University of Southern California
Bloodborne Pathogens
Training
USC Environmental Health and Safety
**For annual refresher training ONLY (initial training must be taken in class)
Outline
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Objective
Introduction to Bloodborne Pathogens
Epidemiology and Symptoms
Modes of transmission
Case Reports
Preventive methods
Summary
Objective
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To inform USC healthcare workers (HCW),
students, staff and other personnel about:
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Occupational risk, vaccination program, exposure control plan,
etc.
Comply with OSHA Bloodborne Pathogen
Standard
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29 CFR 1910.1030 & CCR Title 8, section 5193
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Cal-OSHA BBP Std. Guide
Comply with CA Medical Waste
Management Act
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Safety Code, Sections 117600-118360
Bloodborne
Pathogens
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Microorganisms that are present in human and non-human primate
blood and can cause disease in human:
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Transmitted by blood or other bodily fluids/tissue via:
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HBV, HCV, HIV most prevalent (Herpes B, Malaria & Syphilis)
contaminated sharps,
mucosal exposure,
or exposure with non-intact skin
Needlestick – HBV ~30% risk of transmission, HCV 1-10%, HIV ~.3%
Hepatitis B has been the most frequent laboratory-acquired viral
infection, with a rate of 3.5–4.6 cases per 1000 workers. Any
laboratory personnel who collects or handles tubes of blood is
vulnerable
Exposure to Blood: What Healthcare Personnel Need to Know, http://www.cdc.gov/ncidod/dhqp/pdf/bbp/Exp_to_Blood.pdf
Disease characteristics
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Hep B – Acute: liver inflammation, cold/flu-like
symptoms and vomiting. Chronic: cirrhosis, liver cancer,
death
Hep C – many cases asymptomatic, mostly chronic
infection, liver transplant
HIV – once immunocompromised, succumb to
opportunistic infections(CMV, Pneumocystis pneumonia)
Occupationally acquired HIV among
healthcare personnel 1981-2006
Occupation
Documented
Possible
Nurse
24
35
Clinical Laboratory
Worker
16
17
Nonsurgical Physician
6
12
Non-Clinical Laboratory
Technician
3
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Housekeeping or
Maintenance
2
13
Dentist or Dental
Worker
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6
Other healthcare
occupation
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6
Surveillance of Occupationally Acquired HIV/AIDS in Healthcare Personnel, as of December 2006,
http://www.cdc.gov/ncidod/dhqp/bp_hcp_w_hiv.html
Needlesticks
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~85% occupationally acquired HIV
600K-800K injuries annually
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Half are estimated to be unreported.
Most needlesticks due to poor work practices
 Preventable
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Panlilio AL, et al. Infect Control Hosp Epidemiol, 2004
Tasks that may put you at risk
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Phlebotomy
Handling containers of blood, fluid, tissue, or cultures
Pipetting, mixing, or handling blood, fluid, tissue
Using finger stick device for blood testing
Using capillary tube
Providing injections
Cleaning blood or broken contaminated glass
Handling medical waste
Assisting diabetic patient with blood glucose
monitoring
Performing first aid or CPR
Finding improperly discarded needle
An introduction to Bloodborne Pathogens in the Pharmacy, https://webapp.walgreens.com/cePharmacy/viewpdf?fileName=blood_borne_pathogens.pdf
Case Report
Controlling Risk
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Risk Assessment
Universal precautions
Engineering controls, work practice
controls, personal protective equipment
Proper Waste Disposal
Disinfection
Risk Assessment Process
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What is Risk?
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A measure of the likelihood that a loss will occur
(probability) and its potential seriousness
(severity)
Risk Assessment Process (I.A.M)
Identify the hazards
 Assess the potential impact of the hazards
 Manage the potential impact of the hazards
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through risk reduction strategies:
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(Engineering, Administrative, PPE)
Engineering controls
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Biosafety Cabinet (BSC)
Safety-engineered sharps must be used,
such as self-retracting needle, hinged cap
needle
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Proven to reduce number of needlestick
injuries
Plastic capillary tubes/ aspirating pipettes
Biosafety Cabinets
(Engineering Controls)
BSC work practices:
1. Disinfect working area with
appropriate disinfectant and
contact time.
2. Do not block front or back grilles
3. Divide BSC’s working area into:
clean, working and dirty areas.
4. Work from clean to dirty area
5. Have only items needed for
procedures
*Do not overcrowd BSC
6. Minimize rapid movements inside
BSC:
*Move arms in and out slowly
(minimize sweeping motion)
7. Disinfect thoroughly at the end of
experiment.
