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Exposure Information and Courses from MediaLab, Inc.

These are the MediaLab courses that cover Exposure and links to relevant pages within the course.

Learn more about laboratory continuing education for medical technologists to earn CE credit for AMT, ASCP, NCA, and state license renewal and recertification. Or get information about laboratory safety and compliance courses that deliver cost-effective OSHA safety training and continuing education to your laboratory's employees.

Laboratories Individuals

Antibody Detection and Identification
Naturally Occurring Antibodies

Antibodies are immunoglobulin proteins secreted by B-lymphocytes after stimulation by a specific antigen. The antibody formed binds to the specific antigen in order to mark the antigen for destruction.The type of antigenic exposure occurring in the body determines if the antibody is a naturally occurring or immune antibody.Naturally occurring antibodies can be formed after exposure to environmental agents that are similar to red cell antigens, such as bacteria, dust or pollen. Sensitization through previous transfusions, pregnancy or injections is not necessary. These antibodies are usually IgM and react best at room temperature or lower. Most of these antibodies are not clinically significant with the exception of ABO antibodies. Examples of naturally occurring antibodies include anti-A, anti-B, anti-Cw, anti-M, and antibodies in the Lewis and P system.

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Immune Antibodies

Immune antibodies occur in the serum of individuals who become sensitized to foreign antigens through pregnancy or transfusion. IgM predominates in the primary response, IgG in the secondary response. Most react at 37°C and are considered clinically significant. Examples include antibodies in the Kell, Rh, Duffy, and Kidd systems. Immune antibodies can be classified as alloantibodies or autoantibodies.Alloantibodies Produced by exposure to foreign red cell antigens which are non-self antigens but are of the same species. They react only with allogenic cells. Exposure occurs through pregnancy or transfusion. Examples include anti-K and anti-E. Autoantibodies Produced in an autoimmune process and directed against one's own red cell antigens. React with patient's own cells and all cells tested. Can possibly mask the presence of other significant antibodies. It is very important to make sure that no underlying significant antibodies are present if an autoantibody is suspected. A positive direct antiglobulin test (DAT) or auto control could indicate the presence of an autoantibody. Examples include cold auto (P or I) or warm auto (Rh specificity).

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Naturally occurring antibodies found in the ABO blood group system may be due to exposure to which of the following?View Page

Chemical Screening of Urine by Reagent Strip
Clinical Significance cont'd

Individuals with diabetes mellitus may excrete small amounts of protein in the urine which may signal the beginning of reduced glomerular filtration. Stabilizing the blood glucose level at this time may delay progression of diabetic nephropathy. Women in the last month of pregnancy may develop proteinuria as the first sign of impending eclampsia. Eclampsia is the gravest form of toxemia of pregnancy. The presence of protein in this situation must be evaluated by the physician in conjunction with other clinical symptoms.Benign transient proteinuria may be the result of: exposure to cold, strenuous exercise, dehydration, and/or high fever. Benign transient proteinuria may also occur during the acute phase of a severe illness.

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Which of the following may cause false negative bilirubin results on a urine reagent strip? (Choose ALL of the correct answers)View Page
Clinical Significance

No blood is found in the urine of healthy individuals although samples from menstruating females, frequently, but not always, test positive for blood. Hematuria is associated with renal or genital urinary disorders in which the bleeding is the result of irritation to the involved organs or trauma. Examples include renal calculi, pyelonephritis, glomerulonephritis, tumors, trauma or exposure to toxic chemicals or drugs and/or strenuous exercise. Hemoglobinuria may be due to the lysis of red cells within the urinary tract. If it is caused by intravascular hemolysis, the hemoglobin is then filtered through the glomeruli. In the normal individual, the hemoglobin molecule attaches to haptoglobin and in this way bypasses the kidney filtration system. When the hemoglobin/haptoglobin system is overwhelmed, as in cases of hemolytic anemia, severe burns, transfusion reaction, infection or strenuous exercise, hemoglobin passes into the urine.

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CLIA Blood Banking Review
Which of the following activities will put an employee at risk for exposure to a Bloodborne Pathogen (BBP)?View Page
All of the following are benefits of autologous donation except:View Page
Which of the following statements best describes Rh antibodies:View Page

CLIA Chemistry / Urinalysis Review
Which one of the following statements about lead poisoning is false:View Page

CLIA General Laboratory Review
What is the eight hour occupational exposure limit for a chemical called:View Page
Which one of the following statements about Hepatitis is true?View Page
What is the eight hour occupational exposure limit for a chemical called?View Page

CLIA Hematology / Hemostasis Review
The WBC indicated by the arrow in this illustration is exhibiting:View Page

CLIA Microbiology / Serology Review
Match the type of hepatitis with its route of transmissionView Page

Confirmatory and Secondary Urinalysis Screening Tests
Diseases Associated with Proteinuria

Severe proteinuria (greater than 3.5 g/day) is characteristically seen in patients with glomerulonephritis, lupus nephritis, lipoid nephrosis, and severe venous congestion of the kidney. Moderate proteinuria (0.5-3.5g/day) is seen in nephrosclerosis, multiple myeloma, diabetes nephropathy, malignant hypertension, and pyelonephritis with hypertension. Mild proteinuria (less than 0.5 g/day) may be seen with polycystic kidneys, chronic pyelonephritis, benign orthostatic proteinuria, and some renal tubular diseases. Transient proteinuria can also be due to physiologic conditions such as stress, exercise, cold exposure, and fever, in the absence of renal disease.

