What are universal precautions for bloodborne pathogens?

For information regarding online training access, please contact Dr. Quinesha Morgan, Assistant Director Research Safety – Phone: 225-578-5640 or mail to: [email protected]

LSU Exposure Control Plan

Introduction

Louisiana State University (LSU) follows federal regulations and guidelines in the conduct of research and other activities which might place personnel in direct contact with blood that could potentially contain infectious agents, known as bloodborne pathogens (see PS-65).

The Occupational Safety and Health Administration (OSHA) Bloodborne Pathogens Standard (BBP, 29 CFR 1910.1030) builds on the implementation of the universal precautions, specifying the need for control methods, training, compliance and record keeping. The BBP Standard is a “performance” standard, meaning the employer has a mandate to develop an exposure control plan to provide a safe work environment but is allowed some discretion in how this goal is accomplished.

Blood and unfixed tissues of human origin can contain a variety of potential pathogens that can infect humans. The human immunodeficiency viruses, HIV-1 and HIV-2, are the most notorious of these agents, but there are many other viruses and bacterial pathogens that may be present as well. Viruses found in blood include two unrelated hepatitis viruses, the hepatitis B virus (HBV) and the hepatitis C virus (HCV). In addition, there are retroviruses other than HIV (HTLV-I, HTLV-II), encephalitis viruses, certain protozoans, and bacteria such as Treponema pallidum which may be present in human blood.

Hepatitis B virus (HBV) is a hepadnavirus that infects a large number of people worldwide and is an important cause of liver disease and hepatocellular carcinoma. It is more infectious than HIV and often co-infects the same people; both agents may be present in the same blood sample. A safe and effective vaccine is available and vaccination (or declination) is required by the OSHA BBP Standard for all persons who are occupationally exposed to blood or other potentially infectious materials. Hepatitis C virus (HCV), a flavivirus related to yellow fever virus, infects an estimated 4 million people in the U.S. alone. New infections are estimated to occur at about 300,000 per year, and it is the leading cause of liver failure. Unlike HBV, HCV nearly always establishes a chronic, persistent infection and is often asymptomatic, and no vaccine is currently available.

Universities are unique because of the diversity of potential occupational exposures to bloodborne pathogens, including research laboratories where the study of these agents is conducted. Working with the human immunodeficiency virus (HIV) and other bloodborne pathogens requires special precautions to protect researchers from infection. While the bloodborne pathogen regulations apply only to human blood, all blood should be handled as if it contains pathogens. There are many potential zoonotic pathogens which may be present in the blood of a variety of animal species that can infect humans. Prudent safety practices, such as adherence to the universal precautions will protect researchers and others.

The universal precautions are a set of guidelines developed in the 1980’s to minimize the risk of health care workers to HIV infection. The universal precautions are developed around the idea that all blood and certain body fluids should always be treated as though infected with HIV and other bloodborne pathogens. All health care workers should routinely use appropriate barrier precautions to prevent skin and mucous membrane exposure during contact with any patient’s blood or body fluids. The universal precautions apply to blood, other body fluids containing visible blood, semen and vaginal secretions. The universal precautions also apply to tissues and to the following fluids: cerebrospinal, synovial, pleural, peritoneal, pericardial, and amniotic fluids. They do not apply to feces, nasal secretions, sputum, sweat, tears, urine and vomitus unless these substances contain visible blood. Universal precautions do not apply to saliva except when visibly contaminated with blood or in the dental setting where blood contaminated saliva is predictable.

The Centers for Disease Control and Prevention in 1989 issued guidelines for the application of the universal precautions, primarily aimed at health care facilities, but applicable to a variety of work settings including laboratories. These guidelines recommend following the steps outlined below:

• All work activities should be classified according to the potential for exposure. Tasks with a greater potential for exposure have a greater need for appropriate protective equipment. As a minimum, gloves, protective clothing and eye protection should be worn at all times when there is a reasonable potential for exposure
• A detailed work practice program should be developed that includes standard operating procedures (SOPs) for all activities having the potential for exposure. Once these SOPs are developed, a worker education program is implemented to assure familiarity with work practices for potentially exposed workers. No worker should engage in tasks or activities that potentially put them at risk of exposure before receiving training pertaining to the SOPs, work practices and protective equipment required for that task.
• The employer should monitor workers to insure that the required work practices are observed and that protective clothing and equipment are provided and properly used. Records documenting the procedures and criteria used to assess the risk of job activities should be maintained. Copies of all standard operating procedures (SOPs) for tasks or activities involving predictable or unpredictable exposure to blood or other body fluids should also be kept on file, and made accessible to employees. In addition, training records including the dates of training sessions, the content of the sessions and the name and qualifications of the individuals providing the training should also be kept.

