Bloodborne Pathogens Training PPT - University of Michigan-Flint

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Bloodborne Pathogens Training

University of Michigan
-
Flint.

Environment, Health and Safety (EHS)


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.


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

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 1910.1030
(1990).


Michigan Occupational Safety and Health Administration (MIOSHA) Bloodborne
Infectious Diseases


R
325.70001
-

R 325.70018
(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.


What are Bloodborne Pathogens

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
:



o
HBV

o
HCV

o
HIV

o
West Nile

o
Malaria

o
Syphilis

o
Brucellosis

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.


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.

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!

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


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.

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
).

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

Universal Precautions



An
infection control method where

ALL
human blood and other potentially
infectious materials are treated as if known to be infectious
.


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
.

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


Hepatitis B Vaccination


Available to Category A employees at no cost


Series of 3 injections:


1
st
: given at anytime


2
nd
: 1 month after first injection


3
rd
: 5 months after 2
nd

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

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 EHS @ (810)766
-
6763

Hepatitis B Forms

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.

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

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)766
-
6763 for
removal.


Do NOT OVERFILL sharps container.
Overfilled sharps container pose a risk to all
workers.

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


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.



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
.

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,
82
o
C, 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

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

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

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.


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



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.



http://
www.youtube.com/watch?v=gn
OtvAztKoQ


Spill Clean
-
up Procedure

Spill Clean
-
up Procedure


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



Cover and saturate with
disinfectant. Let stand 15
-

20 minutes. Clean and
Dispose of Paper Towel



Re
-
spray area with
disinfectant



Re
-
wipe with paper
towel



Decontaminate materials
used to clean spill


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



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


http://
www.youtube.com/watch?v=vYwypSLiaTUD


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.

Other Communicable Diseases

West Nile

Meningitis

Norovirus

H1N1


Tuberculosis (TB)


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:


H
igh 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.

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)



Meningitis


Inflammation of the membrane (meninges) that covers the brain and spinal cord



Caused by either:

Viral Meningitis(Aseptic) Bacterial Meningitis


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


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

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

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

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

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


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.


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.

Questions


Bibliography


http://rlv.zcache.com.au/bio_hazard_or_biohazard_sign_symbol_warning_purple_postcard
-
p239192129277273011z74oh_125.jpg

(Purple Biohazard Sign)


http://www.papermasters.com/Images/bloodborne
-
pathogens.jpg

(
Bloodborne

Pathogens Sign)


http://i.telegraph.co.uk/multimedia/archive/01487/hiv_1487944c.jpg

(HIV)


http://www.nature.com/nprot/journal/v2/n3/covers/largecover.gif

(HBV)


http://srxa.files.wordpress.com/2011/06/hepatitis_c1.gif

(HCV)


http://scienceray.com/biology/ecology/managing
-
jaundice
/

(Jaundice Hands)


http://
www.fronine.com.au/images/mixmate05.jpg

(Vortex Machine)


http://
blogs.palmbeachpost.com/becoming
-
a
-
doctor/files/2009/07/pipetting.jpg

(Pipet)


http://
www.servoprax.com/images/5000/00249_1.jpg

(Centrifuge Machine)


http://www.torranceca.gov/Images/Mosquito_rdax_400x277.jpg

(WNV)


http://www.cdc.gov/ncidod/dvbid/westnile/images/WNV_03_a.gif

(WNV Map)


http://www.doctortipster.com/wp
-
content/uploads/2011/04/Aseptic
-
Meningitis11.jpg

(Viral Meningitis)


http://nchistorytube2.wikispaces.com/file/view/viral
-
meningitis.jpg/213342706/viral
-
meningitis.jpg

(Viral Meningitis microscopic)


http://www.about
-
child.com/wp
-
content/uploads/2011/07/Bacterial
-
Meningitis
-
In
-
Children
-
3.jpg

(Bacterial Meningitis)


http://
feww.files.wordpress.com/2010/01/bacterial
-
meningitis
-
lg.jpg?w=711

(Bacterial Meningitis microscopic)


http://
www.defendingfoodsafety.com/uploads/image/Norovirus.jpg

(
Norovirus
)


http://knol.google.com/k/
-
/
-
/
30e8n4orj1dsd/1ubdd7/fig2
-
allflu.jpg

(H1N1)


http://
img.webmd.com/dtmcms/live/webmd/consumer_assets/site_images/articles/health_and_medical_reference/infectious_disease/understa
ndi
ng_tuberculosis_basics.jpg

(TB)