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Limitations of the Procedure

The product profile for Ictotest® points out that bilirubin is very light sensitive, so urine specimens should be protected from excessive light exposure and examined as quickly as possible when received in the laboratory. On standing, bilirubin, which has a goldish color, is oxidized to biliverdin, which is a green color. Many of the procedures used to detect bilirubin will not react with biliverdin, so false-negative results may occur if urine is not fresh when tested.

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Current Topics in Clinical Microbiology
The most important modifiable risk factor for enteric colonization with vancomycin-resistant Enterococcus faecium is:View Page
Review 2

Hershow RC. Khayr WF. Smith NL.: A comparison of clinical virulence of nosocomially acquired methicillin-resistant and methicillin-sensitive Staphylococcus aureus infections in a university hospital (University of Illinois at Chicago). Infection Control & Hospital Epidemiology. 13(10):587-93, 1992OBJECTIVES: To compare the clinical virulence of nosocomially acquired methicillin-resistant Staphylococcus aureus (MRSA) and methicillin-sensitive S. aureus (MSSA) infections in 1989.DESIGN: A retrospective comparison of host factors, in-hospital exposures, sites of infections, and outcomes of patients with nosocomial MRSA and MSSA infections. PARTICIPANTS: Forty-four adult patients with nosocomial S.aureus infections.RESULTS: The 22 MRSA-infected and 22 MSSA-infected persons were similar regarding mean age, gender, underlying diseases, and exposure to surgery. Before developing infection, MRSA-infected persons were more likely to have received antibiotics and to have stayed in the hospital > 2 weeks. Bacteremia was the most common presentation in the MRSA and MSSA groups (55% and 59%, respectively). Infectious complications and death were infrequent in both groups.CONCLUSIONS: MRSA and MSSA strains infect patients with similar demographic features and underlying diseases, but MRSA infections are significantly more common among patients with previous antibiotic therapy and a prolonged preinfection hospital stay. Clinical presentations and outcomes did not differ significantly between the 2 groups. Thus, similar to studies in the early 1980s, our findings do not suggest greater intrinsic virulence of MRSA.

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Most Eikenella cellulitis infections result from:View Page
Review 1

Newfield RS. Vargas I. Huma Z.: Eikenella corrodens infections. Case report in two adolescent females with IDDM. Diabetes Care. 19:1011-3, 1996OBJECTIVE: To alert physicians caring for patients with diabetes to the microorganism Eikenella corrodens and to discuss the appropriate preventive and therapeutic measures to take against this potentially morbid opportunistic Gram-negative bacilli.CASES: We present two cases of extra-oral E. corrodens infections in adolescent females with IDDM. The first patient had diabetes of 4 years' duration, which was moderately well controlled. Chronic finger biting resulted in a complex felon that evolved gradually and worsened while the patient received cephalexin orally. Delay in seeking further intervention resulted in necrosis of her distal fingertip and nail bed. The second patient had poorly controlled diabetes for 5 years. She developed an acute thigh abscess at an insulin injection site that resolved after drainage and intravenous antibiotics.CONCLUSIONS: E. corrodens commonly inhabits the human oral cavity and becomes a pathogen mostly when host defenses are impaired, causing abscesses and infections that are at times fatal. Patients with IDDM are compromised hosts and with daily microtrauma to their skin via glucose monitoring and insulin injections, are prone to develop E. corrodens infections that can be introduced through oral secretions by licking or biting their skin. Educational efforts aimed at preventing exposure of traumatized skin to oral secretions can minimize the risk of E. corrodens infections in compromised hosts.Early intravenous administration of antibiotics, bearing in mind E. corrodens resistance to clindamycin, metronidazole, and other antibiotics, coupled with prompt surgical intervention, is essential in successfully managing E. corrodens infections.

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First Aid
Chemical Burns of Skin

Chemical burns occur when caustic or corrosive chemicals come into contact with the skin.Act immediately, since the longer the exposure, the worse the injury.

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Fundamentals of Hemostasis
Primary Hemostasis – The Vascular System & Platelet Involvement

As discussed earlier, a break in the vessel endothelium leads to exposure of collagen and the vessel's subendothelial surface. Ruptured endothelial cells leak ADP and Serotonin, which are the chemical triggers that induce platelet adhesion, the next step in the sequence of hemostatic events. Circulating platelets are drawn to the area by those liberated chemical signals, and begin to physically attach themselves to the rough, damaged surfaces of the breach. As platelets continue to arrive and bind to the exposed collagen and basement membrane, a rudimentary barrier begins to form, as the platelets themselves serve to fill in the breached vessel wall. Platelets possess an inherent “sticky” property which enables them to adhere to one another, and not just to the damaged vessel endothelium. The process by which platelets bind to one another is referred to as platelet aggregation, and is vital because it allows for a platelet plug to be formed. The platelet plug is the structure responsible for plugging the hole in the vessel wall.

