BIOHAZARD COMMUNICATI

Anondho Wijanarko

BIOLOGIC TOXINS WITH BIOTER

BIOHAZARD
DEFINITION
1. A biological agent, such as an
infectious
microorganism,
or
a
condition that constitutes a threat to
humans, especially in biological
research or experimentation.
2. The potential danger, risk, or harm
from exposure to such an agent or
condition.
MEANING
1. any bacterium or virus or toxin that
could be used in biological warfare

BIOLOGICAL HAZARD SIGNS.

The biological hazard warning shall

be used to signify the actual or

potential
presence of a biohazard
and to
identify
equipment,
containers,
rooms,
materials,
experimental
animals,
or
combinations thereof, which contain,
or are contaminated with, viable

Bacillus
anthracis

Smallpox

day 1

day 2

Chickenpox
Gram strain of
Yersinia pestis

THE COWPOCK BY JAMES GILRAY, 180

Biohazard
ASSIGNMENT
RiskOF
Level
PATHOGENS
1:
TO
E. coli
BIOHAZARD
RISK
LEVELS
1-4
Unlikely pathogenicity to humans
No community risk
Biohazard Risk Level 2:
Hep. A
Possible pathogenicity to humans
Unlikely community risk
Biohazard Risk Level 3:
YF, Hep. C*
Serious pathogenicity to humans
Moderate community risk
Usually prophylaxis / treatment
Ebola,
Biohazard Risk Level 4:
smallpox
Serious pathogenicity to humans
High risk of spreading to community
No available treatment or prevention

BIOTERRORISM THREATS
Anthrax
Plague
Tularemia
Smallpox
Brucellosis
Q

fever
Cholera

Venezuelan

equine

encephalitis
Ebola, Lassa,
Marburg
Botulinum toxin
Staphylococcus
enterotoxin B

Agents of Highest Concern

Category A

Bacillus anthracis (Anthrax)

Francisella tularensis (Tularemia)
Yersinia pestis (Plague)
Clostridium botulinum (Botulism)
Variola major (Smallpox)
Viral Hemorrhagic Fevers

Other possible agents

Category B

Brucella species (Brucellosis)

Burkholderia mallei (Glanders)
Burkholderia pseudomallei (Melioidiosis)
Coxiella burnetti (Q-fever)
Arboviruses
Mycotoxins
Ricin toxin (castor beans)
SEB (Staphylococcus Enterotoxin B)

Why these Organisms?

Can cause disease via aerosol route

Fairly stable in aerosolized form
Susceptible civilian population
High morbidity and mortality rates
Difficult to diagnose and/or treat
Some can be transmitted person-toperson

HIGH CONSEQUENCE THREATS

Engineered organisms
Smallpox
Anthrax
Bulk
Food
Contam
Cutaneous
Anthrax
Salmonella
Food
poisoning

Agro Terror

ANTHRAX

ANTHRAX

The anthrax bacteria live in two forms

The growing bacterium -- the weapon
causes disease because it produces very
potent toxins (poisons)

The dormant spore -- the vehicle

spreads by air
extremely resistant to many challenges
can survive in the environment fo
decades
Ingested
by animals (herbivores) while
grazing
Humans are infected
through contact with infected animals and
their products
because of human intervention

Bacteria make the poison

Bacillus
anthracis
Name:

Bacteria
multiply
inside the body
Bacteria
produce
toxins (poisons) that
cause disease

Spores
are
infectious -- but
they
are
not
in a living
made
Spores
are
body
extremely sturdy

IMPORTANT POINTS
Anthrax
is
not
transmitted from person
to person
Spores
can sustain lots of
stresses, withstand vigorous
manipulation, last for very
long time

Bacteria are made in the

body and they produce
the killing poisons

Antibiotics block bacteria, but not

the poison. Therefore, antibiotics
must
be
given
soon
after
suspected exposure

Spores must have a

certain, small size to
reach the lower part of
the respiratory tree -they tend to clump

Very challenging to produce large

stocks of spores of small size to
optimize
infection
(so-called
weapon-grade)

