Bloodborne Pathogens (BBP) Exposure Control Program

1. For Facilities Services Workers At UNC Chapel Hill Bloodborne Pathogens (BBP)Exposure Control Program In accordance with Occupational Safety and Health Administration (OSHA) Bloodborne Pathogen Standard29 CFR 1910.1030 Questions?? Call 962-0227 between 8 a.m. & 5 p.m.

2. INTRODUCTION Questions?? Call 962-0227 between 8 a.m. & 5 p.m.

3. Here are important phone numbers you need to know related to this training module: Important Contact Numbers UEOHC (Clinic): 966-9119 Emergency: 911 Questions regarding this training: 962-5507 We will review these numbers again during the training and we will learn when to use them. Questions?? Call 962-0227 between 8 a.m. & 5 p.m.

4. Why is bloodborne pathogen training required every year? • It’s the law • It’s UNC’s responsibility • Knowing this information can protect your health and the health of others Questions?? Call 962-0227 between 8 a.m. & 5 p.m.

5. 1. It’s 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 UNC keep you, the Facilities Services Worker, safe from workplace hazards. Some occupations at UNC 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.” Questions?? Call 962-0227 between 8 a.m. & 5 p.m.

6. 1. It’s the law (continued) Human blood and body fluids may contain bloodborne pathogens. So could materials or waste from certain laboratories. The germs are called bloodborne pathogens because they get into your blood (mostly by puncturing your skin) and make you sick. On March 6, 1992 OSHA created the Bloodborne Pathogen (BBP) Standard to make sure all employers work to keep their workers safe from bloodborne pathogens. A copy of the actual Bloodborne Pathogens Standard is available at the OSHA website: http://www.osha.gov/pls/oshaweb/owadisp.show_document?p_table=STANDARDS&p_id=10051 or by contacting EHS. Questions?? Call 962-0227 between 8 a.m. & 5 p.m.

7. 2. It’s UNC’s responsibility Employers like UNC demonstrate they are following the Bloodborne Pathogens Standard by implementing an Exposure Control Plan. The Exposure Control Plan lists the steps the employer is taking to keep workers safe. It is the plan to control every worker’s exposure to bloodborne pathogens. This training reviews UNC’s Exposure Control Plan for members of the Facilities Services department who are expected to have job-related exposures to bloodborne pathogens. Housekeeping staff have a separate exposure control plan and should refer to that document at www.ehs.unc.edu/ih/biological/bbp.shtml . Questions?? Call 962-0227 between 8 a.m. & 5 p.m.

8. 2. It’s UNC’s responsibility (continued) All UNC employees identified with the potential for occupational exposure must be familiar with the Exposure Control Plan. They must know its location and comply with the Exposure Control Plan by completing bloodborne pathogens training every year and obtaining or declining the Hepatitis B vaccination. Questions?? Call 962-0227 between 8 a.m. & 5 p.m.

9. 3. Knowing this information can protect your health and the health of others Facilities Services workers are potentially exposed to bloodborne pathogens when they repair equipment or handle materials without a Safety Clearance Form as part of normal job duties in laboratories, clinics, or morgues. These areas also contain waste that may contain bloodborne pathogens . To access the EHS approved Safety Clearance Form, click HERE. Questions?? Call 962-0227 between 8 a.m. & 5 p.m.

10. 3. Knowing this information can protect your health and the health of others (continued) Some buildings on campus are more likely than others to have BSL-2 laboratories and clinics. Brinkhous Bullitt also contains the morgue. In these areas, Facilities Services Workers may encounter contaminated needles, broken glass, or other contaminated laboratory materials or equipment. Facilities Services Workers may be requested to work on plumbing fixtures that may be contaminated with biological waste. Questions?? Call 962-0227 between 8 a.m. & 5 p.m.

11. EXPOSURE DETERMINATION FOR FACILITIES SERVICES WORKERS (excluding Housekeeping) Questions?? Call 962-0227 between 8 a.m. & 5 p.m.

12. How do I determine“Occupational Exposure”? The OSHA definition of Occupational Exposure is Reasonably anticipated skin, eye, mucous membrane or parenteral contact with blood or other potentially infectious materials that may result from the performance of an employee’s job duties. *Parenteral contact is: piercing mucous membranes or skin barrier through needlesticks, human bites, cuts and abrasions. …for definitions of blood or OPIM (other potentially infectious materials), read on Questions?? Call 962-0227 between 8 a.m. & 5 p.m.

13. Bloodborne pathogens live and grow best in human blood. However, other human body fluids also may carry these germs. When making an Exposure Determination, Facilities Services Workers must also consider that these fluids are able to provide an environment for bloodborne pathogens to live and grow: What are Other Potentially Infectious Materials? …so if you may come into contact with this material as part of my job description, you need to be enrolled in the Bloodborne Pathogens program. • Semen • Vaginal secretions • Any fluid surrounding organs in the body • Saliva in dental procedures • Also considered Other Potentially Infectious Materials 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. Questions?? Call 962-0227 between 8 a.m. & 5 p.m.

