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The Infection Prevention Program (IPP) is designed to provide service to employees with occupational exposure to potentially infectious material including tissues from humans and animals or contact with an infectious microorganism. This program mirrors the Occupational Safety and Health Administration (OSHA) mandated Exposure Control Plan outlined in the Bloodborne Pathogens Program (BBP) while also addressing infection prevention policies for employees working with animals, disease-causing microorganisms, and human pathogens other than those specifically addressed by OSHA's BBP program.

Employees who work with potentially infectious material in research labs at Virginia Tech must be familiar with, and closely follow, the policies and procedures described throughout this program.

Employees with occupational exposure to human tissue, blood, fluids, or other potentially infectious material (OPIM) of human origin must be familiar with, and closely follow, the requirements in OSHA's BBP standard 29 CFR Part 1910.130.

Job classifications at Virginia Tech that are included in the IPP include:

  • Animal care;
  • Athletic training;
  • Emergency response;
  • Housekeeping;
  • Medical/clinical work;
  • Regulated medical waste operations;
  • Research with pathogenic microorganisms; and
  • Veterinary medical/clinical work.

Introduction

The purpose of the Infection Prevention Program is to:

  • Provide safety policies for the protection of Virginia Tech employees who have a potential for occupational exposure to infectious material.
  • Establish a program which provides Virginia Tech employees with the following services: 
    • Information relative to their potential exposures;
    • Training on safe work practices, engineering controls, and university policies related to occupational exposure; and
    • Preventative vaccinations and titers (when available) and infection control services following an exposure incident.

The Infection Prevention Program is intended for distribution university-wide. Each department having employees at risk for exposure to infectious materials shall develop specific policies and procedures as outlined in this plan. Departmental-specific materials shall be inserted in the document where required. This plan describes engineering controls, work practices, and personal protective equipment that, when used correctly, reduces on–the-job exposure to infectious material. Also described are the university’s training, vaccination, and incident reporting programs.

The Infection Prevention Program is designed to provide service to employees with occupational exposure to potentially infectious material including tissues from humans and animals or contact with an infectious microorganism (see Appendices B and C). This program mirrors the Occupational Safety and Health Administration (OSHA) mandated Exposure Control Plan for Bloodborne Pathogens while also addressing infection control policies for employees working with animals, disease-causing microorganisms, and human pathogens other than those specifically addressed by OSHA’s Bloodborne Pathogens Program.

Virginia Tech, through its missions of research, has the potential to house a number of different types of biological agents that are associated with specific types of hazards (see Table 1). In addition, Virginia Tech has employees with the potential for exposure to infectious disease while working in human and veterinary medical settings, housekeeping, maintenance, and child/elder care (see Table 2).

Table 1. Types of Biological Agents Potentially Found at Virginia Tech

Type of Agent

Associated Hazard

Microorganisms and other toxins (certain bacteria, fungi, rickettsia, viruses [other than arboviruses], and their products)

Infection, exposure, or allergic reaction

Prions (proteinaceous infectious particles lacking nucleic acids)

Neurodegenerative disease (e.g., Creutzfeldt-Jakob disease)

Vertebrate animals and their protein allergens (i.e., urine, feces, hair, saliva, and dander)

Zoonotic diseases, allergic reactions

Invertebrate animals

  • Arthropods (crustaceans, arachnids, insects)
  • Parasites (protozoa, flatworms, roundworms)

Bites or stings resulting in skin inflammation, system intoxication, the transmission of infectious agents (i.e., arboviruses), or allergic reaction

Higher plants and their allergens/toxins

Dermatitis from skin contact or rhinitis or asthma from inhalation

Lower plants (lichens, liverworts, and ferns)

Allergic reactions; systemic infections; skin inflammation

Source: Fundamentals of Industrial Hygiene, Plog (Ed.), 4th ed., 1996

Table 2. At-Risk Occupations and Tasks

Occupations

Job Tasks

Medical staff (physicians, nurses, athletic trainers)

  • Patient care.
  • Cleaning operations where potentially infectious materials may be present.
  • Cleaning blood or other body fluid spills.

First responders (police, rescue squad)

  • Patient care.
  • Contact with victims or perpetrators.
  • Employees with designated first aid or medical assistance duties.

Housekeepers

  • Laundry sorting and cleaning.
  • Cleaning operations where potentially infectious materials may be present.
  • Response to blood spills and similar events.

Plumbers and utility workers

Work involving sanitary sewer systems.

Regulated medical waste operations

Waste collection, handling and disposal.

Animal care

  • Patient care.
  • Cleaning operations where potentially infectious materials may be present.
  • Animal husbandry.

Research and clinical laboratory operations

  • Diagnostic or other screening procedures performed on blood or other potentially infectious materials.
  • Phlebotomy.
  • Research involving organisms identified in Table 1, above.

Responsibilities

Environmental Health & Safety is responsible for coordinating the following program elements:

  • Identification of at-risk employees;
  • Conducting training classes as needed;
  • Conducting infection control classes before work that has potential for exposure begins, conducting classes when the work changes (such as a new organism is being handled, or duties change), or verifying that such training has been administered;
  • Conduct yearly bloodborne pathogens training for those who must comply with OSHA’s bloodborne pathogens standard;
  • Maintaining records of vaccination for all program participants;
  • Funding the available Infectious Agent vaccinations of at-risk employees;
  • Creating, distributing, and revising (as regulations or recommendations change) the universitywide Infection Prevention Program;
  • Operating a Regulated Medical Waste disposal program, in compliance with Virginia Department of Environmental Quality regulations; and
  • Oversight of departmental compliance.

Departmental responsibilities:

Each department with employees at risk of occupational exposure to infectious disease has the following compliance responsibilities and functions:

  • Assigning accountability for program implementation to departmental coordinators and/or supervisory personnel. Supervisors of employees with occupational exposure to potentially infectious material or microorganisms should have this responsibility listed in their P-112s, the personnel performance plan, and evaluation forms.
  • Compliance with Virginia Tech’s Health and Safety Policy.
  • Circulating, to appropriate staff, the appendices of the Infection Control Plan that have been customized by the department to document policies and procedures addressing exposures that exist in departmental worksites.
  • Assuring that a personal protective equipment hazard assessment has been performed for workplace exposures.
  • Funding and providing personal protective equipment, as needed.
  • Notifying Environmental Health & Safety and IBC before establishing research endeavors involving infectious material or infectious agents.
  • Notifying Environmental Health & Safety of employee turnover.
  • Ensuring that new hires do not engage in activities with potential exposure until they have had appropriate training.
  • Assuring all at-risk employees attend required training sessions, are familiar with the Infection Control Plan, and follow safe work practices at all times. Please see Table 2 for information on at-risk categories.

Designated departmental coordinators and/or supervisors of “at-risk” employees are responsible for ensuring that the Infection Prevention Program is complete and accessible. Completion of the Infection Prevention Program involves inserting department-specific policies and procedures where indicated. Accessibility means that all at-risk employees must be informed of the location of the departmental Infection Control Program and encouraged to read its contents. The departmental coordinator and/or supervisor is responsible for:

  • Receiving the university Infection Prevention Program;
  • Completing department-specific sections of the Infection Control Program;
  • Storing the Infection Prevention Program in an accessible location;
  • Communicating the Infection Prevention Program location to all at-risk employees;
  • Reviewing and updating department-specific sections annually or earlier if work processes change;
  • Conducting annual review sessions with employees;
  • Assuring that employees receive introductory training prior to exposure to the hazard;
  • Allowing employees to attend training and schedule vaccinations during normal work hours;
  • Providing gloves and other protective equipment for use by employees; and
  • Reporting exposure incidents to Environmental Health & Safety and assist with report paperwork.

Every employee that can reasonably anticipate exposure to infectious material or infectious agents has certain compliance responsibilities. These include:

  • Complete all required training;
  • Complying with procedures outlined in this plan;
  • Utilize appropriate PPE and safe work practices when working with infectious material or potentially infectious animals; and
  • Reporting exposure incidents to supervisors and Environmental Health & Safety.

Employees who work with potentially infectious material in research labs at Virginia Tech must be familiar with, and closely follow, the policies and procedures described in Biosafety for Laboratory Workers.

Employees with occupational exposure to human tissue, blood, fluids, or other potentially infectious material (OPIM) of human origin must be familiar with, and closely follow, the requirements in OSHA’s bloodborne pathogens standard 29 CFR Part 1910.130 including the development of an Exposure Control Plan.

Contractors must follow procedures outlined in the Virginia Tech’s Safety Guide for Contractors and Subcontractors Program.

Exposure Control

It is important to understand how infectious microorganisms get into the body in order to choose the proper engineering controls, administrative controls, or PPE when there is the potential for exposure to disease. The routes of disease transmission, with definitions, are listed below.

  • Injection: Introduction of material directly into the bloodstream. Injection exposure may be from needle stick, animal bite/scratch or cut/puncture from any sharp object.
  • Inhalation: Introduction of material into the respiratory tract via aerosolization or spray of the material near the breathing zone.
  • Ingestion: Introduction of material into the gastrointestinal tract via aerosolization or spray of material near the face, or any activity that brings dirty or gloved hands near the face. Such activity can include eating, smoking, applying makeup or lip balm, scratching the face, chewing on pens or pencils.
  • Absorption: Introduction of material through intact skin or through mucous membranes. Absorption through intact skin is more likely with a chemical exposure since infectious microorganisms are typically too large to pass through intact skin. These organisms CAN pass through the mucous membranes lining the nose, mouth, eyes.

Certain procedures and tools must be used to keep employees safe from exposure to infectious diseases found in biological material (such as human/animal tissues or fluids) or laboratory stocks of infectious microorganisms. These procedures and tools include universal precautions, engineering controls, work practice controls, use of personal protective equipment, housekeeping, laundering, and use of signs and labels as described in the following sections.

Universal precautions/standard precautions

“Universal precautions," as defined by the Centers for Disease Control (CDC), are a set of precautions designed to prevent transmission of the human immunodeficiency virus (HIV), hepatitis B virus (HBV), and other bloodborne pathogens when providing first aid or health care. Under universal precautions, blood and certain body fluids of all patients are considered potentially infectious for HIV, HBV, and other bloodborne pathogens. Universal precautions were developed to protect individuals from exposure to human origin materials but the PPE and work practices prescribed by universal precautions are effective for work with any potentially infectious material such as microbial cultures or when treating sick animals. Universal precautions should also be followed when working with any biological material that has the potential to infect an employee with a disease whether it is a cultured microorganism or blood/tissues/other body fluids from human or animal sources.

The terms universal precautions and ‘standard precautions’ are interchangeable. Universal precautions include:

  • Assume that ALL human blood is positive for HIV, HBV, and HCV or another human pathogen;
  • Assume that ALL other human fluids/tissues are also positive for infectious disease;
  • Use PPE to avoid skin contact with potentially infectious materials;
  • Use PPE to avoid eye, nose, & mouth contact with potentially infectious materials; and
  • Avoid punctures/sticks with contaminated sharp objects.

Engineering controls

Engineering controls are devices and tools that prevent exposure to health hazards. These sorts of safety controls must be used, in conjunction with work practice controls, to eliminate or minimize employee exposure.

These devices/equipment must be inspected and maintained on a regular basis by the departmental coordinator, supervisor, or his or her designee. Worn parts and equipment shall be replaced as soon as indicated through the inspection process.

Some common engineering controls used to protect employees from infectious agents include:

Handwashing facilities: Each department shall provide readily accessible handwashing facilities. This means that there must be a facility to supply adequate running water, soap, and single-use towels or hot air drying machines.

Alternate handwashing devices: When running water handwashing facilities is not feasible, the department shall provide either an appropriate antiseptic hand cleanser with clean cloth/paper towels OR antiseptic towelettes.

Needle safety devices: Departments using medical sharps must make all reasonable attempts to implement the use of these safety devices instead of traditional sharps. There are many products on the market that are designed to prevent needle-stick injuries. Some examples include:

  • Needleless connectors for IV delivery systems (e.g., a blunt cannula for use with pre-pierced ports and valved connectors that accept tapered or luer ends of IV tubing);
  • Protected needle IV connectors (e.g., the IV connector needle is permanently recessed in a rigid plastic housing that fits over IV ports);
  • Needles that retract into a syringe or vacuum tube holder;
  • Hinged or sliding shields attached to phlebotomy needles, winged-steel needles, and blood gas needles;
  • Protective encasements to receive an IV stylet as it is withdrawn from the catheter;
  • Sliding needle shields attached to disposable syringes and vacuum tube holders;
  • Self-blunting phlebotomy and winged-steel needles (a blunt cannula seated inside the phlebotomy needle is advanced beyond the needle tip before the needle is withdrawn from the vein); and
  • Retractable finger/heel-stick lancets.

Desirable features in needle safety devices:

  • The device is needleless;
  • The safety feature is an integral part of the device;
  • The device preferably works passively (requires no activation by user);
  • The user can easily tell whether the safety feature is activated;
  • The safety feature cannot be deactivated and remains protective through disposal; and
  • The device is easy to use and practical.
Sharps containers: Proper containers for storage of contaminated sharps shall be provided by the departments. They shall meet the following description:
  • Puncture resistant;
  • Closeable;
  • Leakproof; and
  • Labeled (Biohazard) or color-coded (orange/red).
Splash guards: Laboratory equipment that can potentially vaporize or splash infectious material should be equipped with a splash guard or similar protective device.

Biosafety cabinets: Are in use in biological laboratories across campus whenever the possibility of exposure to airborne pathogens is present.

Work practice controls

Work practice controls are procedures that employees need to follow in order to keep themselves safe. These required procedures are to be followed by all “at-risk” employees and shall be enforced by all departments.

Hand/skin washing: It is extremely important that all at-risk employees follow strict hand/skin washing procedures at the following times:

  • After removing gloves or other PPE;
  • Following contact with potentially infectious material.

If exposure occurs, hands and other skin areas must be washed with soap and water OR alcohol-based antiseptic cleanser (in the absence of water). Mucous membranes shall be flushed with copious amounts of water for at least 15 minutes. DO NOT use soap or alcohol-based antiseptic cleansers for infectious agent exposures to eyes or nose/mouth.

When an antiseptic cleanser or towelette is used, washing with water and soap should follow as soon as possible.

Sharps handling: Whenever a needle or other sharp device is exposed, injuries can occur. In addition to risks related to device characteristics, needlestick injuries have been related to certain work practices such as:

  • Recapping;
  • Transferring a potentially infectious fluid between containers; and
  • Failing to properly dispose of used needles in puncture-resistant sharps containers.

If recapping cannot be avoided, it must be accomplished through the use of a mechanical device, such as forceps. Also, the one-hand scoop method is allowed, if done safely.

