Blood and - University of Queensland

Risk Assessment and TrainingEach department/school/centre is responsible for ensuring the safety of staff, students, contractors and visitorsby maintaining an ongoing and appropriate risk identification and management process, which includes thefollowing:Identifying the tasks in which potentially infectious material is handled;Assessing the associated risks;Applying local safe work instructions and procedures which result in theMinimisation of the risk involved;Implementing the relevant immunisation requirements;Ensuring personal hygiene is appropriate;Inducting new staff, students and contractors as well as visitors to the area to ensure they are familiarand compliant with the above;Informing all female employees or pregnant woman of the risk to the unborn child of occupationalexposure to certain microorganisms such as Toxoplasma gondii, Listeria monocytogenes, Coxiella burnetii,rubella and hepatitis B, C and E viruses.Risk assessment and management should be carried out using the UQ Risk Assessment Database at:http://www.uq.edu.au/ohs/index.html?page=29960The following types of incidents must be specifically addressed in safe local work instructions: Introduction of blood, blood products, tissue or body fluids through the skin or onto mucosal surfaces (eg.Inside mouth, nose or onto eyes); Reporting of any “near miss” incidents onto mucosal surfaces (eg. inside mouth, nose and into the eye, orneedle stick injuries); Splashes to exposed skin including the face.ImmunisationThe University’s Immunisation Policy and Guideline should be read in detail as those handling human or animalblood, blood products, tissues and body fluids or performing exposure prone invasive procedures are at risk ofcontracting infectious diseases, some of which are vaccine-preventable.Staff and students should refer to their school or centre’s immunisation requirements. The University alsorecognises that many of its students and staff perform duties or placements in Queensland Government facilitiesand these students and staff (and the University) are obliged to observe the immunisation requirements imposedby the state government. In particular Queensland Health requires that all potentially at risk health care staff andvisitors (including students) be vaccinated against hepatitis B. The University of Queensland adopts and complieswith Queensland Health policy in this area.Baseline Serum SampleIt is not recommended that blood samples be taken routinely from new or current staff and students for baselineserum levels. However it may be required as a result of the outcome of a risk assessment and the facilitycontainment level involved. Persons working in Physical Containment 3 (PC3) facilities will require healthmonitoring. This may include initial and periodic examinations requiring a medical examination, chest X-ray andwhere relevant, a baseline serum sample. Such blood samples must be taken after obtaining informed consent.The sample must be stored securely and appropriately bearing in mind the medical and legal implicationsinvolved in the subsequent use of such specimens.Local Safe Work Procedures for Working with Blood and Body Fluids Page 2 of 8Occupational Health & Safety Division May 2012 , v3.2

Equipment surfaces exposed to potential contamination should be disinfected daily. If necessary the equipmentmanufacturer’s advice should be sought regarding compatibility of disinfectants with surfaces or functions. Allinstruments and equipment that require service or repair must be cleaned free of blood and disinfected beforeleaving the laboratory.Local safe work instructions must take into account:The need for transport and repair of instruments used in areas in which blood and body fluids arehandled or stored;The requirement that the Biosafety Adviser or the manufacturer be consulted for advice should anyinstrument need external servicing, particularly if it cannot be decontaminated before being transported.Emergency plans and proceduresEmergency plans should be prepared in consultation with the Occupational Health Nurse Adviser, the BiosafetyAdviser and OHS Division. This plan should be displayed prominently and cover the following:Location of emergency equipment;UQ Emergency Procedures;Management of accidental swallowing of potentially hazardous material, accidental skin puncture or cutand breakages/leakages.Working in laboratoriesLaboratory design and layoutLocal safe work procedures should take into account the following recommendations for laboratory design andlayout:Laboratory space and placement of equipment should not create a crowded working environment norinhibit cleaning;Laboratory surfaces and floors should be made of impervious material to allow for effective cleaning;Facilities for hand washing with elbow or foot operated taps should be provided in each work area;Eyewash stations should be available in each work area;Biohazard containers for the safe disposal of contaminated materials and sharps should be provided inadequate numbers in appropriate places in each work area;Laboratory doors and specimen storage areas should be marked as containing a biohazard;Offices and study areas should be separated from laboratory work areas;Restriction of laboratory access should be enforced as appropriate.Containment of aerosolsLocal safe work procedures should be specific about control of aerosols:Define the tasks required to always be undertaken in laminar flow cabinets;Define the tasks to be undertaken in Biological Safety cabinets;As a minimum, Class I or Class II cabinets should be used for any procedures likely to produce aerosols ofblood, bodily fluids or their products (e.g. sonication, agitation, blending, procedures producing foam,froth, spray and aerosols as well as the decanting of large volumes of fluids in open containers);Define the maintenance and testing procedures for Biological Safety and all ventilation systems to ensurethat they are operating to specification. Ensure they are tested and serviced at intervals of not more thanone year;Centrifuge tubes should be sealed closed or sealed rotors should be used for spinning of any potentiallycontaminated material. Operators should ensure the rotor has completely stopped turning beforeopening the lid.Local Safe Work Procedures for Working with Blood and Body Fluids Page 5 of 8Occupational Health & Safety Division May 2012 , v3.2

