bloodborne pathogens and b virus

Tulane University - Office of Environmental Health & Safety (OEHS)

Bloodborne Pathogens Bloodborne Pathogens and B virusand B virus

For Tulane National Primate Research Center employees whose work involves a high risk of exposure to HIV/SIV/SHIV,

HBV, or B virus

January 2012


This training serves as a review of

Bloodborne Pathogens (BBP) in

relation to the specialized work at

TNPRC in working with nonhuman

primates (NHP).


Bloodborne Pathogens Standard• 1991- OSHA’s “Occupational Exposure to

Bloodborne Pathogens” (29 CFR 1910.1030)

Goal: eliminate or minimize occupational exposure to bloodborne pathogens

• Revised in 2001 in response to the Needlestick Safety and Prevention ActGoal: clarifies employer requirements to identify, evaluate, and make use of safer, effective medical devices.


How does animal blood fit into the Bloodborne Standard?

• The standard covers animal blood only for those animals purposely infected with HIV or HBV.

• Persons handling any animal blood should follow general precautions as recommended by the CDC/NIH, Biosafety in Microbiological and Biomedical Laboratories (BMBL) 5th edition

http://www.cdc.gov/od/ohs/biosfty/bmbl5/bmbl5toc.htm





What are Bloodborne Pathogens (BBP)?

• Pathogenic microorganisms that are present in blood or other potentially infectious materials (OPIM) that can cause disease in humans.

• These pathogens include, but are not limited to HBV (hepatitis B virus) and HIV (human immunodeficiency virus).


Bloodborne Pathogens (BBP)• Other examples of BBP include micro-organisms

that cause:– hepatitis C virus, malaria, syphilis, babesiosis,

brucellosis, leptospirosis, arboviral infections, relapsing fever, Creutzfeldt-Jakob disease, HTLV-1, and viral hemorrhagic fever.

• It is important to know which pathogens (from humans or animals) you may be exposed to at work, especially in the laboratory or clinical setting.


Nonhuman primates, by virtue of their genetic, physiologic, and sometimes social similarities to humans, are particularly likely sources of infectious agents that pose a threat to humans.


What are we concerned about here at TNPRC?

• HIV (human immunodeficiency virus)

• SIV (simian immunodeficiency virus)

• SHIV (simian-human immunodeficiency virus)

• HBV (hepatitis B virus)

• B virus


HIV(Human Immunodeficiency Virus)


HIV• HIV is the virus that causes AIDS

(Acquired Immune Deficiency Syndrome). Once a person has been infected with HIV, it may be many years before AIDS actually develops.

• HIV kills or damages cells in the body’s immune system, gradually destroying the body’s ability to fight infection and certain cancers.

computer generated art quality graphics of HIV was done by Russell Kightley of Canberra, Australia.

mailto:[email protected]

http://www.virology.net/Big_Virology/EM/HIVdark150.JPG

Tulane University - Office of Environmental Health and Safety (OEHS)

HIV

Through December 2001, there were 57 documented cases of occupational HIV transmission to health care workers in the United States, and no confirmed cases have been reported since 1999.

At the end of 2008, an estimated 1,178,350 persons aged 13 and older were living with HIV infection in the United States. Of those, 20% had undiagnosed HIV infections and were unaware of their HIV infection.


HIV• Some infected with HIV have no symptoms for

up to ten years.

• Within a month or two after exposure to the virus some experience flu-like illness such as:

• fever, headache fatigue, weight loss, diarrhea, night sweats, enlarged lymph nodes

• These symptoms usually disappear within a week to a month and are often mistaken for those of another viral infection. During this period, the individual is very infectious.


HIV

• The average risk for HIV transmission after a percutaneous (e.g., needlestick) exposure to HIV-infected blood has been estimated to be approximately 0.3%.

• HIV does not survive well outside the body, making the possibility of environmental transmission remote.


HIV- no cure or vaccine available

• Treatment protocols from the U.S. Public Health Service have been developed using antiretroviral agents from five classes of drugs to treat HIV infection. These include:

• the nucleoside reverse transcriptase inhibitors, nucleotide reverse transcriptase inhibitors, nonnucleoside reverse transcriptase inhibitors, protease inhibitors, and a single fusion inhibitor.

• The recommendations provide guidance to effectively suppress the virus on the basis of HIV transmission risk represented by the exposure.


HIV• Side effects associated with the use of antiviral drugs

can be severe.

• The drug regimen is not a cure for AIDS, but it has greatly improved the health of many people with AIDS and it reduces the amount of virus circulating in the blood to nearly undetectable levels.

• Researchers, however, have shown that HIV remains present in hiding places such as the lymph nodes even in people who have been treated.