Requirements of the OSHA Bloodborne Pathogen Standard

The OSHA BBP standard builds on and extends the universal precautions and adds additional requirements for records, health monitoring and training. Institutions are required to prepare an exposure control plan. Click this link to access the LSU Exposure Control Plan. The following is a brief explanation of the components of the exposure control plan:

Engineering Controls

Louisiana State University biological safety office requires the use of available technology to minimize, isolate or otherwise neutralize the risk of hazards to laboratory workers. Since parenteral exposure due to percutaneous injuries is the main risk posed by bloodborne pathogens, a major emphasis is on the prevention of sharps-related injuries. About 90% of the documented HIV infections resulting from laboratory exposures are due to percutaneous injuries; most are from injuries involving hollow-bore needles. Safety devices such as retracting needles and needle-less injection systems are required to be substituted wherever possible.

Work Practices

The way tasks are carried out can minimize the potential for exposure to infectious pathogens. In the conduct of any activity that places the worker at risk of exposure, methods that reduce the likelihood of contact with potentially infectious materials should be used. Splashes and the generation of aerosols must be avoided.

For research or teaching related activities, standard microbiological practices have been recommended by the CDC and by the NIH for all laboratory containment levels. These practices have been designed to prevent indirect transmission of infectious material from environmental surfaces to the hands and from the hands to the mouth or mucous membranes. Such practices include the prohibition of mouth-pipetting, eating, drinking, smoking, applying cosmetics or handling contact lenses while in the laboratory. The practices also are intended to minimize environmental contamination. These recommended work practices must be strictly adhered to in the conduct of all research or teaching activities.

Personal Protective Equipment (PPE)

Exposure to laboratory workers can be minimized by the appropriate and effective use of personal protective equipment (PPE). What constitutes appropriate PPE is determined by the procedure being conducted and the type, duration and extent of exposure.

Training

An important component to exposure control is training. On-the-job training is not an acceptable alternative to formal safety training. Interactive training sessions must be conducted upon initial hiring and annually thereafter. Training must be conducted by an individual who is knowledgeable about the OSHA standard, safety and the pathogens potentially present.
Employees must be educated about their risk and the institution’s plan to control these risks. There must be no charge for training to the employee, be available during working hours and be understood by the employee. The topics required to be covered by training include:

• Accessibility of the OSHA Bloodborne pathogen standard and Institutional exposure control plan.
• Epidemiology, transmission and symptoms of common bloodborne pathogens.
• Standard precautions.
• Engineering controls, work practices and personal protective equipment.
• Emergency and post-exposure management.
• Hepatitis B virus vaccination program.
• Hazard communications.

For more information or to arrange for bloodborne pathogen training, contact the LSU Environmental Health and Safety (EHS) office at 578-5640.

Medical Care and Monitoring

The exposure control plan is primarily intended to prevent accidental infections, but it also contains specific requirements for hepatitis B vaccination and post-exposure medical care. The hepatitis B vaccine is a safe and effective way to prevent infection with this virus. It consists of a series of three injections of the HbSAg, a major viral surface protein which has been correlated with immunity. Employees must either be vaccinated at the employers expense or sign a waiver indicating they understand the risks of exposure and decline to be vaccinated.

The use of preventive strategies will not completely eliminate the possibility of exposure to infectious materials. Because of this fact, the plan includes a post-exposure evaluation program. For laboratory workers who handle blood, concentrated HIV or other infectious materials, the plan requires a confidential medical evaluation, follow-up and documentation of an exposure incident. An exposure incident is defined as “specific eye, mouth, other mucous membrane, non-intact skin, or parenteral contact with blood or other potentially infectious materials that results from the performance of an employee’s duties.” LSU follows the CDC guidelines for post-exposure measures for exposures to HIV, hepatitis B virus and hepatitis C virus, which is available on line from the CDC atbhttp://www.cdc.gov/mmwr/PDF/rr/rr5011.pdf.

Post-exposure management may include HBV vaccine booster, anti-retroviral chemotherapy and/or immune gamma globulin injections.

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