Bloodborne Pathogens Training

Course Information

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This bloodborne pathogens training program

is required annually for UM-Flint employees

who may reasonably anticipate contact with blood or other potentially infectious materials (OPIM) while on the job.

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Course Topics

• Bloodborne Pathogens Standard (copy available from EHS and online)
• Bloodborne Pathogens
• Transmission
• Exposure Control Plan
• Prevention (Universal Precautions)
• UM-Flint Hepatitis B Immunization Program
• Engineering Controls
• Sharps Disposal
• Personal Protective Clothing and Equipment (PPE)
• Spill Response
• BBP Waste

Bloodborne Pathogens Standards and Regulations

This program was designed to meet the requirements of:

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• 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).
• Needlestick 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.

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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

Other Potentially Infectious Materials (OPIMs)

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

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How are BBPs Transmitted?

• When infected blood or bodily fluid enters a break in the skin or a mucous membrane.
• Mucous Membranes are wet, thin tissue found in openings such as the mouth, eyes and nose.
• Breaks in the skin can allow BBPs to enter:

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• Cuts
• Punctures
• Abrasions
• Rashes
• Acne
• Hangnails

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Bandage affected area and wear double gloves to prevent transmission through breaks in skin.

Hepatitis B (Hep B)

• Infection of the liver may lead to:
• liver disease
• liver cancer
• death
• 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“.

They may suffer from infection at a later time and can be infectious to others for the rest of their lives while not having symptoms of HBV.

Symptoms may occur 2-6 months after exposure and include:

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• Fever
• Vomiting
• Jaundice (yellowing) of eyes and/or skin
• Loss of appetite
• Dark-colored urine
• Aches in muscles and joints

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Hepatitis C (HCV)

• Viral liver infection transmitted via blood or OPIM.
• Symptoms similar to those caused by HBV
• No vaccine is available.
• 80% of individuals have no symptoms & may be lifelong carriers.
• 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 causes Acquired Immunodeficiency Syndrome (AIDS)
• May be passed via infected blood or OPIMs which contact broken skin or mucous membranes
• Some individuals develop flu-like symptoms 7-21 days after exposure.
• Some infected individuals develop AIDS due to their HIV infection.
• Studies suggest the best independent predictors of primary HIV infection are rash and fever following an HIV exposure.
• HIV will not survive long outside host (~90-99% reduction within several hours).

What are Bloodborne Pathogens

Methods to Reduce BBP Exposures:

• Universal Precautions or Standard 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 treatment as soon as possible.

Universal or Standard Precautions

ALL human blood and OPIM

are treated as if infectious.

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Exposure Control Plan (ECP)

• The ECP must be made available to all at risk employees
• ECP must be readily available to employees.
• Employees should be familiar with the ECP and know where it is located.
• ECP should be reviewed/revised ANNUALLY with input from employees.

Reporting an Exposure Incident

• Is it work related?
• Date & time of exposure
• Where & how the exposure occurred
• Procedure being performed
• The type & brand of device involved
• How & when in handling the device the exposure occurred
• Details of the exposure (e.g. the type & amount of fluid)
• Information about the exposure source if known
• Vaccination status of the exposed person
• Additional details can be provided in writing or e-mail to EHS and Work Connections

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Hepatitis B Vaccination

• Available to Category A employees at no cost
• Series of 3 injections:

1^st Dose- given at anytime

2^nd Dose- 1 month after 1^st Dose

3^rd Dose- 5 months after 2^nd Dose

• Provides protective levels of antibody in 97% of healthy individuals
• You don’t 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 already received the complete series
• Antibody testing shows immunity
• 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 Declination/Acceptance Forms

No Vaccines for HCV or HIV

• No vaccine against HCV and no treatment after exposure that will prevent infection.
• No vaccine against HIV.
• For HIV: recommendations from the CDC, suggest a 4-week course of 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

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Sharps

• Departments or units generating sharps waste are responsible for proper disposal.
• Puncture resistant plastic container
• Located where sharps are used
• Sharp containers - Fill only 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 workers.

Sharps (cont’d)

Examples:

• 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

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Workplace Controls

• Wash hands after contacting bodily 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.

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Safe Work Practices

• Remove Personal Protective Equipment (PPE) before leaving the work area
• Follow proper protocol for cleaning blood/bodily fluid spills
• Remove clothing soiled with blood or OPIM soiled immediately
• Wash hands immediately after removing gloves or other protective clothing.
• Wash hands after contact with blood or OPIM.

ECDC Soiled Clothing

• Remove clothing immediately

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• 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^oC, and is on the hot cycle for at least 10 mins)

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• Child’s clothing should be placed in a labeled plastic bag (Soiled) and should be sent home with parents

BBP Exposures

Eyes: Flush with water

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Skin: Wash thoroughly with

soap & water for 15 min.

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IMMEDIATELY notify Supervisor & EHS.

Go to UM Medical Provider

for post-exposure follow-up ASAP

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Protective Work Clothing &� Equipment (PPE)

• PPE is to be provided at no cost to the employee.