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Secondary Hemostasis – The Intrinsic Pathway

Exposure to contact substances, such as collagen, can activate the intrinsic pathway. The exposed collagen is the location where a complex between High Molecular Weight Kininogen (HMWK), Prekallikrein (also known as Fletcher Factor, which activates to Kallikrein), and factor XII (Hageman Factor) forms. Together, this three biochemical complex, adhered to the collagen binding site, catalyzes the conversion of factor XII to its activated form, XIIa, thereby triggering the intrinsic pathway.

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HIV Safety for Florida
Which of the following is not considered a potentially infectious body fluid for transmitting HIV?View Page
The type of health-care occupational exposure with the greatest risk of HIV transmission is:View Page
The follow-up to a healthcare work HIV exposure includes:View Page
A person commits a misdemeanor of the first degree by:View Page
Occupational Exposures

HIV transmission, due to occupational exposure, occurs by: Percutaneous injury, such as a needlestick or a cut with a sharp object; Contact of mucous membrane or abraded skin with HIV-infected blood or body fluids. The risk of HIV transmission after a percutaneous exposure to HIV-infected blood is 0.3%.The risk of HIV transmission after a mucous membrane exposure to HIV-infected blood is .09%.The risk of HIV transmission after contact of abraded skin with HIV-infected blood is estimated to be less than .09%.

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Potentially infectious body fluids

These substances are considered potentially infectious for an occupational exposure: blood cerebrospinal fluid synovial fluid pleural fluid peritoneal fluid pericardial fluid amniotic fluid any body fluid visibly contaminated with blood semen or vaginal fluid tissues removed during surgery.

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Risk factors associated with increased HIV infection

The risk factors that increase the risk of an exposure leading to HIV infection are: larger quantity of blood from source person, and blood from source person in terminal stage of HIV disease.

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Exposure Follow-up

The follow-up to a healthcare work HIV exposure includes: psychological counseling medical evaluation postexposure testing at baseline, 6 weeks, 12 weeks, and 6 months.

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Postexposure prophlaxis

Postexposure prophylaxis will be determined by exposure type and HIV infection status of source person. The postexposure prophylaxis determined by a qualified practitioner will balance risk of infection with toxicity of the medications.The postexposure prophylaxis must be started hours after the exposure.The postexposure prophylaxis should be re-evaluated 72 hours after exposure, particularly if additional information is available about source person.The postexposure prophylaxis may be necessary for 6 months.

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If an Exposure Occurs

Give first aid. Wash needlesticks and cuts with soap and water. Flush splashes to the nose, mouth, or skin with water. Irrigate eyes with clean water, saline, or sterile irrigants. Report exposure to supervisor.

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Match the proper first aid with the exposure type.View Page
Overview

Prevention of HIV exposure is the best line of defense to prevent occupational transmission of HIV as there is no vaccine available to develop specific immunity and the postexposure prophylaxis is toxic. Following appropriate workplace practices in the laboratory focus on preventing needlesticks or other sharps injuries and exposure of mucous membranes and abraded skin to HIV-infected blood or body fluids.

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Work practice controls

Work Practice controls specify how to perform a task. Wherever there is a risk of exposure, they forbid: smoking eating or drinking applying cosmetics or lip balm handling contact lenses mouth pipetting food and drink in specimen refrigerators

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Gloves

Gloves must be worn: when there is a reasonable chance of exposure to blood, other infectious body fluids, mucous membranes, or nonintact skin. during vascular access procedures, including phlebotomy. when handling contaminated items or surfaces.Wear only flat rings under gloves as large rings may tear gloves.Replace gloves: Between patient contacts If they are damaged or contaminated Before leaving the work area. Wash hands after removing gloves.Never wash disposable gloves.

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The following workplace practices minimize risk of HIV exposure to mucous membranes or abraded skin:View Page

Introduction to Bioterrorism
Advantages of using Biological Agents (cont.)

They can have a psychological impact.Biological WMD’s could possibly have a psychological impact that will go far beyond their actual effect. The very thought of exposure to a biological agent may possibly cause many people to panic.  Biological WMDs can tie up resources.Some biological agents can be a hazard for lengthy periods. The use of these agents may require tedious, time-consuming, resource-intensive decontamination and monitoring of facilities before they can be returned to service. Defense may be difficult.It is very difficult for civilian government agencies to prepare for biological terrorist incidents. While most civilian agencies have some kind of hazardous material or HAZMAT response teams; in the event of a biological terrorist incident, these teams are likely to be challenged beyond their capability in terms of human resources, and equipment.

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Disadvantages of using Biological Agents

They are not immediate. The delayed effect, for example, the long incubation period for some agents, may detract and limit their tactful usefulness as a political statement.They are hazardous to all who come in contact.There is the possibility that the biological agents could also affect the health of the aggressor forces. They are hard to control.The dependence of prevailing winds and other weather conditions such as temperature, sunlight, and desiccation may make it difficult to control distribution of the biological agent.  Potential long term effects beyond the initial attack.The persistence of some agents such as spore-forming anthrax in the environment may make an area uninhabitable to aggressor forces for long periods. Results are unpredictable.Morbidity secondary to a biological attack is unpredictable since casualties will be related to the quantity and manner of exposure plus the preventive and treatment measures available.