* UV light is not recommended
Potential Risk of Using Glass Pasteur
Pipettes
Work practice controls
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No recapping of needles
Place sharps container as close to you as
possible, don’t exceed fill line
Immediately dispose of medical waste
When using sharps, focus on task at hand
Practice before using device on patients
Practice good hand hygiene (soap and
water, alcohol based hand sanitizer)
Hand Hygiene
Frequently missed areas
Personal Protective Equipment
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Gloves for any vascular access(latex
alternatives), remove carefully to minimize
contamination of hands, wash hands
afterwards
Lab coat/scrubs
Eye and face protection
when splash potential
Closed-toe shoes
Working with commercial blood bank samples?
Samples are tested for
Hepatitis B core antigen
Hepatitis B surface antigen
Hepatitis C virus
HIV 1 & 2
A, B, O and Rh
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Samples are NOT tested for
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Eastern Equine encephalitis virus (EEEV)
St. Louis encephalitis virus (SLEV)
West Nile Virus (WNV)
Brucellosis
Others
Hazardous Waste Disposal Biomed
PATHOLOGICAL
SOLID
PHARMACEUTICAL
SHARPS
Chemotherapy
Waste Hierarchy
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Decontamination of Biohazardous
Liquid Waste
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Decontaminate tissue and media with 10%
bleach solution with a 30 minute contact time
Flasks must be emptied and surfaces must be
decontaminated at the end of a shift
Disinfection
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1-10% household bleach
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70% Ethanol
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Make 10% solution weekly for effectiveness
Not suitable for non-enveloped viruses
Sani-wipes
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Must be EPA approved
Labeling
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Place International biohazard symbol on:
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Biohazardous waste
Door signs
Incubators
Freezers
Refrigerators
Shipping boxes
Any equipment use for biological samples
Handling, storage, transport
procedures
 Specimens must be placed in a container which
prevents leakage during collection, handling,
processing, storage, transport, or shipping (use
secondary container), container must be labeled
with biohazard symbol
Hep B Vaccination
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Recombinant vaccine
Anti-cancer
Anaphylaxis rare
Contact EH&S for more information and forms:
323-442-2200 or IBC@admin.usc.edu
**In-class training required to obtained vaccination form
Handling Exposures
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Wash affected area with soap and
water, if mucosal exposure, rinse with
water/saline
Report immediately and seek medical
evaluation (Internal Medicine, White
Memorial after-hours)
Counseling, baseline testing, test
source if possible, possibly initiate
PEP, schedule follow-up testing
various timepoints up to 1 year
Post exposure prophylaxis
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HBV: HBIG + vaccine if unvaccinated
HIV: Standard Antiretroviral Therapy
(ART)
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antiretrovirals, 2 or 3 drug expanded regimen
depending on type of exposure (percutaneous
vs. mucosal), status of the source, bodily fluid
HCV: Rivavirin & pegylated-interferon
alpha-2b.
In summary
Practice safe techniques
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Use safety-engineered sharps
Dispose of needles into sharps containers
Don’t recap needles
Wear gloves, lab coat/scrubs, closed-toe
shoes
Good hand hygiene
Follow post-exposure procedures
Exposure control plan
Cal-OSHA BBP & Exposure Control Plan info:
http://www.dir.ca.gov/dosh/dosh_publications/bbpbest1.pdf
Internal Medicine (HCC II) and White Memorial Hospital
References
Cal OSHA Bloodborne Pathogen Standard, http://www.dir.ca.gov/title8/5193.HTML
Surveillance of Occupationally Acquired HIV/AIDS in Healthcare Personnel, as of December 2006,
http://www.cdc.gov/ncidod/dhqp/bp_hcp_w_hiv.html
Panlilio AL, et al. Infect Control Hosp Epidemiol, 2004
Exposure to Blood: What Healthcare Personnel Need to Know, http://www.cdc.gov/ncidod/dhqp/pdf/bbp/Exp_to_Blood.pdf
An introduction to Bloodborne Pathogens in the Pharmacy,
https://webapp.walgreens.com/cePharmacy/viewpdf?fileName=blood_borne_pathogens.pdf
Aoun, H.: When a house officer gets AIDS. N Eng J Med 321(10):693-696, 1989.
FDA Safety Alert: Hepatitis B Transmission via Spring-loaded Lancet Devices
http://www.fda.gov/downloads/MedicalDevices/Safety/AlertsandNotices/PublicHealthNotifications/ucm063124.pdf
NIOSH Alert: Preventing Needlestick Injuries in Health Care Settings, 1999