AIDS was first recognized in the United States in 1981. As of September 1993, the Centers for Disease Control (CDC) has received reports of more than 339,000 cases of AIDS, including 204,000 deaths. Infection with the AIDS virus in the workplace represents a small but real risk to health care workers.

According to a CDC survey, an estimated 300,000 new hepatitis B virus (HBV) infections occur each year in the U.S. Of these 300,000 infected persons, almost one-fourth become acutely ill or jaundiced, about 15,000 are hospitalized, nearly 10% become long-term carriers, and several thousand die from acute and chronic disease. Hepatitis B virus infections occur in about 8,000 to 12,000 health care workers per year and result in over 200 deaths per year due to acute and chronic effects.

In December 1991, the Occupational Safety and Health Administration (OSHA) passed a regulation entitled "Occupational Exposure to Bloodborne Pathogens". This federal law mandates a program of worker protection to eliminate or minimize occupational exposure to HBV, Human Immunodeficiency Virus (HIV) and other bloodborne pathogens. The program consists of a combination of engineering and work practice controls, personal protective equipment, training, medical surveillance, Hepatitis B vaccination and labeling. An important component of the program is the Exposure Control Plan. The plan, which establishes practices and procedures for employees who work with human blood and other potentially infectious materials, must be available to all workers with potential for occupational exposure. To obtain a copy of the University's Exposure Control Plan, call the Office of Environmental Health & Radiation Safety at 898-4453. For more information about the Hospital's Exposure Control Plan, call HUP's Occupational Health Service at 662-2354 or Infection Control at 662-6995.

• A great deal is known about what causes AIDS, how the AIDS virus is transmitted from person to person, and how the AIDS virus can be avoided. What is not yet known is how to cure the disease.

What is Human Immunodeficiency Virus (HIV)?

• AIDS is caused by a virus called HIV, Human Immunodeficiency Virus. If the virus enters a person's bloodstream, it can attack a certain kind of white blood cell that is essential to the proper functioning of the body's immune system, leaving a person susceptible to a variety of life-threatening illnesses. A person who remains in good health after being infected with HIV is capable of transmitting the virus to others, even if he or she exhibits no symptoms.

What is Hepatitis B Virus (HBV)?

• Hepatitis is an inflammation of the liver. There are several types of viral hepatitis (A, B, C, delta and E) but hepatitis B presents the greatest risk to workers in the health care industry. Many people who are infected with HBV never have symptoms. The usual symptoms of acute infections are flu-like; jaundice may occur. Severe HBV infections may be fatal. Chronic carriers of HBV may develop a chronic hepatitis that may progress to cirrhosis, liver cancer, or death. HBV can be transmitted to sexual partners and fetuses.

How are HIV and HBV trasmitted?

• Both HIV and HBV are transmitted by virus-infected fluids, primarily human blood, blood products, semen and vaginal fluids. Of the two viruses, HBV is more easily transmissible. These viruses are not easily spread from person to person. Medical authorities who have studied thousands of cases of AIDS and hepatitis B agree that the viruses are spread in only five ways:
  • 1. Sexual contact involving the exchange of body fluids. Semen and vaginal fluids can transmit either virus.

    2. Sharing IV drug needles with an infected person. Sharing an IV drug needle with someone else can inject either virus directly into the bloodstream.

    3. Transfusion of contaminated blood or blood products.

    4. Contact of contaminated blood with mucous membranes or non-intact skin. The viruses can enter the body through cuts or abrasions.

    5. An infected woman who becomes pregnant can pass either virus to the baby. An HIV-infected woman who breast-feeds may pass the virus to the baby.

Can AIDS or hepatitis B be spread by casual contact?

• HIV and HBV are not generally transmitted through casual contact. There is NO EVIDENCE that the AIDS or hepatitis B viruses are spread by:
  • * sneezing, coughing or spitting

    * touching, hugging, shaking or holding hands

    * toilet seats, bathtubs, showers, swimming pools

    * doorknobs, telephones, linen, clothing, money

    * insects

  NO cases of AIDS have resulted from casual contact. Even when children have played, eaten, slept, kissed and fought with a brother or sister with AIDS, none have become infected.

Should people with AIDS or hepatitis B viruses be allowed to work?

• So long as people diagnosed with AIDS feel well enough to work, they are able to work at no risk to themselves and at no risk to their co-workers or to the public. AIDS is spread through blood or sexual contact. No cases of AIDS have been linked to sharing typewriters, telephones, tools, papers, desks, water fountains, bathrooms, coffee pots or eating facilities. People with hepatitis B may work but should be counselled by their physician or Occupational Health Service regard-ing infection control before returning to work.

What about reports of health care and laboratory workers getting the AIDS virus?

• According to the CDC, a small number of health care workers have been infected with HIV through occupational exposures, and several of these workers have developed AIDS. The highest risk for health care workers appears to be exposure to contaminated blood via a sharp injury, such as a needlestick. The incidence of infection following needlestick injury is less than 0.3%.

Is there a vaccine for the prevention of AIDS?

