General Bloodborne Pathogens (BBP) Annual Training

1. In accordance with Occupational Safety and Health Administration (OSHA) Bloodborne Pathogen Standard29 CFR 1910.1030 GeneralBloodborne Pathogens (BBP)Annual Training

2. Important Contact Numbers Here are important phone numbers you need to know related to this training module: Emergency: 911 from a campus phone or 515-3000 from cell phone Questions regarding this training should be directed to the Environmental Health & Safety (EHS) Biosafety Officer at 515-6858.

3. Why is bloodborne pathogen training required every year? • It is the law • It is North Carolina State University’s responsibility • Knowing this information can protect your health and the health of others • It works!

4. 1. It is the law The Occupational Safety and Health Administration (OSHA) is a federal agency charged with enforcing health and safety legislation. OSHA makes sure that employers such as NC State University keep you, the worker, safe from workplace hazards. Some jobs at NC State are more likely to come into contact with hazards than others. The hazards we are concerned about in this program are germs called “bloodborne pathogens.”

5. 2. It is the university’s responsibility Departments, Supervisors, and/or Principal Investigators must prove to OSHA that they are following the Bloodborne Pathogens Standard by implementing an Exposure Control Plan. By law, the Exposure Control Plan must detail certain steps that are taken to keep workers safe, that is, the plan to control every worker’s exposure to bloodborne pathogens. This training reviews the general information covered in the model Exposure Control Plan. Departments, Supervisors and/or Principal Investigators complete the model Exposure Control Plan for their workers who are expected to have job-related exposures to bloodborne pathogens. The model Exposure Control Plan is located at http://www.ncsu.edu/ncsu/ehs/www99/left/bioSafe/BBP.htm .

6. 2. It is the university’s responsibility (continued) All NC State University workers identified for occupational exposure must be familiar with their Exposure Control Plan that their Supervisor, Principal Investigator, or Department designee updates annually. Also, as a condition of employment, each worker must know its location and comply with the contents of their Exposure Control Plan.

7. 3. Knowing this information can protect your health and the health of others For some NC State workers, the potential for exposure to bloodborne pathogens may exist when encountering spilled blood or body fluids, or equipment or waste contaminated with human blood or body fluids. Some locations on campus are more likely than others to have contaminated equipment or materials.

8. 4. It works! Research shows that trainings such as this reduce the number of exposures in just about every group studied. # of exposures reported nationally (Source: CDC [2002a].)

9. Exposure Determination Departments, Supervisors, and/or Principal Investigators, in cooperation with EHS, use the model Exposure Control Plan to document and track the status of occupational exposure determinations to bloodborne pathogens according to the OSHA Standard (29 CFR 1910.130) for employees according to job duties and/or location. Each determination must be made without regard to use of personal protective equipment and should be conducted upon orientation and “no later than 10 days after the date of employment” (OSHA). This determination must made without regard to use of PPE.

10. Exposure Determination Supervisors are reminded annually to assess this hazard upon completion of the annual Supervisor’s Self Assessment Checklist .

11. How do I determine“Occupational Exposure”? • The OSHA definition states that you have “Occupational Exposure” if your duties may result in a … …reasonably anticipated skin, eye, mucous membrane or parenteral contact* with human blood or other potentially infectious materials. *Parenteral contact is: piercing mucous membranes or skin barrier through such events as needlesticks, human bites, cuts and abrasions. …for definitions of blood or OPIM (other potentially infectious materials), read on

12. What are Other Potentially Infectious Materials (OPIM)? Bloodborne pathogens live and grow best in human blood. However, other human body fluids may also carry these germs. When making an Exposure Determination, Supervisors must also consider that OPIM are able to provide an environment for bloodborne pathogens to live and grow: • Semen • Vaginal secretions • Any fluid surrounding organs in the body • Visible blood in saliva, vomit, or feces

