Exposure Information and Courses from MediaLab, Inc.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

This program will provide you with basic information about bloodborne pathogens and vital precautions you must take to minimize your risk of workplace exposure to these infections.

Up to 1% of the U.S. population harbors the Hepatitis B virus in their bloodstream. In 1990, workplace exposure gave rise to an estimated 8,000 cases of HBV resulting in 200 to 300 deaths from acute and chronic HBV. So occupational exposure to HBV is a serious problem.

After an exposure to HIV by a contaminated needle, 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.

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!

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.

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

Even after taking all the proper precautions there is still a small chance of an exposure incident.Exposure incident: Blood or another potentially infectious body fluid coming into direct contact with mucous membranes or nonintact skin.Parenteral exposure: Needle stick or being cut by a contaminated sharp.

Only you can protect yourself from bloodborne pathogens.Therefore... Use Standard Precautions, Get your Hepatitis B Vaccine, And always think about how to perform each task in a way that minimizes your risk of exposure to bloodborne pathogens.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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:

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.

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.

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.

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.