BIOLOGICAL HAZARDS

…health hazards
associated with
exposure to
biological agents
Definitions

 Biohazard – organisms or products of

organisms that present a risk to humans
 Organism – a living thing, such as a germ,
plant, animal, or human that may consist of
several parts, with each part specializing in a
particular function
 Microorganism – a minute organism, such as
microbes, bacteria, cocci, viruses, molds, etc.
Definitions

 Bloodborne Pathogens - pathogenic

microorganisms that are present in human
blood or other potentially infectious materials
and can cause disease in humans
 Pathogens include but are not limited to:
Hepatitis B
HIV – human immunodeficiency virus
OSHA STANDARD

 29 CFR 1910.1030, Occupational Exposure to

Bloodborne Pathogens
 Published December 1991
 Effective March 1992
 Scope
– ALL occupational exposure to blood and
other potentially infectious material (OPIM).
Development of Biosafety

 Army at Fort Detrick – Frederick, Maryland

– Researching biological warfare agents
 1941 – Chemical Warfare Services
– American Society of Microbiology served as advisors to CWS
 1970’s – Recombinant DNA technology
 1980’s - Appearance of HIV
 1991 – OSHA’s Bloodborne Pathogens Program (29
CFR 1910.1030)
Why the concern?

 Hepatitis B

HIV/AIDS
RECENT INCREASED AWARENESS
OF BIOHAZARDS

 Newest subset of focus

 Contributing to awareness
Legionnaires’ disease
AIDS epidemic
rDNA technology
anthrax
 Specialists exist but their
numbers are small
 S/H/E professionals have
become involved
Occupational hazards…
 Healthcare
– Hepatitis, tuberculosis, infections
– Infections categorized as:
Community acquired – transmitted to
either patients or workers
Occupationally acquired – resulting from
worker exposure
Nosocomial – hospital-acquired infections
of patients
Occupational hazards…
 Research facilities
– Q fever, hepatitis, typhoid fever, tuberculosis,
dermatomycosis
– Percutaneous inoculation (needles/syringes, cuts
or abrasions from contaminated items, and
animal bites/scratches); inhalation of aerosols,
contact between mucous membranes and
contaminated material (hands and surfaces), and
ingestion
 Occupational hazards…

 Agriculture
– Workers may be exposed to infectious
microorganisms that are associated with the
plants or animals
– Food and grain handlers, farmers, laborers – may
be exposed to parasitic diseases
– Processors who handle animal products – may
acquire bacterial skin diseases from working with
contaminated hides, infected with contaminated
fish, meat or poultry, Bacterial infections from
exposure to feces from infected turkeys, geese,
ducks, etc.
Occupational hazards…
 Animal facilities/Veterinary practices
– Bites, scratches, parasites, diseases,
allergens

 Biotechnology facilities
– Genetically engineered bacteria, fungi,
plant and animal cells for development of
products
Occupational hazards…
 Miscellaneous occupations
– Workers maintaining water systems (legionella);
pet shops; zoos; wood-processing facilities
(fungi); sewage workers (bacteria, virus,
parasites); forestry workers (Rocky Mountain
spotted fever, lyme disease, viruses and
bacteria from ticks, fungi); child care workers
(bacteria (shingles), viruses (measles,
chickenpox); public safety workers (bloodborne
pathogens, viral respiratory diseases
(influenza).
Biohazards are…

 Inherently different
from chemicals,
physical agents,
carcinogens, etc.
 BUT, recognition,
evaluation and
control still can be
applied
 Biological materials typically…..

 Have no threshold level of exposure, i.e., dose and

response relationship
 Are ubiquitous in the environment so the idea of
“permissible exposure limits” is inappropriate
 Are affected by biological competition rather than
behaving in an additive or synergistic way
 Interact with the host and its environment to produce
the adverse effects
 For illness to occur…..

 The agent must be pathogenic.

 There must be a reservoir of sufficient
number.
 The agent must escape the reservoir.
 The organism must be able to move
through the environment.
 There must be a portal of entry for the host.
 The host must be susceptible to the agent.
Factors affecting infection and
exposure
 Modes of transmission
– Contact (direct/indirect, zoonotic); vector-borne, airborne
 Routes of entry
 Infectious dose (infective dose)
– Number of microorganism
 Viability and virulence of agent
– Viability - Ability to replicate
– Virulence – Ability to cause disease
 Host susceptibility
– Skin disorders, immune system, vaccination allergy,
infection of fetus, work practices
 Classification of Biohazards
 Microorganisms  Allergens
– Examples: viruses, – Examples: from higher plants
bacteria, fungi, protozoa, – Reactions: Dermatitis,
algae rhinitis, asthma
– Reactions: infection,  Protein Allergens
exposure, allergic – Examples: vertebrate animals
reactions (urine, feces, hair, saliva,
dander)
 Arthropods – Reactions: allergic reactions
– Examples: crustaceans,  Parasites
arachnids, insects – Examples: ticks, hookworms,
– Reactions: skin pinworms
inflammation, allergic – Reactions: skin reaction,
reactions, systemic inflammatory response,
intoxication, transmission allergic reaction
of infectious agents
Some common biological agents

 Bacteria
 Viruses
 Rickettsiae
 Fungi
 Parasites
 BACTERIA

 Simple, one-celled
organisms
 Cocci, bacilli, spirilla
 Some are pathogenic,
some are harmless, some
are even useful
 Broken skin is particularly
vulnerable
 “Food poisoning” in mass
VIRUSES