Spores, once deposited,

tend to stay on the ground

Risk of air-borne infection from

deposited spores is low

It takes ~ 10,000 spores

to initiate an infection

Anthrax tends to be rare, even

where soil is contaminated

HOW CAN A PERSON

INFECTED WITH ANTHRAX
Spores

are inhaled

Inhalation

Spores

anthrax

enter skin through small

lesions
Skin

(cutaneous) anthrax

Spores

GET

are ingested

Gastro-intestinal

(GI) anthrax

INHALATION ANTHRAX -BY AIR

INHALATION ANTHRAX -SYMPTOMS

Initial symptoms usually appear a week
from exposure
Illness begins with non-specific, flu-like
symptoms
malaise,
fatigue,
fever,
chest
discomfort, dry cough
Abrupt
appearance
of
respiratory
distress
severe breathing problems and shock
Chest radiograph may show swelling of
the soft tissues in the middle of the

INHALATION ANTHRAX -- A
CHEST X-RAY

Inhalation anthrax -- the

outcome

As of 11/21/2001, six of 11 patients with

inhalation anthrax have survived

Prompt recognition of the early features

of inhalation anthrax is important

If untreated, the disease is generally

fatal within 24 to 36 hours after the
onset of severe symptoms

Source: Centers for Disease Control

SKIN ANTHRAX

most commo

Anthrax by contact
Usually
affects
exposed
skin least common
areas,such as arms,
hands, face, neck
About
20%
of
untreated cases of
skin anthrax result
in death

Skin Anthrax

Lesions
usually
appear within a
week
from
exposure
Starts as a raised
itchy bump that
develops into a
vesicle and then a
painless ulcer
The
main
characteristic
is
the black area at
the center of the

Gastrointestinal Anthrax
Anthrax by consumption of
contaminated food
Initial symptoms are nausea, loss of
appetite, vomiting, and fever
Later symptoms are abdominal pain,
vomiting of blood, and severe diarrhea
In some cases, symptoms are swelling
and gland enlargement in the neck,
accompanied by difficulty to swallow
and to breath
About 25%-60% of untreated cases

How can we tell ..

that

it is anthrax?

By

recognizing clinical signs and

symptoms
By recovering spores from nasal
swabs
By identifying anthrax bacteria from
nasal swabs, infected tissues or body
fluids
that

person A and person B have

been infected by the

WHAT CAN DOCTORS DO

TO CONTROL ANTHRAX?
Use

antibiotics (after suspected

exposure)

Use

a vaccine (usually before

exposure)

Antibiotics and anthrax

There

are three types of antibiotics

approved for anthrax
Ciprofloxacin

(fluoroquinolone)
Doxycyclin (tetracycline)
Amoxicillin (penicillin)
Source: Food and Drug Administration

POST-EXPOSURE
PROPHYLAXIS
Indicated to prevent inhalation

anthrax
after a confirmed or suspected aerosol
exposure

Initial therapy with ciprofloxacin or

doxycycline is recommended for all
adults and children
Use of tetracyclines and
fluoroquinolones in children has
adverse effects
As

soon as penicillin susceptibility of

the organism has been confirmed,
prophylactic therapy for children
should be changed to amoxicillin

THE ANTHRAX
VACCINE
The current US vaccine

for human use is a

cell-free filtrate vaccine, i.e., it contains no
dead or live bacteria
Multiple immunizations are required
Six doses: 0-2-4 weeks and 6-12-18
months
Yearly boosters are given to maintain
immunity
Limited information on efficacy
(how
In
protective)
the US, anthrax vaccination is
for
recommended
Limited
information
on safety
(side
People
who work directly
with
theeffects)
Problems
organism
with
in the
production
laboratory
and quality control
Veterinarians who handle potentially
reported
infected animal products
All U.S. military personnel (since 1998)
Pregnant women should be vaccinated only

SMALLPOX,
Variola major

SMALLPOX,
Variola major

Clinical
Orthopox virus
symptoms
DNA virus
Acute
Brick-shaped structure
Fever
200 nm in diameter
Heada
Incubation 8-16 days
che
Mortality
30%
Smallpox
Rash
Vomiti
Rash
Begins on face, hands, forearmsng
&
Backa
spreads to lower extremities within
che
7 days

Synchronous
progression:
Lesions on palms
& soles of feet
maculesvesicles pustules
scabs