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• Examples: GLOVES, goggles, apron, “booties”

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• Assure appropriate PPE is readily accessible and fits properly

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• Supervisor will monitor and ensure employee uses PPE.

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• Provide for cleaning, laundering, or disposal of PPE.

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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 peeling, cracked, discolored, punctured, torn or deteriorated
• Gloves all sizes must be available
• Do not reuse disposable gloves
• Remove gloves BEFORE leaving the work area
• Always wash hands after removing gloves

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Blood/Body Fluid Spills

• Spills must be cleaned as soon as possible.
• Wear gloves, gowns or lab coats & eye protection during clean up.
• A solution of 1:10 bleach to water or an EPA-approved disinfectant should be used.
• If broken glass is involved, carefully remove using a mechanical device such as tongs or forceps. Broken glass is placed in the sharps container.

Never pick up broken glass by hand!

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Spill Clean-up Procedure

• Put on personal protective equipment

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• Remove sharp objects carefully with forceps/tongs

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• Circle spill with disinfectant. Use bleach (1:10 dilution), Lysol, Virex, or EPA registered tuberculocidal disinfectant

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• Cover and saturate with disinfectant. Let stand 15 - 20 minutes. Clean and Dispose of Paper Towel

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• Re-spray area with disinfectant

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• Re-wipe with paper towel

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• Decontaminate materials used to clean spill

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Disinfectant Procedure Information

• Take the necessary precautions when handling disinfectants - some may be caustic and hazardous
• Prepare all disinfectants daily. Some prepared diluted mixtures, like bleach and water, are not stable and lose efficacy as a disinfectant over time
• 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

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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

https://uhs.umich.edu/wolverines-wash

Employee Responsibilities

• Know and understand your department’s ECP
• What PPE to use? When?
• What to do when uncertain about an OPIM, 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 & sanitary environment.
• Wash hands.
• Get HBV Vaccine . . . or sign declination form. Discuss other vaccinations that are available with your health care provider.
• Report all exposure incidents immediately
• Participate in your department’s annual ECP review.

Other Communicable Diseases

MPV (Monkeypox)

West Nile

Meningitis

Norovirus

H1N1

Tuberculosis (TB)

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MPV (Monkeypox Virus)

• Monkeypox (MPV) is a potentially serious viral illness. It can be transmitted through direct contact with an infected person’s body fluids or MPV rashes or lesions.
• MPV is part of the same family of viruses as the variola virus, the virus that causes smallpox. MPV symptoms are similar to smallpox symptoms but milder, and monkeypox is rarely fatal.
• The current level of MPV in the U.S. is higher than normal, but the risk to the general population is low. Most people affected in the current outbreak have generally reported having close physical contact for a sustained time with someone who has MPV.
• MPV is not as contagious as COVID-19. It does not spread through casual contact or having a conversation with someone who has MPV. You must have prolonged, physical contact or share bedding/clothing/towels with someone who has MPV for it to spread.

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Source: https://uhs.umich.edu/monkeypox

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How is MPV spread?

MPV can be spread from person to person through close, personal contact (often skin-to-skin contact), including:

• Direct contact with MPV lesions, sores, rashes, or scabs.
• Contact with objects, surfaces, and fabrics (such as clothing, bedding, or towels) that have been used by someone with MPV.
• Through oral fluids or respiratory droplets from a person with MPV during prolonged face-to-face contact.
• This contact can happen during intimate sexual contact, including:
• Anal, oral, and vaginal sex or touching the genitals and/or anus of a person with MPV.
• Hugging, kissing, massaging, and talking closely.
• Touching fabrics and objects during sex that were used by a person with MPV (this includes bedding, sex toys, and towels).

People can also get MPV from an infected animal through a bite or direct contact with the infected animal’s blood, body fluids, or sores.

Source: https://uhs.umich.edu/monkeypox

West Nile

• Derived from being bitten by an infected mosquito

The most serious form of WNV is Fatal

Encephalitis: inflammation of the brain

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• Incubation period is 2-15 days

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Symptoms include:

• High fever
• Neck stiffness
• Disorientation
• Coma
• Tremors
• Convulsions
• Muscle weakness
• Paralysis

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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.

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• 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

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• Caused by either:

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Viral Meningitis (Aseptic) Bacterial Meningitis

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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 7-10 days with full recovery
• No specific treatment

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Bacterial Meningitis

• Highly severe and some forms are contagious

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• 2 strains of the leading cause of Bacterial Meningitis are Streptococcus pneumoniae and Neisseria meningitidis

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• 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

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• Caused by a host of viruses that produces the outcome of vomiting and diarrhea

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• According to the CDC, it is the leading cause of foodborne-disease outbreaks in the United States

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• 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

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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 someone with active TB sings, speaks, coughs or sneezes in the nearby area.

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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

DPS/Medical Staff Soiled Clothing

• Remove clothing immediately

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• Place in a labeled plastic bag (Biohazard)

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• Have clothing be sent to proper laundering facilities that will decontaminate the uniform

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/understanding_tuberculosis_basics.jpg (TB)