1. Bloodborne Pathogens Training
University of Michigan-Flint.
Environment, Health and Safety (EHS)

2. Course Information
This bloodborne pathogens training program is required annually for UM employees who may reasonably anticipate contact with blood or other potentially infectious materials (OPIM), during the performance of their duties.

3. Course Topics
Bloodborne Pathogens Standard (copy available from EHS and online)
Bloodborne Pathogens
Mode of Transmission
Exposure Control Plan
Methods of Prevention (Universal Precautions)
UM Hepatitis B Immunization Program
Engineering Controls
Sharps Disposal
Personal Protective Clothing and Equipment (PPE)
Spill Response
BBP Waste
Communicable Diseases

4. Bloodborne Pathogens Standards and Regulations
This program was designed to meet the requirements of:
Occupational Safety and Health Administration (OSHA) Occupational Exposure to Bloodborne Pathogens
29 CFR (1990).
Michigan Occupational Safety and Health Administration (MIOSHA) Bloodborne Infectious Diseases
R R (1993).
Needle stick Safety and Prevention Act (2000)
Exposure Source Testing MI Act 368 of 1978
These standards apply to workers who are at risk of exposure
to pathogenic microorganisms associated with human blood.

5. What are Bloodborne Pathogens

6. Pathogenic Microorganisms
Bloodborne Pathogens: are pathogenic microorganisms that are present in human blood or other potentially infectious materials (OPIM) and can cause disease. Pathogenic microorganisms include, but are not limited to:
HBV
HCV
HIV
West Nile
Malaria
Syphilis
Brucellosis

7. Other Potentially Infectious Materials (OPIMs)
Blood products, semen, vaginal secretions
Saliva in dental settings
Any body fluid that is contaminated with blood
Any body fluid of unknown source
Unfixed tissues or organs
HIV or HBV containing cells or cultures
Blood, organs or other tissues from experimental animals infected with BBP
Introduction of human-derived materials (i.e. tumor cells) into animals.

8. Mode of Transmission
Transmitted when infected blood or bodily fluid enters the opening of mucosal membrane.
Mucous Membranes are wet, thin tissue found in certain openings of the human body. These openings include the mouth, eyes and nose.
Breaks in the skin are an ideal way for the contaminate to enter:
Cuts
Punctures
Abrasions
Rashes
Acne
Hang Nails
Bandage affected area and wear double gloves to prevent transmission through breaks in skin.

9. Hepatitis B (Hep B)
Infection of the liver which may lead to liver disease, liver cancer and possibly death. It is the leading occupational disease in the United States.
12,000 cases of HBV were identified annually (up to the year 1992). Numbers have decreased to approximately 800 cases annually since the introduction of the immunization.
HBV is extremely stable.
It may survive 10 days outside of host!

10. Hepatitis B (cont’d)
Approximately 10% of infected individuals may become "carriers“.
This means that they may suffer from infection at a later time. They can also be infectious to others for the rest of their lives while not demonstrating any symptoms of HBV.
Symptoms may occur 2-6 months after exposure and include:
Fever
Vomiting
Jaundice (yellowing) of the eyes and/or skin
Loss of appetite
Dark-colored urine
Aches in muscles and joints

11. Hepatitis C (HCV)
Viral infection of the liver that can be transmitted via blood or other potentially infected materials
Symptoms similar to those caused by HBV
Although 80% of individuals may have no symptoms, these infected individuals may be lifelong carriers. No vaccine is available.
Very difficult for body’s immune system to recover from HCV infection
Leading indication for liver transplants in the U.S.

12. Human Immunodeficiency Virus (HIV)
Virus that causes Acquired Immunodeficiency Syndrome (AIDS)
May be passed through infected blood or OPIMs that come in contact with broken skin or mucous membranes
Some infected individuals will develop AIDS as a result of their HIV infection.
Some individuals develop flu-like symptoms within 7-21 days after exposure.
Recent studies suggest the best independent predictors of primary HIV infection are rash and fever among individuals recently exposed to HIV.
HIV will not survive long outside host (~90-99% reduction within several hours).

