Bloodborne Pathogens PowerPoint - Environmental Health and Safety

The 8 th “AEGEAN AIRLINES PRO-AM”29 May – 01 June 2013, Costa Navarino, GreeceTEAM REGISTRATION FORMAmateur Pro-Am package includes:€1,650/golfer in Westin Single room€1,350/golfer in Westin Twin shared room with team member(€550*/non playing partner sharing a double room with a golfer)The Pro-Am package for amateurs includes:5 nights BB accommodation at Westin Resort, Costa Navarino2 Aegean Pro-Am rounds (1 day at The Dunes Course and 1 day at The Bay Course)1 Official practice round (1 day at The Dunes Course or 1 day at The Bay Course)Participation in the Aegean Cup 2013 – 1 round at The Bay CourseBus transfers (Kalamata airport to/from Hotel-transfers to/from Dunes & Bay)Golf balls for practiceBuggies for all roundsOn-course refreshments and snacks for 4 tournament roundsWelcome packWelcome receptionBarbeque eventGala dinner & Prize giving CeremonyLottery ticket for GalaPlayers liability and bodily injury insurance in the courseNot included in the package:Professionals:* Non-playing partner fee:Flights and others means of transportExtras at the hotel and its facilitiesThere is no Pro-Am package fee for each participating professional with a team of 3amateurs. Complimentary accommodation in a double room (no extras) is offered to eachparticipating professional (and spouse/partner) for 5 nights on BB basis at Westin Resort,Costa Navarino.Accompanying person fee applies to spouse/partner of each participating professional.Includes accommodation (shared double room with an amateur golfer) and participationin 3 social events.Final deadline for entries is April 15th, 2013.Entries will be allocated on a first come, first served basis. Places are limited to 60 teams.A team entry is considered valid only after full payment of the amateurs’ Pro-Am package fees.Amateurs are required to provide their exact handicap on the entry form at the time of entry and will be asked to confirm their handicap atthe registration desk of the event. Any amendments MUST be notified by 10.00hrs on Wednesday 29th May.All prize winners will be required to provide current proof of handicap before their team is presented with their prizes.For those players who possess a "EGA/USGA" related handicap, the slope system will apply to the tournament and each amateur will playfrom the applicable handicap. Those players whose handicap is not related to the "slope" system (CONGU) should provide their exact currenthandicap at their home club and this will be readjusted according to the calculation provided by the EGA to suit a “sloped” golf course.For more information about participation – registration details please visit our web site www.aegeanproam.comFor any participation inquires please contact the 8 th “Aegean Airlines Pro-Am” Event Organiser FREI S.A. at reg-aegeanproam@frei.grPlease fill in this Team Registration Form in CAPITAL LETTERS and tick where appropriate. You are kindly requested to send it by fax or e-mail tothe Event Organizer.

7 minutes - fill out Forms•Registration•Hepatitis B Vaccination• Need to fill out both forms and hand in atend of classEH&S UW Bloodborne Pathogen Training 2

Bloodborne PathogensTraining for ResearchersJudy Cashman, RNEH&S Research & Occupational Safety206-221-7770, ehsbio@uw.eduohnurse@uw.eduEH&S UW Bloodborne Pathogen Training 3

Bloodborne Pathogen (BBP)Rule• Washington Administrative Code(WAC) 296-823– Enacted in 1993– Safe sharps requirements in 2000(Needlestick Safety and Prevention Act)• Reduce risk of BBP exposure toworkers• Annual Training requiredEH&S UW Bloodborne Pathogen Training 5

UW BBP Program• All UW employees with a reasonablyanticipated potential for exposure to humansource materials, including human blood and itscomponents, human tissue, all human cell lines, as well asmedications derived from blood (e.g., immune globulins,albumin) and other potentially infectious materials (OPIM),are required to comply with the UW BBP Program.• Principal investigators (PIs)/supervisors areresponsible for assessing activities in the workplace anddetermining if employees have a potential for occupationalexposure.• Requirements of the UW BBP Program:– Developing a BBP Exposure Control Plan– Offering the hepatitis B vaccine– Training 6

BBP Statistics• In Washington, Labor & Industries (L&I) estimates~44,000 needlestick injuries per year• By Dec, 31, 2000, CDC reports:57 health care workers have seroconverted followingoccupational exposure to HIV– 25 have developed AIDS– 3 were lab workers working with concentrated virus– Percutaneous exposure was the most commonrouteEH&S UW Bloodborne Pathogen Training 7