SIV/SHIV(Simian Immunodeficiency Virus/

Simian-Human Immunodeficiency Virus)


SIV • Primate-borne retrovirus closely related to HIV-1 and

HIV-2• Asian macaques are susceptible to SIV infection. SIV

is not a naturally occurring infection of wild macaques in their countries of origin.

• Various strains of SIV are highly pathogenic in macaques and produce a severe immune deficiency disease (similar to AIDS), making it an important animal study model.


SIV• Found in variety of tissue and body fluids

of infected nonhuman primates

-including blood, plasma, CSF, and

parenchyma tissue


SHIV• Laboratory-made hybrid of the simian and

human viruses created by wrapping the SIV core in the HIV envelope

• Virus seems to affect monkeys much like HIV affects humans

• Created to learn what genes are necessary to overcome the species barriers to pathogenesis


SIV/SHIV• Risk of human infection has not been clearly

defined• Since SIV/SHIV shares many similar

characteristics of HIV, many of the same biosafety precautions are indicated.

Specific precautions in handling SIV/SHIV are

based on recommendations developed

for HIV and other lentiviruses.


SIV/SHIV• In the lab, SIV/SHIV must be presumed to be

present in all SIV/SHIV cultures, in all materials derived from such cultures, in all specimens from SIV/SHIV antibody-positive nonhuman primates, and in/on all equipment coming in contact with these materials.

• Skin and mucous membranes should be considered a pathway for virus entry.

• Contact with these sites should be considered an exposure to SIV/SHIV.


HBV(Hepatitis B Virus)

Tulane University - Office of Environmental Health and Safety (OEHS)

Hepatitis B Virus (HBV)• Hepatitis B is caused by a virus that attacks

the liver and can cause lifelong infection, cirrhosis, liver cancer, liver failure, or death.

• In 2009, an estimated 38,000 people were newly infected with HBV. 800,000 - 1.4 million Americans are chronically infected with HBV.


Hepatitis B Virus

• The average volume of blood inoculated during a needlestick injury with a 22-gauge needle is approximately 1 µl, a quantity sufficient to contain up to 100 infectious doses of HBV.

• HBV can survive outside the body at least 7 days and still be capable of causing infection.


Hepatitis B Virus

• About 30% of infected persons have no sign or symptoms of HBV.

• If symptoms occur, they usually begin to appear on the average of 12 weeks (range 9-21 weeks) after exposure to hepatitis B virus.

• If you have symptoms, they might include:• jaundice • abdominal discomfort• dark urine • clay-colored bowel movements • joint pain • fatigue• loss of appetite • nausea


HBV IS PREVENTABLE!A safe & effective vaccine is available.• Hepatitis B vaccine prevents hepatitis B infection and

its serious consequences.• If the vaccine is administered before infection, it

prevents the development of the disease and the carrier state in almost all individuals.

• Hepatitis B vaccine consists of a series of three injections – initial, one a month later, and one six months from the first.

• Available FREE of charge from employer


What treatment is available for HBV?

• In the occupational setting, multiple doses of Hepatitis B Immune Globulin initiated within 1 week following percutaneous exposure to hepatitis B surface antigen-positive blood provides an estimated 75% protection from HBV infection.

• There is no cure available for acute HBV infection. There are antiviral drugs available for the treatment of chronic HBV infection.


B Virus


What is B Virus?• B virus infection is caused by the zoonotic agent

Macacine herpesvirus (formerly Cercopithecine herpesvirus 1)

• Other names: Herpes B virus, Monkey B virus, Herpes Virus Simiae

• It is an alphaherpesvirus that occurs naturally in macaques and produces very mild disease in the primate but can cause a fatal encephalitis in humans.


How Do I get B virus?• Exposure to contaminated monkey saliva,

secretions, or tissues most commonly through:

• Bites or scratches• Splashes• Needlesticks• Indirectly (contact with contaminated cage, etc)


What are the chances that I will get B virus?

• Reported cases of infection in humans are very rare.• Since the identification of the virus in 1932, there

have only been 31 documented human infections by B virus, 21 of which were fatal.

• Most of these infections have resulted from animal bites or scratches or from percutaneous inoculation with infectious materials.

• However, in 1997 a researcher died from B virus infection following a mucosal splash exposure.


Who Is Most at Risk for B virus?

• animal caretakers

• laboratory personnel

• anyone who is exposed to monkeys or monkey tissues

• immune-suppressed individuals may also face a higher risk for infection


B virusSigns and Symptoms (for monkeys)

• Most have no obvious sign of infection.

• Some have ulcerations on the mouth, face, lips genitals, and/or eye.

