Lesson 1-4 Biological Safety (Estridge)

Bloodborne Pathogens (BBP) Standard

OSHA guidelines for preventing occupational exposure to pathogens present in human blood and body fluids, including, but not limited to, HIV and hepatitis B virus (HBV); final OSHA standard of December 6, 1991, effective March 6, 1992

What are the OSHA rules regarding the handling and disposal of used needles?

OSHA prohibits the recapping of needles or removal of needles from used blood- drawing devices. The rule mandates use of safety needles/devices, immediate activation of safety feature after needle use, and discarding of needle into a readily accessible sharps container.

Explain how to properly put on and take off gloves.

See Figure 1-21. Gloves must be changed frequently when working in the laboratory, and hands must be cleansed with antiseptic between each glove change. Gloves that provide both chemical and biological protection should be worn. Gloves are put on by pulling the cuff or wrist area up so that all exposed skin is covered. Workers should not have long fingernails or wear sharp rings or jewelry that can puncture gloves. To remove gloves, hold gloved hands over biohazard disposal container and grasp the outside of one glove cuff; pull the glove down over the hand inside out and contain the removed glove in the palm of the remaining gloved hand; insert bare fingers inside the remaining glove cuff, pull the glove inside out down over the hand taking care not to touch the outside of glove, and discard both gloves into biohazard container.

What personal protective equipment is commonly worn when working in the biological laboratory?

See Figures 1-15 and 1-16. Gloves and fluid-resistant gown or laboratory coat should be worn; mucous membrane protection such as goggles, mask, or face shield, should be worn if splashes are reasonably expected.

aerosol

liquid in the form of a very fine mist

biohazard

risk or hazard to health or the environment from biological agents

alimentary tract

the digestive tube from the mouth to the anus

human immunodeficiency virus (HIV)

the retrovirus that has been identified as the cause of AIDS

hepatitis B virus (HBV)

the virus that causes hepatitis B infection and is transmitted by contact with infected blood or other body fluids

hepatitis C virus (HCV)

the virus that causes hepatitis C infection and is transmitted by contact with infected blood or other body fluids

engineering control

use of available technology and equipment to protect the worker from hazards

Implementing an Exposure Control Plan The employer has several responsibilities to the employee:

-The employer must provide employees with PPE appropriate for the tasks they perform. ● Warning labels and signs must be used to identify all biohazards. ● The exposure control plan must describe the control methods used to comply with the Bloodborne Pathogens Standard and Standard Precautions. ● The employer must provide free HBV immunization to workers at risk for exposure to bloodborne pathogens.

CASE STUDY 1 Janie, a laboratory technician in a group practice clinic, frequently collects blood from clinic patients for laboratory tests. Janie's friend Bonnie came into the clinic for some blood tests. as Janie prepared to per- form the venipuncture, Bonnie became offended when Janie put on gloves before collecting the blood. 1. how should Janie handle this situation?

1. Janie should reassure Bonnie that there is nothing personal in her actions, and that the rules of the clinic require that Standard Precautions be used with all patients for the protection of both workers and patients.

CASE STUDY 2 april is preparing serum chemistry control solutions for analysis in her department. She is wearing a labora- tory coat and face shield. however, she does not like to wear gloves when handling the small control vials because she worries about dropping them. 1. is it permissible for april to not wear gloves in this instance because patients are not involved? 2. What discussion should her supervisor have with her?

1. No. 2. April is using risky behavior that violates the requirements of Standard Precautions. She must wear gloves when handling any biological substance or reagent derived from a biological substance.

Name four types of laboratory disinfectants and two antiseptics. Explain when and how antiseptics and disinfectants should be used.

3. Any four of the following disinfectants are acceptable: dilute chlorine bleach (hypochlorite), 1:10 dilution; alcohols, 70% to 85%; iodophors, 75 parts/million (ppm); phenols; quaternary ammonium compounds. 4. Any two of the following antiseptics are acceptable: alcohols, hydrogen peroxide, triclosan, chlorhexidine (Hibiclens), and iodine. Disinfectants are used on inanimate objects or surfaces; antiseptics are used on skin or tissues. Work surfaces should be cleaned with disinfectant any time a spill occurs and frequently during the work day. Hands should be cleansed with antiseptic before donning gloves, after removing gloves, and any other time contamination is suspected.

Name three work practice controls that should be used in the laboratory workplace.

Any three of the following are acceptable: 4. Wash hands before donning gloves, after glove removal, or any other time necessary. 5. Wear appropriate PPE when cleaning up biological spills. 6. Remove and dispose of PPE when leaving the work area or on completion of a task. 7. Use surface disinfectant such as 10% bleach to clean work area before and after each use and anytime a spill occurs. 8. Use needlestick prevention practices

How have biological safety rules changed in recent decades? Why have they become more stringent?

As the hazard of transmitting agents such as HIV and hepatitis B and C viruses became recognized, more stringent biological safety procedures were mandated. Before the discovery of HIV, early safety guidelines relied on isolation techniques. Universal Precautions applied to blood and body fluids containing visible blood for all patients. Standard Precautions apply the principles of work practice controls and exposure controls to all patients and all patient specimens to prevent exposure of workers to potentially infectious agents and to protect patients.

What class of biological safety cabinet is most commonly used in medical laboratories?

Class II

How does a disinfectant differ from an antiseptic?