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Is the psychological impact of a biological attack an advantage or a disadvantage of using biological weapons?View Page
Laboratory Response - Chemical, Level 2

In addition to the responsibilities listed for Level 3, over 40 laboratories also participate in Level 2 activities. At this level, laboratory personnel are trained to detect exposure to a limited number of toxic chemical agents in human blood or urine, the analysis of cyanide and toxic metals in human samples, for example.

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Laboratory Response - Chemical, Level 1

At present, 5 laboratories participate in Level 1 activities. At this level, technical personnel are trained to detect exposure to an expanded number of chemicals in human blood and urine. This includes all Level 3 and 2 laboratory analyses, plus analyses for mustard agents, nerve agents, and other toxic chemicals.

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What if: Biological Attack

Biological attacks involve bacteria, viruses or natural toxins. The effects of toxins can be immediate but for bacteria and viruses the effects may not be apparent for weeks. A bio-terrorist may attack by infecting animals, contaminating food and water, spraying bacteria or viruses into the air. In infections such as smallpox and plague, once a few individuals are infected they can further spread the disease from person to person. An attack could also come from through a building’s ventilation system, the mail, or even through exposure to an infected terrorist seeking to spread disease during an infectious stage.

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Mycology: Yeasts and Dimorphic Pathogens
Each of the following dimorphic fungal infections have been observed in animals living in their natural environment except:View Page

OSHA Bloodborne Pathogens (updated October 2008)
About This Course

This course will provide you with basic information about bloodborne pathogens, the regulations that govern safe work practices when handling blood and other potentially infectious body fluids, and necessary precautions that must be taken to minimize your risk of exposure to these infections.

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Occupational Exposure Standard

In December of 1991, OSHA issued a standard to guard against occupational exposure to bloodborne pathogens. This standard, part 1910.1030 of the Code of Federal Regulations was published in the Federal Register.On November 27, 2001, OSHA published a compliance directive 2-2.69 that now includes the revisions to the original standard.These regulations are law!Many states have an additional occupation exposure statute that must be followed as well. Your supervisor will know if this applies to you.

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The Relevant Components

These are the relevant components of OSHA standard which are required for each facility: Exposure control plan Preventive measures Hepatitis B vaccination Standard precautions Methods of control Engineering and work practice controls Personal protective equipment Housekeeping Labeling What to do if an exposure incident occurs

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The Exposure Control Plan

Employers must develop and implement an exposure control plan to protect employees from exposure to bloodborne pathogens.This is a document that explains how the employer will implement the OSHA standard. It also specifies what to do if an exposure occurs.The Exposure Control Plan must include an Exposure Determination which lists jobs that will or may subject workers to occupational exposures.

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Exposure category

There are three exposure categories :Category I are those employees who on a day-to-day basis will come in contact with blood or body fluids as part of their normal job. This includes medical technologists, pathologists and operating room nurses.Category II are those employees who may come in contact with blood or body fluid during the course of their normal job. This includes housekeepers, transporters, and some technicians such as EKG techs.Category III are those persons who would not normally ever come in contact with blood or body fluids and generally includes secretaries, administrators and gardeners.Persons may move from one category to another during the course of a work-day.

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Methods of Control

Methods of control are ways you can protect yourself from exposure to bloodborne pathogens by using: Proper equipment Safety features Work practice controls The next few pages will acquaint you with these ways to keep yourself safe.

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Engineering Controls

Engineering Controls are devices which isolate the worker from the hazard of exposure.Examples include: Self-sheathing needles Sharps disposal containers Disposable resuscitation bags Microbiological safety cabinets Handwashing facilitiesProper use of engineering controls in your workplace will help protect you from bloodborne pathogens.

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Work Practice Controls

Work Practice controls specify how to perform a task. Wherever there is a risk of exposure, they forbid: Smoking Eating or drinking Applying cosmetics or lip balm Handling contact lenses Mouth pipetting Storing food or drink in specimen refrigerators

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Personal protective equipment (PPE) that should be used when processing blood specimens includes which of the following?View Page
How can HBV be prevented?

You can avoid exposure to Hepatitis B by taking the appropriate precautions, such as: Receiving the immunization against Hepatitis B. Following standard precautions. Maintain proper work practices. Using proper techniques when handling materials which may be contaminated with blood or other potentially infected body fluids.

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What happens after HBV infection?

After the exposure, there is an incubation period that lasts between 45 and 180 days, with an average of 90 days.Many individuals with acute HBV will have no symptoms at all. Some will have a mild illness with loss of appetite, nausea and vomiting, and fatigue. About 30% of infected individuals will develop clinical hepatitis with jaundice (yellow discoloration of the skin and eyes due to liver dysfunction).

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How common is HBV?

There are approximately 800,000 to 1.4 million chronic hepatitis B carriers in the U.S. Worldwide it is estimated that there are 350 million people infected with HBV, which contributes to an estimated 620,000 deaths worldwide each year (CDC, 2008).The annual number of occupational infections has decreased 95% since hepatitis B vaccine became available in 1982, from more than 10,000 in 1983 to less than 400 in 2001 (CDC "Exposure to Blood" report).