14. EHS, in cooperation with Facilities Services, identifies and tracks the status of occupational exposure determinations to bloodborne pathogens according to the OSHA Standard for all Facilities Services 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). Exposure Determination This determination must made without regard to use of PPE. Questions?? Call 962-0227 between 8 a.m. & 5 p.m.

15. Exposure Determination All Facilities Services Positions must have a completed Appendix C of the Hazards Management Plan returned to EHS for enrollment in the UNC Bloodborne Pathogens program within 10 days from the date of hire. Questions?? Call 962-0227 between 8 a.m. & 5 p.m.

16. The following questions aid in making an Exposure Determination for Facilities Services trades workers: • 1. Does the Facility Services employee work as part of a spill clean-up crew for blood, sewage, or other potentially infectious materials? • 2. Is the Facilities Services employee expected to handle or otherwise manipulate the following items without a Safety Clearance Form as part of their job duties: • Biohazard Waste • Plumbing from a BSL-2 or BSL-3 laboratory, clinic or morgue. • Lab equipment from a BSL-2 or BSL-3 laboratory, clinic or morgue. • Lab equipment or materials labeled with the biohazard warning label or labeled with a red bag bearing the biohazard warning symbol  • 3. Do the job duties of the Facility Services employee require him/her to otherwise come in contact with blood or other potentially infectious materials? Questions?? Call 962-0227 between 8 a.m. & 5 p.m.

17. As a Facilities Services 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. Questions?? Call 962-0227 between 8 a.m. & 5 p.m.

18. GENERAL RISKS AND TRANSMISSION Questions?? Call 962-0227 between 8 a.m. & 5 p.m.

19. Epidemiology Simply put, epidemiology is the science of tracking the spread of disease among a population. The population of concern in this training is Facilities Services workers who are potentially exposed to bloodborne pathogens at UNC-CH. And the diseases of concern here are those caused by bloodborne pathogens. Questions?? Call 962-0227 between 8 a.m. & 5 p.m.

20. OSHA defines bloodborne pathogens as: Pathogenic microorganisms that are present in human blood that can cause disease in humans. What are Bloodborne Pathogens? Bloodborne Pathogens are germs that live and grow best in human material. 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. Questions?? Call 962-0227 between 8 a.m. & 5 p.m.

21. Only workers with documented training in bloodborne pathogens should handle the clean up of this type of spill or work in these areas. 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 a doctor. The risks and infections of the following bloodborne pathogens will be discussed in this training: hepatitis B virus (HBV) hepatitis C virus (HCV) human immunodeficiency virus (HIV) Questions?? Call 962-0227 between 8 a.m. & 5 p.m.

22. Hepatitis B virus Questions?? Call 962-0227 between 8 a.m. & 5 p.m.

23. 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. Questions?? Call 962-0227 between 8 a.m. & 5 p.m.

24. Viral Hepatitis • 5 types: • Hep A • Hep B Virus (HBV) • Hep C Virus (HCV) • Hep D • HepE In the United States, HCV is the most common type related to occupational exposure to bloodborne pathogens. Questions?? Call 962-0227 between 8 a.m. & 5 p.m.

25. 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) Questions?? Call 962-0227 between 8 a.m. & 5 p.m.

26. Hepatitis B Vaccination A safe and effective vaccine to prevent Hepatitis B has been available since 1982. All UNC employees enrolled in this Bloodborne Pathogens program must meet the requirements for Hepatitis B vaccination or sign a declination. OSHA requires that vaccination or declination be made available within 10 working days of initial assignment. Questions?? Call 962-0227 between 8 a.m. & 5 p.m.

27. 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 UNC at no cost to you. To obtain the Hepatitis B vaccination, complete these steps: • Fill out the Hepatitis B vaccination consent form available here. • If you don't have a medical record number, call 966-2555 to get one. • Schedule your appointment with the University Employee Occupational Health Clinic at 966-9119. To Decline the Hepatitis B vaccination: Complete this form and follow the directions on the form to submit it to the University Employee Occupational Health Clinic. Go on, do it now. Questions?? Call 962-0227 between 8 a.m. & 5 p.m.

28. 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. Symptoms include jaundice, loss of appetite, fatigue, intermittent nausea, abdominal pain and vomiting. There is no vaccine for Hepatitis C. A healthy and diseased human liver Questions?? Call 962-0227 between 8 a.m. & 5 p.m.

29. --Common Practice-- • Wash Your Hands Often! • Wash your hands with soap and water for 20 Seconds. The suds scrub dirt and germs away. Wash your hands front and back and between the fingers. Soap up your wrists too. • 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. Questions?? Call 962-0227 between 8 a.m. & 5 p.m.