Smallpox, disease

Smallpox, disease

Smallpox,
disease

PLAGUE
Yersinia pestis
Distribution
Highest

in 4 corners area Western

states
Prairie dog population

PLAGUE
Yersinia pestis

Transmission
Inhalation
Direct contact
Fleas

PLAGUE, Clinical presentations

Bubonic
Flu-like

with
painful buboes
(lymph nodes)

Septicemic
Similar

to
bubonic
No swelling of
lymph nodes

PLAGUE
Pneumonic
Highest

mortality
Rapid
transmission
Fever
Hemoptosis
Lymphadenopat
hy
Cough

BIOLOGIC TOXINS WITH

BIOTERRORISM
POTENTIAL
Biological Agents
of Highest Concern
Category A Agents
Botulinum toxin (Botulism, BOTOX)

Biological Toxins of 2nd

Highest Concern

Category
B
Agents
Ricin toxin from Ricinus communis
(castor bean)
Epsilon toxin from Clostridium
perfringens
Staphlococcus enterotoxin B

Clostridium Botulinum
C. botulinum spores found in soil worldwide
Toxin causative agent of botulism
Types
A-G; A,B&E most commonly
associated with human disease
Most potent toxin known (lethal dose
1ng/kg)
Inactivated by chlorine (~20min) and
sunlight (1-3hrs); destroyed by heat
(5min at 85C)
Absorbed into circulation via mucosal
surface or wound, not intact skin

BOTULISM,
ENVIRONMENTAL
DECONTAMINATION
Botox
(botulism)
is
a
white
crystalline substance in its pure
form. The route of exposure and
subsequent decay rates determine
the environmental decontamination
required.
Aerosolized
botox
is
susceptible
to
environmental

BOTULISM AND
BIOTERRORISM

Weaponized by former U.S. and Soviet

offensive BW programs
Iran, Iraq, N. Korea, Syria believed to have
developed/be developing toxin as a
weapon
Therapeutic botox impractical BT weapon
Licensed vial of type A only 0.3%
estimated human lethal inhalational
dose

BOTULISM, CLINICAL
FORMS

Food-borne
Toxin produced anaerobically in
improperly processed or canned,
low-acid foods contaminated by
spores
Wound
Toxin
produced by organisms
contaminating wound
Infant
Toxin produced by organisms in
*3 accidental cases in veterinary personnel,
intestinal tract
Inhalation botulism

Clostridium botulinum,
EPIDEMIOLOGY
Approximately 100 reported cases
botulism/year in the U.S.
Infant most common (72%)
Food-borne not common
Incubation (food-borne): 12-72 hrs
(range 2hr-8d)
Dose dependent
Could be less following a BT attack
No person-to-person transmission
Death 60% untreated; <5% treated

BOTULISM: CASE DEFINITION

Ingestion of botulinum toxin results in

an illness of variable severity.
Common symptoms are diplopia,
blurred vision and bulbar weakness.
Symmetric paralysis may progress
rapidly.
Laboratory* criteria for diagnosis:
Detection of botulinum toxin in
serum, stool or patients food
(food-borne)
or
other
clinical
specimen (botulism, other) OR
*Assay
available
CDC & some
Isolation
of at
Clostridium
botulinum
state
labs
from public
stool health
(food-borne)
or other
MMWR 1997;46(RR-10
clinical specimen

BOTULISM: CASE

CLASSIFICATION
Botulism, Food-borne
Probable:

Clinically compatible with

an epidemiologic link
Confirmed: Clinically compatible case
that is laboratory confirmed or that
occurs among persons who ate the
same food as persons who have
laboratory-confirmed botulism
Botulism, Other
Confirmed: Clinically compatible case
*age parameter
not apply
in BT in a
that ismay
laboratory
confirmed
patient 1 yr* who
has no
history of
MMWR
1997;46(RR-1
ingestion of suspect food and has no
wounds

Clostridium Botulinum,
PATHOGENESIS
Toxin

absorbed into circulation via

mucosal surface or wound, not
intact skin

Binds

acetylcholine
receptor
irreversibly and blocks release of
acetylcholine into neuromuscular
junction

