1. Training for the Solid Waste Industry

2. Why is This Issue So Important? Solid waste personnel can be exposed to BBPs and other diseases through improper or even illegal disposal of infectious waste. Customers and facility contractors can expose solid waste personnel through routine interactions (both office and operations.) Providing first aid exposes the rescuer. Effective personnel training is a key to minimizing exposures.

3. This is a Serious Issue for the Solid Waste Industry Information for this presentation provided by OSHA, CDC, NIOSH, and the Center for Women’s Health Information Center.

4. What is a Bloodborne Pathogen? Bloodborne Pathogens means pathogenic microorganisms that are present in human blood and can cause disease in humans. These pathogens include, but are not limited to, hepatitis B virus (HBV) and human immunodeficiency virus (HIV). Bloodborne Pathogens are infectious microorganisms in human blood that can cause disease in humans. These pathogens include, but are not limited to, hepatitis B (HBV), hepatitis C (HCV) and human immunodeficiency virus (HIV). Needle sticks and other sharps-related injuries may expose workers to bloodborne pathogens. Workers in many occupations, including first aid team members, housekeeping personnel in some industries, nurses and other healthcare personnel may be at risk of exposure to bloodborne pathogens.

5. How are BBPs transmitted? Exposure Incident means a specific eye, mouth, other mucous membrane, non- intact skin, or parenteral contact with blood or other potentially infectious materials that results from the performance of an employee's duties. Other Potentially Infectious Materials means (1) The following human body fluids: semen, vaginal secretions, cerebrospinal fluid, synovial fluid, pleural fluid, pericardial fluid, peritoneal fluid, amniotic fluid, saliva in dental procedures, any body fluid that is visibly contaminated with blood, and all body fluids in situations where it is difficult or impossible to differentiate between body fluids; (2) Any unfixed tissue or organ (other than intact skin) from a human (living or dead); and (3) HIV-containing cell or tissue cultures, organ cultures, and HIV- or HBV- containing culture medium or other solutions; and blood, organs, or other tissues from experimental animals infected with HIV or HBV. Parenteral means piercing mucous membranes or the skin barrier through such events as needle sticks, human bites, cuts, and abrasions.

6. OSHA’s Bloodborne Pathogen Standard OSHA's Bloodborne Pathogens Standard (29 CFR 1910.1030) as amended pursuant to the 2000 Needle stick Safety and Prevention Act, is a regulation that prescribes safeguards to protect workers against health hazards related to bloodborne pathogens. It has provisions dealing with exposure control plans, engineering and work practice controls, hepatitis B vaccination, hazard communication and training, and recordkeeping. The standard imposes requirements on employers of workers who may be exposed to blood or other potentially infectious materials such as certain tissues and body fluids.

7. Examples of BBP and Other Diseases of Concern Hepatitis A Hepatitis B Hepatitis C HIV Viral Hemorrhagic Fevers Tuberculosis Rabies, West Nile Disease, Lyme Disease

8. Types of Hepatitis Hepatitis A: caused by eating food and drinking water infected with a virus called HAV. It can also be caused by anal-oral contact during sex. While it can cause swelling and inflammation in the liver, it doesn't lead to chronic, or life long, disease. Almost everyone who gets hepatitis A has a full recovery. Hepatitis B: caused by the virus HBV. It is spread by contact with an infected person's blood, semen, or other body fluid. And, it is a sexually transmitted disease (STD). Having unprotected sex (not using a condom) with an infected person. It can be transmitted by: Sharing drug needles (for illegal drugs like heroin and cocaine or legal drugs like vitamins and steroids). Getting a tattoo or body piercing with dirty (unsterile) needles and tools that were used on someone else. Getting pricked with a needle that has infected blood on it (health care workers can get hepatitis B this way). Sharing a toothbrush, razor, or other personal items with an infected person. An infected woman can give hepatitis B to her baby at birth or through her breast milk. Through a bite from another person. Source: National Women's Health Information Center

9. Types of Hepatitis - Continued Hepatitis B: With hepatitis B, the liver also swells. Hepatitis B can be a serious infection that can cause liver damage, which may result in cancer. Some people are not able to get rid of the virus, which makes the infection chronic, or life long. Blood banks test all donated blood for hepatitis B, greatly reducing the risk for getting the virus from blood transfusions or blood products. Source: National Women's Health Information Center

10. Types of Hepatitis - Continued Hepatitis C: caused by the virus HCV. It is spread the same way as hepatitis B, through contact with an infected person's blood, semen, or body fluid (see above). Like hepatitis B, hepatitis C causes swelling of the liver and can cause liver damage that can lead to cancer. Most people who have hepatitis C develop a chronic infection. This may lead to a scarring of the liver, called cirrhosis. Blood banks test all donated blood for hepatitis C, greatly reducing the risk for getting the virus from blood transfusions or blood products. Hepatitis D: caused by the virus HDV. You can only get hepatitis D if you are already infected with hepatitis B. It is spread through contact with infected blood, dirty needles that have HDV on them, and unprotected sex (not using a condom) with a person infected with HDV. Hepatitis D causes swelling of the liver. Hepatitis E: caused by the virus HEV. You get hepatitis E by drinking water infected with the virus. This type of hepatitis doesn't often occur in the U.S. It causes swelling of the liver, but no long-term damage. Source: National Women's Health Information Center

