UF Bloodborne Pathogen Training

2012 UF Bloodborne Pathogen TrainingBiological Safety OfficeEnvironmental Health & Safety352-392-1591www.ehs.ufl.edubso@ehs.ufl.edu

1990: Occupational Safety & Health Administration (OSHA) estimates >200 deaths & 9000 infections/year from occupational BBP exposure

BBP standard implemented in 1991 to protect workers from occupational exposure 29 CFR 1910.1030 http://www.osha.gov/pls/oshaweb/owadisp.show_document?p_table=STANDARDS&p_id=10051

Revised in 2001 safe sharps devices, maintain a log of injuries from contaminated sharps

BBP Standard

1990 OSHA estimated more than 200 deaths and 9000 infections/year from occupational BBP exposure. BBP standard issued to protect workers from occupational exposure.CDC 2004 estimated 385,000 needlestick and sharps injuries each year to health care workers in hospital settings, more than 1000/day!2UF follows OSHA requirementALL employees, staff, students, volunteers, affiliates with potential exposure to BBP from human blood/OPIMGeneral and workplace-specific trainingCompleted BEFORE individual is assigned to tasks with the potential for BBP exposure and ANNUALLY thereafter

In addition to training, individuals with potential exposure must also have:Access to the regulatory text and an explanation of its contents

Access to a copy of the UF Exposure Control Plan http://www.ehs.ufl.edu/Bio/BBP/ECP2012.pdf

Access to site-specific Standard Operating Procedures (SOPs) http://www.ehs.ufl.edu/Bio/BBP/BBPSOPS.pdf BBP Training Requirement

Exposure control plan and SOPs are site-specific and detail equipment, practices & PPE used at your site. Update annually or as needed. Should be available in the lab and all members should have reviewed the documents.3Pathogenic microorganisms present in blood and other potentially infectious material (OPIM) that are able to cause disease in humans

Hepatitis B virus (HBV, HepB)Hepatitis C virus (HCV, HepC) Human immunodeficiency virus (HIV)

Less commonly, human T-lymphotropic virus (HTLV-1), Epstein-Barr virus (EBV), malaria, brucellosis, rabies, leptospirosis, babesiosis, syphilis, Creutzfeld-Jakob disease, arboviral infections (WNV, EEE), etc.Bloodborne Pathogens (BBPs)

The big 3 account for most cases of occupationally acquired blood-borne infection4What constitutes OPIM?YESNO (unless visibly contaminated with blood)Cerebrospinal fluidTearsSynovial fluidFecesPeritoneal fluidUrinePericardial fluidSalivaPleural fluidNasal secretionsSemen/Vaginal secretionsSputumBreast milkSweatAmniotic fluidVomitSaliva from dental proceduresUnfixed human tissue or organs (other than intact skin)Cell or tissue cultures that may contain BBP agentsBlood/tissues from animals infected with BBP agentsCell lines may be infected or become infected/contaminated in subsequent handling/passaging

ATCC started testing newly manufactured/deposited cell lines for common viral pathogens (HIV, HepB, HepC, HPV, EBV, and CMV) in January 2010

Many infectious agents yet to be discovered and for which there is no test Remember HIV?

Use Universal Precautions for all human cell lines

Research using human cell linesHIV detected in a plasma sample dating back to 1959 not officially identified until early 80sLymphocytic choriomeningitis virus in cell lines6More stringent control measures

Work must be registered with EH&S Biosafety Office (rDNA or BA registration forms online at http://www.ehs.ufl.edu/Bio/Registration_Forms.htm)

Enrollment in medical surveillance program

Follow CDC/NIH BSL-2 containment practices at a minimumHIV/Hepatitis Research Labs

Cuts or punctures with contaminated sharp objects (needles, glass, scalpels, etc)

Splashes to mucous membranes (eyes, nose, mouth)

Contamination of broken/non-intact skinHow are BBPs commonly transmitted in the workplace?