Minimize splashing: All procedures involving potentially infectious materials shall be performed in such a manner as to minimize splashing, spraying, spattering, and generation of droplets.

Avoid ingestion: Eating, drinking, chewing gum, smoking, applying cosmetics or lip balm, and handling contact lenses are strictly prohibited in work areas where there is a reasonable likelihood of occupational exposure to infectious material.

  • Food and drink shall not be kept where potentially infectious materials are present.
  • Mouth pipetting/suctioning of potentially infectious materials is prohibited.
Dealing with contaminated equipment: The following procedures shall be followed when having potentially contaminated equipment serviced:
  • Look for evidence of contamination;
  • Decontaminate if necessary and feasible;
  • If NOT feasible, label equipment with a BIOHAZARD label;
  • Include on the label which parts are contaminated;
  • Convey information to affected employees and servicing representatives prior to shipping, so that precautions can be taken.

Personal protective equipment

Where occupational exposure remains after the implementation of engineering and work practice controls, PPE shall also be used. Departments shall provide, at no cost to the employee, appropriate PPE including, but not limited to:

  • Gloves;
  • Gowns;
  • Lab coats;
  • Face shields;
  • Masks;
  • Respirators; and
  • Eye protection
PPE is considered appropriate if it is needed for, and is capable of preventing, blood or other fluids from passing through to the employee's clothing, skin, or mucous membranes. PPE selection shall be made after completing a PPE Hazard Assessment as outlined in Virginia Tech’s Personal Protective Equipment Program.

Departments shall ensure proper use, accessibility, cleaning, disposal, repair, and replacement of PPE.

Employees must remove PPE before leaving the work area or whenever the PPE has become saturated with blood or other potentially infectious materials. Disposable PPE must NOT be reused. Used PPE must be placed in an appropriately designated area or container for storage, washing, decontamination, or disposal.

Employees are not permitted to take their protective equipment home and launder it. It is the responsibility of the department to provide, launder, repair, replace, and dispose of personal protective equipment as needed.

Gloves: Gloves shall be worn when it can be reasonably anticipated that the employee may have hand contact with potentially infectious biological material, when performing vascular access procedures on humans, or when handling contaminated equipment or surfaces.

Guidelines for Glove Use

Glove Type:

Washable?

Decontaminate?

When To Discard:

Disposable

NO

NO

Torn, punctured, contaminated, when removed for any reason

Utility

YES

YES

Cracked, peeling, torn, punctured, deteriorating

Face and eye protection: Masks, respirators, goggles, glasses, and/or face shields are to be worn whenever splashes, spray, spatter, or droplets of potentially infectious materials may be generated, when eye, nose or mouth contamination can be reasonably anticipated, or when the pathogenic organism’s mode of transmission is via aerosol. Masks and other respiratory protection devices may only be purchased after consultation with Environmental Health & Safety personnel.

Body protection: Gowns, aprons, sleeve protectors, lab coats, clinic jackets, and other protective body clothing are to be worn in occupational exposure situations when appropriate. The type and characteristics of the PPE will depend upon the task and degree of exposure anticipated.

Housekeeping

All worksites are to be maintained in clean and sanitary conditions at all times. Each work area must establish a written cleaning schedule. All such schedules should be included in this manual, following this section.

Decontamination/cleaning of surfaces and equipment shall be performed at the following times:

  • At the frequency determined in the written schedule;
  • Following a contamination incident;
  • Following routine procedures that may cause contamination; and
  • At the end of work shifts, if contamination may have occurred since the last cleaning.

The following are surfaces that are likely to need decontamination:

  • Lab equipment;
  • Bench/countertops;
  • Re-useable receptacles that may store biological material;
  • Environmental surfaces such as patient examination tables; and
  • Large areas such as an ambulance interior, animal holding room, entire lab room, etc.

Protective coverings should be removed and replaced as soon as feasible when they become obviously contaminated or at the end of the work shift if they may have become contaminated during that shift. Coverings include:

  • Plastic wrap;
  • Aluminum foil; and
  • Imperviously-backed absorbent paper.

Broken glass shall not be picked up directly with the hands. It shall be cleaned up mechanically. Use a brush and dustpan, tongs, or forceps.

Employees must never reach into containers of contaminated sharps.

Chemical decontamination

Acceptable methods of chemical decontamination

Method

Acceptable for…

How?

Special Precautions

Comments

Sodium hypochlorite

General use; not recommended for skin disinfection. Will corrode metals.

Common household bleach diluted to a 1/10 to 1/100 with water.

1. Strong oxidizer.

2. Corrosive.

Note: May discolor certain materials.

At high concentrations and extended contact time, considered cold sterilants.

Alcohols

General use.

70-90% ethyl or isopropyl alcohol for 10-30 minutes contact time.

1. They evaporate fast and have a limited exposure time.

2. Can cause contact dermatitis.

1. Less active against non-lipid viruses.

2. Ineffective against bacterial spores.

3. Concentrations above 90% are less effective.

Iodophores

Most often used as antiseptics and in surgical soaps.

0.47% concentration for 10-30 minutes.

Can cause skin irritations.

 

Formaldehyde

Used for the same applications as glutaraldehyde; can be sporicidal.

4-8% concentration for 10-30 minutes.

Formaldehyde is a human carcinogen and creates respiratory problems.

 

Glutaraldehyde

Glassware and instruments; items that can be submerged and soaked in a covered container; considered a sporicidal.

2% concentration for 10-600 minutes; rinse with sterile water to remove residuals.

Sensitivity problems developed in workers using it at high levels.

 

Phenolic compounds

General use on walls, floors, bench tops; bacteria; fungi; and lipid-containing viruses.

0.2-3% concentration for 10-30 minutes.

Can cause depigmentation; occupational leukoderma; idiopathic neonatal hyperbilirubinemia.

Not active against spores or non-lipid viruses.

Quaternary ammonium compounds (Quats)

General use; active against gram-positive bacteria and lipid-containing viruses.

0.1-2% concentration for 10-30 minutes.

Can cause minor skin dermatitis.

1. Least effective against gram-negative bacteria and not active against non-lipid-containing viruses.

2. Easily inactivated by organic materials, are corrosive, and not sporicidal.

Laundry - proper practices

Contaminated laundry — laundry that has been soiled with blood or other potentially infectious materials — must be handled, stored, and transported in accordance with very specific requirements as follows:

  • Contaminated laundry must be handled as little as possible.
  • Employees that have contact with contaminated laundry must wear protective gloves and other appropriate personal protective equipment.
  • Contaminated laundry must be bagged or containerized at the location where it was used and may not be sorted or rinsed in the location of use.
  • Contaminated laundry containers must be labeled with the Biohazard symbol, or color-coded fluorescent orange or orange-red.
  • If the laundry is wet and presents a reasonable likelihood of leakage to the exterior of the container, the container must be capable of preventing soak-through.
  • Contaminated laundry must be handled following universal precautions. Contaminated laundry should not be taken home to be laundered by staff. Environmental Health & Safety strongly recommends that Departments arrange to have contaminated items laundered on-site (in an area separate from where the contaminated laundry is generated) or via an appropriate vendor.

Labels and signs

The OSHA Bloodborne Pathogens Standard requires labels to be placed on items that may be contaminated by bloodborne pathogens. This may include:

  • Equipment (e.g., refrigerators, freezers, and incubators);
  • Shipping containers;
  • Primary and secondary agent containers;
  • Regulated medical waste containers; and
  • Sharps containers.

All-access doors to labs or animal rooms where biologicals are present must be posted with biohazard information in addition to the emergency contact information required by Virginia Tech's Chemical Management Program. For additional information on required signage, go to the Biological Safety Program page. This biohazard information must include:

  • The universal biohazard symbol is red/orange in color with black lettering
  • Name of the agent(s) present in the lab;
  • Required biosafety level for working with these agents;
  • Required immunizations for entering the room;
  • Personal protective equipment that must be worn in the room;
  • Special procedures for entering or exiting the lab; and
  • Name and telephone number of the principal investigator, another responsible person (s), and Environmental Health & Safety emergency personnel.

Training program

Training is required yearly for all employees who work with, or may be exposed to, human blood, fluids, tissues, or other potentially infectious materials (OPIM) of human origin. Training for employees exposed to bloodborne pathogens must be arranged through Environmental Health & Safety.

Bloodborne pathogens training is offered twice monthly by Environmental Health & Safety. Please refer to Environmental Health & Safety training pae for available classes or contact Environmental Health & Safety at 540-231-4034 for information on the course schedule. Refresher training for large workgroups that cannot be accommodated during a standing bloodborne pathogens class will be arranged upon request.

Training is required for all employees and personnel working in laboratories or animal rooms where biological agents are in use. It is the responsibility of the principal investigator, lab director, or animal facility director to ensure that adequate instruction is provided. This training may be given by a responsible person in the lab or arranged by contacting Environmental Health & Safety or the Institutional Animal Care and Use Committee (IACUC). Laboratory personnel training should include, at a minimum, the following topics:

  • Principles of Biosafety;
  • Hazards in the lab (biological, chemical, and radiological) including pathogen transmission and epidemiology;
  • Infection Control Plan requirements and policies;
  • Completion of the pre-contact medical surveillance questionnaire;
  • The Infectious Agent Vaccination Program;
  • Acceptable laboratory and animal practices;
  • Personal protective equipment requirements;
  • Proper use of specific equipment used in the lab;
  • Signs and labeling requirements;
  • How to decontaminate, disinfect, and sterilize;
  • Proper waste handling, packaging, and disposal;
  • Packaging/shipping etiologic agents; and
  • Emergency procedures.

The Occupational Health and Safety Program for Animal Handlers can be used as a resource in training.

Training is required for all employees and personnel working with farm animals. It is the responsibility of the Principal Investigator, station director, or farm manager to ensure that adequate instruction is provided. This training may be given by the aforementioned individuals or arranged by contacting Environmental Health & Safety or IACUC. Training should include, at a minimum, the following topics:

  • Special education on large animal diseases;
  • Infection control plan requirements and policies;
  • Completion of the pre-contact medical surveillance questionnaire;
  • The Infectious Agent Vaccination Program;
  • Personal protective equipment requirements;
  • Animal handling and restraint procedures;
  • Signs and labeling requirements; and
  • Emergency procedures.

The Occupational Health and Safety Program for Animal Handlers can be used as a resource in training.

The department coordinator or supervisor of at-risk employees must ensure that department-specific training is performed annually, or as needed, on the following subjects:

  • New tasks that present potential for occupational exposure;
  • Department-specific sections of the Infection Prevention Program;
  • Available engineering controls;
  • Required work practice controls; and
  • Location and use of personal protective equipment.

Infectious Agent Vaccination and Occupational Health Assurance Program

University employees who are identified as being at risk for work-related exposure to infectious agents will be offered vaccinations if they are available for the agent in question. See below for the list of vaccinations offered by Virginia Tech. If employees have an exposure incident, the employee will be offered testing, evaluation, and counseling as needed. Employees may, in certain situations, decline vaccinations. The following bullets summarize this program:

  • Environmental Health & Safety administers this program and will maintain documentation of all vaccinations, titers, declination of vaccinations, and all other medical records. Please contact Environmental Health & Safety at 540-231-8733 or mjdadras@vt.edu if additional information is needed.
  • All medical services are provided at no cost to the employee.
  • All medical services will be made available at a reasonable time and place.
  • Vaccines (if available for the agent in question) must be offered to all known at-risk personnel. Vaccinations must be offered to the employee prior to exposure to the hazard. See the following section for a list of vaccinations that are currently being offered.
  • Hepatitis B vaccinations must be offered to all personnel identified as “at-risk” for exposure to human blood. See the university’s Exposure Control Plan for a detailed explanation.
  • Routine titer checks are provided for individuals working with BSL2 and BSL3 organisms, if such tests are available.
  • Medical exams will be provided for individuals following an exposure incident to blood, potentially infectious material, or to a specific agent.
  • medical survey questionnaire is to be completed by all persons having “substantial animal contact.”
  • It is the responsibility of the principal investigator, researcher, lab director/supervisor, or animal facility director to identify at-risk personnel and personnel with “substantial animal contact.” This information must be communicated to Environmental Health & Safety. See forms in Appendix A.

Employees with potential for exposure to certain infectious agents via patient care activities (such as doctors, nurses, rescue squad, athletic trainers, veterinarians, animal care staff), or who are conducting research with specific infectious organisms, will be eligible to receive vaccinations against the microorganisms of concern. Below is a list of infectious agent vaccinations offered at Virginia Tech and the eligibility criteria for each. Other vaccinations and titers will be offered if warranted by exposure conditions and if the vaccinations are commercially available.

C. Botulinum vaccine:

Laboratory personnel who are working with Clostridium Botulinum toxin.

Hepatitis A vaccine:

Employees working with, or who may potentially be exposed to, raw sewage.

Hepatitis B vaccine:

Employees who are working with or may potentially be exposed to human blood, tissue, body fluids or other potentially infectious materials.

Influenza (seasonal flu):

Employees who provide patient care (i.e. Schiffert Student Health Clinic and Virginia Tech Rescue Squad personnel) or are working with the organism in a research lab.

Measles, Mumps, Rubella:

Employees who provide patient care (i.e. Schiffert Student Health Clinic and Virginia Tech Rescue Squad personnel).

Rabies vaccine:

Employees who are working with any animal species known to be a rabies reservoir, working with a wide variety of animal species that may include a species known to be a rabies reservoir, or who may be doing fieldwork in habitat with known rabies reservoir species.

Tetanus (with pertussis):

Employees working with animals or who have the potential for acquiring a wound on dirty equipment at work (such as farmworkers, garbage handlers, groundskeepers).

Typhoid:

Employees working with, or who may potentially be exposed to, raw sewage or laboratory personnel who are working with S. Typhi.

Exposure reporting

Appendices

Please click on the following links for additional information on the disease listed.

Hepatitis A (HAV) is a liver disease caused by the Hepatitis A virus. Hepatitis A is found in the stool (feces) of persons with Hepatitis A or in water that has been contaminated with human waste. 

Hepatitis A virus is spread from person to person by putting something in the mouth that has been contaminated with the stool of a person with Hepatitis A (i.e ‘fecal-oral’ transmission).  For this reason, the virus is more easily spread in areas where there are poor sanitary conditions or where good personal hygiene is not observed. Individuals who work with raw sewage also have a small risk of being exposed to HAV.

Most infections result from contact with a household member or sex partner who has Hepatitis A. Casual contact, as in the office, factory, or school setting, does not spread the virus. Individuals who travel to areas with a high rate of HAV or where poor sanitary conditions are likely should practice good hand hygiene, and thoroughly wash and cook any foods.