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Spread of HBV In The Community

HBV is spread in the community through: Sexual contact. Drug abusers sharing contaminated needles. An infant's exposure to its mother's body fluids.

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How easily is HIV transmitted?

After an exposure to HIV such as by a needlestick, the chance of becoming infected is usually less than 1%. However, exposures from patients with high numbers of viral particles in their blood may be more hazardous. Because of the extremely serious nature of HIV, we must take every precaution to avoid workplace exposure.

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What happens after HIV infection?

Days to weeks after exposure, the patient may begin to complain of fever, headache and fatigue. This may also be accompanied by a rash.For the first several months after the infection, the exposed individual maybe HIV antibody negative - this is called a "window" period.The disease may remain silent in the patient for months to years even with no treatment.At some point in time, when the immune system is weakened enough, the patient will develop opportunistic infections and be classified as having AIDS (acquired immunodeficiency syndrome).

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What happens after Hepatitis C infection

Five to twelve weeks after the exposure, some individuals may develop flu like illness, including nausea, vomiting, tiredness and loss of appetite. These may last from weeks to months.Approximately 80% of infected individuals will have no symptoms at all.

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Transmission of Hepatitis B can be prevented by:View Page
Transmission of the hepatitis B virus (HBV) can occur from all of the following EXCEPT:View Page
Gloves Must be Worn

When there is a reasonable chance of exposure to blood, other infectious body fluids, mucous membranes, or nonintact skin. During vascular access procedures, including phlebotomy. When handling contaminated items or surfaces.

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Appropriate personal protective equipment includes all of the following except View Page
Which of the following are considered engineering controls?View Page
Exposure Incident

Even after taking all the proper precautions there is still a small chance of an exposure incident. An Exposure incident occurs when: Blood or another potentially infectious body fluid comes into direct contact with mucous membranes or non-intact skin. Parenteral exposure means: Exposure occurring as a result of piercing the skin barrier through needlesticks, cuts, or abrasions.

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If an Exposure Occurs

If an exposure occurs, wash the affected area immediately with soap and water.Contact your supervisor immediately, regardless of the situation or the time of day.

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Avoiding exposure

Only you can protect yourself from bloodborne pathogens.Therefore... Always think about how to perform each task in a way that minimizes your risk of exposure to bloodborne pathogens. Ensure that you are using the proper PPE for the task.Ask your supervisor if you are unsure how to accomplish the task safely.

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OSHA Chemical Hygiene (updated 2007)
Goals of this Program

Locate potentially hazardous chemicals in your workplace. Describe the procedure for obtaining a copy of an MSDS. Recognize chemical labeling and its meaning. Discuss exposure control measures with your supervisor. Locate the MSDS book in your workplace.

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Haz-Com

In 1987, OSHA issued a regulation to help control workplace exposure to chemicals. This regulation is called the Hazard Communication Standard, but is more commonly known as Haz-Com, or the Right-to-Know Law.

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Hazardous Ingredients

What makes up the chemical. What the 8-hour occupational exposure limit is for the threshold limit value, or TLV. On some MSDS, the short term exposure limit (or STEL) for 15 minutes will also be listed.

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Personal Protective Equipment

Personal protective equipment is an essential way to protect yourself from the dangers of chemicals. You'll find on the label or MSDS exactly what kinds of clothing, gloves, and coverings you'll need to keep yourself safe. Also, the laboratory's chemical hygiene plan will include information about necessary personal protective equipment and engineering controls that will reduce your exposure to hazardous chemicals. At a minimum, safety goggles and rubber or nitrile gloves (not necessarily utility gloves) are necessary parts of your personal protective equipment.

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Monitoring

Certain chemicals in use in the laboratory, such as formaldehyde, are hazardous if your exposure to them is too prolonged. The amount of the chemical to which you can be exposed before possible danger is called the threshold limit value. Monitoring badges are used from time to time to measure your exposure. These are worn in the "breathing zone" for a certain period of time--often eight hours (for long-term exposure) or fifteen minutes (for short-term exposure). Based on the results of this monitoring, additional personal safety measures, such as ventilation or face-fitted masks, may be implemented for your protection.

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OSHA Formaldehyde
Relevant OSHA Standards

1987 Haz-Com Standard is designed to help control employee exposure to chemicals on the job.1990 Chemical Hygiene Standard is specifically designed to meet the needs of laboratories with large varieties of chemicals, and to require specific training for laboratory employees.1992 Formaldehyde Standard is specifically for employees that work with formaldehyde. The goal was to reduce the risk of formaldehyde overexposure by establishing safe exposure limits.

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Symptoms of Overexposure

Formaldehyde exposure as low as 0.1 ppm can cause: Skin irritation Tearing of the eyes Airway irritation Headaches and dizziness

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Surveillance Questionnaire

Depending on the exposure level at your workplace, a medical surveillance questionnaire may need to be completed by you prior to your working with formaldehyde.This questionnaire helps determine your personal risk from exposure to formaldehyde.If your level of exposure is high enough, you may be required to complete this questionnaire annually.