13. Controlling the Risk of Exposure
Here are the ways to reduce your likelihood of exposure to blood or other potentially infectious materials:
Universal Precautions
Exposure Control plan (ECP)
Hepatitis B Vaccination
Engineering Controls
Workplace Controls
Safe Work Practices
Personal Protective Equipment (PPE)
Proper Hand-washing Technique
Reporting exposures immediately and seeking medical follow-up treatment as soon as possible

14. Universal Precautions
An infection control method where ALL human blood and other potentially infectious materials are treated as if known to be infectious.

15. Exposure Control Plan (ECP)
The ECP must be made available to all employees who are determined to be at risk.
Employees must be familiar with the ECP and know where it is located.
ECP reviewed/revised ANNUALLY with input from employees.
ECP is readily available to employees.

16. Reporting an Exposure Incident
Is it work related?
Date and time of exposure
Details of the procedure being performed, including where and how the exposure occurred. If related to a sharp device, the type and brand of device and how and when in the course of handling the device the exposure occurred must be included in the report
Details of the exposure, including the type and amount of fluid or material and the severity of the exposure
Details about the exposure source if known
Details about the exposed person… vaccinated?
May need to attach sheet of paper with details to work connection form

17. Hepatitis B Vaccination
Available to Category A employees at no cost
Series of 3 injections:
1st: given at anytime
2nd: 1 month after first injection
3rd: 5 months after 2nd injection
Provides protective levels of antibody in 97% of healthy individuals
You cannot get HBV from the vaccine
No booster shot required (lifelong immunity)
According to the FDA, the current shot is one of the safest available
Side effects may include: soreness, redness and swelling at injection site
For further information, EHS encourages you to contact your primary care physician/practitioner

18. Hepatitis B (cont’d) Vaccination need not be offered if…
Individuals have previously received the complete series
Antibody testing has revealed the individual is immune
The vaccine is contraindicated for medical reasons
The vaccine is NOT mandatory.
Employer must offer the vaccine, however, you do not have to accept the vaccine.
You may decline the vaccination series, in which you will be asked to sign a declination form.
To receive the Hepatitis B Vaccine, please contact: UM-Flint (810)

19. Hepatitis B Forms

20. No Vaccines for HCV and HIV
There is no vaccine against HCV and no treatment after exposure that will prevent infection.
There is no vaccine against HIV.
The Public Health Service, under recommendations from the CDC, suggests a 4-week course of administration of the antiretroviral drugs depending upon the risk of transmission (exposures involving a larger volume of blood with larger amount of HIV). This should begin within hours after exposure.

21. Engineering Controls
Are used to isolate or remove the potential hazard from the workplace. Controls are used in combination with safe work practice controls.
Sharps disposal containers
Hand washing facilities &waterless soap dispensers
Biohazard bags/waste containers
Spill/clean-up kits
Use tongs for picking up hazardous object
Sharps disposal containers
Hand washing facilities
Biological Safety Cabinets
Autoclave
Facilities
Mechanical means to remove broken sharps items

22. Sharps
Departments generating sharp waste are responsible for proper disposal.
Must use a puncture resistant plastic container
Must be located in area where sharps are used
Sharp containers can only be filled to indicator line or ¾ full. Call EHS (810) for removal.
Do NOT OVERFILL sharps container. Overfilled sharps container pose a risk to all workers.

23. Sharps (cont’d) Examples of sharps are: Needles Scalpels Razor blades
Lancets
Contaminated glass Pasteur pipettes
Glass capillary tubes
Contaminated broken glass
Contaminated microscope slides and cover slips
Exposed ends of dental wires

24. Workplace Controls
Wash hands after contacting body fluids or contaminated surfaces
Keep fingernails short
Scrub nail area
Clean surfaces regularly
Keep disinfectant solution and waterless hand disinfectant nearby.
Keep PPE in stock and readily available.

25. Safe Work Practices
Personal Protective Equipment (PPE) must be removed before leaving the work area
Clothing penetrated with blood or OPIM must be removed immediately
Follow proper protocol for cleaning blood/bodily fluid spills
Wash hands immediately after removing gloves or other protective clothing.
Wash hands after contact with blood or OPIM.