 Adults will have signs and symptoms more often than children. These signs and symptoms include:

  • Jaundice;
  • Fatigue;
  • Abdominal pain;
  • Loss of appetite;
  • Nausea;
  • Diarrhea; and/or
  • Fever.

1. Vaccination:

All employees who could potentially be exposed to Hepatitis A due to work related activity will be offered Hepatitis A vaccination at no cost to the employee.

2. PPE:

  • Clinical setting: Gloves should be worn when caring for a HAV positive patient. Care should be taken when handling linens or clothing that has been soiled with the patient’s feces. Face protection should be worn when the activity presents a chance of splash or aerosolization of feces. Wash hands immediately after removing PPE.
  • Research/animal care setting: PPE use would be based on the risk of exposure that an activity presents. Face protection would be necessary if there is risk of aerosolization of contaminated feces or culture material; gloves, lab coat/coveralls would be needed for activities with potential for skin exposure.
 

3. Other protective measures:

Please refer to the Virginia Tech Biosafety Manual for recommendations on use of biosafety cabinets and other recommendations on engineering/administrative controls that may be required for work with this organism.

  • Rinse affected area immediately. Use soap and water (except on eyes) or flush with just water.
  • Notify your supervisor.
  • You or your supervisor must notify Environmental Health & Safety as soon as possible after an exposure. Environmental Health & Safety will consult with Virginia Tech’s Occupational Health Physician regarding appropriate treatment for the exposure.
  • If necessary, seek medical attention for an emergency (i.e. severe bleeding, difficulty breathing) before contacting Environmental Health & Safety.
  • If you seek medical attention before contacting Environmental Health & Safety you MUST notify the care provider that you may have had an exposure to an infectious agent before arriving at the clinic or emergency department.
  • Complete the Employer’s Accident Report, which may be accessed from this link:  https://froi.sedgwick.com/account?ReturnUrl=%2f  More information for the Workers Compensation program can be found on the HR website:
    https://www.hr.vt.edu/benefits/workers-compensation.html
  • For more information visit cdc.gov look for Hepatitis A in the A-Z index.

Hepatitis B is a serious disease caused by a virus that attacks the liver. The virus, which is called hepatitis B virus (HBV), can cause lifelong infection, cirrhosis (scarring) of the liver, liver cancer, liver failure, and death. HBV is found in the blood of infected people.

Hepatitis B vaccine is available for all age groups to prevent hepatitis B virus infection.

HBV is spread when blood from an infected person enters the body of a person who is not infected. For example, HBV is spread through having sex with an infected person without using a condom (the efficacy of latex condoms in preventing infection with HBV is unknown, but their proper use might reduce transmission), by sharing drugs, needles, or "works" when "shooting" drugs, through needlesticks or sharps exposures on the job, or from an infected mother to her baby during birth.

Hepatitis B is not spread through food or water, sharing eating utensils, breastfeeding, hugging, kissing, coughing, sneezing, or by casual contact.

About 30 percent of persons with HBV will have no signs or symptoms. Signs and symptoms are less common in children than adults. Signs and symptoms can include:

  • Jaundice;
  • Fatigue;
  • Abdominal pain;
  • Loss of appetite;
  • Nausea, vomiting; and/or
  • Joint pain.

1. Vaccination:

All employees who could potentially be exposed to human blood, tissue, or other body fluids due to a work-related activity will be offered Hepatitis B vaccination at no cost to the employee.

2. PPE:

  • Clinical setting: Gloves should be worn when caring for an HBV-positive patient. Face protection should be worn when the activity presents a chance of splash or aerosolization of blood.
  • Research setting: PPE use would be based on the risk of exposure that an activity presents. Face protection would be necessary if there is a risk of aerosolization or splash of contaminated blood or culture material; gloves, lab coat/coveralls would be needed for activities with potential for skin exposure.

3. Other protective measures:

Please refer to the Virginia Tech Biosafety Manual for recommendations on the use of biosafety cabinets and other engineering/administrative controls that may be required for work with this organism.

  • Rinse affected area immediately. Use soap and water (except on eyes) or flush with just water.
  • Notify your supervisor.
  • You or your supervisor must notify Environmental Health & Safety as soon as possible after an exposure. Environmental Health & Safety will consult with Virginia Tech’s Occupational Health physician regarding appropriate treatment for the exposure.
  • If necessary, seek medical attention for an emergency (i.e. severe bleeding, difficulty breathing) before contacting Environmental Health & Safety.
  • If you seek medical attention before contacting Environmental Health & Safety you MUST notify the care provider that you may have had an exposure to an infectious agent before arriving at the clinic or emergency department.
  • Complete the Employer’s Accident Report, which may be downloaded from hr.vt.edu.
  • For more information visit cdc.gov look for Hepatitis B in the A-Z index.

HIV is found in varying concentrations or amounts in human blood, semen, vaginal fluid, breast milk, saliva, and tears. Scientists and medical authorities agree that HIV does not survive well outside the body, making the possibility of environmental transmission remote.

HIV transmission can occur when blood, semen, pre-seminal fluid, vaginal fluid, or breast milk from an infected person enters the body of an uninfected person.

HIV can enter the body through a vein (e.g., injection drug use), the lining of the anus or rectum, the lining of the vagina and/or cervix, the opening to the penis, the mouth, other mucous membranes (e.g., eyes or inside of the nose), or cuts and sores. Intact, healthy skin is an excellent barrier against HIV and other viruses and bacteria.

These are the most common ways that HIV is transmitted from one person to another:

  • By having sex (anal, vaginal, or oral) with an HIV-infected person;
  • By sharing needles or injection equipment with an injection drug user who is infected with HIV; or
  • From HIV-infected women to their babies before or during birth, or through breast feeding.

HIV is not transmitted by day-to-day contact in the workplace, schools, or social settings. HIV is not transmitted through shaking hands, hugging, or a casual kiss. You cannot become infected from a toilet seat, a drinking fountain, a door knob, dishes, drinking glasses, food, or pets.

The only way to know if you are infected is to be tested for HIV infection. You cannot rely on symptoms to know whether or not you are infected. Many people who are infected with HIV do not have any symptoms at all for 10 years or more.

The following may be warning signs of advanced HIV infection:

  • Rapid weight loss;
  • Dry cough;
  • Recurring fever or profuse night sweats;
  • Profound and unexplained fatigue;
  • Swollen lymph glands in the armpits, groin, or neck;
  • Diarrhea that lasts for more than a week;
  • White spots or unusual blemishes on the tongue, in the mouth, or in the throat;
  • Pneumonia;
  • Red, brown, pink, or purplish blotches on or under the skin or inside the mouth, nose, or eyelids; and/or
  • Memory loss, depression, and other neurological disorders.

However, no one should assume they are infected if they have any of these symptoms. Each of these symptoms can be related to other illnesses. 

1. Vaccination:

There currently is no vaccination for HIV.

2. PPE:

  • Clinical setting: Gloves should be worn when caring for a n HIV positive patient. Face protection should be worn when the activity presents a chance of splash or aerosolization of blood.
  • Research setting: PPE use would be based on the risk of exposure that an activity presents. Face protection would be necessary if there is risk of aerosolization of contaminated blood or culture material; gloves, lab coat/coveralls would be needed for activities with potential for skin exposure.

3. Other protective measures:

Please refer to the Virginia Tech Biosafety Manual for recommendations on use of biosafety cabinets and other engineering/administrative controls that may be required for work with this organism.

  • Rinse the affected area immediately. Use soap and water (except on eyes) or flush with just water.
  • Notify your supervisor.
  • You or your supervisor must notify Environmental Health & Safety as soon as possible after an exposure. Environmental Health & Safety will consult with Virginia Tech’s Occupational Health physician regarding appropriate treatment for the exposure.
  • If necessary, seek medical attention for an emergency (i.e. severe bleeding, difficulty breathing) before contacting Environmental Health & Safety.
  • If you seek medical attention before contacting Environmental Health & Safety you MUST notify the care provider that you may have had exposure to an infectious agent before arriving at the clinic or emergency department.
  • Complete the Employer’s Accident Report, which may be downloaded from hr.vt.edu.
  •  For more information go to cdc.gov look for HIV in the A-Z index.

Influenza, commonly called "the flu," is caused by the influenza virus, which infects the respiratory tract (nose, throat, lungs).

The main way that influenza viruses are spread is from person-to-person in respiratory droplets of coughs and sneezes (i.e. "droplet spread"). This can happen when droplets from a cough or sneeze of an infected person are propelled (generally up to 3 feet) through the air and deposited on the mouth or nose of people nearby. Though much less frequent, the viruses also can be spread when a person touches respiratory droplets on another person or an object and then touches their own mouth or nose (or someone else’s mouth or nose) before washing their hands. A risky exposure to culture material in the lab is a concern for employees doing research with influenza virus.

Influenza is a respiratory illness. Symptoms of flu include fever, headache, extreme tiredness, dry cough, sore throat, runny or stuffy nose, and muscle aches. Children can have additional gastrointestinal symptoms, such as nausea, vomiting, and diarrhea, but these symptoms are uncommon in adults.

Although the term "stomach flu" is sometimes used to describe vomiting, nausea, or diarrhea, these illnesses are caused by certain other viruses, bacteria, or possibly parasites, and are rarely related to influenza.

The flu and the common cold are both respiratory illnesses but they are caused by different viruses. Because these two types of illnesses have similar flu-like symptoms, it can be difficult to tell the difference between them based on symptoms alone. In general, the flu is worse than the common cold, and symptoms such as fever, body aches, extreme tiredness, and dry cough are more common and intense. Colds are usually milder than the flu. People with colds are more likely to have a runny or stuffy nose. Colds generally do not result in serious health problems, such as pneumonia, bacterial infections, or hospitalizations.

1. Vaccination:

All employees who could potentially be exposed to seasonal flu due to providing care for individuals in a group setting, patients with upper respiratory illness, or research activities will be offered the Influenza vaccination at no cost to the employee.

2. PPE:

  • Clinical setting: Gloves should be worn when caring for a patient with the flu. Face protection should be worn when the activity presents a chance of splash or aerosolization of respiratory secretions.
  • Research setting: PPE use would be based on the risk of exposure that an activity presents. Respiratory protection would be necessary if there is risk of aerosolization of contaminated respiratory tract secretions or culture material; gloves, lab coat/coveralls would be needed for activities with potential for skin exposure.

3. Other protective measures:

Isolation of a highly infectious patient may be necessary in a clinical setting. Care providers and laboratory personnel should wash hands immediately after removing PPE.

Please refer to the Virginia Tech Biosafety Manual for recommendations on use of Biosafety Cabinets and other engineering/administrative controls that may be required for research with this organism.

  • Rinse the affected area immediately. Use soap and water (except on eyes) or flush with just water.
  • Notify your supervisor.
  • You or your supervisor must notify Environmental Health & Safety as soon as possible after an exposure. Environmental Health & Safety will consult with Virginia Tech’s Occupational Health Physician regarding appropriate treatment for the exposure.
  • If necessary, seek medical attention for an emergency (i.e. severe bleeding, difficulty breathing) before contacting Environmental Health & Safety.
  • If you seek medical attention before contacting Environmental Health & Safety you MUST notify the care provider that you may have had exposure to an infectious agent before arriving at the clinic or emergency department.
  • Complete the Employer’s Accident Report, which may be downloaded from hr.vt.edu.
  • For more information, visit cdc.gov look for Influenza in the A-Z index.

Malaria is a serious and sometimes fatal disease caused by a parasite. Four kinds of malaria parasites can infect humans: Plasmodium falciparum, P. vivax, P. ovale, and P. malariae. Even though malaria was eradicated from the United States in the early 1950s, the disease still occurs in over 100 countries and territories. More than 40 percent of the world's population is at risk. Large areas of Central and South America, Hispaniola (the Caribbean island that is divided between Haiti and the Dominican Republic), Africa, the Indian subcontinent, Southeast Asia, the Middle East, and Oceania are considered malaria-risk areas. Travelers who visit these areas risk getting malaria. In addition, researchers who work with malaria-infected blood are at small risk of contracting the disease if they are exposed to the blood.

Infection with any of the malaria species can make a person feel very ill; infection with P. falciparum, if not promptly treated, may be fatal. Although malaria can be a fatal disease, illness and death from malaria are largely preventable. The vast majority of cases in the United States are in travelers and immigrants returning from malaria-risk areas, many from sub-Saharan Africa and the Indian subcontinent.  

Usually, people get malaria by being bitten by an infected female Anopheles mosquito. Only Anopheles mosquitoes can transmit malaria and they must have been infected through a previous blood meal taken on an infected person.

Returning travelers and arriving immigrants could also reintroduce the disease in the United States if they are infected with malaria when they return. The mosquito that transmits malaria, Anopheles, is found throughout much of the United States. If local mosquitoes bite an infected person, those mosquitoes can, in turn, infect local residents (introduced malaria).

A few cases of malaria occur every year in the United States in people who have not left the country. Fortunately, these are very rare occurrences. Malaria may be transmitted through blood transfusions, organ transplants, shared use of needles or syringes, or by local transmission.

Patients with malaria typically are very sick with high fevers, shaking chills, and flu-like illness.

1. Vaccination:

There is no vaccine for malaria. Individuals who travel to areas where malaria is endemic should follow CDC and Virginia Dept of Health recommendations regarding the use of anti-malarial medications.

2. PPE:

  • Clinical setting: Since Malaria is not commonly transmitted person-to-person, only PPE that would routinely be worn for various patient care activities is necessary.
  • Research setting: PPE use would be based on the risk of exposure that an activity presents. Face shield, goggles, or respiratory protection would be necessary if there is a risk of aerosolization of contaminated blood or culture material; gloves, lab coat/coveralls would be needed for activities with potential for skin exposure. Working with known infectious mosquitoes would require skin protection that would prevent employees from getting bitten by the infected mosquitoes.

3. Other protective measures:

Please refer to the Virginia Tech Biosafety Manual for recommendations on use of biosafety cabinets and other engineering/administrative controls that may be required for research with this organism.

  • Rinse the affected area immediately. Use soap and water (except on eyes) or flush with just water.
  • Notify your supervisor.
  • You or your supervisor must notify Environmental Health & Safety as soon as possible after an exposure. Envi ronmental Health & Safety will consult with Virginia Tech’s Occupational Health physician regarding appropriate treatment for the exposure.
  • If necessary, seek medical attention for an emergency (i.e severe bleeding, difficulty breathing) before contacting Environmental Health & Safety.
  • If you seek medical attention before contacting Environmental Health & Safety you MUST notify the care provider that you may have had exposure to an infectious agent before arriving at the clinic or emergency department.
  • Complete the Employer’s Accident Report, which may be downloaded from hr.vt.edu.
  • For more information, visit cdc.gov and look for Malaria in the A-Z index.