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Permissible Limits

PEL = 0.75 ppm (Permissible Exposure Limit for an eight hour exposure)STEL = 2.0 ppm (Short Term Exposure Limit for a 15 minute exposure)Action Level = 0.5 ppm (Action Level for an eight hour exposure)These limits ensure that you will be protected from any ill effects due to formaldehyde exposure.

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Corrective Action

When monitoring results exceed the STEL or PEL, the employer must: Develop a written plan to reduce exposure to levels below the PEL and STEL. Provide written notice of corrective actions to employees.

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Respirators (continued)

Respirators acceptable for use with formaldehyde are of the negative pressure type and must be face-fitted for each employee.Because of the OSHA face fit requirements, any employee using a respirators must not have facial hair.Wash your face after each respirator use to prevent skin irritation from exposure to formaldehyde in the areas of your face not protected by the respirator.

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Respirators

Respirators usually are not needed.However, they are required if exposure exceeds action level of 0.5 ppm.If you require respirators for your work, they will be provided at no cost to you.

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OSHA Formaldehyde (updated 2009)
Relevant OSHA Standards

1987 Haz-Com Standard (29 CFR 1910.1200) is designed to help control employee exposure to chemicals on the job. 1990 Chemical Hygiene Standard (29 CFR 1910.1450) is specifically designed to meet the needs of laboratories with large varieties of chemicals, and to require specific training for laboratory employees. 1992 Formaldehyde Standard (29-CFR 1910.1048) is designed specifically for employees who work with formaldehyde. The goal of this standard is to reduce the risk of formaldehyde overexposure by establishing safe exposure limits.

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Warning Signs

Areas where formalin may exceed exposure limits must have warning signs. Access to these areas is limited to authorized persons trained to recognize the hazards of formaldehyde.

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Respirators

Respirators usually are not needed in a pathology laboratory. However, they are required if exposure exceeds the Action Level of 0.5 ppm. Respirators, if required, must be provided to you at no cost.

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Respirators (continued)

Respirators acceptable for use with formaldehyde are of the negative pressure type and must be face-fitted for each employee. Because of the OSHA face fit requirement, employees using respirators must not have facial hair. Employees must wash their face after each respirator use to prevent skin irritation from formaldehyde exposure in areas incompletely protected by the respirator.

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Symptoms of Overexposure

Formaldehyde exposure as low as 0.1 ppm (parts per million) may cause: Skin irritation Eye irritation Airway irritation Headaches and dizziness Symptoms possibly related to formadehyde exposure should be reported immediately to management.

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Surveillance Questionnaire

Depending on the exposure level at your workplace, you may need to complete a medical surveillance questionnaire before you begin to work with formaldehyde. This questionnaire helps determine your personal risk from exposure to formaldehyde. If your level of exposure is high enough, you may be required to complete this questionnaire annually. The questionnaire is reviewed by a licensed physician and may require a medical follow-up exam. The questionnaire and exam are given at no cost to you and remain confidential.

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How is Exposure to Formaldehyde Monitored?

A monitoring badge is attached to your lab coat collar in the "breathing zone." for a specified length of time. This badge is then sent to an outside laboratory by your supervisor to determine your level of exposure to formaldehyde.

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OSHA has set these Permissible Limits for Formaldehyde Exposure:

PEL = 0.75 ppm Permissible Exposure Limit for an eight hour time weighted average (TWA). STEL = 2.0 ppm Short Term Exposure Limit for a 15 minute exposure. Action Level = 0.5 ppm Action Level for an eight hour time weighted average (TWA).

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Corrective Action

When monitoring results exceed the STEL or PEL, the employer must: Develop a written plan to reduce exposure to levels below the PEL and STEL. Provide written notice of corrective actions to employees.

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Fume Hoods and other Controls

Engineering controls must be established to reduce formalin exposure to the lowest possible level. In most cases, chemical fume hoods or/and ventilated grossing stations serve as the primary engineering controls to reduce formaldehyde vapors. Rooms in which formalin is used may also require special direct exhaust ventilation. Formaldehyde should be dispensed or used in a chemical fume hood or other appropriately ventilated and approved work area. Check your laboratory's policies and procedures to be sure you use the engineering controls provided, as well as the required personal protective equipment.

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Packaging and Shipping Infectious Materials
What are the Training Requirements?