26. ECDC Soiled Clothing Remove clothing immediately
Place in a labeled plastic bag (To Be Washed) and separate from normal laundry and use proper laundering techniques. (Make sure water is hot, 82oC, and is on the hot cycle for at least 10 mins)
Child’s clothing should be placed in a labeled plastic bag (Soiled) and should be sent home with parents

27. DPS/Medical Staff Soiled Clothing
Remove clothing immediately
Place in a labeled plastic bag (Biohazard)
Have clothing be sent to proper laundering facilities that will decontaminate the uniform

28. BBP Exposures Eyes: Flush with water
Skin: Wash thoroughly with soap and water for 15 mins.
IMMEDIATELY notify Supervisor & EHS.
Go to UM Medical Provider
for post-exposure follow-up ASAP

29. Protective Work Clothing and Equipment (PPE)
PPE shall be provided at no cost to the employee.
Examples: GLOVES, goggles, apron, “booties”
Assure appropriate PPE is readily accessible and fits properly
Supervisor will monitor and ensure employee uses PPE.
Provide for cleaning, laundering, or disposal of PPE.

30. Protective Work Clothing and Equipment (PPE)
Hand Protection:
Ensure equipment is available
Non-latex products must be available for individuals with latex allergies
Disposable gloves should be replaced if they are peeling, cracked, discolored, or if they have punctures, tears, or other evidence of deterioration
Gloves of appropriate size must be available
Do not re-use disposable gloves
Remove gloves before leaving the work area
Always wash hands after removing gloves

31. Blood/Body Fluid Spills
All spills must be safely cleaned as soon as possible.
Wear gloves, gowns or lab coats and eye protection during clean up.
A solution of 1:10 bleach and water or an EPA- approved disinfectant should be used.
If broken glass is involved, it should be carefully removed using a mechanical device such as tongs or forceps and the broken glass placed in the sharps container.
Never pick up broken glass by hand!

32. Spill Clean-up Procedure

33. Spill Clean-up Procedure
Cover and saturate with disinfectant. Let stand minutes. Clean and Dispose of Paper Towel
Re-spray area with disinfectant
Re-wipe with paper towel
Decontaminate materials used to clean spill
Put on personal protective equipment
Remove sharp objects carefully with forceps/tongs
Circle spill with disinfectant. Use bleach (1:10 dilution), Lysol, Virex, or EPA registered tuberculocidal disinfectant

34. Disinfectant Procedure Information
Take the necessary precautions when handling disinfectants because of them are caustic and hazardous chemicals
Always prepare all disinfectants daily. Some prepared diluted mixtures, like bleach and water, are not stable and lose it’s efficacy as a disinfectant when not made daily
When using, spray on and allow to air dry
If area is heavily soiled, clean with detergent and water first
Impervious (waterproof) surfaces are cleaned differently than porous/fabric surfaces.
Do not use commercially pre-saturated wipes to sanitize surfaces as their efficacy has not been tested
The contamination of the wipe during use may not be sufficiently controlled by the bleach solution in the wipe

35. Hand-washing First line of defense against infectious disease
Hands and other skin surfaces must be washed immediately, and thoroughly, after handling potentially infectious materials
Wash hands and lather, rubbing front and back for at least 20 seconds with soap
Rinse under running warm water from wrists to fingertips
Dry with paper towel and turn faucet off with paper towel
After watching the video, if there is one thing you could change, what would that be?

36. Employee Responsibilities
Know and understand your department’s ECP
What PPE should be worn? When?
What do you do if you are not sure if a substance is a BBP or not?
Who in your department is authorized to clean up blood? Category A or B? What are you?
ALWAYS Follow SAFE Work Practices… maintain a clean and sanitary environment.
Wash hands.
Get HBV Vaccine or sign declination form. Discuss other vaccinations that are available for you with your family physician.
Report all exposure incidents immediately
Participate in your department’s annual ECP review.

37. Other Communicable Diseases
West Nile
Meningitis
Norovirus
H1N1
Tuberculosis (TB)

38. West Nile Derived from being bitten by an infected mosquito
The most serious form of WNV is Fatal
Encephalitis: inflammation of the brain
Incubation period is 2-15 days
Symptoms include:
High fever
Neck stiffness
Disorientation
Coma
Tremors
Convulsions
Muscle weakness
Paralysis
According to the CDC, 1 in 150 people get infected, however, 4 out of 5
people infected with the virus express asymptomatic infections. This means
that they do not show any signs of sickness.

