D virus (HDV). If this happens, people often become very sickPeople who get infected with HBV can also get infected with Hepatitis D virus (HDV). If this happens, people often become very sick »Source

24. US&A (v. 2/07) 24 HBV Cannot be Spread by: Sneezing or coughing Kissing or hugging Breast feeding Food or water Sharing eating utensils or drinking glasses Casual contact

25. US&A (v. 2/07) 25 Concentration of Hepatitis B Virus in Various Body Fluids

26. US&A (v. 2/07) 26 Average Incubation Period The average incubation period (The time between an initial exposure to the virus and the development of symptoms) for Hepatitis B is about 16 weeks

27. US&A (v. 2/07) 27Hepatitis Acute : 6-8 weeks, 90% –30-40% with acute HBV have no idea how or when they became infected –5-15% of infected carry virus for longer than 6 months (carriers) Chronic: Life, 10% – –Hepatitis B carriers are people infected with HBV and never fully recover. They carry the virus and can infect others for the rest of their lives – –Approximately one million people in the US carry HBV

28. US&A (v. 2/07) 28 Hepatitis B 1,000,000 - 1,000,000,000 virus particles per ml of blood Virus can live outside the body for several days

29. US&A (v. 2/07) 29 Hepatitis B “The risk of contracting Hepatitis B from a single needlestick contaminated with blood from a person with known Hepatitis B ranges from 6% to 30%.”“The risk of contracting Hepatitis B from a single needlestick contaminated with blood from a person with known Hepatitis B ranges from 6% to 30%.” “Approximately 10% of those infected become chronic carriers who can infect their families and friends. They have up to 300 times greater than normal risk of developing liver cancer.”“Approximately 10% of those infected become chronic carriers who can infect their families and friends. They have up to 300 times greater than normal risk of developing liver cancer.” “Every year, approximately 5,000 Americans, die of HBV or its complications.“Every year, approximately 5,000 Americans, die of HBV or its complications.

30. US&A (v. 2/07) 30 HIV vs. Hepatitis B

31. US&A (v. 2/07) 31 Hepatitis C An Estimated 3.9 million Americans have been infected with HBC Hepatitis C virus (HCV) infection is the most common chronic bloodborne infection in the United States

32. US&A (v. 2/07) 32 Hepatitis C Disease can incubate for decadesDisease can incubate for decades By 2010 may affect more Americans each year than AIDSBy 2010 may affect more Americans each year than AIDS HCV not related to the viruses that cause HBA and HBVHCV not related to the viruses that cause HBA and HBV

33. US&A (v. 2/07) 33 Sources of Infection -- Hepatitis C

34. US&A (v. 2/07) 34 Hepatitis C Risk Factors: –Long-term kidney dialysis –Sex with multiple partners –Tattooing or body piercing with shared needles or unsterilized equipment –Intranasal cocaine use with shared straws Pamela Anderson claims her infection came from a tattoo needle

35. US&A (v. 2/07) 35 Hepatitis C Prevention If you are thinking about getting a tattoo or body piercing, consider the risks.If you are thinking about getting a tattoo or body piercing, consider the risks. –You might get infected if tools have someone else’s blood on them or if the artist or piercer does not follow good health practices such as washing hands, using sterile equipment and disposable gloves.

36. US&A (v. 2/07) 36 Some signs and symptoms of HBV and HBC include: Flu-like symptomsFlu-like symptoms fatiguefatigue jaundicejaundice severe pain in jointssevere pain in joints lung diseaselung disease inflammation of liverinflammation of liver inflammation on and ulcers of the coloninflammation on and ulcers of the colon may be asymptomatic (i.e. no symptoms indicated)may be asymptomatic (i.e. no symptoms indicated)

37. US&A (v. 2/07) 37 HBV and HCV Liver is located behind the lower ribs on the right side of your abdomenLiver is located behind the lower ribs on the right side of your abdomen Weighs about 3 pounds and is roughly the size of a football.Weighs about 3 pounds and is roughly the size of a football. If infected with HBV, the liver often becomes tender and enlargedIf infected with HBV, the liver often becomes tender and enlarged

38. US&A (v. 2/07) 38 Hepatitis B (and C) There is no cure for Hepatitis B or C…There is no cure for Hepatitis B or C… but unlike HIV, there is a vaccination for Hepatitis B.but unlike HIV, there is a vaccination for Hepatitis B. (There is no vaccination for Hepatitis C) (There is no vaccination for Hepatitis C)

39. US&A (v. 2/07) 39 The ABC’s of Hepatitis

40. US&A (v. 2/07) 40 How Long Can the Virus Survive Outside the Body? Hepatitis A is caused by Hepatitis A virus (HAV) HAV can live outside the body for months, depending on the environmental conditions Hepatitis B is caused by Hepatitis B virus (HBV) HBV can survive outside the body at least 7 days and still be capable of transmitting infection. (HCV)Hepatitis C is caused by Hepatitis C virus (HCV) Recent studies have shown that HCV can survive outside the body and still transmit infection for 16 hours, but not longer than 4 days.