Roles & Responsibilities• EH&S– Administer the UWBBP Program– Assist in obtaining theHepatitis B Vaccine– Provide BBP Training– Issue Biological UseAuthorization to labs– Consultation andIncident/accidentfollow-up investigationEH&S UW Bloodborne Pathogen Training 8

Roles & Responsibilities• Principal Investigator– ID hazards and who needs to be in the BBPProgram– Develop/review lab Exposure Control Plan– Provide personal protective equipment– Provide lab specific safety training– Enforce safety rulesEH&S UW Bloodborne Pathogen Training 9

Roles & Responsibilities• Staff (You)– Follow the exposure control plan– Wear required PPE– Ask questions– Suggest safer work practices/ procedures toyour PIEH&S UW Bloodborne Pathogen Training 10

How are Suggestions or changes to workpractices communicated?1. staff meetings2. email3. 1:14. suggestion box/other5. Don’t know/not sureEH&S UW Bloodborne Pathogen Training 11

Roles & Responsibilities• Employee HealthCenter– Provide clinicalservices– Administer hepatitis Bvaccine– Provide Post-exposurecounselingEH&S UW Bloodborne Pathogen Training 12

Bloodborne Pathogens• Microorganisms that are present in human blood andits components and can cause disease.• Human Immunodeficiency Virus (HIV) - AIDS• Hepatitis B virus (HBV) – Hepatitis B• Hepatitis C virus (HCV) – Hepatitis C• Brucella spp. (bacterium) – Brucellosis• Babesia (parasite) - Babesiosis• Treponema pallidum- Syphilis• Arboviruses- Viral hemorrhagic fever, West Nile Virus• Prions- Creutzfeld-Jakob Disease• Plasmodium spp. - MalariaEH&S UW Bloodborne Pathogen Training 13

Not Risk for BBP transmission• …unless you can SEE the blood inthem…but still handle with caution.– Urine– Feces– Vomit– Sweat– Tears– SalivaEH&S UW Bloodborne Pathogen Training 15

Where will I go if I have aquestion about “OPIM”?• Check the Washington AdministrativeCode (WAC) 296-823• See the EH&S website:www.ehs.washington.edu/• Call Research and Occupational Safety:206-221-7770• Check the lab Biosafety ManualEH&S UW Bloodborne Pathogen Training 16

Transmission of BBPOccupational Exposure• Reasonably anticipated skin, eye, mucousmembrane, or parenteral (piercing of the skin)contact with blood or OPIM that may result fromthe performance of an employee's dutiesExposure Incident• is a specific contact with blood orOPIM that is capable oftransmitting a bloodborne diseaseEH&S UW Bloodborne Pathogen Training 17

BBP-Occupational Exposure• Skin– Needle sticks or contaminated sharpsinjuries– Open wound contamination: cut, rash,dermatitis, psoriasis• Mucous membrane exposure: eyes,nose, mouthEH&S UW Bloodborne Pathogen Training 18

Transmission Risk of BBPRisk of infection depends on several factors:Pathogen involvedType/route of exposureAmount of virus in infectedblood during exposureAmount of infected bloodinvolved in the exposureIf post-exposure treatmentwas takenSpecific immune response ofinfected individualCourtesy of Owen Mumford, Inc.EH&S UW Bloodborne Pathogen Training 19

Transmission Risk followingExposure to Infected BloodVirus# of virusparticles/ml of bloodHepatitis B 10 6 -10 13(Millions – trillions)Hepatitis C 10 6(Millions)HIV (AIDS) 10-10 3(Tens – thousands)Risk of infectionfollowing parenteral(needlestick or cut)exposure1 in 3(30%)1 in 30(3%)1 in 300(0.3%)Source: Centers for Disease Control and Prevention20

Hepatitis B• Statistically thegreatest risk• 6-30% risk followingexposure incident(non-immunized)• Incubation period is 6weeks- 6 months(45-180 days)• 30-50% of infecteddevelop clinical illness• 0.5-1% of infecteddevelop rapid fatal liverdisease• 2-10% of infecteddevelop chronic activehepatitis-carrier state,infectious for life.• Very stable-persists atroom temp for 7days.EH&S UW Bloodborne Pathogen Training 21

Hepatitis C• Most common chronicbloodborne infection• 80% infected withoutsymptoms (CDC)• Incubation period 2weeks-6 months• ~16 hrs-4 days onsurfaces• No vaccineEH&S UW Bloodborne Pathogen Training 22