13. More OPIM • Also considered Other Potentially Infectious Materials (OPIM) are: • Any body fluid visibly contaminated with blood; • All body fluids when it is difficult to differentiate between body fluids; • Any unfixed organ or tissue* from a human, living or dead (clinics & morgues) and; • Other experimental human material (from laboratories) whether purposely infected or otherwise. * For researchers, this includes primary and continuous human cell lines (even HELA and 293 cells). Click this link for more info on the OSHA BBP Standard and established human cell lines (OSHA interpretation letter 06/21/1994). …so if I may come into contact with this material as part of my job description, I need to be enrolled in the Bloodborne Pathogens program.

14. Making an Exposure Determination at NC State University • These questions can aid in making an Exposure Determination for workers at NC State University: • --Does the employee work as part of a spill clean-up crew for human blood, or other potentially infectious materials (OPIM)? • --Is the employee a First Responder (e.g. public safety, EMS, etc.)? • --Is the worker expected to handle or otherwise manipulate the following items as part of their duties: • Biohazard Waste • Sewage from human health care facilities • Lab equipment or materials labeled with the biohazard warning label or labeled with a red bag bearing the biohazard warning symbol  • Primary or continuous human cell lines (even well established lines like HELA and 293). • --Do the job duties of the employee require him/her to otherwise come in contact with human blood or other potentially infectious materials (OPIM)?

15. Environmental Health & Safety can help • As a University worker, if you have concerns about your exposure to bloodborne pathogens, you should discuss them with your supervisor and EHS. • Your supervisor and EHS can help determine ways to make your job safer.

16. Now that we’ve discussed how to make an exposure determination, let’s look at what it means to be exposed.

17. Epidemiology • Simply put, epidemiology is the science of tracking the spread of disease among a population. The population of concern in this training is workers who are potentially exposed to bloodborne pathogens at NC State University. And the diseases of concern here are those caused by bloodborne pathogens.

18. What are Bloodborne Pathogens? Bloodborne Pathogens are germs that live and grow best in human material like blood. They enter your body through a puncture in your skin or through your eyes, nose or mouth. Many diseases are linked to bloodborne pathogens, but few bloodborne pathogens are frequently responsible for infections in the workplace. • OSHA defines bloodborne pathogens as: • “Pathogenic microorganisms that are present in human blood that can cause disease in humans.”

19. The “Big Three” Only workers with documented training about Bloodborne Pathogens and their Exposure Control Plan should handle materials contaminated with human blood or OPIM. As part of this training, the worker should know some basic concepts about these diseases so that s/he can discuss them with a supervisor, family members, and their health care provider. The risks and infections of the “Big Three” bloodborne pathogens will be discussed in this training: • hepatitis B virus (HBV) • hepatitis C virus (HCV) • human immunodeficiency virus (HIV)

20. Disease Transmission in the Workplace Hepatitis B, Hepatitis C and HIV are passed by contact with the blood or other body fluids of someone who has the virus. The three main ways to get hepatitis B, C, or HIV are: • (1) having sex without latex condoms with someone who is infected; • (2) being born to a mother who is infected; and • (3) sharing needles and syringes with someone who is infected. During normal workplace duties Bloodborne Pathogens are not a major concern. But we know that these viruses can be carried in infected human bodily fluids such as those defined under “Other Potentially Infectious Materials” (OPIM) in this training. And, if the Potentially Infectious Material contains enough of these pathogens, they can get into your bloodstream and may eventually cause disease. They can enter the bloodstream if the fluids come into contact with an unprotected break in your skin such as an open wound, acne, rash, etc. or if you experience a splash to your eyes, nose, or mouth.

21. Viral Hepatitis “Hepatitis” means inflammation of the liver. Viral hepatitis is inflammation of the liver caused by a virus. Your liver helps your body digest food, store energy, and get rid of poisons. It acts as a filtration system for your body. As the filter begins to fail, impurities build up in your body and symptoms can occur such as jaundice (yellowing color of the skin and eyes), dark urine, extreme fatigue, anorexia, nausea, abdominal pain, and sometimes joint pain, rash, and fever.