• Virus resides permanently in the monkey and can be periodically reactivated (usually if stressed or immunosuppressed). The virus can be shed by monkeys without visible lesions or symptoms.

• .


B virus: Signs and Symptoms (for humans)

• Vesicular (small blister) skin lesions at or near the site of injury

• Localized neurological symptoms such as pain, numbness or itching near the wound site

• Flu-like aches and pains

• Fever and chills• Headaches lasting more

than 24 hours• Fatigue• Lack of muscular

coordination• Shortness of breath

*These generally occur within one month of exposure.


Precautions to Consider • Exercise caution at all times. Nonhuman primates can

and will bite.

• Wear appropriate, protective clothing.

• Work together with at least one other person when handling nonhuman primates. Minimize direct handling.

• Report any observed facial, lip or oral lesions in the nonhuman primates to a veterinarian.

• For bite or scratch injuries involving a monkey, or scratches with cages or equipment that might be contaminated with their secretions, wash thoroughly and seek medical care immediately.


How can I protect myself from B virus infection?

• Read TNPRC Procedure on Herpes B virus

• Follow all standard procedures for your area

• Wash Hands!!!!


How could I be exposed to these pathogens at work?


Chain of Infection

Infection Control = Break any link in the chain


Modes of transmission of BBP• Percutaneous - the direct inoculation of infectious

material by piercing through the skin barrier (needlestick, bites, scratches from animals or cages)

• Non-intact skin - exposure of infectious material to pre-existing lesions, cuts, abrasions, or rashes provides a route of entry into the body.

• Mucous membrane contact – splashes of infectious material to an individual's unprotected eyes, nose, or mouth in clinical or laboratory settings.


What can I do to prevent occupational exposure

incidents?


Occupational Exposure Prevention

The risk of occupational exposure can be minimized or eliminated using a combination of engineering and work practice controls, personal protective clothing and equipment, training, medical surveillance, HBV vaccination, warning signs or labels, and other provisions described in this training section.


Standard Precautions• Guidelines to decrease the risk of occupational

exposure to blood or body fluids.

• A system of infection control which assumes that every direct contact with body fluids is infectious and requires every employee exposed to direct contact with body fluids to be protected as though such body fluids were infected with a bloodborne pathogen.

• Provides adequate protection against bloodborne infections from both humans and animals.


Employee Responsibilities• Completing training/orientation as required

• Following the Standard Precautions Policy and the Exposure Control Plan (Written plan provided to eliminate or minimize occupational exposure to BBP.)

• Using work practices, engineering controls, and personal protective equipment as outlined in the Exposure Control Plan


Employee Responsibilities• Reporting exposure incidents to your supervisor and

assisting the supervisor in completing First Report of Injury/Illness Form

• Knowing in advance what to do if an exposure incident occurs

• Pursuing follow-up care at after an exposure incident with TNPRC Occupational Health

Failure to follow these policies could result in disciplinary action.


Engineering Controls

• Sharps with Engineered Sharps Injury Protection (SESIP)– a non-needle sharp or needle with a built-in safety feature or mechanism that effectively reduces the risk of an exposure incident

Examples include: Self-sheathing syringe

More Examples of Engineered Sharps Safety Devices

In use

Retractable lancets

Self-blunting needles

Retractable needle technology

Add-ons (needle covers)

After use


Engineering Controls• Needleless Systems = Device

that does not use a needle for:• collection of body fluids• administration of

medication/fluids• any other procedure with

potential percutaneous exposure to a contaminated sharp

• Squeeze cages• Transfer boxes


Work Practice Controls• Contaminated needles/sharps shall not

be bent, recapped or removed unless there is no feasible alternative or if required by a specific medical procedure

• Such bending, recapping, or removal must be done through use of mechanical device or a one-handed technique

• Use puncture-resistant sharps container for disposal of sharps


Work Practice Controls• No food/drink/smoking, handling of contacts,

or application of cosmetics in work area where there is potential for exposure

• Minimize splashing, spraying, spattering, and generation of droplets

• Use secondary containment for transport, shipping, or storage of containers

• Decontaminate surfaces and equipment


Personal Protective Equipment• Gloves (latex or nonlatex)

– When to use them:• when there is reasonable anticipation

of employee hand contact with blood, mucous membranes, non-intact skin, or other potentially infectious materials

• when performing vascular access procedures• when handling or touching contaminated surfaces or

items. – Remove prior to leaving the work area and discard

as biohazard waste


Handwashing• Employees must wash their hands

immediately or as soon as feasible after removal of gloves or other personal protective equipment.