Hepatitis B and C Symptoms• jaundice• fatigue• loss of appetite• nausea• abdominal discomfort• dark urine• clay-colored stoolNormal eyesJaundiced eyesEH&S UW Bloodborne Pathogen Training 23

HumanImmunodeficiencyVirus (HIV)• Fragile – lives only a few hours outside thebody• Causes Acquired Immunodeficiency Syndrome(AIDS)• AIDS allows development of opportunisticdisease, which ultimately causes death.• A flu-like illness can occur 1-6 weeks afterexposure to the virus:-Fever, sweats, malaise, muscle pains, nausea, diarrhea,• Enlarged lymph nodes, mycological oralinfections, fatigue, weight loss• Symptom-free period of 5-10 years can occurEH&S UW Bloodborne Pathogen Training 24

What is the most common routeof exposure to BBP in theworkplace?1. Injury from contaminatedneedlesticks and/or sharps2. Eye and mucous membrane exposure3. Open wound contamination (cut,dermatitis, psoriasis)EH&S UW Bloodborne Pathogen Training 25

Exposure Control Plan (ECP)• Must include BBP standardhttp://www.lni.wa.gov/wisha/Rules/bbpathogens/default.htm• Biosafety Manual containsUW Core ECP, in Section IX• See online athttp://www.ehs.washington.edu/rbsbiosafe/bsmanualindex.shtmEH&S UW Bloodborne Pathogen Training 26

Exposure Control Plan1. Exposure Determination2. Method of Compliance orimplementation3. Hepatitis B vaccination, Post-Exposure evaluation andfollow-up4. Communication of Hazardsto employees5. Record keepingEH&S UW Bloodborne Pathogen Training 27

Exposure Control Plan1. ExposureDetermination:• By job classification• By tasks andprocedures• Withoutconsideration ofPPE wornEH&S UW Bloodborne Pathogen Training 28

Exposure Control Plan2. Control Employee Exposure:• Universal precautions• Engineering controls• Work practices• Personal Protective EquipmentEH&S UW Bloodborne Pathogen Training 29

ECP- Universal Precautions• Blood and OPIMALWAYS consideredinfectious• Appropriate barriers andprocedures must beused when contact withblood or OPIM isanticipatedEH&S UW Bloodborne Pathogen Training 30

ECP-Engineering ControlsTOOLS toPreventExposureBiological Safety Cabinet(BSC)EH&S UW Bloodborne Pathogen Training 31

Safe BSC Use Video:Proper Use of a Biological Safety Cabinet (SD – 2002)An excellent review of safe BSC work practices covering preplanning,PPE, cabinet preparation, work practices, spills, andpost process steps.NOTE! There are three differences for BSC work at the UW.‣ Important: Sharps are not prohibited in BSCs at the UW.‣ Water can be used after the decontaminating bleach and isrecommended by Baker for their BSCs.‣ Good hand washing is more about sudsing soap andscrubbing for at least 20 seconds than the use ofgermicidal soap.http://vimeo.com/groups/34691/videos/7642083EH&S UW Bloodborne Pathogen Training 32

ECP-Engineering Controls• Centrifuge SafetyFeatures– Receive training– Safety cups/buckets or O-ring– When in Biosafety Cabinet (BSC)place at rear, don’t performother work while running– Wait 5 minutes to unload– Stop immediately for unusualvibration or noise and notifysupervisor– Ensure proper balancing– Do not overfillEH&S UW Bloodborne Pathogen Training 33

ECP-Engineering Controls• Safer Medical Devices– Needleless systems– Sharps with engineeredsharps injury protections(SESIP)– Self-blunting needles– Plastic capillary tubes– Exemptions for saferneedle requirements, ifnot using theseUnprotected positionProtected positionExample of needle guard with protectedsliding sheath that is pushed forward afteruse and locks (with some designs the shieldmust be twisted to engage the lock).EH&SUW Bloodborne Pathogen Training34

ECP-Engineering ControlsSharps disposal containers- Closable- Puncture-resistant- Leak-proof- Labeled or color-coded- Upright, conveniently placedin area where sharps used- DO NOT OVERFILL!EH&S UW Bloodborne Pathogen Training 35

Sharps Containers withProblemsEH&S UW Bloodborne Pathogen Training 36

ECP-Work Practice ControlsKey ConceptPerform alltasks in amanner thatreducesspraying,splashing oraerosolization.EH&S UW Bloodborne Pathogen Training 37