All human blood or OPIM is treated as infectiousStandard precautions = universal precautions + body substance isolation. Applies to blood & all other body fluids, secretions, excretions (except sweat), nonintact skin, and mucous membranesUNIVERSAL PRECAUTIONSCornerstone of exposure prevention

9Spread through direct contact with infected blood or OPIM; 50-100 times more infectious than HIVInfection may be acute or chronic5-10 % of infected adults will develop chronic infection; ~1.2 million people with chronic HBV15-25% develop cirrhosis, liver failure, or liver cancer (~ 3000 deaths/year)Symptoms of acute infection can appear 6 wks - 6 mos after exposure & include:

Hepatitis B (HepB, HBV)FeverAbdominal painFatigueLoss of appetiteNausea Vomiting JaundiceJoint painDark urine

Younger age when infected increases risk of chronic infection > 90% of infants, 25-50% in 1-5 years, 5-10% older children and adults~70% of adults will develop symptoms after acute infectionMany people have no symptoms but can still spread the virus10Needlestick/sharp injury from HepB contaminated source ~30% of these exposures results in infection

Mucosal exposure to blood/body fluids

Exposure to nonintact skin from contaminated surfaces and equipment HBV can remain infective in dried blood at RT for at least 1 week (MacCannell et al., Clin Liver Dis 2010; 14:23-36)

Occupational HepB Exposures

What besides Universal Precautions & appropriate cleaning & disinfection can be used to prevent HepB infection.. ?SafeGiven to newborns, 120 million people in U.S. have received at least one doseEffective >95% develop immunity after full series (3 doses given at 0, 1, 6 mos)In Gainesville, free to UF employees @SHCC (392-0627)Bring completed Acceptance/Declination statement http://www.ehs.ufl.edu/Bio/BBP/TNV.pdf If you decline, can change mind at any timeHepB Vaccine

Became available in 1982. Routine childhood vaccination started in 1991. Incidence of acute HepB among children and adolescents dropped by more than 95% and by 75% in all age groups. Inverse correlation with age and risk of chronic infection - 90% of infants, 25-50% in 1-5 years, 6-10% older children and adultsAlternative schedules available: 0, 1, and 4 mos or 0,2, and 4 mos

12Health-care workers or public safety workers at high risk for continued percutaneous or mucosal exposure to blood or body fluids, HBV research lab workers

Performed 1-2 months after dose #3HepB surface antibody (anti-HBs) 10 mIU/mL - immuneAnti-HBs < 10 mIU/mL revaccinate (3 doses) and retest anti-HBsStill negative nonresponder, need HBIG after exposure

Previously vaccinated but not tested? Test for anti-HBs after an exposure; if negative, treat as susceptible.Postvaccination testing

Transmitted primarily through contact with infected blood

~3.2 million Americans chronically infected; many do not know they are infected b/c they are asymptomatic (if symptoms do occur, similar to HepB)~ 12,000 deaths/year

Leading indication for liver transplant in U.S.

Hepatitis C (HepC, HCV)

14Percutaneous injury, esp. with deep punctures or extensive blood exposures~2% develop infection

Mucosal/nonintact skin exposures rarely documented Proper cleaning/disinfection of surfaces importantHCV in dried blood samples remains infective for at least 16 hours (Kamili et al., Infect Control Hosp Epidemiol 2007; 28:519-524)

Universal Precautions for Prevention!NO VACCINEAntivirals (peginterferon/ribavirin) can have serious side effects, treatment lasts 24-48 weeks New HCV protease inhibitors boceprevir & telaprevir (approved 5/11). Given in combination with traditional therapy, many side effects, drug resistance, only effective for genotype 1

Occupational HepC Exposures

Side effects fatigue, fever, nausea, diarrhea, insomnia, irritability, depressionInterferon injectedNS3/4A serine protease reqd for RNA replication and virion assembly15Transmitted through contact with infected blood/OPIMAttacks & destroys CD4+ T cellsCan be asymptomatic for many years AIDS - occurrence of opportunistic infections or HIV-related cancers & a decline in CD4+ T cell (