• To date, no vaccine is available to prevent AIDS and no antiviral drugs are available to cure AIDS. Some drugs, however, have been found to inhibit the action of the virus and others are able to fight certain opportunistic infections. Research is currently underway to develop antiviral drugs and vaccines; however, prevention is currently the only approach to control the spread of the disease.

Is there a vaccine for the prevention of hepatitis B?

• A hepatitis B vaccine is available that is safe and effective in the prevention of HBV infection. This vaccine is strongly recommended for persons at risk of HBV infection including anyone that has contact with human blood, blood products or body fluids. All high risk individuals should be vaccinated. The risk associated with the vaccine is minimal. Free hepatitis B vaccination is available to all occupationally at-risk University personnel. Call 898-4453 for more information. If you are a HUP employee, see your supervisor or call the Occupational Health Service (662-2354) for additional information.

Is information available on how to protect myself against occupational exposure to infectious materials?

• The Office of Environmental Health & Radiation Safety offers OSHA-mandated training on "Occupational Exposure to Bloodborne Pathogens". This training is presented monthly at various University locations. For more information, call 898-4453. Hospital personnel should contact Infection Control at 662-6995.

• Universal precautions include but are not limited to the following do's and don'ts of infection control: Refer to HUP's Infection Control Manual, the School of Dental Medicine's Infection Exposure Control Plan and the University's Biological Safety Manual for more detailed information.

DO:

• WEAR GLOVES for all contact with blood, body fluids, mucous membranes or non-intact skin of all patients and when handling any container or fluid that contains or has any possibility of being contaminated with blood or serum.

  DISCARD GLOVES after working with potentially contaminated materials and when punctured or torn. Do not wash or reuse gloves. Always change gloves between patient contacts.

  WASH HANDS with an antiseptic soap after removing gloves, before leaving contaminated areas and immediately after contact with a patient, with blood or with body fluids.

  WEAR A FLUID RESISTANT GOWN OR COAT that covers your chest and abdomen to prevent contamination of your clothing in the event of a spill.

  WEAR APPROPRIATE FACE AND EYE PROTECTION such as a mask and glasses with solid side shields or a chin-length face shield when splashes, sprays, splatters or droplets of blood or other potentially infectious materials pose a hazard to the eyes, nose or mouth.

  USE POCKET MASKS, RESUSCITATION BAGS or other ventilation devices to minimize exposure that may occur during emergency mouth to mouth resuscitation.

  USE ABSORBABLE/DISPOSABLE BENCH TOP COVERING in areas where serum or blood is used. Disposable pads confine spills and reduce small droplet generation after spills. They should be changed daily or if overtly contaminated.

  DISPOSE OF SHARPS in designated "sharps" containers.

  REPORT TO OCCUPATIONAL HEALTH SERVICE if you incur a needlestick injury or have a mucous membrane or percutaneous exposure to patient's blood or body fluids.

  REPORT TO OCCUPATIONAL HEALTH SERVICE if you have a weeping or a draining dermatitis (skin rash) and you are a health care worker.

IN LABS:

• MANIPULATE INFECTIOUS MATERIALS CAREFULLY to avoid generation of aerosols.

  USE VORTEX MIXING; it creates fewer droplets than does pipette or manual shaking.

  PERFORM AEROSOL GENERATING PROCEDURES IN A BIOSAFETY CABINET that is certified annually and after relocation.

  DECONTAMINATE WORK SURFACES before and after use and immediately after spills.

DON'T:

• DON'T GO to other areas wearing potentially contaminated gloves; do not answer the telephone, use a computer keyboard, or open doors while wearing the gloves.

  DON'T RECAP, BEND, CLIP OR REMOVE NEEDLES FROM SYRINGES prior to disposal. Needles, syringes and other sharps should be discarded in the designated "sharps" containers with as little manipulation as possible. When recapping, bending or removing contaminated needles is required by a medical procedure, use a mechanical means such as a forceps or a one-handed technique.

  DON'T LEAVE NEEDLES on trays, at the bedside or in bed linens.

  DON'T ASSUME THAT ANY PATIENT'S BLOOD OR BODY FLUIDS ARE SAFE.

  DON'T EAT, DRINK, SMOKE OR STORE FOOD in the laboratory.

  DON'T MOUTH PIPETTE under any circumstances.

  DON'T take soiled, contaminated protective clothing home to launder. Use the service provided by your employer.

Dispose of all used sharps in designated "sharps " containers and discard as infectious waste. Used sharps are sharps that have been in contact with infectious agents or that have been used in animal or patient care or treatment. They include : hypodermic needles, syringes (with or without attached needles), pasteur pipettes, scalpel blades, blood vials, needles with attached tubing, culture dishes, suture needles, slides, coverslips and other broken or unbroken glass or plasticware. Sharps containers must be leakproof, rigid, puncture-resistant and tightly lidded. They must display the words "Infectious Waste" and the universal biohazard symbol.

Contaminated fluids (volumes greater than 20cc) must be segregated from other infectious waste and decontaminated prior to disposal into the sanitary sewer system.

• Nurses and physicians have a high incidence of needlestick injuries. Nurses and physicians must practice universal precautions when handling blood or blood products and body fluids. The Hepatitis B vaccine is strongly recommended.