22. Types of Viral Hepatitis There are at least five types of viral hepatitis and each one is caused by a different virus. Hepatitis B is caused by hepatitis B virus (HBV), and hepatitis C is caused by hepatitis C virus (HCV). In the United States, HBV and HCV are the most common types related to occupational exposure to bloodborne pathogens. • Viral Hepatitis • At least 5 types: • Hep A • Hep B Virus (HBV) • Hep C Virus (HCV) • Hep D • HepE

23. Hepatitis B in the U.S. • Annually, there are 10,000 new cases of Hepatitis B virus (HBV) reported in the U.S., with an estimated one to two million carriers of HBV. The hepatitis B virus takes about 2 months to show up in your blood. It may stay in your blood for months or years. Nine out of every 10 adults will get rid of the virus from their bodies after a few months. We say they have acute hepatitis B. One out of every 10 adults will never get rid of the virus from their bodies. We say they have chronic hepatitis B. They are called carriers. Most people with chronic hepatitis B will remain carriers of the virus if they do not get treated. The best things carriers can do is make sure their babies get all of their hepatitis B shots, make sure they do not spread it to their sex partners, and get good medical care. • (Source: www.cdc.gov)

24. Hepatitis B Vaccination A safe and effective vaccine to prevent hepatitis B has been available since 1982. In short, a vaccine teaches your body how to defend against the virus and fight it off before it can make you sick. All NC State University employees working under an Exposure Control Plan must meet the requirements for Hepatatis B vaccination as a condition of employment. OSHA requires that vaccination be made available within 10 working days of initial assignment.

25. Do you still need to schedule or decline the Hepatitis B vaccine? This requirement needs to be met within 10 working days after your exposure determination is made. The vaccine is offered by NC State University at no cost to you. To obtain the Hepatitis B vaccination, complete these steps: Refer to the Procedures for Requesting a Vaccination section of your department’s or supervisor’s Exposure Control Plan. Notify your supervisor of your request. Schedule your appointment with the Clinic indicated on your Exposure Control Plan. To Decline the Hepatitis B vaccination: Copy the Declination Form located in your Exposure Control Plan. Complete the form and submit a copy according to the instructions on the form. Go on, do it now.

26. Hepatitis C Virus Hepatitis C virus is the most frequently occurring bloodborne pathogen infection. At least 85 out of 100 people infected with HCV become chronically infected, and chronic liver disease develops in an average of 67 out of 100. HCV is most often transmitted by large or repeated percutaneous (skin puncture) exposures to blood, such as through the transfusion of blood or blood products from infected donors and sharing of contaminated needles among injection drug users. There is no vaccine to prevent hepatitis C. A healthy and diseased human liver

27. Hepatitis A? Unlike Hepatitis B and C, Hepatitis A is not a bloodborne pathogen. Instead, it is transmitted by the fecal oral route. It is mentioned here because many people in the USA (33 out of 100 people) have had Hepatitis A virus with the most common being school children and young adults. Infection with HAV is always acute; it is therefore much less severe than HBV or HCV. A vaccine is available for HAV. All prevention programs for NC State University employees should emphasize proper handwashing after visiting or working in bathrooms or other fecal-contaminated areas. Source: Viral Hepatitis and Liver Disease 1984;9-22J Infect Dis 1989;160:887-890

28. Wash Your Hands Often! • Wash your hands with soap and water for 20 Seconds. The suds scrub dirt and germs away.Don't Leave Anything Out. Wash your hands front and back and between the fingers. Soap up your wrists too. And don't forget your fingernails. • Hands are to be washed immediately or as soon as feasible after removal of gloves or other personal protective equipment. • Use a utility or restroom sink for handwashing, do not use sinks in food preparation areas. • If handwashing facilities are not immediately available use antiseptic hand cleanser and/or disposable wipes for the short term... • …but wash your hands as soon as handwashing facilities are available.