BOTULISM, CLINICAL
PRESENTATION
Acute, afebrile, symmetric descending
flaccid paralysis
Always begins in bulbar musculature -->
cranial nerve palsies
Skeletal muscle paralysis follows
Respiratory failure can occur in as little as
24 hours
Clear sensorium: sensation and mental
status normal
Afebrile patient

BOTULISM, CLINICAL
PRESENTATION

Gastrointestinal symptoms
May precede neurological symptoms in
food-borne botulism
Thought
to be secondary to other
substances contaminating the food
May not occur in BT attack

Autonomic effects dry mouth,

constipation, urinary retention

ileus,

BOTULISM, SYMPTOMS
Diplopia

Fatigue

Blurry

Dizziness

vision
Dyspnea
Dysphagia
GI
Dysarthria

symptoms

BOTULISM, SIGNS
Ptosis (drooping
of the upper
eyelids)
Gaze
Fixed

paralysis

or
dilated pupils

Diminished

gag reflex

Tongue

weakness

Arm

and leg
weakness

BOTULISM,
DIFFERENTIAL
Condition
Features that distinguish
DIAGNOSIS condition from botulism
Guillain-Barre and
variants

Myasthenia gravis
Stroke

*Electromyogram

H/o antecedent infection;

paresthesias; often ascending
paralysis, early areflexia;
eventual CSF protein increase;
EMG* findings
Recurrent paralysis; EMG
findings; sustained response to
anticholinesterase therapy
Paralysis often asymmetric;
abnormal CNS image
Source: Arnon et al. JAMA 2001;285:1059-1070

BOTULISM,
DIFFERENTIAL
Condition
that distinguish
DIAGNOSIS Features
condition from botulism
Intoxication with depressants

H/o exposure, excessive drug

levels in body fluids

Lambert Eaton syndrome

Increased strength with sustained

contraction; Evidence of lung
carcinoma; EMG findings similar
to botulism

Tick paralysis

Paresthesias; ascending paralysis;

tick attached to skin

BOTULISM, DIAGNOSIS
Exclusionary

tests to rule out

other causes
Normal

CSF
Edrophonium (Tensilon test)
Reverses paralysis in
myasthenia gravis
May have false positive with
botulism
Normal imaging

BOTULISM, TREATMENT
Ventilatory
assistance
and
supportive care
Recovery
depends
on
regeneration of new motor
axons and may take weeks to
months
Botulinum antitoxin
Most effective if given early:
does not reverse action of
already-bound toxin
Trivalent
equine
product
against types A,B, and E

BOTULISM, TREATMENT

Botulinum antitoxin
Single 10ml vial per patient,
diluted 1:10 in 0.9% saline &
administered by slow IV
infusion
Screen for hypersensitivity
before administering equine
antitoxin and desensitize if
necessary
Monitor closely during
treatment
Diphenhydramine and
epinephrine on hand to treat

BOTULISM, TREATMENT
Ventilatory assistance and
supportive care
Standard precautions
Botulinum antitoxin
Most effective if given early:
does not reverse effect of toxin
already
bound
to
nerve
receptor
Trivalent
equine
product
against types A,B, and E
currently available from CDC

BOTULISM, PROPHYLAXIS
Pre-exposure
Prophylaxis
for at-risk lab
workers and military with
investigational vaccine
No
pre-exposure prophylaxis
recommended
for
general
public
Post-exposure: close monitoring
of those exposed; treat with
antitoxin at first signs of illness

BOTULISM,
DECONTAMINATION
Wash

exposed surfaces with

soap and water.

Decontaminate

environmental surfaces with

0.1% bleach solution, if
necessary.
Without

intervention, toxin will

degrade or dissipate over hours
to days.