11. HIV HIV: HIV stands for human immunodeficiency virus. It is the virus that can lead to acquired immunodeficiency syndrome, or AIDS. Unlike some other viruses, the human body cannot get rid of HIV. That means that once you have HIV, you have it for life. Casual Contact: HIV cannot be spread by casual contact such as hugging or shaking hands. Can someone get HIV from being spit on or scratched by an HIV-infected person? No. HIV cannot be spread through saliva, and there is no documented case of transmission from an HIV-infected person spitting on another person. There is no risk of transmission from scratching because there is no transfer of body fluids between people.

12. HIV How can someone working in the solid waste industry become infected with HIV in the work environment? Being stuck with an HIV-contaminated needle or other sharp object. This is a risk mainly for health care workers. Being bitten by a person with HIV. Each of the very small number of documented cases has involved severe trauma with extensive tissue damage and the presence of blood. There is no risk of transmission if the skin is not broken. Contact between broken skin, wounds, or mucous membranes and HIV-infected blood or blood-contaminated body fluids. These reports have also been extremely rare. HIV does not survive long outside the human body (such as on surfaces), and it cannot reproduce. It is not spread by: Air or water. Insects, including mosquitoes or ticks. Saliva, tears, or sweat. There is no documented case of HIV being transmitted by spitting. Casual contact like shaking hands or sharing dishes. Closed-mouth or “social” kissing Toilet seats.

13. Tuberculosis Tuberculosis: caused by a bacterium called Mycobacterium tuberculosis. The bacteria usually attack the lungs, but TB bacteria can attack any part of the body such as the kidney, spine, and brain. If not treated properly, TB disease can be fatal. How is it transmitted? TB is spread through the air from one person to another. The TB bacteria are put into the air when a person with TB disease of the lungs or throat coughs, sneezes, speaks, or sings. People nearby may breathe in these bacteria and become infected. TB is NOT spread by: shaking someone's hand sharing food or drink touching bed linens or toilet seats sharing toothbrushes kissing

14. Rabies, West Nile Disease, and Lyme Disease Rabies: Spread by infected animals. Avoid contact with raccoons, rats, etc. Report any animal bites and seek medical attention. West Nile Disease: Spread by mosquitos. Use mosquito repellent with DEET. Lyme Disease: Spread by ticks. Check for ticks after possible exposure. Report tick bites and seek medical attention if symptoms develop (rash, “bulls eye ring”, swelling around bite area.)

15. Iowa Regulations for Infectious Waste 567—109.9(455B,455D) Infectious waste. Infectious waste which is generated and treated at a medical clinic, doctor’s office, nursing care facility, health care facility, dentist’s office or other similar facility may be placed with municipal solid waste and not handled in a special way if it is rendered nonpathological, does not contain free liquids, and sharps are shredded, blunted, granulated, incinerated or mechanically destroyed. The generator of the infectious waste must notify the waste hauler and the sanitary landfill that infectious waste is being placed with the regular municipal solid waste and, with the notice, certify that the infectious waste is properly treated in accordance with the requirements of this rule.

16. How Can BBPs and Diseases be Transmitted at Solid Waste Facilities? Punctures Eyes Inhalation Ingestion Bites Laceration Scratches that break skin

17. What are Specific Hazards for Solid Waste Personnel? Materials Collection Materials Sorting/Processing Equipment Inspection/Maintenance Landfill Active Face Transfer Station/Recycling Center Tip Floor Providing First Aid Human Interaction Animal Interaction

18. Stay Safe! Implement the use of universal precautions Treat all human blood and other potentially infectious material as if known to be infectious for bloodborne pathogens. Practice good personal hygiene. Provide personal protective equipment (PPE), such as gloves, eye protection, and masks. Make available hepatitis B vaccinations to all workers with occupational exposure. Make available post-exposure evaluation and follow-up to any occupationally exposed worker who experiences an exposure incident. Provide information and training to workers.

19. As the Saying Goes…. If it is wet, and it’s not yours…. DON’T TOUCH IT!!

20. Information Sources Occupational Safety and Health Agency (OSHA) www.osha.gov National Women’s Health Information Center www.womenshealth.gov Centers for Disease Control (CDC) www.cdc.gov The National Institute for Occupational Safety and Health (NIOSH) www.cdc.gov/niosh/

21. Contact Information: Losscontrol@iowaleague.org 800.257.2708 www.imwca.org