The Measles virus normally grows in the cells that line the back of the throat and in the mucus in the nose and throat of the infected person. When that person sneezes or coughs, droplets spray into the air. The infected mucus can land in other people’s noses or throats when they breathe or put their fingers in their mouth or nose after touching a contaminated surface. The virus can remain airborne and infectious for up to 2 hours and remains active and contagious on infected surfaces for up to 2 hours. Measles spreads so easily that anyone who is not immunized is at very high risk of contracting the disease if exposed to the virus.

This disease is easily spread by contact with an infected person, through coughing and sneezing.

The disease is highly contagious, and can be transmitted from 4 days prior to the onset of the rash to 4 days after the onset. If one person has it, 90 percent of their susceptible close contacts will also become infected with the measles virus.

Symptoms include: rash, high fever, cough, runny nose, and red, watery eyes. Approximately 20 percent of reported measles cases experience one or more complications. Complication can include: Diarrhea, ear infections, pneumonia, encephalitis, seizures, and death. These complications are more common among children under 5 years of age and adults over 20 years old.

1. Vaccination:

Vaccination is typically done in childhood. However, some people may need a booster or may have not gotten this vaccine in childhood. Current CDC recommendations for measles vaccination are:

You do NOT need the measles, mumps, rubella vaccine (MMR) if:

  • You had blood tests that show you are immune to measles, mumps, and rubella.
  • You are a man born before 1957.
  • You are a woman born before 1957 who is sure she is not having more children, has already had rubella vaccine, or has had a positive rubella test.
  • You already had two doses of MMR or one dose of MMR plus a second dose of the measles vaccine.
  • You already had one dose of MMR and are not at high risk of measles exposure.

You SHOULD get the measles vaccine if you are not among the categories listed above, and:

  • You are a college student, trade school student, or another student beyond high school.
  • You work in a hospital or other medical facility.
  • You travel internationally or are a passenger on a cruise ship.
  • You are a woman of childbearing age.

2. PPE:

  • Clinical setting: Gloves should be worn as necessary for routine patient care activities. Face protection should be worn when the activity presents a chance of splash or aerosolization of respiratory secretions.
  • Research setting: PPE use would be based on the risk of exposure that an activity presents. Respiratory protection would be necessary if there is a risk of aerosolization of contaminated respiratory secretions or culture material.

3. Other protective measures:

Please refer to the Virginia Tech Biosafety Manual for recommendations on the use of biosafety cabinets and another engineering/administrative controls that may be required for work with this organism.

  • Rinse the affected area immediately. Use soap and water (except on eyes) or flush with just water.
  • Notify your supervisor.
  • You or your supervisor must notify Environmental Health & Safety as soon as possible after an exposure. Environmental Health & Safety will consult with Virginia Tech’s Occupational Health physician regarding appropriate treatment for the exposure.
  • If necessary, seek medical attention for an emergency (i.e severe bleeding, difficulty breathing) before contacting Environmental Health & Safety.
  • If you seek medical attention before contacting Environmental Health & Safety you MUST notify the care provider that you may have had exposure to an infectious agent before arriving at the clinic or emergency department.
  • Complete the Employer’s Accident Report, which may be downloaded from hr.vt.edu.
  • For more information, visit cdc.gov and look for Measles in the A-Z index.

Staphylococcus aureus, often simply referred to simply as “staph,” are bacteria commonly found on the skin and in the noses of healthy people. Occasionally, staph can cause infection; staph bacteria are one of the most common causes of skin infections in the United States. Most of these infections are minor (such as pimples, boils, and other skin conditions) and most can be treated without antimicrobial agents (also known as antibiotics or antibacterial agents). However, staph bacteria can also cause serious and sometimes fatal infections (such as bloodstream infections, surgical wound infections, and pneumonia). In the past, most serious staph bacterial infections were treated with a type of antimicrobial agent related to penicillin. Over the past 50 years, treatment of these infections has become more difficult because staph bacteria have become resistant to various antimicrobial agents, including the commonly used penicillin-related antibiotics.

Methicillin-resistant Staphylococcus Aureus (MRSA) is a type of staph aureus that is resistant to certain antibiotics. These antibiotics include methicillin and other more common antibiotics such as oxacillin, penicillin, and amoxicillin. Staph infections, including MRSA, occur most frequently among persons in hospitals and healthcare facilities (such as nursing homes and dialysis centers) who have weakened immune systems.

VISA and VRSA are specific types of antimicrobial-resistant staph bacteria. While most staph bacteria are susceptible to the antimicrobial agent vancomycin some have developed resistance. VISA and VRSA cannot be successfully treated with vancomycin because these organisms are no longer susceptible to vancomycin. However, to date, all VISA and VRSA isolates have been susceptible to other Food and Drug Administration (FDA) approved drugs.

MRSA infections that are acquired by persons who have not been recently (within the past year) hospitalized or had a medical procedure (such as dialysis, surgery, catheters) are known as community-acquired MRSA (CA-MRSA) infections. Staph or MRSA infections in the community are usually manifested as skin infections, such as pimples and boils, and occur in otherwise healthy people. MRSA can be a concern in settings such as schools, athletic competitions, gyms, the workplace.

Staph is transmitted via direct contact with materials containing the organism. Such contact can include:

  • Colonized or infected patients;
  • Colonized or infected body sites of the personnel themselves; and/or
  • Devices, items, or environmental surfaces contaminated with body fluids containing MRSA/VRSA.

Although hospital personnel can serve as reservoirs for MRSA and may harbor the organism for many months, they have been more commonly identified as a link for transmission between colonized or infected patients.

Staph bacteria, including MRSA/VRSA, can cause skin infections that may look like a pimple or boil and can be red, swollen, painful, or have pus or other drainage. More serious infections may cause pneumonia, bloodstream infections, or surgical wound infections.

1. Vaccination:

There is no vaccination for staphylococcus aureus.

2. PPE:

Clinical setting: Since staph is known to be transmitted person-to-person, standard precautions must be closely followed and contact precautions may be necessary. Protection recommendations are the same for any of the antibiotic-resistant strains of staph.

Standard precautions include:

  • Handwashing: Wash hands after touching blood, body fluids, secretions, excretions, and contaminated items, whether or not gloves are worn. Wash hands immediately after gloves are removed, between patient contacts, and when otherwise indicated to avoid transfer of microorganisms to other patients or environments. It may be necessary to wash hands between tasks and procedures on the same patient to prevent cross-contamination of different body sites.
  • Gloving: Wear gloves (clean non-sterile gloves are adequate) when touching blood, body fluids, secretions, excretions, and contaminated items; put on clean gloves just before touching mucous membranes and non-intact skin. Remove gloves promptly after use, before touching non-contaminated items and environmental surfaces, and before going to another patient, and wash hands immediately to avoid the transfer of microorganisms to other patients or environments.
  • Masking: Wear a mask and eye protection or a face shield to protect mucous membranes of the eyes, nose, and mouth during procedures and patient-care activities that are likely to generate splashes or sprays of blood, body fluids, secretions, and excretions.
  • Gowning: Wear a gown (a clean non-sterile gown is adequate) to protect skin and prevent soiling of clothes during procedures and patient-care activities that are likely to generate splashes or sprays of blood, body fluids, secretions, and excretions or cause soiling of clothing.
  • Appropriate device handling: Handle used patient-care equipment soiled with blood, body fluids, secretions, and excretions in a manner that prevents skin and mucous membrane exposures, contamination of clothing, and transfer of microorganisms to other patients and environments. Ensure that reusable equipment is not used for the care of another patient until it has been appropriately cleaned and reprocessed and those single-use items are properly discarded.
  • Appropriate handling of laundry: Handle, transport, and process used linen soiled with blood, body fluids, secretions, and excretions in a manner that prevents skin and mucous membrane exposures, contamination of clothing, and transfer of microorganisms to other patients and environments.

If MRSA/VRSA is judged by the facility’s infection control program to be of special clinical or epidemiologic significance, then contact precautions should be considered.

Contact precautions consist of:

  • Placing a patient with MRSA/VRSA in a private room. When a private room is not available, the patient may be placed in a room with a patient(s) who has active infection with MRSA/VRSA, but with no other infection (cohorting).
  • Wearing gloves (clean non-sterile gloves are adequate) when entering the room. During the course of providing care for a patient, change gloves after having contact with infective material that may contain high concentrations of microorganisms (e.g., fecal material and wound drainage). Remove gloves before leaving the patient's room and wash hands immediately with an antimicrobial agent. After glove removal and handwashing, ensure that hands do not touch potentially contaminated environmental surfaces or items in the patient's room to avoid the transfer of microorganisms to other patients and environments.
  • Wearing a gown when entering the room if you anticipate that your clothing will have substantial contact with the patient, environmental surfaces, or items in the patient's room, or if the patient is incontinent, or has diarrhea, an ileostomy, a colostomy, or wound drainage not contained by a dressing. Remove the gown before leaving the patient's room. After gown removal, ensure that clothing does not contact potentially contaminated environmental surfaces to avoid the transfer of microorganisms to other patients and environments.
  • Limiting the movement and transport of the patient from the room to essential purposes only. If the patient is transported out of the room, ensure that precautions are maintained to minimize the risk of transmission of microorganisms to other patients and contamination of environmental surfaces or equipment.
  • Ensuring that patient-care items, bedside equipment, and frequently touched surfaces receive daily cleaning.
  • When possible, dedicating the use of noncritical patient-care equipment and items such as stethoscope, sphygmomanometer, bedside commode, or electronic rectal thermometer to a single patient (or cohort of patients infected or colonized with MRSA) to avoid sharing between patients. If the use of common equipment or items is unavoidable, then adequately clean and disinfect them before use on another patient.

3. Other protective measures:

Please refer to the Virginia Tech Biosafety Manual for recommendations on the use of biosafety cabinets and other engineering/administrative controls that may be required for work with this organism.

Employees that have been diagnosed with MRSA or VRSA infections may return to work with the permission of their treating clinician. These individuals must keep the lesions covered and minimize touching the bandage while at work and must closely follow their clinician's instructions for safely doing any bandage changes that must be done during work hours.

Culturing of personnel and management of personnel carriers of MRSA:

Unless the objective of the hospital is to eradicate all MRSA carriage and treat all personnel who are MRSA carriers, whether or not they disseminate MRSA, it may be prudent to culture only personnel who are implicated in MRSA transmission based on epidemiologic data. MRSA-carrier personnel who are epidemiologically linked to transmission should be removed from direct patient care until the treatment of the MRSA-carrier status is successful. If the hospital elects to culture all personnel to identify MRSA carriers, a) surveillance cultures need to be done frequently, and b) it is likely that personnel colonized by MRSA who are not linked to the transmission and/or who may not be MRSA disseminators will be identified, subjected to treatment, and/or removed from patient contact unnecessarily. Because of the high-cost attendant of repeated surveillance cultures and the potential of repeated culturing to result in serious consequences to health care workers, hospitals should weigh the advantages and the adverse effects of routinely culturing personnel before doing so.

Control of MRSA outbreaks:

When an outbreak of MRSA infection occurs, an epidemiologic assessment should be initiated to identify risk factors for MRSA acquisition in the institution; clinical isolates of MRSA should be saved and submitted for strain typing. Colonized or infected patients should be identified as quickly as possible, appropriate barrier precautions should be instituted, and handwashing by medical personnel before and after all patient contacts should be strictly adhered to.

All personnel should be reinstructed on appropriate precautions for patients colonized or infected with multiresistant microorganisms and on the importance of handwashing and barrier precautions in preventing contact transmission.

If additional help is needed by the hospital, a consultation with the local or state health department or CDC may be necessary.

Research/animal care setting: PPE use would be based on the risk of exposure that activity presents. Face protection would be necessary if there is a risk of aerosolization of contaminated material; gloves, lab coat/coveralls would be needed for activities with potential for skin exposure.

  • Rinse the affected area immediately. Use soap and water (except on eyes) or flush with just water.
  • Notify your supervisor.
  • You or your supervisor must notify Environmental Health & Safety as soon as possible after an exposure. Environmental Health & Safety will consult with Virginia Tech’s Occupational Health physician regarding appropriate treatment for the exposure.
  • If necessary, seek medical attention for an emergency (i.e severe bleeding, difficulty breathing) before contacting Environmental Health & Safety.
  • If you seek medical attention before contacting Environmental Health & Safety you MUST notify the care provider that you may have had exposure to an infectious agent before arriving at the clinic or emergency department.
  • Complete the Employer’s Accident Report, which may be downloaded from hr.vt.edu.
  • For more information, visit cdc.gov and look for MRSA or VRSA in the A-Z index.

The mumps virus replicates in the upper respiratory tract and is spread through direct contact with respiratory secretions or saliva or when contaminated surfaces, such as doorknobs or phones, are touched and the person transfers the virus to their eyes, nose, or mouth.

This disease is easily spread by direct contact with an infected person, through an infected person’s coughing and sneezing, or through contact with materials or surfaces that are contaminated with the mumps virus.

The infectious period (i.e. time that an infected person can transmit mumps to a non-infected person) is from 3 days before symptoms appear to about 9 days after the symptoms appear.

The incubation time, which is the period from when a person is exposed to virus to the onset of any symptoms, can vary from 16-to-18 days (range 12-25 days).

Fever, headache, muscle aches, tiredness, and loss of appetite; followed by swelling of salivary glands. The parotid salivary glands (which are located within your cheek, near your jaw line, below your ears) are most frequently affected.

Severe complications are rare. However, mumps can cause:

  • Inflammation of the brain and/or tissue covering the brain and spinal cord (encephalitis/meningitis);
  • Inflammation of the testicles (orchitis);
  • Inflammation of the ovaries and/or breasts (oophoritis and mastitis);
  • Spontaneous abortion; and/or
  • Deafness, usually permanent.

1. Vaccination:

Vaccination is typically done in childhood. However, some people may need a booster or may have not gotten this vaccine in childhood. Current CDC recommendations for mumps vaccination are:

You do NOT need the measles, mumps, rubella vaccine (MMR) if:

  • You had blood tests that show you are immune to measles, mumps, and rubella.
  • You are a man born before 1957.
  • You are a woman born before 1957 who is sure she is not having more children, has already had rubella vaccine, or has had a positive rubella test.
  • You already had two doses of MMR or one dose of MMR plus a second dose of the measles vaccine.
  • You already had one dose of MMR and are not at high risk of measles exposure.

You SHOULD get the MMR vaccine if you are not among the categories listed above, and:

  • You are a college student, trade school student, or other student beyond high school.
  • You work in a hospital or other medical facility.
  • You travel internationally or are a passenger on a cruise ship.
  • You are a woman of childbearing age.

