Q&A ON OSHA’S BLOODBORNE PATHOGENS STANDARD

 WHO IS COVERED UNDER OSHA’S BLOODBORNE PATHOGENS STANDARD?

• Anyone exposed to human blood, blood by-products, or other potentially infectious materials during their job duties. (See the following question for definitions.)
• Anyone whose job requires them to provide 1st Aid or CPR or use an AED. (e.g., Student Health employees, Department of Public Safety, Health Sciences staff)
• Anyone whose job requires them to drive an injured employee or student to the hospital. (e.g., Department of Public Safety)
• Anyone handling biohazardous or infectious waste. (e.g., Faculty, Laboratory Personnel, Student Workers, Environmental Health and Radiation Safety (EHRS)
• Anyone cleaning up spills of blood, blood by-products, or other potentially infectious material. (e.g., Facilities Services Personnel, Faculty, Laboratory Personnel, EHRS)

WHAT ARE THE DEFINITIONS OF BLOOD, BLOODBORNE PATHOGENS AND "OTHER POTENTIALLY INFECTIOUS MATERIALS (OPIM)"?

• "Blood" means human blood, human blood components and products made from human blood.  The term "human blood components" includes plasma, platelets, and serosanguinous fluids (e.g., exudates from wounds).  Also included are medications derived from blood, such as immune globulins, albumin, and factors 8 and 9.
• "Bloodborne Pathogens" means pathogenic microorganisms that are present in human blood and can cause disease in humans.  While Hepatitis B Virus (HBV) and Human Immunodeficiency Virus (HIV) are specifically identified in the standard, the term includes any pathogenic microorganism that is present in human blood or OPIM (other potentially infectious materials) and can infect and cause disease in persons who are exposed to blood containing the pathogen.   Pathogenic microorganisms can also cause diseases such as hepatitis C, malaria, syphilis, babesiosis, brucellosis, leptospirosis, arboviral infections, relapsing fever, Creutzfeldt-Jakob disease, adult T-cell leukemia/lymphoma (caused by HTLV-I), HTLV-I associated myelopathy, diseases associated with HTLV-II, and viral hemorrhagic fever.
• "Other Potentially Infectious Materials" include:   semen, vaginal secretions, cerebrospinal fluid, synovial fluid, pleural fluid, pericardial fluid, peritoneal fluid, amniotic fluid, saliva in dental procedures, any body fluid that is visibly contaminated with blood, all body fluids in situations where it is difficult or impossible to differentiate between body fluids.

Any unfixed tissue or organ (other than intact skin) from a living or dead human being.

HIV-containing cell or tissue cultures, organ cultures, and HIV- or HBV - containing culture  media or other solutions; and blood, organs, or other tissues from experimental animals  infected with HIV or HBV.

WHERE IS OUR EXPOSURE CONTROL PLAN LOCATED?

• EHRS Department: McNeil Science & Technology Center, Room #223
• EHRS Department: Griffith Hall Stockroom, Griffith Building, Room B1
• EHRS Department: McNeil Science and Technology Center, room #112
• EHRS Web Page: http://www.usip.edu/safety/bmanual/index.htm

WHAT ARE THE SIGNS AND SYMPTOMS AND SOME ADDITIONAL INFORMATION ON HUMAN IMMUNODEFICIENCY VIRUS (HIV)?

• Human Immunodeficiency Virus (HIV) is the virus that causes acquired immunodeficiency syndrome (AIDS). AIDS was first reported in the U.S. in 1981, and has since become a major worldwide epidemic. HIV is passed from one person to another through blood-to-blood and sexual contact. Pregnant women infected with HIV can also pass the virus to their baby during pregnancy or delivery, and through breast-feeding.
  
  Body fluids in which HIV can be detected are human blood, semen, vaginal secretions, breast milk, and other body fluids containing blood. Contact with saliva, sweat, vomit, feces, and tears has never been shown to result in HIV transmission. HIV is not spread through casual contact. Mosquitoes and other insects do not transmit HIV. In addition, HIV does not survive well outside of the body.
  
  HIV progressively destroys the body's ability to fight infectious and certain cancers. People diagnosed with AIDS may get life-threatening diseases called opportunistic infectious, which are caused by microbes such as viruses or bacteria that usually do not affect healthy people.
  
