Bloodborne Pathogens OSHA 29 CFR 1910.1030

1. Bloodborne PathogensOSHA 29 CFR 1910.1030 University of Kentucky Department of Biological Safety

2. The Bloodborne Pathogens Standard covers all occupational exposures to blood or other potentially infectious materials and serves to provide methods to protect workers from exposure to bloodborne pathogens. For a copy of the standard: http://www.osha.gov/pls/oshaweb/owadisp.show_document?p_table=STANDARDS&p_id=10051

3. How does the Bloodborne Pathogen Standard apply to my research lab? • Work with human blood or tissue • Work with human cell lines • Work with viral vectors derived from bloodborne viruses, Lentiviral vectors • Use of infectious agents that are bloodborne pathogens, HIV, HBV, Cytomegalovirus, Malaria, Leptospirosis, Herpesviruses, Syphilis

4. Definitions • Blood: • Human blood, • Human blood components, • And products made from human blood. • This includes plasma and products derived from plasma such as human serum albumin (HSA). • This definition also includes human umbilical cord blood cells (hUCB).

5. Definitions • Bloodborne Pathogens: • Pathogenic microorganisms that are present in human blood and can cause disease in humans. • These pathogens include, but are not limited to, human immunodeficiency virus (HIV) and hepatitis B virus (HBV).

6. Human Immunodeficiency Virus (HIV) • A retrovirus that causes AIDS (Acquired Immune Deficiency Syndrome) by infecting helper T cells of the immune system. • HIV is transmitted through direct contact with infected material, such as a needlestick injury. • Initial symptoms of HIV may be a mild flu-like illness developing within 1 to 6 weeks of exposure. • After a latent period which may last several years, AIDS develops and the disease is characterized by the loss of T cell function and prevalence of opportunistic infections

7. Human Immunodeficiency Virus (HIV) The probability of being infected following an exposure to a known HIV positive source is only about 0.4% and there are only 5 reported cases of laboratory acquired HIV infections. If the probability of infection is so low, why are all these precautions recommended? While the onset of AIDS may be delayed through drug therapy and opportunistic infections may be treatable, AIDS is at this time incurable and fatal.

8. Hepatitis B Virus (HBV) • A member of the Hepadnaviridae, HBV is a DNA virus that affects primarily the liver. • HBV is transmitted by percutaneous and mucosal exposures to blood and other potentially infectious material. • Initial infection may have few or no symptoms but can develop into a chronic infection leading to cirrhosis, chronic active hepatitis, and liver cancer. • Nearly 1/3 of the world’s population has been or is actively infected with HBV. This high prevalence leads to great potential for infection following exposure to blood or other potentially infectious material (OPIM).

9. Definitions • Contaminated Sharps: • Any contaminated object that can penetrate the skin including, but not limited to, needles, scalpels, broken glass, broken capillary tubes, and exposed ends of dental wires. • This includes serological pipets and pipet tips contaminated with other potentially infected materials such as human cell and tissue cultures. http://www.uspinc.com/pipettips.htm www.coleparmer.ca

10. Definitions • Engineering Controls: • Controls that isolate or remove the bloodborne pathogens hazard from the workplace. • These may include sharps disposal containers, self-sheathing needles, or needleless systems. Fisher Scientific 15-353-25, 15-353-24

11. Safer Sharps http://catalog.bd.com/ecat/help/f12/safetywithoutcompromise.pdf

12. Definitions • Exposure Incident: • A specific eye, mouth, other mucous membrane, non-intact skin, or parenteral contact (needle-stick) with blood or other potentially infectious materials that results from the performance of an employee’s duties.

13. Preventing Exposure One way to prevent exposure to bloodborne pathogens is through the practice of universal precautions. Universal precautions are an approach to infection control in which all human blood and certain human body fluids are treated as if known to be infectious for HIV, HBV, and other bloodborne pathogens.

14. Definitions • Other Potentially Infectious Material (OPIM) • The following human fluids are considered potentially infectious: • Semen • Vaginal Secretions • Cerebrospinal Fluid • Pleural Fluid • Pericardial Fluid • Peritoneal Fluid • Amniotic Fluid • Saliva in dental procedures • Any body fluid visibly contaminated with blood • All body fluids when it is difficult or impossible to differentiate between body fluids

15. Definitions- OPIM Continued • Other Potentially Infectious Material (OPIM) • Any unfixed tissue or organ (other than skin) from a human (living or dead) • HIV-containing cell or tissue cultures, organ cultures • HIV- or HBV-containing culture medium or other solutions • Blood, organs or other tissues from experimental animals infected with HIV or HBV

16. Definitions • Regulated Medical Waste: • Liquid or semi-liquid blood or OPIM • Contaminated items that would release blood or OPIM in a liquid or semi-liquid state if compressed • Items that are caked with dried blood or OPIM and are capable of releasing these materials during handling • Contaminated sharps • Pathological and microbiological wastes containing blood or OPIM

17. Engineering and Work Practice Controls • The equipment and procedures that are used to minimize or eliminate employee exposure to bloodborne pathogens. • Any exposure risk remaining after the institution of engineering and work practice controls shall be mitigated via the use of personal protective equipment (PPE). Fisher Scientific 14-827-109

18. Engineering and Work Practice Controls • Handwashing facilities should be readily available for employee use. • Hands should be washed after removing gloves and after any exposure incident. • Waterless hand sanitizer can be utilized if handwashing facilities are not available but hands should be washed with soap and water as soon as feasible. • For more information on hand hygiene: http://ehs.uky.edu/biosafety/handhyg.html

19. Engineering and Work Practice Controls • Examples: • Performing human cell culture in a Biological Safety Cabinet. • Discarding used needles in an approved sharps container without recapping the needle. • Performing procedures involving blood or OPIM in a manner which minimizes splashes and generation of aerosols.