2. PPE:

  • Clinical setting: Gloves should be worn as necessary for routine patient care activities. Face protection should be worn when the activity presents a chance of splash or aerosolization of respiratory secretions.
  • Research setting: PPE use would be based on the risk of exposure that an activity presents. Respiratory protection would be necessary if there is a risk of aerosolization of contaminated respiratory secretions or culture material.

3. Other protective measures:

Please refer to the Virginia Tech Biosafety Manual for recommendations on the use of biosafety cabinets and other engineering/administrative controls that may be required for work with this organism.

  • Rinse the affected area immediately. Use soap and water (except on eyes) or flush with just water.
  • Notify your supervisor.
  • You or your supervisor must notify Environmental Health & Safety as soon as possible after an exposure. Environmental Health & Safety will consult with Virginia Tech’s Occupational Health physician regarding appropriate treatment for the exposure.
  • If necessary, seek medical attention for an emergency (i.e severe bleeding, difficulty breathing) before contacting Environmental Health & Safety.
  • If you seek medical attention before contacting Environmental Health & Safety you MUST notify the care provider that you may have had exposure to an infectious agent before arriving at the clinic or emergency department.
  • Complete the Employer’s Accident Report, which may be downloaded from hr.vt.edu.
  • For more information, visit cdc.gov and look for Mumps in the A-Z index.

Noroviruses are found in the stool or vomit of infected people. This is a group of viruses that cause gastroenteritis (commonly known as ‘stomach flu’). The term norovirus was recently approved as the official name for this group of viruses. Several other names have been used for noroviruses, including:

  • Norwalk-like viruses (NLVs);
  • Caliciviruses (because they belong to the virus family Caliciviridae); and
  • Small round structured viruses.

People can become infected with the virus in several ways, including:

  • Eating food or drinking liquids that are contaminated with norovirus;
  • Touching surfaces or objects contaminated with norovirus, and then placing their hand in their mouth; and/or
  • Having direct contact with another person who is infected and showing symptoms (for example, when caring for someone with illness, or sharing foods or eating utensils with someone who is ill).

Noroviruses are very contagious and can spread easily from person to person. Both stool and vomit are infectious. People infected with norovirus are contagious from the moment they begin feeling ill to at least 3 days after recovery. Some people may be contagious for as long as 2 weeks after recovery. Therefore, it is particularly important for people to use good handwashing and other hygienic practices after they have recently recovered from norovirus illness.

Persons working in day-care centers or nursing homes should pay special attention to children or residents who have norovirus illness. People who work in a food service industry must not handle food or utensils during the period that they are contagious. Contagious individuals must stay home during their infectious period.

The symptoms of norovirus illness usually include nausea, vomiting, diarrhea, and some stomach cramping. Sometimes people additionally have a low-grade fever, chills, headache, muscle aches, and a general sense of tiredness. The illness often begins suddenly, and the infected person may feel very sick. In most people the illness is self-limiting with symptoms lasting for about 1 or 2 days. In general, children experience more vomiting than adults. Most people with norovirus illness have both of these symptoms.

People may feel very sick and vomit many times a day, but most people get better within 1 or 2 days, and they have no long-term health effects related to their illness. However, sometimes people are unable to drink enough liquids to replace the liquids they lost because of vomiting and diarrhea. These persons can become dehydrated and may need special medical attention. This problem with dehydration is usually only seen among the very young, the elderly, and persons with weakened immune systems.

1. Vaccination:

There is no vaccination for this group of viruses.

2. PPE:

  • Clinical setting: Gloves should be worn when caring for a patient with norovirus. Face protection should be worn when the activity presents a chance of splash or aerosolization of contaminated material.
  • Research setting: PPE use would be based on the risk of exposure that an activity presents. Face protection would be necessary if there is a risk of aerosolization of contaminated feces, vomit, or culture material; gloves, lab coat/coveralls would be needed for activities with potential for skin exposure.

3. Other protective measures:

Isolation of a highly infectious patient may be necessary for a clinical setting. Care providers and laboratory personnel should wash hands immediately after removing PPE.

Please refer to the Virginia Tech Biosafety Manual for recommendations on the use of biosafety cabinets and other engineering/administrative controls that may be required for research with this organism.

  • Rinse the affected area immediately. Use soap and water (except on eyes) or flush with just water.
  • Notify your supervisor.
  • You or your supervisor must notify Environmental Health & Safety as soon as possible after an exposure. Environmental Health & Safety will consult with Virginia Tech’s Occupational Health physician regarding appropriate treatment for the exposure.
  • If necessary, seek medical attention for an emergency (i.e severe dehydration, difficulty keeping food/fluids down for several days) before contacting Environmental Health & Safety.
  • If you seek medical attention before contacting Environmental Health & Safety you MUST notify the care provider that you may have had exposure to an infectious agent before arriving at the clinic or emergency department.
  • Complete the Employer’s Accident Report, which may be downloaded from hr.vt.edu.
  • For more information, visit cdc.gov look for Norovirus in the A-Z index.

Prion diseases or transmissible spongiform encephalopathy’s (TSEs) are a family of rare progressive neurodegenerative disorders that affect both humans and animals. They are distinguished by long incubation periods, characteristic spongiform changes associated with neuronal loss, and a failure to induce an inflammatory response.

The causative agent of TSEs is believed to be a prion. A prion is an abnormal, transmissible agent that is able to induce abnormal folding of normal cellular prion proteins in the brain, leading to brain damage and the characteristics signs and symptoms of the disease. Prion diseases can have a long latent period (a decade or more in humans) but once symptoms occur, they are usually rapidly progressive and always fatal.

Chronic wasting disease (CWD) is a prion disease that affects North American cervids (hoofed ruminant mammals, with males, characteristically having antlers). The known natural hosts of CWD are mule deer, white-tailed deer, elk, and moose. CWD was first identified as a fatal wasting syndrome in captive mule deer in Colorado in the late 1960s and in the wild in 1981. It was recognized as a spongiform encephalopathy in 1978. To date, no strong evidence of CWD transmission to humans has been reported.

Prion diseases include the following.

Animal Prion diseases

  • Bovine Spongiform Encephalopathy (BSE)
  • Chronic Wasting Disease (CWD)
  • Scrapie
  • Transmissible mink encephalopathy
  • Feline spongiform encephalopathy
  • Ungulate spongiform encephalopathy

Human Prion diseases

  • Creutzfeldt-Jakob Disease (CJD)
  • Variant Creutzfeldt-Jakob Disease (vCJD)
  • Gerstmann-Straussler-Scheinker Syndrome
  • Fatal Familial Insomnia
  • Kuru

The nature of the transmissible agent is not well understood. Current theory is that the agent is a modified form of a normal protein known as prion protein. For reasons that are not yet clear, the normal prion protein changes into a pathogenic form that then damages the central nervous system.

There is evidence of prion transmission via food: BSE possibly originated as a result of feeding cattle meat-and-bone meal that contained scrapie-infected sheep products. Scrapie is a prion disease of sheep. There is strong evidence and general agreement that the outbreak was then amplified and spread throughout the United Kingdom cattle industry by feeding rendered, prion-infected, bovine meat-and-bone meal to young calves.

In addition, there is strong epidemiologic and laboratory evidence for a causal association between a new human prion disease called variant Creutzfeldt-Jakob disease (vCJD) that was first reported from the United Kingdom in 1996 and the BSE outbreak in cattle. The interval between the most likely period for the initial extended exposure of the population to potentially BSE-contaminated food (1984-86) and the onset of initial variant CJD cases (1994-96) is consistent with known incubation periods for the human forms of prion disease.

CWD can be highly transmissible within deer and elk populations. The mode of transmission is not fully understood, but evidence supports the possibility that the disease is spread through direct animal-to-animal contact or as a result of indirect exposure to prions in the environment (e.g., in contaminated feed and water sources). Several epidemiologic studies provide evidence that, to date, CWD has not been transmitted to humans. Additionally, routine surveillance has not shown any increase in the incidence of Creutzfeldt-Jakob disease in Colorado or Wyoming.

Specific studies have begun that focus on identifying human prion disease in a population that is at increased risk for exposure to potentially CWD-infected deer or elk meat. Because of the long time between exposure to CWD and the development of disease, many years of continued follow-up are required to be able to say what the risk, if any, of CWD is to humans.

Signs and symptoms of prion diseases can vary between the various forms and among the species affected by prion diseases. Typically changes in behavior and neurological function will be seen.

1. Vaccination:

There is no vaccination for this organism.

2. PPE:

  • Clinical setting: Since prion diseases are rarely transmitted person-to-person, only PPE that would be worn for various patient care activities is necessary.
  • Research/animal care setting: PPE use would be based on the risk of exposure that an activity presents. Anyone working with human neurological material, eyes or corneas should assume that these tissues have the potential for harboring prions. Face protection would be necessary if there is a risk of aerosolization of known or potentially contaminated material; gloves, lab coat/coveralls would be needed for activities with potential for skin exposure.

3. Other protective measures:

Please refer to the Virginia Tech Biosafety Manual for recommendations on use of biosafety cabinets and other engineering/administrative controls that may be required for work with this organism.

  • Rinse the affected area immediately. Use soap and water (except on eyes) or flush with just water.
  • Notify your supervisor.
  • You or your supervisor must notify Environmental Health & Safety as soon as possible after an exposure. Environmental Health & Safety will consult with Virginia Tech’s Occupational Health physician regarding appropriate treatment for the exposure.
  • If necessary, seek medical attention for an emergency (i.e. severe bleeding, difficulty breathing) before contacting Environmental Health & Safety.
  • If you seek medical attention before contacting Environmental Health & Safety you MUST notify the care provider that you may have had exposure to an infectious agent before arriving at the clinic or emergency department.
  • Complete the Employer’s Accident Report which may be downloaded from hr.vt.edu.
  • For more information, visit cdc.gov look for Prion disease in the A-Z index.

Rubella occurs worldwide. Although more than half of all the World Health Organization member countries now use rubella vaccine, rubella still remains a common disease in many parts of the world. The risk of exposure to rubella outside the United States can be high; thus, all travelers leaving the United States should be immune to rubella.

Rubella is an acute viral disease that can affect susceptible persons of any age. This disease is spread by contact with an infected person, through coughing and sneezing.

Although rubella is generally a mild rash illness, if contracted in the early months of pregnancy it is associated with a high rate of fetal loss or a constellation of birth defects known as congenital rubella syndrome (CRS).

Rubella usually presents as a rash and fever for two to three days. However, asymptomatic infections are common; up to 50 percent of infections occur without rash. In adults or adolescents, the rash may be preceded by early symptoms lasting 1- to 5-day and consisting of low-grade fever, headache, malaise, anorexia, mild conjunctivitis, acute inflammation of the mucous membrane of the nasal cavities, sore throat, and abnormal enlargement of the lymph nodes.

Birth defects can occur if this disease is acquired by a pregnant woman. These birth defects can include: deafness, cataracts, heart defects, mental retardation, and liver and spleen damage (there is at least a 20 percent chance of damage to the fetus if a woman is infected early in pregnancy).

1. Vaccination:

Vaccination is typically done in childhood. However, some people may need a booster or may have not gotten this vaccine in childhood. Current CDC recommendations for rubella vaccination are:

You do NOT need the measles, mumps, rubella vaccine (MMR) if:

  • You had blood tests that show you are immune to measles, mumps, and rubella.
  • You are a man born before 1957.
  • You are a woman born before 1957 who is sure she is not having more children, has already had rubella vaccine, or has had a positive rubella test.
  • You already had two doses of MMR or one dose of MMR plus a second dose of the measles vaccine.
  • You already had one dose of MMR and are not at high risk of measles exposure.

You SHOULD get the MMR vaccine if you are not among the categories listed above, and:

  • You are a college student, trade school student, or another student beyond high school.
  • You work in a hospital or other medical facility.
  • You travel internationally or are a passenger on a cruise ship.
  • You are a woman of childbearing age.

2. PPE:

  • Clinical setting: Gloves should be worn as necessary for routine patient care activities. Face protection should be worn when the activity presents a chance of splash or aerosolization of respiratory secretions.
  • Research setting: PPE use would be based on the risk of exposure that an activity presents. Respiratory protection would be necessary if there is a risk of aerosolization of contaminated respiratory secretions or culture material.

3. Other protective measures:

Please refer to the Virginia Tech Biosafety Manual for recommendations on the use of biosafety cabinets and another engineering/administrative controls that may be required for work with this organism.

  • Rinse the affected area immediately. Use soap and water (except on eyes) or flush with just water.
  • Notify your supervisor.
  • You or your supervisor must notify Environmental Health & Safety as soon as possible after an exposure. Environmental Health & Safety will consult with Virginia Tech’s Occupational Health physician regarding appropriate treatment for the exposure.
  • If necessary, seek medical attention for an emergency (i.e severe bleeding, difficulty breathing) before contacting Environmental Health & Safety.
  • If you seek medical attention before contacting Environmental Health & Safety you MUST notify the care provider that you may have had exposure to an infectious agent before arriving at the clinic or emergency department.
  • Complete the Employer’s Accident Report which may be downloaded from hr.vt.edu.
  • For more information, visit cdc.gov look for Rubella in the A-Z index.

Typhoid fever is a life-threatening illness caused by the bacterium Salmonella Typhi. Persons with typhoid fever carry the bacteria in their bloodstream and intestinal tract. In addition, a small number of persons, called carriers, recover from typhoid fever but continue to carry the bacteria. Both ill persons and carriers shed S. Typhi in their feces (stool).

Typhoid fever is common in most parts of the world (where it affects about 21.5 million persons each year) except in industrialized regions such as the United States, Canada, western Europe, Australia, and Japan. Therefore, if you are traveling to the developing world, you should consider taking precautions. Over the past 10 years, travelers from the United States to Asia, Africa, and Latin America have been especially at risk. In the United States about 400 cases occur each year, and 75 percent of these are acquired while traveling internationally.

You can get typhoid fever if you eat food or drink beverages that have been handled by a person who is shedding S. Typhi or if sewage contaminated with S. Typhi bacteria gets into the water you use for drinking or washing food. Therefore, typhoid fever is more common in areas of the world where handwashing is less frequent and water is likely to be contaminated with sewage.

Persons with typhoid fever usually have a sustained fever as high as 103° to 104° F. They may also feel weak, or have stomach pains, headache, or loss of appetite. In some cases, patients have a rash of flat, rose-colored spots. The only way to know for sure if an illness is typhoid fever is to have samples of stool or blood tested for the presence of S. Typhi.

1. Vaccination:

If you are working with this organism in the lab or traveling to a country where typhoid is common, you should consider being vaccinated against typhoid. You will need to complete your vaccination at least 1 week before working with the organism or traveling to an area of concern so that the vaccine has time to take effect.