ECP-Work Practice ControlsHandle sharps safely to minimize exposure toblood or OPIM:‣ Don’t recap or removeneedles‣ Don’t bend, shear or breakneedles‣ Place contaminated reusablesharps immediately inappropriate containers untilproperly decontaminatedEH&SUW Bloodborne Pathogen Training38

EH&SUW Bloodborne PathogenTraining39

More Tips on Safe Sharps Handling‣ Know what Sharps include:http://www.ehs.washington.edu/rbsresplan/sharp.shtm(needles, IV tubing with needles attached,scalpel blades, lancets, syringes that have beenremoved from their original sterile containers, andglass tubes that could be broken during handling)‣ Develop and implement specific policies for safehandling:http://safeneedle.org/us-needlesticks/preventingneedlestick-injuries-a-checklist/‣ Do not handle broken glassware directly by hand9/17/2012 EH&S UW Bloodborne Pathogen Training

ECP-Work Practice Controls• Hand washing• No food/cosmetics• No mouth pipetting• Dispose of gloves after useEH&S UW Bloodborne Pathogen Training 41

ECP-Work Practice Controls• Remove gloves safely andproperly– Grasp near cuff of glove andturn it inside out. Hold in thegloved hand.– Place fingers of bare handinside cuff of gloved hand andalso turn inside out and overthe first glove.– Dispose gloves into properwaste containerDEMO of GLOVE REMOVAL:https://depts.washington.edu/ehas/pubcookie/train/bbpx/bbp6a.phpEH&S UW Bloodborne Pathogen Training 42

ECP-Work Practice Controls• Written cleaning anddecontamination scheduleand procedures• Decontamination Agents:– Bleach 1:10– EPA certified agent (alcoholis not)– Quaternary Compounds– Premixed:• Environcide• clavicide• Contact time is criticalEH&S UW Bloodborne Pathogen Training 43

ECP- Work Practice Controls• Decontamination1. Place absorbent material atopspill, sufficiently spray/coverentire area. Some start at theedges and work in, others justcover the area.2. You want to ensure that youcover the contaminated area.SPILLS VIDEO:https://depts.washington.edu/ehas/pubcookie/train/bbpx/bbp7.phpEH&S UW Bloodborne Pathogen Training 44

ECP-Work Practice ControlsRegulated Waste• Close immediately beforeremoving or replacing• Place in second container ifleaking possible or if outsidecontamination of primarycontainer occurs• Contaminated equipment musthave biohazard sign attachedinformsupervisorBIOHAZARDOUS WASTE, incl. Flow Chartshttp://www.ehs.washington.edu/ohsreslab/biowaste.shtmEH&SUW Bloodborne Pathogen Training45

ECP- Signs and Labelshttp://www.ehs.washington.edu/rbsbiosafe/postbz.shtmEH&S UW Bloodborne Pathogen Training 46

Precautions required whentransporting blood• Put in secondary leakproof container– Plastic ziplock, or styrofoam• If in a Biohazard container or other designatedcontainer, don’t need label– Consider where the sample will travel(the end user)More information on EH&S websitehttp://www.ehs.washington.edu/rbsbiosafe/appendixb.pdfEH&S UW Bloodborne Pathogen Training 47

ECP-Personal ProtectiveEquipment (PPE)Type and amount of PPE requireddepends on the task and anticipatedexposure.– Must not permit blood or OPIM topass through or reach outer orinner clothing, mucous membranesor skin.– If clothing becomes contaminated,immediately remove it.– Must be removed prior to leavingthe work area. PPE must not beworn in common areas.– Provided at no cost to employee.Nitrile gloves for alcohol. EH&SUW Bloodborne Pathogen Training48

ECP-LaundryFor Contaminated articles:– Handle as little as possible• Bag/contain where used• Don’t sort or rinse where used• Place in leak-proof, labeled orcolor-coded containers or bags– Wear PPE when handling and/orsorting• Gloves• GownEH&S UW Bloodborne Pathogen Training 49

ECP-Medical Management3. Medical Managementa. Hepatitis B vaccineb. Post exposureevaluationc. Follow-upEH&S UW Bloodborne Pathogen Training 50

ECP- Medical ManagementHepatitis B Vaccine• Must be offered within 10 days of initialassignment• 3 injections at 0, 1, 6 months• Check titer 1-2 months after series• 96-99% effective• No boosters needed• Call your Employee Health Center for anappointment – FREE – During work hoursEH&S UW Bloodborne Pathogen Training 51