41. US&A (v. 2/07) 41 Only employees at moderate risk are included in the campus Bloodborne Pathogens Exposure Control Plan.Only employees at moderate risk are included in the campus Bloodborne Pathogens Exposure Control Plan. Employees in the plan can receive HBV vaccinations at no cost.Employees in the plan can receive HBV vaccinations at no cost. There are specific training, engineering, and work practice controls for those potentially at risk of exposure to BBP on the job.There are specific training, engineering, and work practice controls for those potentially at risk of exposure to BBP on the job. How to Reduce Your Risk

42. US&A (v. 2/07) 42 How to Reduce Your Risk Universal Precautions/ Standard Precautions: –A system of infection control which assumes that all human blood and certain body fluids are treated as if known to be infectious.

43. US&A (v. 2/07) 43 How Bloodborne Pathogens Spread on the Job By a sharp object that is contaminated by the virus when it cuts or punctures your skin.By a sharp object that is contaminated by the virus when it cuts or punctures your skin.

44. US&A (v. 2/07) 44 How Bloodborne Pathogens Spread on the Job When you touch a contaminated surface and then touch your eyes, nose, mouth, or open wounds or inflamed skinWhen you touch a contaminated surface and then touch your eyes, nose, mouth, or open wounds or inflamed skin When a contaminated object touches inflamed skin, acne, skin abrasionsWhen a contaminated object touches inflamed skin, acne, skin abrasions

45. US&A (v. 2/07) 45 Use Spill Kit for Clean-up Kit Includes: Face MaskFace Mask GlovesGloves GogglesGoggles Sharps Disposal ContainerSharps Disposal Container VobanVoban Fluid Control SolidifierFluid Control Solidifier Personal Safety Equipment Cleaning PadsPersonal Safety Equipment Cleaning Pads

46. US&A (v. 2/07) 46 How to Reduce Your Risk Don’t Recap NeedlesDon’t Recap Needles

47. US&A (v. 2/07) 47 How to Reduce Your Risk Do not bend, shear, break or recap needlesDo not bend, shear, break or recap needles If you must recap, use one-handed methodIf you must recap, use one-handed method

48. US&A (v. 2/07) 48 Needles and other sharps must be discarded in rigid, leak-proof, puncture resistance containersNeedles and other sharps must be discarded in rigid, leak-proof, puncture resistance containers How to Reduce Your Risk

49. US&A (v. 2/07) 49 When emptying trash containers, do not use your hands to compress the trash in the bag. How to Reduce Your Risk

50. US&A (v. 2/07) 50 Lift and carry the trash bag away from your body How to Reduce Your Risk

51. US&A (v. 2/07) 51 Do not eat, drink, smoke, apply cosmetics or handle contact lenses in areas where there is the possibility of exposure to BBP, such as in UWM labsDo not eat, drink, smoke, apply cosmetics or handle contact lenses in areas where there is the possibility of exposure to BBP, such as in UWM labs How to Reduce Your Risk

52. US&A (v. 2/07) 52 Personal Protective Equipment Gloves, masks, eye protection, CPR microshieldsGloves, masks, eye protection, CPR microshields (PPE is provided by UWM)

53. US&A (v. 2/07) 53

54. US&A (v. 2/07) 54 Get Spill Kit from Janitorial ClosetGet Spill Kit from Janitorial Closet Put on gloves.Put on gloves. Body Fluid Cleanup Procedures

55. US&A (v. 2/07) 55 If splashing is anticipated, wear protective eyewear and mask Body Fluid Cleanup Procedures

56. US&A (v. 2/07) 56 Remove visible material with absorbent towelsRemove visible material with absorbent towels Body Fluid Cleanup Procedures

57. US&A (v. 2/07) 57 Area should be decontaminated for 10 minutes Once the area has been disinfected, dry area with absorbent towels and dispose of towels in regular trash Body Fluid Cleanup Procedures

58. US&A (v. 2/07) 58 Glove removal and disposal techniqueGlove removal and disposal technique Body Fluid Cleanup Procedures

59. US&A (v. 2/07) 59 Glove Removal and Disposal Grip one glove near the cuff & peel it down until it comes off inside out.Grip one glove near the cuff & peel it down until it comes off inside out. Cup in the palm of your gloved hand.Cup in the palm of your gloved hand. Place two fingers of your bare hand inside cuff of remaining glove.Place two fingers of your bare hand inside cuff of remaining glove.