  The symptoms of HIV infection range from an asymptomatic state to severe immunodeficiency and associated opportunistic infections, cancers, and other conditions. Initial infectious can be followed by an acute flu-like illness within one or two months after infection, with such symptoms as: fever, headache, nausea, vomiting, diarrhea, swollen lymph glands, sweats, fatigue, myalgia, rash, sore throat.
  
  As of July 2010, the CDC estimates that more than one million people are living with HIV in the United States. In addition, one in five (21%) of those people living with HIV is unaware of their infection. With the help of medications, life threatening symptoms may not occur for years, until the immune system is depressed enough for severe infections to occur. To date, no vaccine is available to prevent HIV or AIDS.

WHAT ARE THE SIGNS AND SYMPTOMS AND SOME ADDITIONAL INFORMATION ON HEPATITIS B VIRUS (HBV)?

• Acute viral hepatitis is a common, sometimes serious infection of the liver leading to inflammation and necrosis.
  
  An estimated 1.25 million Americans are chronically infected with the Hepatitis B virus, and about 20% - 30% of those infected acquired the infection during childhood. 15% - 25% of chronically infected persons develop chronic liver disease, including cirrhosis, liver failure, or liver cancer. The Hepatitis B vaccine has been available since 1982, and routine Hepatitis B vaccinations have greatly reduced the rate of disease among children and adolescents.
  
  About one-third of persons infected with HBV have no signs or symptoms. Symptoms begin an average of 90 days (range: 45 - 180 days) after exposure to HBV. Symptoms include: jaundice, fatigue, abdominal pain, fever, loss of appetite, nausea, vomiting, joint pain, dark urine, clay colored bowel movements.
  
  Transmission of the Hepatitis B virus (HBV) occurs when an infected person's blood or body fluids enters the body of a person who is not immune. Transmission occurs primarily through; birth from an infected mother, sexual contact with an infected person, sharing of contaminated needles, syringes or other injection drug equipment, needle sticks and other sharp instrument injuries or blood splashed onto non-intact skin. HBV is not spread through casual contact with infected individuals. HBV is durable and can survive in dried form on countertops for at least 7 days.
  
  The Bloodborne Pathogen standard requires employers to make the Hepatitis B vaccine and vaccination series available to all employees who have occupational exposure to HBV.
  
  CDC Hepatitis B FAQ's updated 2009 http://www.cdc.gov/hepatitis/b/bfaq.htm

WHAT ARE THE SIGNS AND SYMPTOMS AND SOME ADDITIONAL INFORMATION ON HEPATITIS C VIRUS (HCV)?

• The Hepatitis C virus (HCV) is a major cause of acute hepatitis and chronic liver disease, including cirrhosis and liver cancer. According to estimates from the Centers for Disease Control and Prevention, an estimated 3.9 million Americans (1.8%) have been infected with HCV, and 3.2 million are chronically infected. Approximately 75% - 85% of people who become infected with HCV develop chronic or lifelong infection. Serious liver problems can develop including liver damage, cirrhosis, liver failure, or liver cancer.
  
  The number of new infectious per year has declined from an average of 240,000 in the 1980's to about 17,000 currently and most likely due to changing behaviors among intravenous drug users (education) and better screening of blood for Hepatitis C.
  
  Although HCV is transmitted via the same routes as HBV and HIV (direct exposure to blood), according to the CDC contact with blood of an infected person through sharing of contaminated needles, syringes, or other injection drug equipment is the primary cause of infection. Many people infected with Hepatitis C have no signs or symptoms. Those that have symptoms and signs may exhibit the following: jaundice, fatigue, fever, dark urine, gray colored stools, abdominal pain, joint pain, loss of appetite, nausea and vomiting.
  
  HCV can be detected in blood within 1-3 weeks after exposure. Incubation period is 14 to 180 days (average: 45 days). There is currently no vaccine to prevent Hepatitis C.
  
  CDC Hepatitis C FAQ's updated 2009, http://www.cdc.gov/hepatitis/c/cfaq.htm

WHO SHOULD CLEAN UP A SPILL?

• No one is to clean up a blood/body fluid spill as part of their job until they have had USciences' initial bloodborne pathogens training which must be updated annually and have been offered the Hepatitis B vaccine.
• If the spill is a hazardous material in a special use area, e.g., laboratory or storage area for chemicals or biohazardous materials, the person directly responsible for that area should make sure that it is cleaned up properly.
  
