Blood, Sweat & Fears: Blood-Borne Pathogens, Part III

In October 1997 there was an incident at the Yerkes Regional Primate Research Center field station in Lawrenceville, Georgia. While attempting a group capture of Rhesus Macaque monkeys, a research scientist was splashed in the eye with body fluid from an unidentified monkey. Subsequently, the worker, who was not wearing eye protection at the time of the exposure, was infected with herpes B virus (Herpesvirus simiae) and died as a result.¹

Any situation similar to this would cause fear and anxiety in most research professionals. However, by taking the proper steps risks can be minimized. In our final article on our model program based on the OSHA standard for blood-borne pathogens,² we address exposure incidents and postexposure prophylaxis (i.e., what to do after an exposure incident). In addition, we discuss waste handling, housekeeping and laundry, and personal protective equipment (PPE), along with a few other issues.

So far in this series we have emphasized the Golden Rule of BBP—using universal precautions³—which assumes that all fluids are infectious and avoids contact by use of appropriate PPE. So far we have covered:

Knowing which tissues/materials present the most risk
Recognizing the potential exposure routes—mucous membranes of eyes, nose, and mouth; skin (especially non-intact skin); and inhalation, in certain instances
Developing an exposure control plan (ECP)—determining exposure; communicating hazards to employees; and engineering controls, work practices, and recordkeeping.

This month we wrap up the ECP discussing housekeeping, laundry, waste handling, and PPE. And we finish off with exposure incident/postexposure procedures.

Let’s begin with the easy stuff, housekeeping and laundry. The housekeeping section of the OSHA standard basically states that the employer must implement a written schedule for cleaning and decontamination ensuring that the worksite is maintained in a clean and sanitary condition. This is good practice for all laboratory facilities. We should include all equipment and working surfaces and ensure that they are cleaned and decontaminated on a regular schedule, such as at the end of the work shift and after contact with blood or other potentially infectious materials (OPIMs). Spills of blood or OPIM should be cleaned up immediately or as soon as practical.

Appropriate disinfectants—for example, 10 percent bleach solutions or the equivalent—should always be used. One very important thing to remember is that any potentially contaminated broken glassware should not be cleaned up by hand but by using tongs, forceps, brushes, dustpans, or other mechanical means. Contaminated laundry is always placed and transported in bags or containers that will prevent fluids from soaking through and/or leaking to the exterior. The key is that these procedures are included in the written ECP and are monitored in order to guarantee they are being followed.

Handling of contaminated waste is a critical component of preventing pathogenic infections and of the written ECP. Our previous articles discussed proper handling of contaminated sharps. You may recall that used, contaminated sharps such as needles and scalpels should be placed in labeled or color-coded containers that are puncture- resistant, closable, and leakproof. Take care to ensure that these containers are not overfilled, replacing them when they approach 80 percent of capacity, for example. In addition to contaminated sharps, other waste we should include in our model program and handle carefully are liquid or semiliquid blood or OPIM, contaminated items that would release blood or OPIM if compressed, items that are caked with dried blood or OPIM and are capable of releasing these materials during handling, and pathological and microbiological waste containing blood or OPIM. Like sharps, this waste must be collected and transported using containers meeting the same requirements as for contaminated sharps.

Whenever there is the possibility for occupational exposure to potentially infectious material, the employer must provide appropriate personal protective equipment to the employee at no cost. Typical PPE used by research scientists includes gloves, coveralls, lab coats, gowns, and eye protection such as eyeglasses, goggles, face shields, and masks. OSHA considers PPE appropriate if it does not permit infectious materials to pass through to or contact an employee’s clothes, skin, or mucous membranes during normal conditions of use. The employer must also ensure that proper PPE is readily available, repaired and replaced as needed, and laundered as required. Most important, the employer has a responsibility to make sure proper PPE is being used. Another key item for the research professional to keep in mind is that PPE is always removed prior to leaving the work area.

Remember our opening incident? Here is where we find out what to do after an exposure. OSHA defines an exposure incident as contact during performance of employee duties with blood or other potentially infectious material by eye, mouth, mucous membrane, or non-intact skin and any piercing, cut, or abrasion of these routes. However, unlike with human pathogens, dealing with animal or other pathogens may require exceptional and specific prophylaxis. First and foremost, you must know what you are dealing with and follow the most current recommended procedures for the specific agent involved. Immediately upon discovery, follow appropriate steps to clean or wash the wound. The next action is to report the exposure incident to your supervisor or employer. Following an exposure incident, the employer must provide the exposed employee a confidential medical evaluation as soon as feasible and appropriate medical follow-up as prescribed by a health care professional (HCP). An important key to the medical evaluation and follow-up is to provide information regarding human pathogenic infectivity of the specific agent or source material. With this information the HCP will establish proper followup based on the most current guidelines from the United States Public Health Service.⁴ All medical evaluations, medically indicated follow-up, and counseling are provided at no cost to the employee. During the medical evaluations and follow-up and all the reporting that goes with them, remember to ensure that the employee’s medical confidentiality and compliance with the Health Insurance Portability and Accountability Act are maintained.