60. US&A (v. 2/07) 60 Glove Removal and Disposal Peel that glove down so that it also comes off inside out and over the first glove.Peel that glove down so that it also comes off inside out and over the first glove. Dispose of gloves in the normal trash.Dispose of gloves in the normal trash.

61. US&A (v. 2/07) 61 Wash Hands Well Wet your hands and apply liquid, bar or powder soap. Rub hands together vigorously to make a lather and scrub all surfaces. Continue for 20 seconds! It takes that long for the soap and scrubbing action to dislodge & remove stubborn germs. Rinse hands well under running water. Dry your hands using a paper towel or air dryer. If possible, use your paper towel to turn off the faucet

62. US&A (v. 2/07) 62 Exposure Incident What should you do if you have an exposure to blood and/or other body fluids that might contain Hepatitis B virus (HBV), Hepatitis C virus (HCV), or (HIV) virus?

63. US&A (v. 2/07) 63 Following an Exposure If you have an exposure incident – immediately wash the exposed area with warm water and soap. If the exposure was in your eyes, immediately flush with water (or saline solution) – make sure to completely irrigate the eye area.

64. US&A (v. 2/07) 64 Removal of Contaminated Clothing If a pullover shirt becomes contaminated you must remove it in such a way as to avoid contact with the contaminated surfaceIf a pullover shirt becomes contaminated you must remove it in such a way as to avoid contact with the contaminated surface Rolling the shirt as it is pulled toward the head will reduce the chance of contact with the contaminated areaRolling the shirt as it is pulled toward the head will reduce the chance of contact with the contaminated area After carefully rolling the shirt, pull it over the head – avoiding contact with mucous membranesAfter carefully rolling the shirt, pull it over the head – avoiding contact with mucous membranes If the shirt cannot be removed without contamination, it is recommended that the shirt be cut and removedIf the shirt cannot be removed without contamination, it is recommended that the shirt be cut and removed

65. US&A (v. 2/07) 65 Following an Exposure Report the incident to your supervisorReport the incident to your supervisor Immediately seek medical treatmentImmediately seek medical treatment Complete Accident/Injury Report as soon as possible and turn in to your supervisorComplete Accident/Injury Report as soon as possible and turn in to your supervisor Form is submitted to Workers CompensationForm is submitted to Workers Compensation

66. US&A (v. 2/07) 66 Hepatitis B Vaccination

67. US&A (v. 2/07) 67 Hepatitis B Vaccination Beginning with the 1997-98 school year, Wisconsin state law began to phase in the Hepatitis B vaccination requirement.

68. US&A (v. 2/07) 68Vaccination Very low risk vaccineVery low risk vaccine Three doses over 6 monthsThree doses over 6 months Must receive all three dosesMust receive all three doses >79% effective>79% effective Free to employeesFree to employees May decline vaccine (but must sign waiver)May decline vaccine (but must sign waiver) May receive vaccine laterMay receive vaccine later

69. US&A (v. 2/07) 69 Vaccination Form You may choose one of the following options: –Yes, I do wish to receive the Hepatitis B vaccine or –I decline the Hepatitis B vaccination at this time

70. US&A (v. 2/07) 70 Adult Immunization Schedule Persons with medical/exposure indications

71. US&A (v. 2/07) 71 Vaccination Appointments Appointments for your vaccination can be scheduled at the Norris Health CenterAppointments for your vaccination can be scheduled at the Norris Health Center

72. US&A (v. 2/07) 72 Top 11 Most Frequently Asked Questions About Viral Hepatitis

73. US&A (v. 2/07) 73 What is Chronic HBV? Life-long liver disease caused by infection with HBV These people are infected for life and can spread the disease to others

74. US&A (v. 2/07) 74 Will I die from Hepatitis B? Most people do not die from it. There are cases where Hepatitis B can cause liver damage (cirrhosis) that does not go away. Hepatitis B can also cause liver cancer, which may lead to death. Good medical care can make your risk less for these.

75. US&A (v. 2/07) 75 Treatment for Chronic Hepatitis B Check with your doctor about treatment for chronic hepatitis B. Most people with chronic hepatitis B will remain carriers of the virus if they do not get treated. The best things carriers can do: –make sure their babies get all of their hepatitis B shots –make sure they do not spread it to others –get good health care

76. US&A (v. 2/07) 76 Booster Doses and Post-vaccination Testing Vaccine-induced hepatitis B surface antibody levels may decline over time; however, immune memory remains intact indefinitely following immunization. Persons with declining antibody levels are still protected against clinical illness and chronic disease. After routine vaccination of infants, children, adolescents or adults, post-vaccination testing for adequate antibody response is not necessary Source: CDC, 2003

77. US&A (v. 2/07) 77 If my hepatitis B vaccination series is interrupted, do I have to start over? No. If the vaccination series is interrupted, resume with the next dose in the series.

78. US&A (v. 2/07) 78Conclusion Questions?