The training requirements that are stated in the US Code of Federal Regulations at 49 CFR 172.704 must be met by all personnel who are involved in shipping hazardous materials in the United States and training must be completed within 90 days of employment or performance of the required hazmat function (relevant documented training from a previous employer is acceptable).These requirements include: General awareness/familiarization training Function-specific training Safety training Security awareness training (Category A substances) Safety training, must be provided by the facility where the infectious materials are packaged and must include: Emergency response information Measures to protect the employee from the hazards associated with hazardous materials to which they may be exposed in the work place, including specific measures the hazmat employer has implemented to protect employees from exposure Methods and procedures for avoiding accidents, such as the proper procedures for handling packages containing hazardous materials

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Category A Definition and Examples

A category A infectious substance is in a form that is capable of causing permanent disability or life-threatening or fatal disease in otherwise healthy humans or animals when exposure to it occurs. Exposure would occur if the substance were released from its protective packaging and a human or animal came into contact with it. Some examples of category A infectious substances include: Bacillus anthracis (cultures only) Brucella abortus (cultures only) Brucella melitensis (cultures only) Burkholderia mallei (cultures only) Clostridium botulinum (cultures only) Dengue virus (cultures only) Escherichia coli, verotoxigenic (cultures only) Ebola virus Francisella tularensis (cultures only) Hantaviruses causing hemorrhagic fever with renal syndrome Herpes B virus (cultures only) Human immunodeficiency virus (cultures only) Lassa virus Mycobacterium tuberculosis (cultures only) Poliovirus (cultures only) Rabies and other lyssaviruses (culture only) Shigella dysenteriae type I (cultures only) West Nile virus (cultures only) Yersinia pestis (cultures only)This is not an exhaustive list. Sometimes, deciding on the classification of an infectious substance requires professional judgement and involves knowing the medical history or symptoms of the source patient or animal and/or knowing the local epidemiological conditions at the time the patient specimen or culture was obtained. If there is doubt as to whether or not a substance meets the criteria of category A, it must be treated as a category A substance for shipping.

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Category B Definition, Shipping Name, and Identification Number

A category B infectious substance is not in a form generally capable of causing permanent disability or life-threatening or fatal disease in otherwise healthy humans or animals when exposure to it occurs. The proper shipping name and Identification number is:Biological substance, Category B, UN 3373

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Security Awareness

A category A infectious substance is in a form that is capable of causing permanent disability or life-threatening or fatal disease in otherwise healthy humans or animals when exposure to it occurs. Exposure would occur if the substance were released from its protective packaging and a human or animal came into contact with it. Therefore, it is critical that a category A infectious substance does not end up in the hands of an unauthorized individual who may purposely or unknowingly release the substance from its protective packaging and endanger humans or animals. Being aware of the people that you interact with in the process of packaging and sending category A substances is vital to the safety of the transport and prevention of a health disaster. An outsider with limited access and system knowledge could constitute a threat, but be aware that insiders could also be a threat, e.g., a disgruntled employee or a person who is angry with his or her supervisor or job or the government. Anyone desiring to do harm could potentially seize the opportunity to steal a hazardous material.Follow these precautionary procedures: When you are questioned about an infectious substance that you are packaging for shipment, it is important that you know the person that is asking AND that he or she has a need to know. If you do not know the person and if you are not aware that the person needs to know about the substance that is being shipped, do not answer the questions. You could refer him or her to your supervisor. Watch for unusual behavior. Secure the package until it is picked up. Check the identification of the courier who will be picking up the package. Use an intralaboratory chain of custody procedure if the specimens are tranferred within the facility or system. Track the package once it has been sent to be sure it arrives safely. Notify the Responsible Official or federal authority if the package does not arrive at its destination.

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Parasitology Review
Arrange the following phases of the Chilomastix life cycle beginning with human transmission:View Page

Phlebotomy
Hemogard ™ blood collection tubes

Blood collection tubes with Hemogard ™ (BD) closure protect you from blood which might splatter when the tube is opened. The rubber stopper is recessed inside the plastic shield, preventing exposure to blood present on the stopper. You will probably be using Hemogard or other tubes having protective devices.

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Activation of safety device

Activate the safety device in use at your institution.Be sure to follow your institution’s procedure for activating this device to protect yourself from needlestick exposure.

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OSHA bloodborne pathogens standard

The Occupational Health and Safety Administration (OSHA), of the federal government has mandated bloodborne pathogen training for all US workers who are at risk of exposure. The next few slides cover a few highlights of this training. You will receive complete OSHA bloodborne pathogens training before you begin work.

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Red Cell Disorders: Peripheral Blood Clues to Nonneoplastic Conditions
Atypical smear: Case follow-up

The patient whose blood smear is shown in the photograph was a 32-year-old female from Virginia who came to the high country of Colorado to ski. The day after arrival, she experienced shortness of breath, fatigue, and upper abdominal pain. She was seen in a medical center in the mountains where a working diagnosis of altitude sickness was made. A CBC revealed RBCs 5.1 x 1012/L, hemoglobin 12.8g/dL, MCV 60fL, hematocrit 40.9%, and normal total WBC, differential, and platelet count. The RDW was normal. Further questioning revealed a previous diagnosis of heterozygous beta-chain thalassemia. No other abnormal hemoglobins were found on hemoglobin electrophoresis, but HbA-2 was elevated to 5%, supporting the diagnosis of beta thalassemia. The patient's poikylocytosis and anisocytosis may be a clue to an underlying erythrocyte abnormality. Persons with iron deficiency anemia may experience various degrees of hypoxia upon arriving at high altitudes. Those with sickle cell disease and thalassemia minor (as in this case) may experience bone pain or other symptoms of "crisis" and/or alteration in the appearance of their erythrocytes upon sudden high altitude exposure. The classic teaching is that in differentiating iron deficiency anemia from thalassemia, increased RDW would favor iron deficiency; normal RDW favors thalassemia.