• If the spill contains blood or body fluids from an injury or incident anywhere on campus, trained Facilities personnel are responsible for cleaning up the spill. (Contact Facilities Services at X8955)
  
• Anyone who does not feel comfortable cleaning up a spill can call the Environmental Health and Radiation Safety (EHRS) Department (X8925) or contact their Supervisor. You must receive training on proper spill clean-up procedures.

See the Biological Safety Emergency Response section for spill clean-up procedures.

WHAT CLEANING AGENTS CAN BE USED TO CLEAN UP A BLOOD/BODY FLUID SPILL?

• OSHA states that an EPA-registered tuberculocidal disinfectant, or EPA-registered disinfectants effective against both HIV and HBV, a diluted bleach solution (solution of 5.25 percent sodium hypochlorite (household bleach) diluted between 1:10 (1cup of bleach to 9 cups of water) and 1:100 (1/4 cup bleach per gallon of water) are acceptable for clean-up of a contaminated surface or item. The bleach solution should be mixed daily. However, it may be corrosive to some equipment and environmental surfaces and therefore may not be an appropriate choice for all situations.
• When using disinfectant products, it is required that there be strict adherence to the instructions on the label.

• Warn others in the area and isolate the contaminated area. (Prevent others from walking through or near the spill.)
• Put on personal protective equipment (PPE) appropriate for the spill size. (e.g., gloves, long-sleeved coveralls, safety goggles).
• Remove glass or sharps, if necessary, with forceps, tongs or scoop.
• For a wet spill, cover with disinfectant-soaked absorbent towels, wipe, and remove toweling. (This decreases the likelihood of causing a splash.) Any visible blood or body fluid must be cleaned thoroughly before proceeding to the next step.
• Apply appropriate disinfectant to the area.
• Allow adequate contact time. (Approximately 10 minutes to help ensure bloodborne pathogens are killed.)
• Wipe up and clean again with soap and water.
• Properly dispose of clean-up materials into red biohazard waste bags/containers. Also, place glass, needles, rigid plastic or other sharps into red biohazard sharps containers. No items are allowed to stick out of any biohazard container. (e.g., mops, etc.) The containers must be kept closed.
• Remove gloves, place in waste, but put on a new pair of gloves.
• Bring the biohazard waste containers to the Griffith Hall or McNeil Science and Technology Center stockrooms for proper disposal.
• Remove gloves. Throw in normal trash (if not contaminated).
• Wash your hands.

DO I HAVE TO GET THE HEPATITIS B VACCINE?

• No. You may decline the vaccinations, but you do have to sign the Declination Form indicating that you do not want it. (Part II of the Hepatitis B Vaccination form) However, potentially exposed individuals may change their mind at any time and accept the vaccinations.
• The Hepatitis B Vaccinations are a series of 3 injections over a 6 month period. Possible side effects include: pain, itching and swelling at the vaccination site, flu-like symptoms, or an allergic reaction to the yeast component of the vaccine. These reactions were no more frequent than among those receiving a placebo (sugar water).
• If you attended an initial Bloodborne Pathogens classroom training and you would like to begin the vaccination series, complete the Hepatitis B Vaccination form (Part I) and return it to the EHRS Department at STC #223, box #85 or to a.montgo@usp.edu.

DO I HAVE TO PAY FOR THE VACCINE?

• If you are a USciences employee or a paid student worker, and your job duties expose you to blood and other potentially infectious materials, you do not have to pay for the vaccination series.

WHAT IS POST-VACCINATION TESTING FOR IMMUNE RESPONSE AND DO I NEED IT?

• Post-vaccination testing is when you have your blood drawn to determine if there is an adequate immune response or if there are adequate antibodies after receiving the 3 doses of Hepatitis B vaccine. Post-vaccination testing should be completed 1 - 2 months after the 3rd dose. However, OSHA does not require or recommend having the post-vaccination testing unless you have on-going contact or are routinely exposed to blood or body fluids. [It is always required after an exposure incident.] Examples of job descriptions on campus that require the University to offer and pay for post-vaccination testing are: student health nurse/and other staff routinely exposed, individuals who clean up blood spills, research conducted with human blood, cells, or tissue that have not been certified to be free of Hepatitis B, Hepatitis C, HIV, HTLV, syphilis, etc. Other job descriptions may be evaluated for routine exposure to blood or body fluids. Post-vaccination testing will be conducted at the Hospital of the University of Pa. Occupational Medicine Department. You may decline the testing.