BOTULISM, SUMMARY

1. Botulism presents as symmetric bilateral

OF KEY
weakness
or POINTS
paralysis with cranial nerve
abnormalities and a clear sensorium.
2. Inhalational botulism does not occur naturally,
and any potential cases suggest a deliberate
source of infection.
3. Gastrointestinal symptoms may not occur with
inhalational botulism or with food-borne botulism
(e.g., resulting from deliberate contamination of
the food supply).
4. A careful dietary and activity/travel history is
important when evaluating potential botulism
cases.
5. An outbreak occurring with a common
geographic factor, but with no common food

Ricin
The castor bean plant,
Ricinus communis, is a "native of
tropical
Africa
cultivated
in
several varieties for the oil found
in its leaves and for its bold
foliage
Poisoning by ingestion of the
castor bean is due to ricin in the
bean
Extracted castor oil does NOT
contain ricin

RICIN POISONING
Accidental exposure to ricin is
highly unlikely.
Exposure
Inhalation.
Contamination of water or food.
Injection
If injected as little as 500 mg
could kill an adult.
A 500-microgram dose of ricin
would be about the size of the
head of a pin.
Much more needed to kill if

RICIN POISONING
The symptoms are:
abdominal pain
vomiting
diarrhea, sometimes bloody.
Within several days there is:
severe dehydration,
a decrease in urine,
and a decrease in blood
pressure.
If death has not occurred in 3-5
days, the victim usually recovers.
Children are at high risk

MANAGEMENT OF
RICIN POISONING
Decontamination
Supportive medical care
depending on route of exposure
Ventilation
Intravenous fluids
Management of seizure and low
blood pressure
Activated charcoal if the ricin
very recently ingested
Flushing eyes if irritated

South Carolina Area Health Education Consortium

Disease

SUMMARY - CATEGORY A
CRITICAL AGENTS
Transmit
Man to
Man

Infective Dose*
(Aerosol)

Incubation
Period

Duration of Illness

Approx. case
fatality rate

Inhalation
anthrax
Pneumonic
Plague

No

8,000-50,000
spores
100-500
organisms

1-6 days

3-5 days (usually

fatal if untreated)
1-6 days
(usually fatal)

High

Tularemia

No
High

2-10 days
(average 3-5)
7-17 days
(average 12)

> 2 weeks

Smallpox

Viral
Hemorrhagic
Fevers

Moderate

10-50
organisms
Assumed low
(10-100
organisms)
1-10 organisms

2-21 days

Death between
7-16 days

Botulism

No

0.001 g/kg is
LD50 for type A

1-5 days

Death in 24-72
hours; lasts
months if not
lethal

High

2-3 days

4 weeks

High unless
treated within 1224 hours
Moderate if
untreated
High to moderate
High for Zaire
strain, moderate
with Sudan
High without
respiratory
support

us dose may be less in certain circumstances

Modified from: USAMRIIDs Medical Management of

Occupational Exposure to
Bloodborne Pathogens
BIOHAZARD

Scope and Application *

The Standard applies to all occupational
exposure to blood or other potentially infectious
materials (OPIM).

What is occupational exposure?

Reasonably anticipated skin, eye, mucous membrane, or parenteral
contact with blood or other potentially infectious materials
that may result from the performance of an employees duties;

Who is covered by this standard?

Parenteral
The standard covers all employees who could
be
reasonably expected to come into contact with
human blood and OPIM in the course of their work.

Literally, entry into the body by

any other route than the
mouth/digestive system; typically,
this takes the form of needlesticks,
cuts and abrasions.
This definition includes human bites
that break the skin, which are most
likely to occur in violent situations,
e.g., prison and law enforcement
personnel, psychiatric ward workers.

* Full rule located on the web at:

http://www.cbs.state.or.us/external/osha/pdf/rules/division_2/div2z-1030-bloodborne.pdf

Blood means human blood, components and products of human blood.

Definitions
BIOHAZARD

Bloodborne Pathogens

Pathogen:

An agent of disease; pathogens include bacteria such

as staph, viruses such as HIV, and fungi such as
yeast.
The term "pathogen" was devised about 1880 and was
compounded from patho- meaning disease + gen
indicating a producer = a producer of disease.

Pathogenic micro-organisms in human blood that can cause disease

While HIV, HBV and HCV are specifically named, the term includes any pathogenic microorganism that is present in human blood or OPIM and can infect and cause disease in
persons who are exposed to blood containing the pathogen.

Other Potentially Infectious Materials (OPIM) include:

1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.