29. HIV HIV stands for human immunodeficiency virus. It is different from most other viruses because it attacks the immune system. The immune system gives our bodies the ability to fight infections. HIV is the virus that causes AIDS (acquired immunodeficiency syndrome), the final stage of HIV infection. It can take years for a person infected with HIV, even without treatment, to reach this stage. Having AIDS means that the virus has weakened the immune system to the point at which the body has a difficult time fighting infections.

30. HIV Testing The only way to know whether you are infected is to be tested for HIV. You cannot rely on symptoms alone because many people who are infected with HIV do not have symptoms for many years. Someone can look and feel healthy but can still be infected. In fact, one quarter of the HIV-infected persons in the United States do not know that they are infected. Once HIV enters the body, the body starts to produce antibodies—substances the immune system creates after infection. Most HIV tests look for these antibodies rather than the virus itself. There are many different kinds of HIV tests, including rapid tests and home test kits. All HIV tests approved by the US government are very good at identifying HIV.

31. More about HIV HIV is a fragile virus. It cannot live for very long outside the body. As a result, the virus is not transmitted through day-to-day activities such as shaking hands, hugging, or a casual kiss. You cannot become infected from a toilet seat, drinking fountain, doorknob, dishes, drinking glasses, food, or pets. You also cannot get HIV from mosquitoes. HIV can enter the bloodstream similarly to HBV: if potentially infectious materials (like blood) come into contact with an unprotected break in your skin such as an open wound, acne, rash, etc. or if you experience a splash into your eyes and/or nose.

32. Responding to an incident at NC State University Now that we’ve discussed what it means to be exposed, let’s look what to do in the event of a potential exposure. An important part of this training program is to make sure all employees know (1) if they have an exposure incident and (2) what to do after they have an exposure incident. An exposure incident could happen three ways: When human blood or other potentially infectious material (OPIM) get onto an unprotected break in your skin such as an open wound, acne, rash, etc.; or When blood or OPIM splashes or otherwise gets into your eyes, nose, or mouth; or If you are cut or stuck by an object (it must break the skin) that is contaminated with human blood or OPIM.

33. What is a BBP exposure? • The OSHA Definition: • “A specific eye, mouth, other mucous membrane, non-intact skin or parenteral contact with blood or OPIM that results from the performance of an employee’s duties.” BBP Exposure = Blood, OPIM contact with: Eye, Nose, Mouth, Shaving cut, rash, etc. • Also, remember: • NC State University requires you to report ANY incident resulting in injury from the performance of your duties.

34. What to do for needlesticks, cuts from contaminated objects, animal bites or scratches: • Remove contaminated gloves and if possible, allow the wound to bleed freely for a minute. • Wash the wound with soap and water for 15 minutes and apply sterile gauze or a bandage, if necessary. • Decontaminate and remove protective clothing and • CALL 911 to be escorted to a medical facility.

35. What to do for splash to eyes, nose, or mouth: • Rinse the area with continuous clean running water. • Eyes should be irrigated for at least 15 minutes using an emergency eyewash station if available or a sink. • Decontaminate and remove protective clothing and • CALL 911to be escorted to a medical facility.

36. Report Exposures Immediately! Immediately report exposures to your supervisor and Dial 911. • After any exposure to human blood or OPIM, employees must be seen immediately at an Occupational Health Clinic or Emergency Room. Dial 911 so that NC State University emergency responders can help you determine the need for immediate treatment and escort you to the proper location for appropriate blood tests to be drawn and medications to be dispensed.