IF I ATTENDED THE TRAINING CLASS LAST YEAR, DO I HAVE TO GO AGAIN THIS YEAR?

• OSHA requires that training be completed every year.  However, if an employee attended an initial classroom training, subsequent trainings may be fulfilled by completing on-line training and a quiz on Bloodborne Pathogens.

WHAT IS AN EXPOSURE INCIDENT?

• An exposure incident is when blood or other potentially infectious materials gets into your eye, mouth, or any other mucous membrane (mucous membrane splash), or if it comes in contact with non-intact skin (broken or damaged skin). If you stick yourself with a contaminated needle or other contaminated sharp object, that is an exposure incident also (percutaneous exposure). [Remember:  Hepatitis B virus can survive on surfaces, dried, and at room temperature for at least one week].

WHAT DO I DO IF I HAVE AN EXPOSURE?

• Immediately flood the exposed area with copious amounts of water, and clean any wound with soap and water or a skin disinfectant if available. Do not rub hard or abrade the skin.
  
• For eye splashes, flush the eyes with copious amounts of water. Hold eyelids open to flush out eyelids well. Seek medical attention. (Turn on eyewashes to flush once a week for a minimum of 3 minutes to prevent the buildup of amoeba and bacteria. This will prevent eye infections, which can lead to blindness, during its use in an emergency.)

  When an injury or exposure occurs:

Student and Visitor Accidents/Hazardous Substance Exposures

• Students must notify their instructor or resident director of all injuries or illnesses occurring at the University, including those related to hazardous substance exposures. The incident must then be immediately reported to Public Safety (X7000) so that it can be documented properly. If a student refuses medical treatment, their signature must be documented on Public Safety's Incident Reporting Form.
• Visitor accidents or incidents must also be immediately reported to Public Safety.
• If it is an emergency, call 911 and Public Safety at X7000. If Public Safety transports a student to the hospital, someone other than the Public Safety Officer (i.e., fellow student, instructor) should accompany the student into the medical facility.
• Do not move a seriously injured person unless they are in further danger.
• In the event of a hazardous substance exposure, do what is necessary to prevent further injury or illness. (i.e, flush skin or eyes with copious amounts of water for approximately 15 minutes, leave the area and get fresh air for an inhalation exposure) Also, someone should forward the Material Safety Data Sheet (MSDS) to the medical facility.
• Any student who is working for the University, and their injury or illness occurs during the performance of their duties, will be covered under the University's worker's compensation carrier. Therefore, Human Resource's Supervisor's Accident Investigation Report should be completed, and procedures followed, as required under the "Employee Accident" section.
• An employee or paid student worker may follow-up with an occupational medicine specialist at University of Pennsylvania's Occupational Medicine Department. These physicians specialize in hazardous substance exposures. Medical reports and information will and must be kept in the strictest confidence.

See the Accident Reporting section in the Safety Manual for more information.

WHERE DO I PUT MY BIOHAZARD WASTE?

• All contaminated or infectious dry solid type waste (i.e., gloves, personal protective equipment, paper towels, gauze/bandages, bodily fluid/blood saturated items, etc.) must be placed in double red bags stored inside proper biohazard boxes with lids. Do not put sharps or liquids into red-bagged boxes. Keep the weight of box reasonable, 30 lbs. or less.
• All contaminated needles or other contaminated sharps (i.e.; needles, syringes, glass and plastic pipettes, slides, rigid plasticware having sharp edges or points, capillary tubes, syringes, blades, glassware, etc.) must be placed into red sharps containers or red buckets that are puncture-resistant and leakproof. Anything that could potentially puncture a bag should be placed into a sharps container. This also includes plastic pipettes.
• By law, non-contaminated needles and syringes with or without needles attached, must still be placed into a red sharps container. Containers must not be over-filled and must be closed and disposed of when 3/4's full.
• Contaminated laboratory liquid waste (aqueous biological or infectious solutions such as blood, urine, cells, microbial cultures) must be autoclaved or chemically disinfected (i.e., 10% bleach solution) prior to disposal. Upon obtaining a one time approval from Environmental Health & Radiation Safety (EHRS) for compliance, the bleach disinfected waste may be flushed into the sanitary sewer system if flushed with large amounts of water. The containers that held the decontaminated liquids must be disposed into proper biohazard waste containers.
• Otherwise, these liquids must be in break-resistant containers that are tightly sealed before being placed into red biohazard waste buckets. There should be sufficient absorbent material in the bucket to absorb the entire contents of the liquid in the event of a release. (e.g., absorbent pads or vermiculite)
• Never place hazardous pharmaceutical (including chemo drugs), chemicals, radioactive waste, or regular garbage into the biohazard waste containers.
• Never autoclave bleach treated waste, flammables, corrosives, reactives, cancer drugs, volatile chemicals or radioactive materials.
• Infectious biohazard waste containing virulent pathogens, recombinant or synthetic nucleic acids, higher risk BSL-2 agents, or presenting a risk to individuals handling it must be autoclaved or decontaminated before being placed into biohazard waste containers for disposal.

