Immunology - Safety

1. What is the appropriate procedure for cleaning a blood spill?

1. Wear gloves and a laboratory coat 2. Absorb the blood with disposable towels. Remove as much liquid blood or serum as possible before decontamination. 3. Using a diluted bleach solution, clean the spill site of all visible blood 4. Wipe down the spill site with paper towels soaked with diluted bleach 5. Place all disposable materials used for decontamination into a biohazard container

1. How often should laboratory personnel wash their hands?

1. After completing laboratory work and before leaving the laboratory 2. After removing gloves 3. Before eating, drinking, applying makeup, and changing contact lenses, and before and after using the lavatory 4. Before all activities that involve hand contact with mucous membranes or breaks in the skin 5. Immediately after accidental skin contact with blood, body fluids, or tissues.

1. What does Standard Precautions say about blood and body fluids?

All blood and body fluids are to be considered potentially infectious for Human Immunodeficiency Virus (HIV), Hepatitis B Virus (HBV) or other blood-borne microorganisms that can cause disease in humans

1. How should work surfaces be decontaminated? How often?

All work surfaces should be cleaned and sanitized at the beginning and end of the shift with a 1:10 dilution of household bleach.

1. How long is HBV stable in dried blood and blood products?

HBV is stable in dried blood and blood products at 25C for up to 7 days.

1. The likelihood of infection after exposure to HBV or HIV depends on what four factors?

HBV or HIV infection depends on: • concentration of HBV or HIV virus • duration of the contact • presence of skin lesions or abrasions on the hands or exposed skin of the health care worker • immune status of the health care worker for HBV

1. Which vaccines are strongly recommended for healthcare workers?

Hepatitis B, Influenza, Measles, Mumps, Rubella, and Varicella

What does OSHA mandate for compliance in providing a safe working environment?

OSHA mandates the employer: • educate and train all health care workers in Universal Precautions and in preventing blood-borne infections • provide proper equipment and supplies (lab coats, gloves, etc) • monitor compliance with the protective biosafety policies

1. What is the proper procedure for handling used needles and other sharps?

Place sharps and broken glassware in rigid, leakproof, and puncture resistant containers conspicuously marked "Biohazard" with the universal biohazard symbol. The containers should be the universal color of orange, orange and black, or red. What your textbook does not state about needles, you already know: the safety device must be activated upon removal from the patient's arm.

1. What is the single most important source of HBV, HIV, and other blood-borne pathogens in the laboratory setting?

blood

1. What is the single most important safety practice?

handwashing

1. What are the guidelines for glove usage during phlebotomy procedures?

• Gloves must be used by phlebotomists who have cuts, scratches, or other breaks in their skin. The presence of skin lesions will increase the likelihood of infection subsequent to skin exposure. • Gloves should be worn when the phlebotomist judges that hand contamination may occur. • Gloves must be worn when performing fingersticks and/or heelsticks • Gloves must be worn when receiving phlebotomy training • Gloves should be changed between each patient contact

1. How should infectious waste be properly decontaminated?

• Incineration, or • Autoclaving (if incineration is not done in the health care facility or by an outside contractor) - all contaminated disposables should be autoclaved before leaving the facility for disposal with routine waste. Disposal of medical waste should be done by licensed organizations to ensure that no environmental contamination or aesthetic problem occurs. Various acts and regulations have been passed by the U.S. Congress to assist the EPA to carry out this process in the most prudent manner.

1. What tests are used to determine if a healthcare worker has contracted tuberculosis (TB) after exposure to a patient with active tuberculosis?

• Tuberculin skin test (PPD, Mantoux) • QuantiFERON-TB Gold (QFT)

1. When should laboratory personnel use the following personal protective equipment:

• facial barriers: Facial barrier protection should be used if there is potential for splashing or spraying of blood or certain body fluids. Masks and/or facial protection should be worn if mucous membrane contact with blood or certain body fluids is anticipated • laboratory coats or gowns: These garments should be worn in the laboratory and changed when leaving the laboratory

1. How long do HBV and HIV survive once decontamination of work surfaces has taken place?

Diluted household bleach prepared daily inactivates HBV in 10 minutes and HIV in 2 minutes

1. What is the proper safety practice for the following situations: food and drink in the laboratory:

Food and drinks should not be consumed in work areas or stored in the same area as specimens

1. How long is HIV stable in dried blood and blood products?

HIV is stable in dried blood and blood products at 25C for up to 3 days. It is stable in an aqueous environment at 25C for up to 7 days.

removing rubber stoppers from vacutainer tubes:

Slowly and carefully open test tubes with rubber stoppers with a 2x2 gauze square placed over the stopper to minimize aerosol production

specimens needing centrifugation:

Specimens needing centrifugation should be capped before being placed into the centrifuge

Safety Plan

The purpose of a safety plan is to minimize risks to the health and safety of employees, volunteers, and patients.

1. What is the purpose of infection control efforts for HBV, HIV, and other blood-borne pathogens?

The purpose of infection control efforts is to prevent occupational exposure to HIV, HBV, and other blood and blood-borne pathogens

pipetting:

Use safety bulbs for pipetting. Pipetting by mouth of any clinical material is strictly forbidden

1. What is the procedure for a known or suspected sharps (needle) exposure?

Vaccination against hepatitis B and compliance with Standard Precautions are the best prophylaxis against blood-borne pathogens. • Hepatitis B (HBV) - PEP with HBIG and hepatitis B vaccine series should be considered for occupational exposures after evaluation of the hepatits B surface antigen (HBsAg) status of the source and the vaccination and vaccine-response status of the exposed person. Postvaccination testing for the development of antibody to HBsAg should be done to ensure that the vaccination has been successful. • Hepatitis C (HCV) - for HCV postexposure management, the HCV status of the source and the exposed person should be determined. If the source is HCV-positive, immune globulin should be given as soon as possible. No vaccine is currently available. Follow-up HCV testing should be performed to determine if infection develops. • HIV - HIV antibody status of the source should be determined. If the source is a patient, voluntary consent should be obtained, if possible for testing for HIV antibodies as soon as possible. High-risk exposure prophylaxis includes the use of a combination of antiretroviral agents to prevent seroconversion. • If a laboratory worker is exposed to blood or body fluids, either through a needlestick incident or through a specimen, the lab worker should contact his/her supervisor IMMEDIATELY. Every healthcare organization has a postexposure protocol. Occupational exposures should be considered urgent medical concerns to ensure timely postexposure management and administration of HBIG, hepatitis B vaccine, and HIV PEP.

1. List four ways in which HBV and HIV may be directly transmitted.

• percutaneous inoculation of blood, plasma, serum, or certain other body fluids from accidental needlesticks and so forth • contamination of the skin with blood or certain other body fluids without overt puncture, as a result of scratches, abrasions, burns, weeping, or exudative skin lesions • exposure of mucous membranes to blood or certain body fluids, as the direct result of pipetting by mouth, splashes, or splattering • centrifuge accidents or the improper removal of rubber stoppers from test tubes, thereby producing droplets