2. PPE:

  • Clinical setting: Gloves should be worn when caring for a patient with typhoid. Face protection should be worn when the activity presents a chance of splash or aerosolization of contaminated material.
  • Research setting: PPE use would be based on the risk of exposure that an activity presents. Face protection would be necessary if there is a risk of aerosolization of contaminated feces or culture material; gloves, lab coat/coveralls would be needed for activities with potential for skin exposure.

3. Other protective measures:

Isolation of a highly infectious patient may be necessary for a clinical setting. Care providers and laboratory personnel should wash hands immediately after removing PPE.

Please refer to the Virginia Tech Biosafety Manual for recommendations on the use of biosafety cabinets and other engineering/administrative controls that may be required for research with this organism.

Rinse the affected area immediately. Use soap and water (except on eyes) or flush with just water.

  • Notify your supervisor.
  • You or your supervisor must notify Environmental Health & Safety as soon as possible after an exposure. Environmental Health & Safety will consult with Virginia Tech’s Occupational Health physician regarding appropriate treatment for the exposure.
  • If necessary, seek medical attention for an emergency (i.e. severe dehydration, difficulty keeping food/fluids down for several days) before contacting Environmental Health & Safety.
  • If you seek medical attention before contacting Environmental Health & Safety you MUST notify the care provider that you may have had exposure to an infectious agent before arriving at the clinic or emergency department.
  • Complete the Employer’s Accident Report which may be downloaded from hr.vt.edu.
  • For more information, visit cdc.gov and look for Typhoid in the A-Z index.

Tuberculosis (TB) is a disease caused by Mycobacterium tuberculosis. The bacteria usually attack the lungs but can also attack any part of the body such as kidneys, spine, and brain. If not treated properly, TB can be fatal. TB was once the leading cause of death in the United States.

Documented places where transmission has occurred include crowded hospitals, prisons, homeless shelters, and other settings where susceptible persons come in contact with persons with TB disease. Travelers should be aware that certain areas of the world have high rates of TB in the population.

Air travel itself carries a relatively low risk of infection with TB of any kind. The risk of acquiring any type of TB depends on several factors, such as extent of disease in the patient with TB, duration of exposure, and ventilation. Most important, there must be someone with infectious TB disease on the same flight to present any risk. If someone on the flight does have TB disease, persons on flights lasting 8 hours or longer are at greater risk than persons on shorter flights.

Multidrug-resistant TB (MDR TB) is TB that is resistant to at least two of the best anti-TB drugs, isoniazid and rifampin. These drugs are considered first-line drugs and are used to treat all persons with TB disease.

Extensively drug resistant TB (XDR TB) is a rare type of MDR TB. XDR TB is defined as TB which is resistant to isoniazid and rifampin, plus resistant to any fluoroquinolone and at least one of three injectable second-line drugs (i.e., amikacin, kanamycin, or capreomycin). Because XDR TB is resistant to first-line and secondline drugs, patients are left with treatment options that are much less effective.

XDR TB is of special concern for persons with HIV infection or other conditions that can weaken the immune system. These persons are more likely to develop TB disease once they are infected, and also have a higher risk of death once they develop TB.

TB is spread through the air from one person to another. The bacteria are aerosolized when a person with active TB of the lungs or throat coughs or sneezes. People nearby may breathe in these bacteria and become infected.

However, not everyone infected with TB bacteria becomes sick. People who are not sick have ‘latent TB infection’. People with latent TB infection do not feel sick, do not have any symptoms, and cannot spread TB to others. Some people with latent TB infection go on to get TB disease.

People with active TB can be successfully treated if they seek medical help. Most people with latent TB infection can be treated to prevent the development of active TB disease.

The general symptoms of TB include feelings of sickness or weakness, weight loss, fever, and night sweats. The symptoms of TB disease of the lungs also include coughing, chest pain, and the coughing up of blood. Symptoms of TB disease in other parts of the body depend on the area affected. If you have these symptoms, you should contact your doctor or local health department.

1. Vaccination:

There is a vaccine for TB called Bacille Calmette-Guerin (BCG). It is used in some countries to prevent severe forms of TB in children. However, BCG is not generally recommended in the United States because it has limited effectiveness for preventing TB overall.

2. PPE:

  • Clinical setting: Gloves and respiratory protection should be worn when caring for a patient with TB.
  • Research setting: PPE use would be based on the risk of exposure that an activity presents. Respiratory protection would be necessary if there is risk of aerosolization of contaminated respiratory tract secretions or culture material; gloves, lab coat/coveralls would be needed for activities with potential for skin exposure.

3. Other protective measures:

Isolation of a highly infectious patient may be necessary in a clinical setting. Refer to the CDC website for more detailed information on infection control in health care settings for patients with TB.

Please refer to the Virginia Tech Biosafety Manual for recommendations on use of biosafety cabinets and other engineering/administrative controls that may be required for research with this organism.

  • Rinse the affected area immediately. Use soap and water (except on eyes) or flush with just water.
  • Notify your supervisor.
  • You or your supervisor must notify Environmental Health & Safety as soon as possible after an exposure. Environmental Health & Safety will consult with Virginia Tech’s Occupational Health physician regarding appropriate treatment for the exposure.
  • If necessary, seek medical attention for an emergency (i.e. severe bleeding, difficulty breathing) before contacting Environmental Health & Safety.
  • If you seek medical attention before contacting Environmental Health & Safety you MUST notify the care provider that you may have had exposure to an infectious agent before arriving at the clinic or emergency department.
  • Complete the Employer’s Accident Report which may be downloaded from hr.vt.edu.
  • For more information, visit cdc.gov and look for Tuberculosis in the A-Z index.

Zoonotic diseases can be transmitted between animals and humans. Please click on the following links for additional information on the disease listed.

Anthrax is an acute infectious disease caused by the spore-forming bacterium Bacillus anthracis. Anthrax most commonly occurs in wild and domestic lower vertebrates (cattle, sheep, goats, camels, antelopes, and other herbivores), but it can also occur in humans when they are exposed to infected animals or to tissue from infected animals or when anthrax spores are used as a bioterrorist weapon. Anthrax can also be found in research laboratories that are approved to work with Select Agents.

Anthrax is not known to spread from one person to another person. B. anthracis spores can live in the soil for many years, and humans can become infected with anthrax by handling products from infected animals or by inhaling anthrax spores from contaminated animal products. Anthrax can also be spread by eating undercooked meat from infected animals. It is rare to find infected animals in the United States. Anthrax spores can be used as a bioterrorist weapon, as was the case in 2001 when Bacillus anthracis spores were intentionally distributed through the postal system, causing 22 cases of anthrax including 5 deaths.

  • Cutaneous: Most (about 95 percent) anthrax infections occur when the bacterium enters a cut or abrasion on the skin, such as when handling contaminated wool, hides, leather or hair products (especially goat hair) of infected animals. Skin infection begins as a raised itchy bump that resembles an insect bite but within 1-2 days develops into a vesicle and then a painless ulcer, usually 1-3 cm in diameter, with a characteristic black necrotic (dying) area in the center. Lymph glands in the adjacent area may swell. About 20 percent of untreated cases of cutaneous anthrax will result in death. Deaths are rare with appropriate antimicrobial therapy.
  • Inhalation: Initial symptoms may resemble a common cold – sore throat, mild fever, muscle aches, and malaise. After several days, the symptoms may progress to severe breathing problems and shock. Inhalation anthrax is usually fatal.
  • Gastrointestinal: The intestinal disease form of anthrax may follow the consumption of contaminated meat and is characterized by acute inflammation of the intestinal tract. Initial signs of nausea, loss of appetite, vomiting, fever are followed by abdominal pain, vomiting of blood, and severe diarrhea. Intestinal anthrax results in death in 25-to-60 percent of cases.

1. Vaccination:

A vaccine has been developed for anthrax that is protective against invasive disease, but it is currently only recommended for high-risk populations. The Advisory Committee on Immunization Practices (ACIP) has recommended anthrax vaccination for the following groups:

  • Persons who work directly with the organism in the laboratory.
  • Persons who work with imported animal hides or furs in areas where standards are insufficient to prevent exposure to anthrax spores.
  • Persons who handle potentially infected animal products in high-incidence areas; while incidence is low in the United States, veterinarians who travel to work in other countries where incidence is higher should consider being vaccinated.
  • Military personnel deployed to areas with high risk for exposure to the organism.

2. PPE:

  • Clinical setting: Since Anthrax is unknown to be transmitted person-to-person, only PPE that would be worn for various patient care activities is necessary.
  • Research/animal care setting: PPE use would be based on the risk of exposure that an activity presents. Respiratory protection would be necessary if there is a risk of aerosolization of spores; gloves, lab coat/coveralls would be needed for activities with potential for skin exposure.

3. Other protective measures:

Please refer to the Virginia Tech Biosafety Manual for recommendations on the use of biosafety cabinets and other engineering/administrative controls that may be required for work with this organism.

  • Rinse the affected area immediately. Use soap and water (except on eyes) or flush with just water.
  • Notify your supervisor.
  • You or your supervisor must notify Environmental Health & Safety as soon as possible after an exposure. Environmental Health & Safety will consult with Virginia Tech’s Occupational Health physician regarding appropriate treatment for the exposure.
  • If necessary, seek medical attention for an emergency (i.e. severe bleeding, difficulty breathing) before contacting Environmental Health & Safety.
  • If you seek medical attention before contacting Environmental Health & Safety you MUST notify the care provider that you may have had exposure to an infectious agent before arriving at the clinic or emergency department.
  • Complete the Employer’s Accident Report, which may be downloaded from hr.vt.edu.
  •  For more information, visit cdc.gov and look for Anthrax in the A-Z index.

Brucellosis is an infectious disease caused by the bacteria of the genus Brucella. These bacteria are primarily passed among animals, and they cause disease in many different vertebrates.

Various Brucella species affect sheep, goats, cattle, deer, elk, pigs, dogs, and several other animals. Humans become infected by coming in contact with animals or animal products that are contaminated with these bacteria.

Brucellosis is not very common in the United States, with only 100-to-200 cases occurring each year. Brucellosis can be very common in countries where animal disease control programs have not reduced the amount of disease among animals.

Although brucellosis can be found worldwide, it is more common in countries that do not have good standardized and effective public health and domestic animal health programs. Areas currently listed as high risk are the Mediterranean Basin (Portugal, Spain, Southern France, Italy, Greece, Turkey, North Africa), South and Central America, Eastern Europe, Asia, Africa, the Caribbean, and the Middle East. Unpasteurized cheeses, sometimes called "village cheeses," from these areas may represent a particular risk for tourists.

Humans are generally infected in one of three ways:

  1. Eating or drinking something that is contaminated with Brucella;
  2. inhalation of the organism; or
  3. The bacteria entering the body through skin wounds.

The most common way to be infected is by eating or drinking contaminated milk products that have not been pasteurized. When sheep, goats, cows, or camels are infected, their milk is contaminated with the bacteria.

Inhalation of Brucella organisms is not a common route of infection, but it can be a significant hazard for people in certain occupations, such as those working in laboratories where the organism is cultured. Inhalation is often responsible for a significant percentage of cases in abattoir employees.

Contamination of skin wounds may be a problem for persons working in slaughterhouses or meat packing plants or for veterinarians. Hunters may be infected through skin wounds or by accidentally ingesting the bacteria after cleaning deer, elk, moose, or wild pigs that they have killed.

Direct person-to-person spread of brucellosis is extremely rare. Mothers who are breast-feeding may transmit the infection to their infants. Sexual transmission has also been reported. For both sexual and breast-feeding transmission, if the infant or person at risk is treated for brucellosis, their risk of becoming infected will probably be eliminated within 3 days. Although uncommon, transmission may also occur via contaminated tissue transplantation.

In humans brucellosis can cause a range of symptoms that are similar to the flu and may include fever, sweats, headaches, back pains, and physical weakness. Severe infections of the central nervous systems or lining of the heart may occur. Brucellosis can also cause long-lasting or chronic symptoms that include recurrent fevers, joint pain, and fatigue.

1. Vaccination:

There is no vaccine available for humans.

2. PPE:

  • Clinical setting: Since brucellosis is rarely transmitted person-to-person, only PPE that would be worn for various patient care activities is necessary.
  • Research/animal care setting: PPE use would be based on the risk of exposure that an activity presents. Respiratory protection would be necessary if there is risk of aerosolization of known or potentially contaminated material; gloves, lab coat/coveralls would be needed for activities with potential for skin exposure.

3. Other protective measures:

Please refer to the Virginia Tech Biosafety Manual for recommendations on use of biosafety cabinets and other engineering/administrative controls that may be required for work with this organism.

  • Rinse affected area immediately. Use soap and water (except on eyes) or flush with just water.
  • Notify your supervisor.
  • You or your supervisor must notify Environmental Health & Safety as soon as possible after an exposure. Environmental Health & Safety will consult with Virginia Tech’s Occupational Health physician regarding appropriate treatment for the exposure.
  • If necessary, seek medical attention for an emergency (i.e. severe bleeding, difficulty breathing) before contacting Environmental Health & Safety.
  • If you seek medical attention before contacting Environmental Health & Safety you MUST notify the care provider that you may have had an exposure to an infectious agent before arriving at the clinic or emergency department.
  • Complete the Employer’s Accident Report, which may be downloaded from hr.vt.edu.
  • For more information, visit the CDC's website.

Giardiasis is a diarrheal illness caused by a one-celled, microscopic parasite, Giardia intestinalis (also known as Giardia lamblia). Once an animal or person has been infected with Giardia intestinalis, the parasite lives in the intestine and is passed in the stool. Because the parasite is protected by a cyst, it can survive outside the body and in the environment for long periods of time.

During the past 2 decades, Giardia infection has become recognized as one of the most common causes of waterborne disease (found in both drinking and recreational water) in humans in the United States. Giardia is found worldwide and within every region of the United States.

Anyone can become infected by this parasite but persons more likely to become infected include:

  • Children who attend day care centers, including diaper-aged children;
  • Childcare workers;
  • Parents of infected children;
  • International travelers;
  • People who swallow water from contaminated sources;
  • Backpackers, hikers, and campers who drink unfiltered, untreated water;
  • Swimmers who swallow water while swimming in lakes, rivers, ponds, and streams; and
  • People who drink from shallow wells.

Contaminated water includes water that has not been boiled, filtered, or disinfected with chemicals. Several communitywide outbreaks of giardiasis have been linked to drinking municipal water or recreational water contaminated with Giardia.