20. Personal Protective Equipment (PPE) • All employees should have access to PPE that is task appropriate and the correct size. • Employee training on PPE should include: • Location • Proper Use • Proper Disposal • Decontamination Procedures for Reusable Equipment • Selection of Proper PPE for the Task • PPE may include, but is not limited to, gloves, gowns, lab coats, face shields, and goggles.

21. Recognizing Exposure Potential To evaluate the effectiveness of engineering and work practice controls and PPE, you need to assess the risk of the task being performed. • Potential for needlestick? • Example, tail vein injections of tumor cells into rodents. • Potential for splash? • Example, vortexing human cell lines.

22. Waste Disposal • Sharps • Approved red sharps container with biohazard symbol (UK Supply Center 320144) • Close and decontaminate the outside when full • Medical Center custodial staff or Environmental Management (323-6280) will collect for disposal by Medical Waste Contractor www.vwr.com Hazardous Waste Pick-up Request

23. Waste Disposal • Human blood or other body fluids and pathological specimens and containers grossly contaminated with human blood (ex. blood bags) • Dispose of in red, biohazard labeled waste bags in red, lidded waste containers • Medical Center custodial staff or Environmental Management (323-6280) will collect for disposal by Medical Waste Contractor when full.

24. Waste Disposal • Human Cell and Tissue Culture Waste • Disposable tissue culture supplies and solid waste • Collect in an orange or clear autoclave bag labeled with biohazard symbol • Autoclave and dispose in regular trash • Serological Pipets, Pipet Tips, Contaminated Broken Glassware • Collect in a plastic-lined cardboard container and place in an orange or clear autoclave bag labeled with biohazard symbol • Autoclave and dispose in regular trash • Liquid Waste • Autoclave or decontaminate with bleach for disposal in sanitary sewer

25. Contaminated Laundry Reusable lab coats should never be taken home to be laundered. Lab coats worn during the manipulation of blood or OPIM should be bagged and appropriately labeled with the universal biohazard symbol prior to pick-up or drop-off for laundry service. Attempts should be made to limit contact with contaminated laundry.

26. Exposure Control Plan (ECP) • A manual for how to work safely with blood and OPIM. • A comprehensive, workplace-specific document that outlines in detail all measures that will be taken to minimize or eliminate employee exposure. UK Exposure Control Plan Template: http://ehs.uky.edu/docs/doc/bio_attachment_ecp.rtf

27. Exposure Control Plan (ECP) • The components of the ECP: • Exposure Determination • Methods of Compliance • Hepatitis B Vaccination • Communication of Hazards • Post Exposure Evaluation and Follow-up All labs utilizing human blood or OPIM must have an Exposure Control Plan.

28. Exposure Determination • Considers the type of materials being utilized and the tasks and procedures that will be performed in the lab • Risk assessment for exposure to bloodborne pathogens • Allows personnel to familiarize themselves with the hazards present

29. Methods of Compliance Summary of methods to prevent personnel from exposure to blood or OPIM including: • Engineering Controls • Work Practice Controls • PPE • Housekeeping Procedures • Training Documentation • Exposure Incident Contact Information

30. Bloodborne Pathogens Training • Bloodborne pathogen training must be taken on an annual basis by all employees with occupational exposure to blood or OPIM • This training requirement is met by reviewing this on-line training and successfully completing the accompanying quiz • Training certificates should be maintained in the Lab Safety Manual • Research labs utilizing HIV and HBV require additional training

31. Hepatitis B Vaccination • Immunization primary measure for prevention • Administered as a series of 3 injections • Provided at no cost to UK employees who may be exposed to bloodborne pathogens in the workplace • Imparts immunity in over 95% of vaccinated individuals • Safe and effective

32. Hepatitis B Vaccination To decline vaccination, sign a declination form stating: I understand that due to my occupational exposure to blood or other potentially infectious materials I may be at risk of acquiring hepatitis B virus (HBV) infection. I have been given the opportunity to be vaccinated with hepatitis B vaccine, at no charge to myself. However, I decline hepatitis B vaccination at this time. I understand that by declining this vaccine, I continue to be at risk of acquiring hepatitis B, a serious disease. If in the future I continue to have occupational exposure to blood or other potentially infectious materials and I want to be vaccinated with hepatitis B vaccine, I can receive the vaccination series at no charge to me.

33. Communication of Hazards • Labels containing the universal biohazard symbol should be placed anywhere blood or OPIM is used or stored. • This includes labeling of contaminated laundry and waste.

34. Post Exposure Evaluation and Follow-up In the event of an exposure incident: • Wash the area with soap and water or flush with water • Notify your supervisor of the incident • Your supervisor will contact Workers’ Care at 1-800-440-6285 and an appointment will be scheduled for you at University Health Services For more information on post-exposure response: http://ehs.uky.edu/ohs/LabExposureProtocol.pdf

35. Questions? Department of Biological Safety 505 Oldham Court Lexington, KY 40502 http://ehs.uky.edu/biosafety/ E-mail: ehsbiosafety@uky.edu Marcia Finucane Biosafety Officer Phone:  859-257-1049 Cell:  859-699-1553 Holley Trucks Senior Biosafety Specialist Phone:  859-257-8655 Cell:  859-699-6082 Eric Rouse Biosafety Specialist Phone: 323-5728 Cell: 859-797-8431