Hepatitis B Vaccine form• Needs to be filled out unless you havealready done so in the past• If you have had vaccinations, checkthe line stating this, put in date oryear• If you decline the vaccination, checkthis line, sign and dateEH&S UW Bloodborne Pathogen Training 52

ECP-Medical ManagementWhat to do if exposed?1. DO First Aid• Parenteral (break through skin):Immediately thoroughly washwound with sudsing soap andwater—for 15 minutes.• Mucous Membrane: Immediatelythoroughly flush mucousmembrane with water for 15minutes.2. GET Medical HelpEH&S UW Bloodborne Pathogen Training 53

ECP-Medical ManagementHow to Get Medical Help?• Call UW Employee Health Center at 206-685-1026– Harborview Sites: 206-744-3081• After hours or clinic is closed, go to nearestEmergency Room (ER)• Call 911EMERGENCY POSTER:http://www.ehs.washington.edu/manuals/posters/ehsexposureresponseposter.pdfEH&S UW Bloodborne Pathogen Training 54

ECP-Medical Management:Post Exposure Evaluation• Document exposureincident and ID source• Testing and Post-Exposure treatment• Counseling• Evaluation and follow-upEH&S UW Bloodborne Pathogen Training 55

Health Care ProfessionalWritten OpinionHealth Care Professional’s Written O pinion For Post - Exposure EvaluationUse with Chapter 296 - 823 WAC, Occupational Exposure to Bloodborne PathogensEmployee’s Name:Date of Incident: tDate of Evaluation:Health Pro fessional’s Address:Health Professional’s Telephone:________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ The employee named above has been in formed of the results of the evaluation forexposure to blood or other potentially infectious materials.____The employee named above has been told about any health conditions resultingfrom exposure to blood or other potentially infectious materials whi ch require furtherevaluation or treatment.____ Hepatitis B vaccination is ____ is not ____ indicated.Employeeto receivewithin 15days________________________________Health Care Professional’s Name_____________________________________________________________Health Care Professio nal’s Signature DateReturn this form to the employer and provide a copy to the employee within 15 days.Please label the outside of the envelope “Confidential.”Employer’s NameEmployer’s Address :_______________________________________________________________________________________________________________________________________Confidential Fax: _________________ _______________________________EH&S UW Bloodborne Pathogen Training 56

ECP- Hazard Communication4. HazardCommunication• Annual UW BBPtraining• Laboratory specifichazards training• Exposure ControlPlan – annual reviewEH&S UW Bloodborne Pathogen Training 57

ECP-Records5. Record Keeping• Training records- EH&Sand PI- keep 3 years• Medical records-kept atEmployee Health Centerfor duration ofemployment plus 30 years• You &/or Supervisor fill outthe OARS (online) reportafter incident-EHSEH&S UW Bloodborne Pathogen Training 58

Additional RequirementsHIV/HBV/HCV Research Labs• Lab specific biosafety manual-reviewed annually• Special Practices– Labs doors closed when working with virus– No bench work/must use BSC– Limited needle/syringe use– Limited access only to those aware of hazards– PPE in labs—NOT to be worn outside lab,decontaminated before laundered.• Training– Demonstrated proficiency-microbiologicalpractices and practices and operations specific tothe facility BEFORE work w/virus.EH&S UW Bloodborne Pathogen Training 59

Resources• International Sharps Injury Prevention Society(ISIPS): http://www.isips.org/• WA State Department of Safety and Health BBPpage:http://www.lni.wa.gov/Safety/Topics/AtoZ/BBPathogens/default.asp• Centers for Disease Control and Prevention(CDC) Biosafety in Microbiological andBiomedical Laboratories (BMBL)website:http://www.cdc.gov/OD/ohs/biosfty/bmbl5/bmbl5toc.htmEH&S UW Bloodborne Pathogen Training 60

Resources• EH&S Site-Specific Exposure Control Plan:http://www.ehs.washington.edu/forms/rbs/researchlaboratorysupplementalform.doc• Specimen Handling Transport EH&S Class:http://www.ehs.washington.edu/eposhiphazmat/index.shtm• EH&S Research and Occupational Safety:206-221-7770, ehsbio@uw.edu,http://www.ehs.washington.edu/rbs/bbp.shtmEH&S UW Bloodborne Pathogen Training 61

QUESTIONS?Be sure to look at your workplaceExposure Control Plan!See you next year… online!"I hear & see - I learn, but may forget,But if I do, I understand."EH&S UW Bloodborne Pathogen Training 62