Human blood components and/or products

Semen
Vaginal secretions
Cerebrospinal fluid
Synovial fluid (joints)
Pleural fluid (chest)
Pericardial fluid (heart)
Peritoneal fluid (abdomen)
Amniotic fluid (childbirth)
Saliva in dental procedures
Any body fluid that is visibly contaminated with blood
Any fluids in which differentiation of body fluid types is
difficult or impossible

Bloodborne Infectious Diseases...HIV/AIDS

What is HIV?
HIV (human immunodeficiency virus) is the virus that causes AIDS.
Passed from one person to another through blood-to-blood and sexual contact

BIOHAZARD

Infected pregnantwomen can pass HIV to their babies during pregnancy or delivery, as well as through
breast-feeding.
People with HIV have what is called HIV infection. Most of these people will develop AIDS as a result of
their HIV infection.

What is AIDS?

AIDS stands for Acquired Immuno-Deficiency Syndrome.

Caused by the HIV virus

The HIV virus destroys a certain kind of blood cells CD4+ T cells (helper cells) which are crucial to the
bodys immune system.
The immune system is weakened to the point that it has difficulty fighting off certain infections. These
types of infections are known as "opportunistic" infections because they seize the opportunity a
weakened immune system provides to cause illness.

What body fluids transmit HIV?

These body fluids DO SPREAD
the HIV virus...:

These body fluids MAY SPREAD

the HIV virus

blood
semen
vaginal fluid
breast milk
other body fluids containing blood

Cerebrospinal fluid
Synovial fluid
Amniotic fluid

BIOHAZARD

Bloodborne Infectious Diseases...Hepatitis B Virus

What is hepatitis B?
Hepatitis B is a germ

(virus) that gets into your

body and attacks your
liver.
Your liver helps your body
digest the food you eat.

It also helps your body

get rid of poisons.

Bloodborne Infectious Diseases...Hepatitis B Virus

BIOHAZARD

How do you get hepatitis B?

It is passed by contact with the
blood or other body fluids of
someone who has the virus.

Hepatitis B...
100 times easier to
catch than HIV!
Get vaccinated
against this disease!

There are 3 main ways to get

hepatitis B:
Having sex without condoms
with someone who has the
hepatitis B virus
Being born to a mother who
has the virus

Will I die from hepatitis B?

Most people (9 out of 10)

recover from HBV, but some do
not. Recovery usually results in
lifetime immunity.

Hepatitis B sometimes causes

liver
damage
(cirrhosis)
that does not go away.

It can also
cancer,
which
to death.

Good medical care can make

your risk less for these.

cause
may

liver
lead

Sharing needles and syringes

BIOHAZARD

Bloodborne Infectious Diseases...Hepatitis C Virus

What is hepatitis C (HCV)?

The most common chronic bloodborne
infection in the United States (CDC)

In about 85% of the cases the infection is

permanent, and people infected become
chronic carriers.

The number one cause

transplants in the U.S.

of

liver

How is Hepatitis C spread?

Primarily through large or repeated direct percutaneous (via blood vessels) exposures to human blood,
i.e., injecting drug use
blood and blood product transfusion prior to 1992 (very rare since 1992)

Bloodborne Infectious Diseases...Hepatitis C Virus

BIOHAZARD

Occupational Transmission of HCV

Inefficiently transmitted by occupational exposures
Case reports of transmission from blood splash to eye
No reports of transmission from skin exposures to blood
Post-exposure prophylaxis with HBIG is not generally effective in preventing Hepatitis C.

Health Care Personnel (HCP)- toPatient Transmission of HCV

Rare; prevalence 1-2% among health

care workers

Hepatitis B
Immune Globulin

In U.S., none related to performing

invasive procedures

Most appear related to HCW substance

abuse

Other Transmission Issues

HCV is not spread by kissing, hugging,

sneezing, coughing, food or water,
sharing eating utensils or drinking
glasses, or casual contact.

RECAP: DISEASES TRANSMITTED IN BLOOD

BIOHAZARD

Hepatitis B virus

Hepatitis B infection can cause cirrhosis and is the leading cause of liver cancer in the
world. The virus is extremely infectious and can stay alive in dried blood for up to a year.
Only 10 percent of infected adults become chronic carriers, but 60 percent to 90 percent of
infected children under 1 year old end up with a chronic condition. The-fourth of chronic
carriers eventually die of
liver cancer or cirrhosis. An effective three-shot vaccine
has been available since 1982.