Transport of SpecimensThe Transport of Dangerous Goods Class 6.2 Infectious substances are regulated by the following, depending onthe mode of transport:International Air Transport Association (IATA) Dangerous Goods regulationsAustralia Post Dangerous and Prohibited Goods and Packaging Post GuideAustralian Code for the Transport of Dangerous Goods by Road and RailThese regulations require mandatory training for:Packaging to IATA standards (i.e. to send biological material on either domestic or international flights);Packaging and transport for land transport of biological material. An important issue is the lack ofinsurance cover if such material is transported in a private vehicle.If you are transporting biological material, which is either infectious or diagnostic, please contact the BiosafetyAdviser at the Occupational Health and Safety Division for advice.Protective clothingDetailed advice about the best type of protective clothing appropriate for use in each circumstance can be soughtfrom OH&S Division. The following are important points, which should, as appropriate, be incorporated, in localsafe work instructions and on-site training.GlovesAlways wear when likely to be in contact with the specimen or contaminated surfaces or material.Always wear if there is any open skin lesion or dermatitis as these conditions increase the risk of infection.Select disposable gloves, which fit well and are easily replaced.Damaged gloves must be replaced immediately.Remove gloves after task completion (eg before handling telephones, performing office work and leavingthe laboratory).If a telephone is contaminated wipe thoroughly with 70% alcohol.Gloves must be worn when working in a biological safety cabinet in PC2 certified facilities.Gloves must be worn when working in PC3 certified facilities.Face and Eye ProtectionGownsFootwearFacial protection such as safety glasses, mask or face shield must be worn if there is a risk of splashing orspraying of blood or body fluids.Eye protection should be worn when transferring blood or bodily fluids. A full-face shield provides thegreatest degree of protection (see Guideline on Eye Protection in Laboratories).Contact lenses will not protect the eyes from exposure and may absorb chemicals or biologicals.Wear in laboratories at all times and remove whenever leaving the laboratory.Back opening or wrap around gowns are preferable and ensure gowns have a closed, completely coveredfront.Gowns should be discarded appropriately when soiled or contaminated.Gowns are assumed to be infectious and should be kept separate from other linen.Specify closed shoes as appropriate (eg in laboratories).Exclude high heels as appropriate (eg in the laboratory environment).Local Safe Work Procedures for Working with Blood and Body Fluids Page 6 of 8Occupational Health & Safety Division May 2012 , v3.2

Personal hygieneThe following are important points, which should, as appropriate, be included in local safe work instructions andon-site training.Hand WashingHand CareAttention to hand washing is an essential part of good practice.Hands should be washed thoroughly with soap and water immediately if contaminated with blood orother body fluids or if gloves have been torn or punctured.All wounds should be covered with waterproof dressings.Hands should be washed at completion of the workday or session.Elbow or foot operated taps should be available.The use of moisturising cream is recommended where frequent hand washing is required.Antimicrobial hand gels are available with moisturisers and these can reduce the drying effects offrequent hand washing.Nails should be kept trimmed and clean.Avoiding contactStaff must avoid inadvertent contact with their skin or mucosal surface (eyes, mouth).Mouth pipetting is prohibited.Cosmetics must not be applied in the laboratory and long hair should be tied back.Food and drink must not be kept in nor consumed in the laboratory.Skin injuryAll skin problems such as cuts, abrasions, exudations and exudative rashes should be covered by awaterproof dressing applied prior to entering the laboratory.Local Safe Work Procedures for Working with Blood and Body Fluids Page 7 of 8Occupational Health & Safety Division May 2012 , v3.2