30. HIV The clinical symptoms of HIV infection ranges from those who have no symptoms to those with severe immunodeficiency or Acquired Immune Deficiency Syndrome (AIDS). Initial infection can be followed by an acute flu-like illness with non-specific symptoms such as fever, swollen lymph nodes, rash, malaise, sore throat, and headache. Other symptoms can include anorexia, chronic diarrhea, weight loss, and fatigue. Opportunistic infections and malignant diseases without a known cause for immune deficiency can also be indicative. Questions?? Call 962-0227 between 8 a.m. & 5 p.m.

31. HIV 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. 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. Questions?? Call 962-0227 between 8 a.m. & 5 p.m.

32. As a properly trained UNC employee, when you come into contact with any material that you suspect is contaminated with human blood, body fluids, or OPIM, keep this information in mind. It will help you understand the importance of the following sections in this document. BIOHAZARD Questions?? Call 962-0227 between 8 a.m. & 5 p.m.

33. REPORTING AN INCIDENT AT UNC Questions?? Call 962-0227 between 8 a.m. & 5 p.m.

34. REPORTING AN INCIDENT AT UNC 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 blood or other potentially infectious material (OPIM) get into an unprotected break in your skin, open wound, acne, rash or scratch. When blood or OPIM splashes or 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 blood or OPIM. Questions?? Call 962-0227 between 8 a.m. & 5 p.m.

35. 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: • UNC requires you to report ANY incident resulting in injury from the performance of your duties. Questions?? Call 962-0227 between 8 a.m. & 5 p.m.

36. 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 5 minutes and apply sterile gauze or a bandage, if necessary. • Decontaminate and remove protective clothing and proceed immediately to UEOHC or call HealthLink. If the injury requires immediate medical attention, go to the Emergency Room. Questions?? Call 962-0227 between 8 a.m. & 5 p.m.

37. Rinse the area with continuous clean running water. Eyes should be irrigated for at least 5 minutes using an emergency eyewash station if available or a sink. Decontaminate and remove protective clothing and proceed immediately to UEOHC or call HealthLink. What to do for splash to eyes, nose, or mouth: Questions?? Call 962-0227 between 8 a.m. & 5 p.m.

38. Report Exposures Immediately Immediately report the incident to your supervisor and/or call the University Employee Occupational Health (UEOHC) at 6-9119. Emergency Contact Numbers UEOHC Clinic: 966-9119 Emergency: 911 After any exposure event during work hours, employees must be seen by the University Employee Occupational Health Clinic (UEOHC) for treatment and documentation of exposure. After hours, all calls to the UEOHC are routed to HealthLink (966-6900) through UNC Hospitals. You should request that the MD on call for UEOHC after hours bloodborne pathogen exposures be called. The on-call MD will determine the need for immediate treatment and if needed, direct the worker to meet him/her in the ER, or otherwise arrange for appropriate blood tests to be drawn and medications to be dispensed. Questions?? Call 962-0227 between 8 a.m. & 5 p.m.

39. Following the incident, UNC will provide you 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 Post-Exposure Evaluation Employees are not billed for work-related injuries and medical records are kept separate and confidential from performance reviews. Questions?? Call 962-0227 between 8 a.m. & 5 p.m.

40. Spill Clean Up for Bloodborne Pathogen Training Questions?? Call 962-0227 between 8 a.m. & 5 p.m.

41. Bloodborne Pathogens Spills Spills may occur when an injured person drips blood on the floor, when sewage overflows, or when containers of 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. Questions?? Call 962-0227 between 8 a.m. & 5 p.m.

42. Remember Your Sharps Precautions During a Spill Contaminated broken glassware is cleaned up by mechanical means (e.g. tongs, forceps, pieces of cardboard). Questions?? Call 962-0227 between 8 a.m. & 5 p.m.

43. BBP Spill Clean Up Kits typically include: 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) • 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), Questions?? Call 962-0227 between 8 a.m. & 5 p.m.

44. Spill Clean Up… --Steps-- First, evacuate the area and allow 30 minutes for germs in the air to settle prior to spill cleanup. Locate the Blood and Bodily Fluid Clean-Up Kit. Instructions are located on the inside top lid. Instructions are in English and Spanish. Questions?? Call 962-0227 between 8 a.m. & 5 p.m.

45. 1. Spill Clean Up… • 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 Questions?? Call 962-0227 between 8 a.m. & 5 p.m.

46. 2. Spill Clean Up… 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). Questions?? Call 962-0227 between 8 a.m. & 5 p.m.

47. 3. Spill Clean Up… 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. Questions?? Call 962-0227 between 8 a.m. & 5 p.m.

48. 4. Spill Clean Up… --Steps-- 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. Questions?? Call 962-0227 between 8 a.m. & 5 p.m.

49. 5. Spill Clean Up… 5. Use disposable wiping cloth to wipe up all the disinfectant, and then discard in second Red Biohazrd Plastic Bag. Questions?? Call 962-0227 between 8 a.m. & 5 p.m.

50. 6. Spill Clean Up… 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. Questions?? Call 962-0227 between 8 a.m. & 5 p.m.