LABORATORY WORKERS

• Occupationally, lab workers have a negligible chance of acquiring HIV infection, but a substantial risk of acquiring HBV infection (10-20% of lab workers handling serum). Lab workers handling human blood, blood products or body fluids must practice universal precautions and are strongly recommended to have Hepatitis B vaccine. For more information, check with your supervisor or department chair.

DENTAL PERSONNEL

• All clinical procedures involving contact with human blood or saliva have the potential for transmitting HIV/HBV. As a routine, dental personnel must follow universal precautions and are recommended to have Hepatitis B vaccination. Refer to University of Pennsylvania School of Dental Medicine Infection Exposure Control Plan.

FOOD SERVICE PERSONNEL

• HIV and HBV are not transmitted through preparation or serving of food or beverages. Food is not a vehicle for transmitting AIDS. All food service workers should observe good personal hygiene and sanitary food-handling procedures.

HOUSEKEEPERS AND PHYSICAL PLANT

• Laboratories handling HIV or HBV will be labeled with BIOHAZARD signs. It is safe to enter areas that are labeled with a BIOHAZARD sign. DO NOT handle anything labeled as biohazardous without special training. Wear gloves and face protection when working in areas such as drains where contact with blood is possible.

SAFETY AND SECURITY PERSONNEL

• Because HIV or are not spread by routine contact, react calmly and rationally when helping someone who may be infected with HIV or HBV. Take precautions when in contact with blood or other body fluids from any person. Wear gloves and keep disposable airway equipment or resuscitation bags available for emergency use. Practice good hygiene including washing your hands frequently. Change uniforms soiled with body fluids as soon as possible.

PREGNANT WORKERS

• Pregnant health care workers are not known to be at greater risk of contracting HIV or HBV that health care workers who are not pregnant; however, if a health care worker develops HBV or HIV infection during pregnancy, the infant is at risk of infection resulting from perinatal transmission. Because of this risk, pregnant health care workers should strictly adhere to precautions to minimize the risk of HIV/HBV transmission. Because of this risk, pregnant and potentially child bearing employee to seek information regarding work related health hazards from the Occupational Health Service, the Office of Environmental Health & Radiation Safety or from her obstetrician.

• Treat all human blood, tissue and body fluids as potentially infectious.

  Get a Hepatitis B vaccination if you are at substantial risk of acquiring HBV infection.

  Use latex condoms plus nonoxynol-9 spermicide when engaging in sexual activity with a person whose infectious state is uncertain.

  Rethink your sexual behavior; avoid casual relationships and pick-ups.

  Don't use IV Drugs.

• 1. National AIDS Information Hotline:1-800-342-AIDS

  2. National Sexually Transmitted Disease Hotline: 1-800-227-8922

  3. American Red Cross AIDS Program: 1-800-26-BLOOD

  4. AIDS Prevention Project: 985-AIDS

  5. Philadelphia Community Health Alternatives (Anonymous AIDS Testing Center): 735-1911

NEEDLESTICK OR SHARP INJURY

• Any worker who sustains a needlestick or sharp instrument injury resulting in exposure to human blood and/or body fluids should:
  • 1. immediately wash affected area with soap and water;

    2. cover area with a bandage or dressing if possible;

    3. call HUP Occupational Health Service or Emergency Service immediately, then report for evaluation. (See inside front cover.)

    4. report injury to supervisor.

  Contamination of mucous membranes or open cuts/lacerations with human blood or body fluids must receive similar prompt evaluation.

SPILLS OF BLOOD OR OTHER BODY FLUID

• Gloves and a fluid-resistant gown must be worn during clean-up of a spill. Blood/body fluid should be wiped up using paper towels. When the liquid has been absorbed, the entire spill site should be cleaned with an appropriate disinfectant such as a 1:10 dilution of bleach. All disposable contaminated materials must be discarded as infectious waste.

ACCIDENT/EMERGENCY PROCEDURES

• If you are injured and require assistance, call:
  • UNIVERSITY POLICE 511 or 898-7333

  In case of emergency, Faculty and Staff report to:

  MONDAY-FRIDAY
  8 A.M. - 4 P.M.

  • HUP OCCUPATIONAL HEALTH SERVICE
    GROUND FLOOR
    RAVDIN/SILVERSTEIN CORRIDOR
    622-2354

  In case of emergency, Students report to:

  MONDAY-FRIDAY
  8 A.M. - 9 P.M.

  SATURDAY - SUNDAY
  11 A.M. - 8 P.M.

  • STUDENT HEALTH HEALTH SERVICE
    LOWER LEVEL, PENN TOWER HOTEL
    33RD & CIVIC CENTER BLVD.
    622-2850

  AFTER HOURS (FOR ALL)
  

  • HUP EMERGENCY SERVICE
    GROUND FLOOR SILVERSTEIN
    622-3920

• 1. Office of Environmental Health & Radiation Safety 898-4453

  2. HUP Safety Management Systems 662-3642

  3. HUP Occupational Health Service 662-2354

  4. HUP Infection Control Department 662-6995

  5. Dental School Office of Infection Control 898-9771

  6. Student Health Service 662-2850