Useful LinksUniversity of Queensland:Incident Reporting: http://www.risk.admin.uq.edu.au/uq-injury/forms/default_content.aspAlternative Programs for Students with a Disability (Students with a Blood- borne Virus):https://ppl.app.uq.edu.au/content/3.50.08-alternative-academic-arrangements-students-disabilityDisability Action Plan: http://www.uq.edu.au/equity/docs/UQ-Disability-Action-Plan-2011-2014.pdfStaff Responsibilities for Occupational Health and Safety:https://ppl.app.uq.edu.au/content/2.10.04-staff-responsibilities-occupational-health-and-safetyFirst Aid Policy: https://ppl.app.uq.edu.au/content/2.30.10-first-aid#PolicyHepatitis B Information for Students and Staff exposed to Human Blood and Blood Products:http://www.uq.edu.au/ohs/pdfs/hepb.pdfImmunisation Policy:https://ppl.app.uq.edu.au/content/2.30.15-immunisation#PolicyRisk Assessment database:https://new.risk.admin.uq.edu.au/Signin.aspxExternal links: Blood and Body Fluid Exposure; Management of:http://www.health.qld.gov.au/CHRISP/IC_GUIDELINES/CONTENTS.ASP Hepatitis B Fact Sheet: http://access.health.qld.gov.au/hid/InfectionsandParasites/ViralInfections/hepatitisB_fs.asp Hepatitis B information (concerning sexual Health) Queensland Health:http://www.health.qld.gov.au/sexhealth/default.asp Hepatitis C information:http://access.health.qld.gov.au/hid/InfectionsandParasites/ViralInfections/hepatitisC_fs.asp HIV information:http://access.health.qld.gov.au/hid/InfectionsandParasites/SexuallyTransmittedDiseases/hivAndAids_fs.asp Infected Health Care Workers-Management of:http://www.medicalboard.gov.au/Notifications.aspx (information onthe management of impaired practitioners and students) Infection Control Guidelines Communicable Diseases Network Australia, the National Public Health Partnership andthe Australian Health Ministers’ Advisory Council January2004:http://www.health.gov.au/internet/main/publishing.nsf/Content/icg-guidelines-index.htm Safety in Laboratories (Microbiology) Standards Australia and New Zealand AS/NZS 2243.3:2010:o http://www.saiglobal.com/online/autologin.asp Queensland Health Infection Control Guidelines, 2008:http://www.health.qld.gov.au/CHRISP/IC_GUIDELINES/CONTENTS.ASP Health care associated infections-Centre for Disease Control: http://www.cdc.gov/hai/*Invasive procedures include any surgical entry into tissue, body cavities or organs, or repair of traumatic injury, and carry aparticularly high risk of infection. “Exposure prone procedures” area subset of invasive procedures. These are usuallycharacterised by the potential for direct contact between the skin (usually fingers and thumb) of the HCW and sharp surgicalinstruments, needles, or sharp tissues (spicules of bone or teeth) in body cavities or in poorly visualised or confined bodysites, including the mouth. In the broader sense, and for the purpose of these guidelines, an exposure prone situation isconsidered to be any situation where there is a potentially high risk of transmission of blood borne disease from HCWs topatients during medical or dental procedures.The policy and guidelines have been modified with permission from similar documents published by Monash University.Contact for Additional InformationOccupational Health Nurse AdviserFiona CoulthardEmail: f.coulthard@uq.edu.auPhone: 07 3365 4883 (ext 54883)Local Safe Work Procedures for Working with Blood and Body Fluids Page 8 of 8Occupational Health & Safety Division May 2012 , v3.2