Hepatitis C virus

Also attacks the liver. More than 80 percent of those infected become chronic carriers, and
one-fifth of those will develop cirrhosis within 10 to 40 years. A smaller percentage
develop liver cancer. The first test for the virus became available in 1989, so much is still
unknown about the disease. There is no vaccine. Treatment with interferon is expensive,
limited to adults and effective in less than 20 percent of cases.

HIV, also known as the AIDS virus

Chance of getting
hepatitis B from a
syringe infected
with the hepatitis
B virus

30%

Chance of getting
hepatitis C from a
syringe infected with
the
hepatitis C virus

3%-5%

The AIDS virus attacks the immune system, allowing other diseases to develop.
AIDS was considered fatal until a recent combination of new drugs led to a
dramatic
drop
in
the
death
rate
in
the
United
States.

HIV is transmitted primarily through sexual contact. Transmission risk from a

needle is low..

More than 20 other infections can be transmitted

through contaminated needles, including:

Syphilis, malaria, streptococcal and staphylococcal sepsis, Dengue fever,

human T-lymphotropic virus Type 1, Rocky Mountain spotted fever, herpes,
hepatitis D and G, babesiosis, brucellosis, leptospirosis, arboviral infections,
relapsing fever, Creutzfeldt-Jakob disease and viral fevers caused by Ebola.

Chance of
getting HIV
from a syringe
infected with
the HIV virus

0.3%

BIOHAZARD

Regulated Waste

What is Regulated Waste?

Liquid or semi-liquid blood or OPIM
Contaminated items that would release
blood or OPIM in a liquid or semi-liquid state if
compressed

HOW DO I DECIDE WHETHER

SOMETHING IS REGULATED WASTE?*

Items caked with dried blood or OPIM that

are capable of releasing these materials
during handling

The compliance officer should not use the actual volume

of blood as the determining factor as to whether or not a
particular material is to be considered regulated waste.
While 10ml. of blood on a disposable bed sheet would
appear as a spot (not regulated waste), the same amount
of blood on a cotton ball would likely cause saturation and
dripping (and hence would be considered regulated
waste).

Contaminated sharps

Pathological and microbiological wastes

containing blood or OPIM

Similarly, an item may adequately contain these materials

when in a static state yet liberate them when compacted
in the waste container.
Instead the compliance officer should consider the
potential for dripping of liquid blood or OPIM, or flaking off
of dried blood or OPIM.

* Excerpt from Inspection and Citation

Guidelines used by the compliance officer

BIOHAZARD

Regulated Waste continued...

Needles must be disposed of in
a sharps container.

Sharps containers must be:

Improperly disposed needles

can injure housekeepers,
custodians and other people.

Closeable
Puncture resistant
Leakproof

Laundry

Labeled or color-coded

Contaminated laundry must be

handled as little as possible with a
minimum of agitation. It must be:

During use, containers must be:

Easily accessible

Bagged/containerized
where used

Maintained upright
Replaced routinely (no overfill)

When moved, containers must be:

Closed immediately

If leaking,
container

If reusable, opened, emptied,

cleaned in a manner that will not
expose employees

put

in

secondary

Not sorted/rinsed
where used
Placed/transported in
labeled or
color-coded
bags or containers
Placed/transported in
leak-proof bags or
containers if leaks likely
Employees must wear
proper PPE.

Hepatitis B Vaccination
BIOHAZARD

General

Hepatitis B vaccine and vaccination series

made available to all who have occupational
exposure after training and within 10
working days of initial assignment

Employee may decline to be vaccinated,

signed declination statement on file

Employee may change mind at any time,

employer to provide vaccination at no
charge

Employees trained to report exposures

immediately after they occur, particularly
because HBIG, Hep B vaccine and
HIV
PEP
(Post-Exposure
Prophylaxis)
are most likely to be effective if
administered as soon after the exposure as
possible

Post-exposure evaluation and follow-up,

including prophylaxis must also be made
available.
Services to be free to the employee at
a reasonable time and place

performed or supervised by a physician or

other health care professional tests to be
conducted by an accredited laboratory

May personnel service/temporary

employment agencies require as a
condition of employment that prospective
employees obtain the
HepB vaccination on their own?
Yes. Since there is no employeremployee relationship established in
instances
of
pre-employment,
OSHA standards do not apply.