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Stomatocytes

Stomatocytes are erythrocytes with a slit-like central pallor. Otherwise, they resemble typical RBC's in size and shape. Unless 10% or more of the RBC's are stomatocytes, their presence is probably artifactual. Stomatocytes form at a low blood acidic pH as seen in exposure to cationic detergents, and in patients receiving phenolthiazine. Hereditary stomatocytosis has some resemblance to hereditary spherocytosis, as stomatocytes may develop into spherocytes with further metamorphosis. In hereditary stomatocytosis, mild anemia and findings of on-going hemolysis should be evident if the condition presents as a clinical problem at all.

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Semen Analysis
Information to be obtained from patient

At the time of semen collection the patient should provide the following information that will be reported as part of the final report:The time of collectionDays of abstinenceLocation at which specimen was collected: clinic or homeDifficulties during collection (e.g. spillage)Difficulties during transport (e.g. exposure to cold temperatures)Information on collection method (e.g. masturbation, withdrawal)Names of medications that he is takingA sample supplemental information collection form is shown below:

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Tuberculosis Awareness for Healthcare Workers
Tuberculosis infection

The natural history of TB infection is usually followed by an immune response and latency after exposure. In about 5-10% of cases, the latent period progresses to an active infection.The organism that causes TB infection is Mycobacterium tuberculosis. This organism is pictured in the photograph to the right as observed when stained with acridine orange stain. Infection occurs when a susceptible person inhales droplet nuclei containing Mycobacterium tuberculosis and the organism reaches the alveoli of the lungs.About 2-12 weeks after infection, the immune system limits multiplication of additional bacteria and the immunological test becomes positive.Latent tuberculosis infection (LTBI) is the stage when the viable organism remains in the body, and the patient has no symptoms and is non-infectious.Most infected persons do not experience clinical illness and are noninfectious. About 5-10% of persons infected with Mycobacterium tuberculosis who are not treated will develop TB during their lifetime. The risk for progression is highest during the first several years after infection.TB infects the lungs most often; however, it can infect almost any organ in the body, including bones and joints.

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How tuberculosis is spread

The Mycobacterium tuberculosis organism is spread through infectious droplet nuclei.When a person infected with pulmonary tuberculosis coughs, sneezes, shouts, or sings, the infectious particles are expelled into the air.The risk of infection is related to both concentration of infectious droplet nuclei and duration of exposure.

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High Risk Infection Groups

The following persons are at higher risk for exposure to and infection from Mycobacterium tuberculosis: Frequent travelers to tuberculosis endemic areas; Residents and employees of high-risk congregate settings such as correctional facilities, long-term care facilities, and homeless shelters; Healthcare workers who serve high-risk patients or have unprotected exposure; Medically underserved and low-income populations; Infants, children, and adolescents exposed to adults in high-risk categories.

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Matching FactsView Page
Tuberculosis Exposure Control Plan

The CDC Guidelines for Prevention of Tuberculosis in Healthcare Settings recommend that all healthcare facilities develop a TB exposure control. The plan should include an exposure determination at defined intervals for all employees who may have occupational exposure to tuberculosis.

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Health Care Worker Tuberculosis Screening

All HCWS receive baseline TB screening upon hire, using either the two step skin test or BAMT. Annual screening varies depending on setting risk. In low risk settings, screening is not necessary unless an exposure occurs. In a medium risk setting, all HCWS are screened for symptoms and HCWs with negative baseline results are tested.In a potential ongoing transmission setting, HCWs receive testing every 8-10 weeks until lapses are corrected.

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Match the recommended frequency for TB screening of a healthcare worker with the risk category of the healthcare setting from the drop-down box:View Page
Three levels of TB Infection Control

Administrative controls reduce the risk of exposure to persons who might have TB disease.Environmental controls prevent the spread and reduce the concentration of infectious droplet nuclei in ambient air.Respiratory protection controls are for situations that pose a high risk of exposure to further reduce risk of exposure of HCWs to infectious droplet nuclei that have been expelled into the air from a patient with infectious TB disease.

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Respiratory Protective Equipment

Respirators are used in situations that pose a high risk for exposure.Respirator usage for TB is now regulated under the general industry standard for respiratory protection.Risk assessment determines HCWs who should wear respiratory protection.HCWS are screened for medical conditions by a physician prior to using respiratory protection.Respirators should be selected from those approved by CDC and NIOSH.Fit testing provides a method to determine which respirator model and size fits the wearer best and to confirm that the wearer can properly fit the respirator. Each time the respirator is worn, the wearer performs a user-seal check to ensure adequate respiratory protection.

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Protect Yourself

Healthcare workers must be alert for signs and symptoms of TB to protect themselves from inadvertent exposure.Help protect yourself, coworkers, patients, and visitors by: Having current TB screening according to the risk classification of your setting, Understanding the risks of TB in your work area, Practicing good infection control at work and at home.

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White Cell and Platelet Disorders: Peripheral Blood Clues to Nonneoplastic Conditions
The pale-staining cytoplasmic bodies marked by the arrow in the photograph may be seen in each of the following conditions except:View Page


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