The Giardia parasite can be found in the intestine of infected humans or animals, in soil, food, water, or on surfaces that have been contaminated with the feces from infected humans or animals. Giardia can be spread by:

  • Accidentally putting something into your mouth or swallowing something that has come into contact with feces of a person or animal infected with Giardia.
  • Swallowing recreational water contaminated with Giardia . Recreational water includes water in swimming pools, hot tubs, jacuzzis, fountains, lakes, rivers, springs, ponds, or streams that can be contaminated with sewage or feces from humans or animals.
  • Eating uncooked food contaminated with Giardia.
  • Accidentally swallowing Giardia picked up from surfaces (such as bathroom fixtures, changing tables, diaper pails, or toys) contaminated with feces from an infected person.
  • You can become infected after accidentally swallowing the parasite; you cannot become infected through contact with blood.

Giardia infection can cause a variety of intestinal symptoms, which include:

  • Diarrhea;
  • Gas or flatulence;
  • Greasy stools that tend to float;
  • Stomach cramps; and
  • Upset stomach or nausea.

These symptoms, if left untreated, may lead to weight loss and dehydration. Some people with giardiasis are asymptomatic.

Symptoms of giardiasis normally begin 1-to-2 weeks (average 7 days) after becoming infected. In otherwise healthy persons, symptoms of giardiasis may last 2-to-6 weeks. Occasionally, symptoms last longer.

1. Vaccination:

There is no vaccine available for this organism.

2. PPE:

  • Clinical setting: Since giardia can be transmitted person-to-person, gloves should be worn when caring for an infected patient. Face protection should be worn when the activity presents a chance of splash or aerosolization of contaminated material. Wash hands immediately after removing gloves.
  • Research setting: PPE use would be based on the risk of exposure that an activity presents. Face protection would be necessary if there is risk of aerosolization of contaminated feces or culture material; gloves, lab coat/coveralls would be needed for activities with potential for skin exposure. Wash hands immediately after removing gloves.

3. Other protective measures:

Please refer to the Virginia Tech Biosafety Manual for recommendations on use of biosafety cabinets and other engineering/administrative controls that may be required for work with this organism.

  • Rinse the affected area immediately. Use soap and water (except on eyes) or flush with just water.
  • Notify your supervisor.
  • You or your supervisor must notify Environmental Health & Safety as soon as possible after an exposure. Environmental Health & Safety will consult with Virginia Tech’s Occupational Health physician regarding appropriate treatment for the exposure.
  • If necessary, seek medical attention for an emergency (i.e. severe bleeding, difficulty breathing) before contacting Environmental Health & Safety.
  • If you seek medical attention before contacting Environmental Health & Safety you MUST notify the care provider that you may have had an exposure to an infectious agent before arriving at the clinic or emergency department.
  • Complete the Employer’s Accident Report, which may be downloaded from hr.vt.edu.

For more information, visit the CDC's website.

The H5N1 Highly Pathogenic Avian Influenza (HPAI) is a virus that impacts the avian and human pulmonary system.

  • Animal reservoir: domestic poultry, migratory birds (there is no evidence of this strain in birds in the U.S. at this time).
  • Virus survival in the environment: The virus can survive, at cool temperatures, in contaminated manure for at least three months. In water, the virus can survive for up to four days at 72 oF and for more than 30 days at 32 oF. The virus can also survive in mud or other debris found on equipment or on the feet of humans and animals.

This virus is spread via aerosolization or splash of feces, or exposure to nasal/throat secretions when working with infected birds. Since there is evidence that this virus can live in the environment for a while, it may be possible to catch it from contaminated surfaces. This is unclear at this time

Sustained human to human transmission has not been reported at this time.

  • Flu-like (fever, muscle aches);
  • Severe shortness of breath;
  • Eye irritation (conjunctivitis); and
  • Symptoms appear within 7-10 days of exposure.

Human mortality is high. In humans, this virus causes much more severe respiratory symptoms than seasonal flu.

1. Vaccination:

There is currently no vaccine for this strain of flu. Employees who may be exposed to H5N1 avian flu due to work activities should get the seasonal flu shot.

2. PPE:

  • Clinical setting: Gloves should be worn when caring for a patient with the flu. Face protection should be worn when the activity presents a chance of splash or aerosolization of respiratory secretions.
  • Research setting: PPE use would be based on the risk of exposure that an activity presents. Respiratory protection would be necessary if there is risk of aerosolization of contaminated respiratory tract secretions or culture material; gloves, lab coat/coveralls would be needed for activities with potential for skin exposure.

3. Other protective measures:

Isolation of a highly infectious patient may be necessary in a clinical setting. Care providers and laboratory personnel should wash hands immediately after removing PPE.

Please refer to the Virginia Tech Biosafety Manual for recommendations on use of biosafety cabinets and other engineering/administrative controls that may be required for work with this organism.

  • Rinse the affected area immediately. Use soap and water (except on eyes) or flush with just water.
  • Notify your supervisor.
  • You or your supervisor must notify Environmental Health & Safety as soon as possible after an exposure. Environmental Health & Safety will consult with Virginia Tech’s Occupational Health physician regarding appropriate treatment for the exposure.
  • If necessary, seek medical attention for an emergency (i.e. severe bleeding, difficulty breathing) before contacting Environmental Health & Safety.
  • If you seek medical attention before contacting Environmental Health & Safety you MUST notify the care provider that you may have had exposure to an infectious agent before arriving at the clinic or emergency department.
  • Complete the Employer’s Accident Report, which may be downloaded from hr.vt.edu.
  • For more information, visit:

Hantavirus pulmonary syndrome (HPS) is a rare but potentially deadly disease in humans. The deer mouse (Peromyscus maniculatus) is the primary reservoir of the hantavirus that causes hantavirus pulmonary syndrome (HPS) in the United States. Hantavirus is also found in cotton and rice rats, and the white-footed deer mouse. Rodents can transmit hantaviruses through urine, droppings, or saliva.

Hantavirus is most often associated with rodents in the Four Corners region of the western United States but mouse populations that carry a strain of hantavirus have been identified worldwide. Mouse populations in WV and VA have been verified as carriers of Hantavirus by VT researchers.

Virus survival in the environment varies but in normal environment hantavirus can remain viable for 2-3 days. Hantavirus is very susceptible to UV light and its viability increases as temperature decreases. However, in a rodent contaminated area, the virus is constantly being replenished so environmental viability is less a concern than the fact that there is a rodent infestation.

HPS is transmitted to humans via aerosolizationof dried materials (typically rodent nests) contaminated by rodent excreta or saliva. Transmission via rodent bite was confirmed in 2009 by CDC. HPS in the United States cannot be transmitted person to person.

In addition, HPS in the United States is not known to be transmitted by farm animals, dogs, or cats or from rodents purchased from a pet store.

  • Flu-like (fever, muscle aches).
  • Severe shortness of breath.
  • Symptoms appear within 45 days of exposure.

Early symptoms include fatigue, fever and muscle aches, especially in the large muscle groups-thighs, hips, back, and sometimes shoulders. These symptoms are universal.

There may also be headaches, dizziness, chills, and abdominal problems, such as nausea, vomiting, diarrhea, and abdominal pain. About half of all HPS patients experience these symptoms.

Four to 10 days after the initial phase of illness, the late symptoms of HPS appear. These include coughing and shortness of breath, with the sensation of, as one survivor put it, a "...tight band around my chest and a pillow over my face" as the lungs fill with fluid.

1. Vaccination:

There is no vaccine available for this organism.

2. PPE:

  • Clinical setting: Since hantavirus cannot be transmitted person-to-person, only PPE that would be worn for various patient care activities is necessary.
  • Research setting: PPE use would be based on the risk of exposure that an activity presents. Respiratory protection would be necessary if there is risk of aerosolization of potentially contaminated nests or culture material; gloves resistant to rodent bites and scratches and lab coat/coveralls would be needed for activities with potential for skin exposure. Wash hands immediately after removing PPE.

3. Other protective measures:

Please refer to the Virginia Tech Biosafety Manual for recommendations on use of biosafety cabinets and other engineering/administrative controls that may be required for work with this organism.

Also refer to the CDC website when doing field work with rodents.

  • Rinse affected area immediately. Use soap and water (except on eyes) or flush with just water.
  • Notify your supervisor.
  • You or your supervisor must notify Environmental Health & Safety as soon as possible after an exposure. Environmental Health & Safety will consult with Virginia Tech’s Occupational Health physician regarding appropriate treatment for the exposure.
  • If necessary, seek medical attention for an emergency (i.e. severe bleeding, difficulty breathing) before contacting Environmental Health & Safety.
  • If you seek medical attention before contacting Environmental Health & Safety you MUST notify the care provider that you have had an exposure to rodents or their nesting material.
  • Complete the Employer’s Accident Report, which may be downloaded from hr.vt.edu.
  • For more information, visit the CDC's website.

Please refer to Appendix B above.

Q fever is a Rickettsial infection caused by Coxiella burnetii. Approximately half the people infected with this organism get sick with Q fever.

Animals can transmit Q fever to people. Cattle, sheep, and goats are most likely to carry C. burnetii, but other species of animals can also have this disease. Most infected animals do not show signs of Q fever, but the organism can be in barnyard dust that contains manure, urine or dried fluids from the births of calves or lambs. People usually get Q fever by inhaling aerosolized material that is contaminated with Coxiella burnetii.

People can also get Q fever from drinking contaminated milk, human to human transmission, or from tick bites but these modes of transmission are very rare.

The incubation period for Q fever varies depending on the number of organisms that initially infect the patient. Infection with greater numbers of organisms will result in shorter incubation periods. Those who recover fully from infection may possess lifelong protection against re-infection.

Typically, people who become ill start having symptoms 2-to-3 weeks after exposure to C. burnetii, although symptoms can start sooner. These symptoms include fever, headache, chest or stomach pain, vomiting, and diarrhea. The fever can last 1-to-2 weeks, but many people can also get more serious lung or liver infections as a result of Q fever.

Patients typically recover within 1-to-2 months after symptoms begin. Only 1- 2 percent of people with acute Q fever die of the disease.

Rarely, people can be sick from Q fever a year or more after getting this disease. For these individuals, inflammation of the heart, especially the valves in the heart, can be a serious problem. Chronic Q fever, characterized by infection that persists for more than 6 months is uncommon but is a much more serious disease. Patients who have had acute Q fever may develop the chronic form as soon as 1 year or as long as 20 years after initial infection. A serious complication of chronic Q fever is endocarditis, generally involving the aortic heart valves, less commonly the mitral valve. Most patients who develop chronic Q fever have pre-existing valvular heart disease or have a history of vascular graft. Transplant recipients, patients with cancer, and those with chronic kidney disease are also at risk of developing chronic Q fever. As many as 65 percent of persons with chronic Q fever may die of the disease.

1. Vaccination:

A vaccine for Q fever has been developed and has successfully protected humans in occupational settings in Australia. However, this vaccine is not commercially available in the United States. Persons wishing to be vaccinated should first have a skin test to determine a history of previous exposure. Individuals who have previously been exposed to C. burnetii should not receive the vaccine because severe reactions, localized to the area of the injected vaccine, may occur. A vaccine for use in animals has also been developed, but it is not available in the United States.

2. PPE:

  • Clinical setting: Since Q Fever is rarely transmitted person-to-person, only PPE that would be worn for various patient care activities is necessary.
  • Research/animal care setting: PPE use would be based on the risk of exposure that an activity presents. Respiratory protection would be necessary if there is a risk of aerosolization of known or potentially contaminated material; gloves, lab coat/coveralls would be needed for activities with potential for skin exposure.

3. Other protective measures:

  • Appropriately dispose of the placenta, birth products, fetal membranes, and aborted fetuses at facilities housing sheep and goats.
  • Restrict access to barns and laboratories used in housing potentially infected animals.
  • Use only pasteurized milk and milk products.
  • Use appropriate procedures for bagging, autoclaving, and washing of laboratory clothing.
  • Vaccinate (where possible) individuals engaged in research with pregnant sheep or live C. burnetii.
  • Quarantine imported animals.
  • Ensure that holding facilities for sheep should be located away from populated areas.  Animals should be routinely tested for antibodies to C. burnetii, and measures should be implemented to prevent airflow to other occupied areas.
  • Counsel persons at highest risk for developing chronic Q fever, especially persons with pre-existing cardiac valvular disease or individuals with vascular grafts.

Please refer to the Virginia Tech Biosafety Manual for recommendations on the use of biosafety cabinets and other engineering/administrative controls that may be required for work with this organism.

  • Rinse affected area immediately. Use soap and water (except on eyes) or flush with just water.
  • Notify your supervisor.
  • You or your supervisor must notify Environmental Health & Safety as soon as possible after an exposure. Environmental Health & Safety will consult with Virginia Tech’s Occupational Health physician regarding appropriate treatment for the exposure.
  • If necessary, seek medical attention for an emergency (i.e. severe bleeding, difficulty breathing) before contacting Environmental Health & Safety.
  • If you seek medical attention before contacting Environmental Health & Safety you MUST notify the care provider that you may have had an exposure to an infectious agent before arriving at the clinic or emergency department.
  • Complete the Employer’s Accident Report, which may be downloaded from hr.vt.edu.
  • For more information, visit the CDC's website.

Rabies is a disease caused by the rabies virus. Wild animals are much more likely to carry rabies, especially raccoons, skunks, bats, foxes, and coyotes. However, dogs, cats, cattle, or any warm-blooded animal can transmit rabies to people.

The East Coast region of the U.S. has a very high number of reported rabies cases each year. For more information on the epidemiology of rabies in the US go to : https://www.cdc.gov/rabies/  

Transmission of rabies virus usually begins when infected saliva of a host is passed to an uninfected animal. Various routes of transmission have been documented and include contamination of mucous membranes (i.e., eyes, nose, mouth), aerosol transmission, and corneal transplantations. The most common mode of rabies virus transmission is through the bite and virus-containing saliva of an infected host.

Non-bite exposures to rabies are very rare. Scratches, abrasions, open wounds, or mucous membranes contaminated with saliva or other potentially infectious material (such as brain tissue) from a rabid animal constitute non-bite exposures. Occasionally reports of non-bite exposure are such that postexposure prophylaxis is given.

Inhalation of aerosolized rabies virus is also a potential non-bite route of exposure, but other than laboratory workers, most people are unlikely to encounter an aerosol of rabies virus. Other contacts, such as petting a rabid animal or contact with the blood, urine, or feces (e.g., guano) of a rabid animal, do not constitute exposure and are not an indication for prophylaxis.