Chemo/Cytotoxic and Hazardous Drug Biohazardous Waste Disposal

• Discarded contaminated items containing trace amounts of chemo/cytotoxic drugs and hazardous pharmaceuticals may be disposed of into the appropriate red or yellow (chemo) biohazard waste containers.
  
  
• Original cytotoxic/hazardous drug bottles or dilutes stocks containing drugs must be disposed as hazardous chemical waste and brought to the Central Stockroom(s). However, bottles, tubing, vials, syringes and other discarded contaminated items containing residual or trace amounts of these drugs may be placed into the appropriate red or yellow (chemo) biohazard containers.
  
  
• Carcasses and bedding containing chemo/cytotoxic drugs must be placed in yellow "chemo-labeled" double bagged, yellow biohazard containers only. While storing carcasses with bedding the refrigerator/freezer, these should be double-bagged in sealed yellow chemo-labeled bags.
  
  
• Sharps containing chemo/cytotoxic drugs must be placed in yellow chemo/cytotoxic biohazard sharps containers only.

Non-contaminated sharps whether plastic or glass, (except needles, syringes and blades), must be placed into blue and white laboratory glassware boxes. (Not in regular trashcans)

While storing biohazard bags and containers in the laboratory, THEY MUST BE KEPT CLOSED, unless adding waste. Before transport from the laboratory, also check to make sure that they are sealed and not leaking.

Do not leave a waste container unsecured. (It must be locked up or in a locked laboratory when unattended)

Do not store biohazard waste in hallways or near general traffic. Biohazard waste, excluding used sharps, may be stored at room temperature until the storage container is full, but no longer than 30 days from the date of generation. It may be refrigerated for up to 30 days and frozen for up to 90 days from the date of generation. Biohazard waste must be dated when refrigerated or frozen for storage. Storage of biohazard waste in a freezer must be approved by the Environmental Health and Radiation Safety Department.

All bags and containers are available in the Central Stockrooms.

Bring the waste to the appropriate stockroom only if you have been Department of Transportation trained or contact the Central Stockrooms at X8843 or X3141 to schedule a pick-up.

See the Biohazard Waste Disposal procedures in the Biosafety Manual for more information.

HOW CAN I PROTECT MYSELF?

• Your risk of infection of Hepatitis B or HIV is very small, but you do need to protect yourself.
• Assume that all blood and body fluids are infectious. This is called "universal" precautions.
• Wear appropriate personal protective equipment (PPE) for the job that you are doing. Wear gloves whenever there is a possibility of contact with blood or other body fluids. Inspect all personal protective equipment before wearing for damage, punctures or tears.
• Identify and use engineering controls. These are devices that isolate or remove bloodborne pathogen hazards, which may include sharps containers, fume hoods, self-sheathing or retractable needles and needleless systems.
• Wear face shields and/or goggles if there is the possibility of blood or body fluids splashing.
• Other types of PPE include; masks, gowns, coveralls, shoecovers, pocket CPR mouth to mouth resuscitation masks. Check with your supervisor or the EHRS Department, if you are unsure if these are needed. Supervisors must ensure personal protective equipment is available to you at no cost, you are using it and you know how to use it properly.
• Follow the established work practices and procedures to limit or prevent exposures.
• Dispose of all waste properly.
• Seriously consider the offer of Hepatitis B Vaccination.
  
• Report any exposure to potentially infectious materials immediately and undertake the necessary medical review and treatment.   

If anyone has any additional questions, please do not hesitate to contact the EHRS Department (X8925)