Disinfectants are chemicals used to kill or inactivate microorganisms on inanimate objects or surfaces such as countertops, floors, instruments, or labware. Antiseptics are chemicals used on skin or tissue to inhibit growth of microbes.

Discuss the advantages of wearing fluid-resistant disposable gowns or laboratory coats.

Fluid-resistant disposable coats provide an inexpensive way to protect clothing from potentially infectious materials, contamination, spills, or stains and eliminate the need to launder contaminated coats.

What action(s) should be taken in case of an exposure incident?

If an accident or exposure incident occurs, the employee must immediately: 0. Flood the exposed area with water and clean any wound with antiseptic and water 1. Report incident to supervisor, risk control officer, or infection prevention officer 2. Seek immediate medical attention

What additional safety rules and equipment are used in the microbiology laboratory?

Procedures in the microbiology laboratory use aseptic technique, and some procedures may require use of a biological safety cabinet. Special care must be taken to prevent exposure to culture materials and pathogenic organisms.

Explain the proper technique for washing hands with antiseptic.

See Figure 1-20. Hands should be wet with warm or room temperature water and an amount of hand antiseptic recommended by the manufacturer applied to the hands. Hands and wrists should be lathered, and hands should be rubbed together vigorously for 15 to 30 seconds, covering all surfaces of the hands and fingers and cleaning fingernails and under rings. The arms or wrists and hands should be rinsed by holding the hands in a downward position and rinsing toward the tips of the fingers. The hands should be dried thoroughly with a disposable towel. Hand-operated faucets should be turned on and off using a clean disposable towel to avoid contaminating hands with organisms or substances that can be present on faucet handles. The use of hot water during handwashing should be avoided because repeated exposure to hot water can increase the risk for dermatitis.

Explain the reason for the Bloodborne Pathogens Standard. Why was it revised in 2001?

The BBP Standard outlines requirements for protection of workers who have potential for exposure to human blood or body fluids in the workplace. In 2001, the BBP Standard was revised to emphasize prevention of needlesticks in the workplace.

List the exposure control methods that are included in the exposure control plan.

The exposure control methods include: 0. Standard Precautions 1. Engineering controls 2. Work practice controls 3. Personal protective equipment

What is meant by exposure control plan or infection control plan?

The exposure control plan (or infection control plan) identifies employees at risk for exposure to blood and body fluids, defines safe work practices, and requires documentation of safety training of employees.

What is the purpose of a safety agreement?

The safety agreement documents annual safety training of employees.

What is meant by the terms Universal Precautions and Standard Precautions?

Universal Precautions is a method of infection control in which all human blood and body fluids containing visible blood are treated as if infectious. Standard Precautions clarify and combine Universal Precautions and BSI. Standard Precautions require that all patients, organs, tissues, and body fluids be treated as if infectious, even if blood is not visible in a body fluid. Protective barriers such as gloves, mask, gown, and goggles prevent exposure of skin or mucous membranes to biological specimens.

acquired immunodeficiency syndrome (AIDS)

a form of severe immunodeficiency caused by infection with the human immunodeficiency virus (HIV)

Universal Precautions (UP)

a method of infection control in which all human blood and other body fluids containing visible blood substances are treated as if infectious

exposure control plan

a plan identifying employees at risk for exposure to bloodborne pathogens and providing training in methods to prevent exposure

Standard Precautions

a set of comprehensive safety guidelines designed to protect patients and healthcare workers by requiring that all patients and all body fluids, body substances, organs, and unfixed tissues be regarded as potentially infectious

hand hygiene

a set of techniques that includes handwashing with soap and water, washing with antiseptic soap, or cleansing with a waterless antiseptic product

biological safety cabinet

a special work cabinet that provides protection to the worker while working with infectious microorganisms

exposure incident

an accident, such as a needlestick, in which an individual is exposed to possible infection through contact with body substances from another individual

other potentially infectious materials (OPIM)

any and all body fluids, tissues, organs, or other specimens from a human source

parenteral

any route other than by the alimentary canal; intravenous, subcutaneous, intramuscular, or mucosal

pathogenic

capable of causing damage or injury to the host

disinfectant

chemical used on inanimate objects to kill or inactivate microbes

antiseptic

chemical used on living tissue to control the growth of infectious agents

hand antisepsis

decontamination of hands using antiseptic soap or waterless antiseptic

nosocomial

hospital-acquired; acquired as a result of being hospitalized or institutionalized

community-acquired infection (CAI )

infection acquired through contact with friends, family, and the public or by contact with contaminated environmental surfaces

healthcare-associated infection (HAI)

infection acquired while being treated for another condition in a healthcare setting; synonym for healthcare-acquired infection; formerly called nosocomial infection

sterilization

killing or inactivation of living organisms and viruses

work practice controls

methods of performing tasks that reduce the worker's exposure to blood and other potentially hazardous materials

bloodborne pathogens (BBP)

pathogens that can be present in human blood (and blood-contaminated body fluids) and that cause disease

personal protective equipment (PPE)

specialized clothing or equipment used by workers to protect from direct exposure to blood or other potentially infectious or hazardous materials; includes, but is not limited to, gloves, laboratory apparel, eye protection, and breathing apparatus

Transmission-Based Precautions

specific safety practices used in addition to Standard Precautions when treating patients known to be or suspected of being infected with pathogens that can be spread by air, droplet, or contact

isolation

the practice of limiting the movement and social contact of a patient who is potentially infectious or who must be protected from exposure to infectious agents; quarantine