39. West Nile
According to the CDC, 1 in 150 people get infected, however, 4 out of 5 people infected with the
virus express asymptomatic infections. This means that they do not show any signs of sickness.
There are 3 possible outcomes from being
infected with WNV:
Asymptomatic: you do not show any signs of infection (most people fall into this category)
Develop West Nile Fever: experience symptoms (expressed in 20% of infected individuals)
Severe West Nile Disease, West Nile Meningitis, West Nile Encephalitis: experience severe symptoms and possibly die (expressed in 1% of infected individuals)

40. Meningitis
Inflammation of the membrane (meninges) that covers the brain and spinal cord
Caused by either:
Viral Meningitis(Aseptic) Bacterial Meningitis

41. Viral Meningitis Caused by Enteroviruses
Less severe and is healed without any specific treatment
Symptoms include:
High fever
Severe Headache
Stiff neck
Sensitivity to bright light
Sleepiness or trouble waking up
Nausea, vomiting
Lack of appetite
Symptoms last between 7-10days with full recovery
No specific treatment

42. Bacterial Meningitis Highly severe and some forms are contagious
2 strains of the leading cause of Bacterial Meningitis are Streptococcus pneumoniae and Neisseria meningitis
Symptoms include:
High fever
Headache
Stiff neck
Discomfort looking into bright lights
Nausea
Vomiting
Confusion
Sleepiness
Brain damage
Hearing loss
Learning disability
Disability

43. Bacterial Meningitis (cont’d)
Transmitted via respiratory and throat secretions
Modes of transmission include:
Coughing
Kissing
Sneezing
Not as contagious as the flu, therefore, you cannot become infected through casual contact
Example: You will not become infected if you breathe in the same air that someone with meningitis breathed
Incubation period ranges from several hours to 2 days
There are vaccines against some forms of meningitis.
According to the CDC, the current vaccines available are safe and effective

44. Norovirus
A type of Gastroenteritis: inflammation of the stomach and small and large intestines
Caused by a host of viruses that produces the outcome of vomiting and diarrhea
According to the CDC, it is the leading cause of foodborne-disease outbreaks in the United States
Common name: Stomach Flu, but not caused by Influenza

45. Norovirus
Symptoms:
Watery diarrhea
Vomiting
Headache
Fever
Abdominal cramps
Symptoms begin 1 to 2 days after infection and lasts for 1 to 10 days depending on the strain of virus.
Transmitted through contaminated food and beverages via the oral-fecal pathway

46. H1N1 (Variant Influenza Virus)
Respiratory disease normally affecting pigs, caused by a specific strain that affects human beings
Spread through the direct contact of infected pig or infected person
According to the CDC, human to human transmission is not as easily spread
Symptoms are similar to those of the human flu

47. Tuberculosis (TB)
It is an airborne disease caused by bacterium, Mycobacterium tuberculosis, which attacks the lungs. It can also attack the kidneys, spine and brain. If untreated it can be fatal.
There are 2 forms of TB:
Latent TB: when the bacteria lives in the host’s body without making the person sick. They test positive for the TB skin test, however, they are not infectious
Active TB: when the bacteria is active in the host’s body and makes the person sick and is infectious.
People can become infected if some one with active TB sings, speaks, coughs or sneezes in the nearby area.

48. Tuberculosis (TB) If infectious, there is a treatment.
TB disease can be treated by taking several drugs for 6 to 9 months. There are 10 drugs currently approved by the U.S. Food and Drug Administration (FDA) for treating TB. Of the approved drugs, the first-line anti-TB agents that form the core of treatment regimens include:
isoniazid (INH)
rifampin (RIF)
ethambutol (EMB)
pyrazinamide (PZA)
Regimens for treating TB disease have an initial phase of 2 months, followed by a choice of several options for the continuation phase of either 4 or 7 months (total of 6 to 9 months for treatment).
Treatment regimen must be fully completed to fully cured. If not taken as prescribed and correctly, infected person’s TB bacteria will become resistant to medication and would require a stronger and expensive medication.

49. Questions

50. Bibliography
(Purple Biohazard Sign)
(Bloodborne Pathogens Sign)
(HIV)
(HBV)
(HCV)
(Jaundice Hands)
(Vortex Machine)
(Pipet)
(Centrifuge Machine)
(WNV)
(WNV Map)
(Viral Meningitis)
(Viral Meningitis microscopic)
(Bacterial Meningitis)
(Bacterial Meningitis microscopic)
(Norovirus)
(H1N1)
(TB)