Communicating HazardsTwo methods

BIOHAZARD

1. Labels and Signs

2. Information and Training
Labels
Labels on any containers
containing blood/OPIM
or regulated waste
disposal, refrigerators,
etc.
Labels include this
biohazard symbol
Fluorescent
orange/red

Signs...
Signs posted at
entrance to
specified work areas
Fluorescent
orange/red
bearing the
following legend

Red bags/containers
can substitute for
labels

(Name of the infectious agent)

(Special requirements for entering area)
(Name, phone number of responsible person

Table 1: Labeling Requirements

BIOHAZARD

Biohazard
Red
Item
Label
Container
_______________________________________________________________
Regulated waste container
(e.g., contaminated sharps
containers)

or

Reusable contaminated sharps

container (e.g., surgical
instruments soaking in a tray)

or

Refrigerator/freezer holding
blood or OPIM

Containers used for storage,

transport or shipping of blood

or

Blood/Blood products for

clinical use

X1

Individual specimen containers

of blood or OPIM remaining
at facility

X1

or

Contaminated equipment needing

service (e.g., dialysis equipment;
suction apparatus)

X2

Specimens and regulated waste

shipped from the primary
facility to another facility for service
or disposal

or

Contaminated laundry

X3

or

Contaminated laundry sent to

another facility that does not
use universal precautions

or

_______________________________________________________________
____

No label is needed if universal precautions are used and specific use of container is known to all
employees.
1

Plus a label specifying where the contamination exists.

Alternative labeling or color coding is sufficient if it permits all employees to recognize the
containers as requiring compliance with Universal Precautions.
3

Communicating Hazards: Two methods continued...

BIOHAZARD

2. Information and Training

At no cost and during working hours
At time of initial assignment to risk of exposure
At least annually thereafter; sooner if changes in tasks or procedures occur
Material appropriate to educational level of employee
Covering key concepts in this workbook
Must also cover site-specifics of employees workplace/tasks and procedures
An opportunity for interactive questions and answers with the trainer is a must!
The trainer is expected to be knowledgeable in the subject matter as it relates to the specific
workplace but not necessarily health professional.

Recordkeeping: Four Categories...

BIOHAZARD

1. Medical Records
2. Sharps Injury Log
3. Training Records
4. OSHA 300 Log

Department or work area

where the exposure
incident occurred

Kept confidential
HBV vaccination status

Any medical records sent to/received from

health-care
professional
related
to
HBV
exposure or immunization status
No HIV or other data may be collected
Maintained for duration of employment
plus 30 years

437-002-1035 Oregon Rule

for Sharps Injury Log

The employer shall

establish and maintain (a
log) for the recording of
percutaneous injuries from
contaminated sharps. It
shall contain at a
minimum:
Type and brand of device
involved in the incident

1. Medical Records

2. Sharps Injury Log*

An explanation of how the

incident occurred
Maintained independent of
the OSHA 300 log
Maintained for 5 years

Under Oregons rule, the requirement to keep a sharps

log applies to any employer who is required to maintain
an Exposure Control Program, regardless of the
number of employees.

Recordkeeping: Four Categories continued:

3. Training Records
BIOHAZARD

Dates of training

3. Training Records

Summary of content covered

4. OSHA 300 Log

Trainer name/qualifications
Maintained for 3 years from the date training
occurred

4. OSHA 300 Log

Recordable injuries include all percutaneous events, e.g.,
Needlesticks from bloody needles
Cuts from a sharp, bloody object
Fluids entering through an open wound, broken cuticle, or scrapped/chapped skin
These are considered to be privacy concern cases.
Nonrecordable events include...
Blood on intact skin
Blood on clothing or equipment
Being near an infected person
Touching an infected person

If you have a "privacy concern case, do not enter the employee's name on the OSHA 300 Log.
Instead, enter "privacy case" in place of employee's name.
You must keep a separate, confidential list of case numbers and
employee names for privacy
concern cases in order to update the cases and furnish information to the compliance officer if
asked to do so.
An employer CAN use the 300 log as their sharps injury log, with
the caveat that it must either be
a separate page used solely
for needlesticks or in a way which provides easily extractable
data, such as a computer spreadsheet program.