• Wash as soon as possible if gross contamination occurs

• Alternate methods:– Antiseptic towelettes– Waterless handwashing gels


• Gowns, aprons, fluid-resistant clothing

• Face shields, eye protection (safety glasses, goggles)

• Surgical mask • N-95 respirator (need medical

clearance and fit-testing prior to use!)• Surgical caps, shoe covers

Personal Protective Equipment (PPE)


Training• Training is required:

– at the time of initial employment and assignment

(or transfer) to job tasks where occupational exposure may occur

– within one year of the employee's previous training and annually thereafter

– when changes such as modification of tasks or procedures or institution of new tasks or procedures affect the employee's potential for occupational exposures, and as new standards for safe work practices evolve


HBV Vaccination

• FREE to employee - paid for by your department (available from Occupational Health) for high-risk employees

• If you initially refuse the vaccine, you may change your mind later and still receive it.


Warning Signs and Labels

• Fluorescent orange or orange-red label with word “Biohazard” and biohazard symbol in contrasting color must be provided on:

• Containers of regulated waste• Refrigerators/freezers used to store blood/OPIM• Containers used to store, transport, or ship

blood/OPIM• Contaminated equipment

• Red bags may be substituted for biohazard labels on biohazardous waste bags.


Housekeeping: Sharps Disposal• Keep sharps container upright,

readily available in the work area

• Never place sharps into the regular trash

• Use a leak-proof, puncture-resistant

sharps container labeled with the biohazard symbol

• Do not overfill - dispose of sharps container as biohazard waste when it is 2/3 full


Housekeeping: Decontamination

Work surfaces should be decontaminated with an appropriate disinfectant such as 10% bleach solution or an EPA approved disinfectant after completion of procedures, immediately or as soon as feasible when surfaces are overtly contaminated or after any spill, and at the end of the work shift.


Where do I go and what must I do if I am

exposed?


What to Do: Post-Exposure

• Wash exposed area with soap and water for 15 minutes; if eye or mucous membrane contact, flush with water or saline for 15 minutes

• Report the incident to your supervisor so the veterinarian can be notified to examine the source monkey to see if it is shedding virus.

• Report to the Occupational Health Trailer for evaluation and follow-up visits

• Complete First Report of Injury/Illness Form


Recordkeeping

• Sharps Injury Log– Maintained by Office of Environmental Health

& Safety (OEHS) independently from OSHA 300 Log

• Training records – 3 years

• Confidential medical records – duration

of employment + 30 years


REMEMBER:Don't wait.

Immediately report all exposures.

You may have to make a quick decision about starting an antiretroviral agent as prophylaxis. The time frame for beginning this treatment is

critical. Reporting is also essential for establishing a claim for Workers

Compensation benefits.


Summary of Post-Exposure Employee Responsibilities

1. Perform 15 minute scrub procedure using soap and water. If mucous membrane contact, flush injured area with sterile saline or water for 15 minutes.

2. Promptly report the incident to your supervisor.3. Report to Occupational Health during business

hours for medical evaluation or report to your supervisor after hours for instructions.

4. Complete the First Report of Injury forms.


Tulane University encourages you to contact your Bloodborne Pathogens

Coordinator or supervisor for questions, comments, or suggestions.

TNPRC Occupational Health (985)966-6600

Bloodborne Pathogens Coordinator (504)419-1391

Office of Env. Health & Safety (OEHS) (504)988-5486


You can always reach the Bloodborne Pathogens Coordinator

24 hours a dayby work cell phone (504)419-1391 or call (504)988-5486 and press 1.


Why was this training so vital?

Healthcare and research personnel are at a great

risk for occupational exposure to bloodborne

pathogens.

Through information and awareness Tulane

University aims to minimize any risk to our

employees and continue the commitment to

safety in the workplace.


ReferencesHIV/SIV

• http://www.cdc.gov/mmwr/preview/mmwrhtml/00001303.htm• http://www.cdc.gov/ncidod/EID/vol11no09/05-0179.htm• http://www.cdc.gov/ncidod/EID/vol11no07/04-0957.htm

HBV• http://www.cdc.gov/ncidod/diseases/hepatitis/b/index.htm

B virus• http://www.cdc.gov/mmwr/preview/mmwrhtml/00015936.htm• http://www.cdc.gov/ncidod/diseases/BVIRUS.pdf• http://dcminfo.wustl.edu/occhealth/factsheet_herpesb.html

BBP• http://www.osha.gov/SLTC/bloodbornepathogens/index.html• http://www.cdc.gov/niosh/topics/bbp/

Tulane UniversityOffice of Environmental Health & Safety (OEHS)

Kellie C. MayerBloodborne Pathogens Coordinator

(504) [email protected]


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