37. Post Exposure Evaluation • Following the incident, you will be provided with a post exposure medical evaluation. • This evaluation may include: • Documenting routes of exposure • Documenting circumstances of the incident • Identifying sources of contamination • Blood tests with consent from employee • Post exposure prophylaxis and counseling Employees are not billed for work-related injuries and medical records are kept separate and confidential from performance reviews.

38. Bloodborne Pathogens Spills Spills may occur when an injured person drips blood on the floor, when sewage overflows, or when containers of human blood or other potentially infectious materials (OPIM) are dropped in the clinic or laboratory. Employees designated to participate in emergency and decontamination procedures are exposed to blood or OPIM; they are to be thoroughly familiar with proper cleaning and decontamination procedures so that the contamination is contained and exposure to other people is minimized.

39. Remember Your Sharps PrecautionsDuring a Spill Contaminated broken glassware is cleaned up by mechanical means (e.g. tongs, forceps, pieces of cardboard).

40. Bloodborne Pathogens Spill Clean Up Kits Typically Include: • 1 pair disposable latex gloves, • 1 disposable faceshield, • 1 disposable face mask, • 1 pair disposable shoe covers, • 1 disposable apron, 1 absorbent pack (w/ MSDS), • 2 disposable towelettes (w/ MSDS), • 2 scoops/scrapers, • 2 biohazard bags with ties, • 1 disposable towel, • 1 instruction sheet, • 1 can 12 oz. Disinfectant spray (w/ MSDS)

41. Spill Clean Up: Sample Procedure First, evacuate the area and allow 30 minutes for germs in the air to settle prior to spill cleanup and locate the Blood and Bodily Fluid Clean-Up Kit. Instructions are located on the inside top lid. Instructions are in English and Spanish

42. 1. Spill Clean Up: Example • Open the kit and put on the following Personal Protection Equipment (PPE): • Disposable exam gloves • Disposable face mask • Disposable face shield • Disposable apron (unfold apron fully) • Disposable shoe covers

43. 2. Spill Clean Up: Example (continued) 2. Open clean-up absorbent pack and sprinkle entire contents of absorbent material evenly over bodily fluid spill (will absorb 80-100 times its weight).

44. 3. Spill Clean Up: Example (continued) 3. After the spill gels (1-2 minutes), use scoop/scraper to pick up material and put into Red Biohazard Bag and tie shut. Keep Personal Protection Equipment on.

45. 4. Spill Clean Up: Example (continued) Follow the directions to apply the enclosed disinfectant (OSHA recommends a disinfectant registered to kill tuberculosis – e.g. phenolic) over the spill area and allow for the contact time indicated on the product.

46. 5. Spill Clean Up: Example (continued) 5. Use disposable wiping cloth to wipe up all the disinfectant, and then discard in second Red Biohazard Plastic Bag.

47. 6. Spill Clean Up: Example (continued) 6. Place all items including PPE and first Red Biohazard Plastic Bag into the second Red Biohazard Plastic Bag. To minimize contamination to your face, remove PPE in the following order: (1) disposable shoe covers; (2) disposable apron and; (3) disposable exam gloves.

48. Spill Clean Up: Example (continued) 7. To minimize contamination to your face use antiseptic towelettes to clean hands before removing the disposable face shield and, lastly, the disposable face mask. Decontaminate hands before putting them to the face.

49. Spill Clean Up: Example (continued) 8. Close the Red Biohazard Bag securely with twist tie to prevent leakage. Contact EHS to dispose of the waste in accordance with local regulations . Finally, wash hands as soon as possible.

50. What to do with biohazard waste after spill clean up Never throw untreated biohazard waste in the regular trash! The disposal of this waste generated on the NC State University campus is subject to federal, state, and local regulations. After spill clean-up is complete and you have closed the Red Biohazard Bag securely with twist tie to prevent leakage, place the waste in a low traffic area and contact your supervisor. The supervisor is responsible for contacting the Department of Environmental Health and Safety at 962-6858. After the location and other pertinent information is given, EHS will remove the waste for proper disposal.