 Smallest known
organisms
 Living (?) non-cellular
entities
 Are “obligate parasites” &
cannot survive without
living cells
 Common occupational
exposures to animal virus,
poxvirus & arbovirus
 RICKETTSIAE

 Bacteria-like but smaller

 Are obligate parasites
 Transmitted to humans
via bloodsucking
arthropods (fleas, ticks
& lice) or through the air
 Responsible for typhus
and Rocky Mountain
spotted fever
FUNGI

 Broadest spectrum
among biological agents
 Are either parasitic or
saprophytic
 Hypersensitivity due to
inhaled fungal antigens
 Fungal disease is rare
but includes ringworm &
athlete’s foot
 PARASITES

 Parasitic to plants or
animals
 Diseases include
malaria and other
blood and GI infections
 Dermatitis and other
skin-related ailments
due to mites and
chiggers, etc.
Exposure Control Plan: Key Components

 Exposure Determination
 The schedule and method of implementation
for:
– Hepatitis B vaccination and post-exposure
evaluation and follow-up for any exposure.
– Communication of hazards to employees.
– Recordkeeping.
Exposure Control Plan:

 The procedure for the evaluation of

circumstances surrounding exposure incidents:
– Immediate availability for exposed
employees to confidential medical evaluation
and follow-up.
– Documentation of the route(s) of exposure,
and the circumstances under which the
exposure incident occurred.
Methods of Compliance

 Standard (universal) Precautions

– …shall be observed to prevent contact with
blood or other potentially infectious materials.

– …all body fluids shall be considered potentially

infectious materials.
Engineering & Work Practice Control

Purpose - to eliminate or minimize employee exposure:

– Readily accessible hand washing facilities.
– Contaminated sharps management.
– Keeping food and drink out of the work area.
– Procedures involving blood handling.
– Transport of specimens.
– Contaminated equipment.
– CFR 1910.1030 (d)(2)
Hand Hygiene

 Teaching appropriate techniques, make no

assumptions!
 Availability of materials.
 Reinforcing and reminding.
 Monitoring.
 Hand Hygiene is a Continuing Challenge

 Provide alcohol-based hand cleansers in multiple

locations.
 Monitor use by volume replacement and observation.
 When they should be used: if hands are not visibly dirty,
if soap and water are not available.
 Frequent use is recommended, good amount, rubbing
into all surfaces of hands until dry.
 Washing with soap and water: careful technique, 20-30
seconds, if hands are dirty, and after direct contact with
potentially infectious material, after toileting, and when
caring for a patient with a C. Difficile infection.
Resources Available

 Posters, fact sheets….OSHA, CDC, NIOSH

 Reminders are helpful !

 Let’s take on the Challenge!

Personal Protective Equipment

 Shall be used where exposure remains after

institution of engineering and work practice
controls.
 Employer shall provide appropriate PPE at no cost
to employee.
 May include: gloves, gowns, laboratory coats, face
shields or masks, eye protection, mouthpieces,
resuscitation bags, pocket masks, or other
ventilation devices.
PPE....

 Use
 Accessibility
 Cleaning, laundering, and disposal
 Repair and replacement
 Garment penetration
 PPE removal prior to leaving work area
Housekeeping/Environmental Services

 Worksite maintained in clean and sanitary

condition.
 Cleaning and decontamination of items.
 Safe disposal.
Regulated Waste

 Contaminated sharps discarding and containment:

– Approved sharp containers
 Easily accessible
 Upright
 Not allowed to overfill
– Container removal
 Close immediately prior to removal
 Place in secondary container if leakage is possible
– Reusable containers
 Not opened, emptied, or cleaned manually
Regulated Waste

 Other regulated waste containment:

– Closeable, constructed to contain all contents,
labeled or color-coded, closed prior to removal.
– If outside contamination of the container occurs, it
shall be placed in a second container.
 Disposal of all regulated waste shall be in
accordance with applicable regulations.
Contaminated Sharps

 Public Law 106-430

 Signed into law November 2000 – enacted in
2001 – part of OSHA standards.
 “Needlestick Safety and Prevention Act”
 Why? In 2000, it was estimated that over
300,000 percutaneous injuries would occur
involving contaminated sharps.
Contaminated Laundry

 Shall be handled as little as possible:

– Bagged or containerized at the location where it was
used.
– Containers labeled or color-coded.
– Leak proof bags or containers.
 Employer shall ensure that employees who
have contact with contaminated laundry wear
protective gloves and other appropriate PPE.
 Shipping to an off-site facility.
Communication of Hazards to Employees

 Labels and Signs

 Information and Education
• At the time of initial assignment
• At least annually
• When changes occur
• Content and vocabulary appropriate
– to educational level,
– literacy, and language of employees.
....Information & Education

 Provided to all employees who may be at risk

for exposure.
 At no cost.
 Minimum requirements
– CFR 1910.1030 (g)(2)(vii) lists all training
program requirements.
Recordkeeping

 Medical Records
– Shall be maintained for duration of employment plus
30 years.
 Training Records
– Shall be maintained for 3 years from the date of
training.
Why do we not have 100% compliance?

 Lack of training

 Busy, hectic, rushing

 Decreased awareness of hazards

 “won’t happen to me….”

 SUMMARY

 A tremendous variety of biological materials

exists as potential exposure agents.
 Effects of bio-hazardous agents are subtle
and slow in developing.
 There is increasing concern about, and
interest in, biological materials.
 Bottom-line: biohazards are (and must be)
treated with extraordinary caution.