The only well-documented documented cases of rabies caused by human-to-human transmission occurred among 8 recipients of transplanted corneas, and recently among three recipients of solid organs. Guidelines for acceptance of suitable cornea and organ donations, as well as the rarity of human rabies in the United States, reduce this risk. In addition to transmission from cornea and organ transplants, bite and non-bite exposures inflicted by infected humans could theoretically transmit rabies, but no such cases have been documented. Casual contact, such as touching a person with rabies or contact with non-infectious fluid or tissue (urine, blood, feces) does not constitute exposure and does not require postexposure prophylaxis.  In addition, contact with someone who is receiving rabies vaccination does not constitute rabies exposure and does not require postexposure prophylaxis.

It may take several weeks or even a few years for people to show symptoms after getting infected with rabies, but usually, people start to show signs of the disease 1-to-3 months after the virus infects them. The first symptoms of rabies may be nonspecific flu-like signs — malaise, fever, or headache, which may last for days. There may be discomfort or numbness, tingling, pricking, burning, or creeping on the skin at the site of exposure (typically a bite), progressing within days to symptoms of cerebral dysfunction, anxiety, confusion, agitation, progressing to delirium, abnormal behavior, hallucinations, and insomnia.

The acute period of disease typically ends after 2-to-10 days (6). Once clinical signs of rabies appear, the disease is nearly always fatal, and treatment is typically supportive. Disease prevention is entirely prophylactic and includes both passive antibodies (immune globulin) and vaccines. Non-lethal exceptions are extremely rare. To date, only six documented cases of human survival from clinical rabies have been reported and each included a history of either pre-or post-exposure prophylaxis.

1. Vaccination:

There is a vaccine available for humans and animals. Individuals who may be exposed to species of concern or are doing fieldwork in areas with endemic rabies should be vaccinated for rabies.

2. PPE:

  • Clinical setting: Since rabies is rarely transmitted person-to-person, only PPE that would be worn for various patient care activities is necessary.
  • Research/animal care setting: PPE use would be based on the risk of exposure that an activity presents. Face protection would be necessary if there is a risk of aerosolization of known or potentially contaminated material; gloves, lab coat/coveralls would be needed for activities with potential for skin exposure.

3. Other protective measures:

Please refer to the Virginia Tech Biosafety Manual for recommendations on the use of biosafety cabinets and other engineering/administrative controls that may be required for work with this organism.

  • Rinse the affected area immediately. Use soap and water (except on eyes) or flush with just water.
  • Notify your supervisor.
  • You or your supervisor must notify Environmental Health & Safety as soon as possible after an exposure. Environmental Health & Safety will consult with Virginia Tech’s Occupational Health physician regarding appropriate treatment for the exposure.
  • DO NOT wait for signs and symptoms to develop before reporting a potential exposure to rabies. Medical assistance should be obtained as soon as possible after exposure. There have been no vaccine failures in the United States (i.e., someone who developed rabies) when postexposure prophylaxis (PEP) was given promptly and appropriately after exposure to rabies.
  • Complete the Employer’s Accident Report which may be downloaded from hr.vt.edu.
  • For more information, go to cdc.gov and look for rabies in the A-Z index or review the Virginia Tech Rabies Fact Sheet.

Many species of Rickettsia can cause illnesses in humans. The term “rickettsiae” conventionally embraces a polyphyletic group of microorganisms in the class Proteobacteria, comprising species belonging to the genera RickettsiaOrientia, Ehrlichia, Anaplasma, Neo-rickettsia, Coxiella, and Bartonella.

Travelers may be at risk for exposure to agents of rickettsial diseases if they engage in occupational or recreational activities which bring them into contact with habitats that support the vectors or animal reservoir species associated with these pathogens. For more information on specific Rickettsial diseases, please click here.

These agents are usually not transmissible directly from person to person except by blood transfusion or organ transplantation, although sexual and placental transmission has been proposed for Coxiella. Transmission generally occurs via an infected arthropod vector or through exposure to an infected animal reservoir host. However, sennetsu fever is acquired following consumption of raw fish products.

With the exception of the louse-borne diseases, for which contact with infectious arthropod feces is the primary mode of transmission (through autoinoculation into a wound, conjunctiva, or inhalation), travelers and health-care providers are generally not at risk for becoming infected via exposure to an ill person.

The clinical severity and duration of illnesses associated with different Rickettsial infections vary considerably, even within a given antigenic group. See the chart above for more specific information on Rickettsial diseases.

Clinical presentations of rickettsial illnesses vary (see table in the link above), but common early symptoms, including fever, headache, and malaise, are generally nonspecific. Illnesses resulting from infection with rickettsial agents may go unrecognized or are attributed to other causes. A typical presentations are common and may be expected with poorly characterized nonindigenous agents, so appropriate samples for examination by specialized reference laboratories should be obtained. A diagnosis of Rickettsial diseases is based on two or more of the following:

  • Clinical symptoms and an epidemiologic history compatible with a Rickettsial disease;
  • The development of specific convalescent-phase antibodies reactive with a given pathogen or antigenic group;
  • A positive polymerase chain reaction test result;
  • Specific immunohistologic detection of the Rickettsial agent; and/or
  • Isolation of a Rickettsial agent. Ascertaining the likely place and the nature of potential exposures is particularly helpful for accurate diagnostic testing.

Rickettsioses range in severity from diseases that are usually relatively mild (rickettsialpox, cat scratch disease, and African tick-bite fever) to those that can be life-threatening (epidemic and murine typhus, Rocky Mountain spotted fever, scrub typhus, and Oroya fever), and they vary in duration from those that can be self-limiting to chronic (Q fever and bartonelloses) or recrudescent (Brill-Zinsser disease). Most patients with rickettsial infections recover with the timely use of appropriate antibiotic therapy.

For more information on the signs and symptoms associated with Rickettsial diseases, click here.

1. Vaccination:

There are no vaccines available for these organisms.

2. PPE:

  • Clinical setting : Since Rickettsial diseases are unlikely to be transmitted person-to-person, only PPE that would be worn for various patient care activities is necessary.
  • Research setting: PPE use would be based on the risk of exposure that an activity presents. Face protection would be necessary if there is risk of aerosolization of contaminated feces or culture material; gloves, lab coat/coveralls would be needed for activities with potential for skin exposure.

3. Other protective measures:

Limiting exposures to vectors or animal reservoirs remains the best means for reducing the risk for disease. Travelers should be advised that prevention is based on avoidance of vector-infested habitats, use of repellents and protective clothing, prompt detection and removal of arthropods from clothing and skin, and attention to hygiene.

Q fever and Bartonella group diseases may pose a special risk for persons with abnormal or prosthetic heart valves, and Rickettsia, Ehrlichia, and Bartonella for persons who are immunocompromised.

Please refer to the Virginia Tech Biosafety Manual for recommendations on use of biosafety cabinets and other engineering/administrative controls that may be required for work with these organisms.

  • Rinse the affected area immediately. Use soap and water (except on eyes) or flush with just water.
  • Notify your supervisor.
  • You or your supervisor must notify Environmental Health & Safety as soon as possible after an exposure. Environmental Health & Safety will consult with Virginia Tech’s Occupational Health physician regarding appropriate treatment for the exposure.
  • If necessary, seek medical attention for an emergency (i.e. severe bleeding, difficulty breathing) before contacting Environmental Health & Safety.
  • If you seek medical attention before contacting Environmental Health & Safety you MUST notify the care provider that you may have had exposure to an infectious agent before arriving at the clinic or emergency department.
  • Complete the Employer’s Accident Report which may be downloaded from hr.vt.edu.
  • For more information, visit cdc.gov and look for Rickettsial diseases in the A-Z index.

Tularemia is a potentially serious illness that occurs naturally in the United States. It is caused by the bacterium Francisella tularensis found in animals (especially rodents, rabbits, and hares). Tularemia, also known as “rabbit fever,” is usually a rural disease and has been reported in all U.S. states except Hawaii.

People can get tularemia in many different ways:

  • Being bitten by an infected tick, deerfly, or another insect;
  • Handling infected animal carcasses;
  • Eating or drinking contaminated food or water; or
  • Inhalation of material containing the bacteria, F. tularensis.

Cases also resulted from laboratory accidents. However, tularemia is not known to be spread from person to person so people who have tularemia do not need to be isolated. People who have been exposed to tularemia bacteria should be treated as soon as possible since the disease can be fatal if it is not treated quickly with the right antibiotics.

Symptoms usually appear 3-to-5 days after exposure to the bacteria, but can take as long as 14 days. The signs and symptoms people develop depend on how they are exposed to tularemia. Possible symptoms include skin ulcers, swollen and painful lymph glands, inflamed eyes, sore throat, mouth sores, diarrhea or pneumonia. If the bacteria are inhaled, symptoms can include abrupt onset of fever, chills, headache, muscle aches, joint pain, dry cough, and progressive weakness. People with pneumonia can develop chest pain, difficulty breathing, bloody sputum, and respiratory failure. Tularemia can be fatal if the person is not treated with appropriate antibiotics.

1. Vaccination: 

There is no vaccine available for this organism.

2. PPE:

  • Clinical setting: Since tularemia cannot be transmitted person-to-person, only PPE that would be worn for various patient care activities is necessary.
  • Research setting: PPE use would be based on the risk of exposure that an activity presents. Respiratory protection would be necessary if there is risk of aerosolization of contaminated material or culture material; gloves, lab coat/coveralls would be needed for activities with potential for skin exposure.

3. Other protective measures:

Please refer to the Virginia Tech Biosafety Manual for recommendations on use of biosafety cabinets and other engineering/administrative controls that may be required for work with this organism.

  • Rinse affected area immediately. Use soap and water (except on eyes) or flush with just water.
  • Notify your supervisor.
  • You or your supervisor must notify Environmental Health & Safety as soon as possible after an exposure. Environmental Health & Safety will consult with Virginia Tech’s Occupational Health physician regarding appropriate treatment for the exposure.
  • If necessary, seek medical attention for an emergency (i.e. severe bleeding, difficulty breathing) before contacting Environmental Health & Safety.
  • If you seek medical attention before contacting Environmental Health & Safety you MUST notify the care provider that you may have had an exposure to an infectious agent before arriving at the clinic or emergency department.
  • Complete the Employer’s Accident Report which may be downloaded from hr.vt.edu.
  • For more information, visit the CDC's website.

Definitions

Term Definition

Biological material

Tissue, fluid, blood, OPIM from human or animal sources. Also, cultures of microorganisms and cell lines.

Bloodborne pathogen

Pathogenic organisms that are present in human blood and can cause disease in humans. These pathogens include, but are not limited to, hepatitis B virus (HBV), and human immunodeficiency virus (HIV).

Clinical laboratory

A workplace where diagnostic or other screening procedures are performed on blood or other potentially infectious materials.

Contaminated sharps

Any contaminated object that can penetrate the skin including, but not limited to, needles, scalpels, broken glass, and exposed ends of dental wires.

Decontamination

The chemical or physical destruction or removal of microorganisms to a lower level, not necessarily zero.

Disinfection

The chemical or physical treatment that destroys most vegetative microbes (or viruses), but not spores, in or on inanimate objects/substances.

Engineering controls

Equipment or devices that isolate or remove the pathogenic hazard from the workplace. Examples include: sharps disposal containers, self-sheathing needles, equipment slash guards, biosafety cabinets, etc.

Exposure incident

A specific incident in which potentially infectious material contacts the employee in one of the following ways:

  • Eye;
  • Mouth;
  • Other mucous membrane;
  • Non-intact skin surface; and
  • Puncture/stick/cut with sharp contaminated object

Human pathogens

Pathogenic microorganisms that are present in human blood, tissues, fluids, or OPIM and can cause disease in humans. See Appendix B for pathogens that employees of Virginia Tech may be exposed to. The listed pathogens are either common in a university setting, endemic to Southwest Virginia or being manipulated in a research lab on campus

Infectious agent

A viable microorganism, such as a bacterium, virus, rickettsia, parasite, or fungus, that is known or reasonably believed to cause disease in humans or animals.

Laboratory acquired infection

Any infection acquired through laboratory or laboratory-related activities regardless whether the infection is symptomatic or asymptomatic in nature.

Occupational exposure

Reasonably anticipated skin, eye, mucous membrane, or parenteral contact with potentially infectious materials that may result from the performance of an employee's duties.

Other Potentially Infectious Materials (OPIM)

The following body fluids:

  • Semen;
  • Vaginal secretions;
  • Cerebrospinal fluid;
  • Synovial fluid;
  • Pleural fluid;
  • Pericardial fluid;
  • Peritoneal fluid;
  • Amniotic fluid;
  • Saliva in dental procedures;
  • Any fluid mixed with blood; and
  • Any unknown body fluid.

The following tissues:

  • Unfixed tissue
  • Unfixed organs

The following research media:

  • Pathogen containing cell culture;
  • Pathogen containing tissue/organ culture; and
  • Pathogen containing culture media.

Principal investigator

A Virginia Tech employee responsible for the operations and associated researchers of a laboratory or group of laboratories.

Regulated medical waste

A waste stream which is regulated by the Department of Environmental Quality and must be disposed of through Environmental Health & Safety, even if it has been autoclaved or treated with another form of decontamination. The particulars of the waste stream are:

  • Cultures and stock of microorganisms and biologicals. Discarded cultures, stocks, specimens, vaccines and associated items likely to contain organisms likely to be pathogenic to healthy humans.
  • Blood and blood products. Wastes consisting of human blood, human blood products and items contaminated by human blood.
  • Human tissues and other anatomical wastes. All human anatomical wastes and all wastes that are human tissues, organs, body parts, or body fluids.
  • Sharps. It is university protocol to include all sharps in the regulated medical waste stream. That is, ALL hollow-bore needles, pipettes, and glassware from biological labs or medical settings.
  • Some animal carcasses, body parts, bedding, and related wastes. Animal carcasses, body parts, bedding, and related wastes if the animal has been intentionally infected with pathogenic organisms and are likely to be contaminated.

Regulated medical waste EXEMPTIONS

 

The following waste streams are not subject to the requirements of regulated medical waste regulations when dispersed among other solid wastes and not accumulated separately:

  • Used products for personal hygiene, such as diapers, facial tissues and sanitary napkins.

Material, not including sharps, containing small amounts of blood or body fluids, but containing no free flowing or unabsorbed liquid (band-Aids).

Sanitization

The reduction of microbial load on an inanimate surface to a “safe” public health level.

Sterilization

The total destruction of all living organisms.

Universal precautions

An approach to infection control, where ALL body fluids and individuals are treated as known positives for HIV and HBV. Universal precautions (or standard precautions) must be utilized when working with any potentially infectious material whether from human, animal, or microorganism culture sources.

Work practice controls

Procedures that reduce the likelihood of exposure through the manner in which tasks are performed.

 

Zoonotic diseases

Diseases caused by infectious agents that can be transmitted between (or are shared by) animals and humans. See Appendix C for the list of diseases of concern for Virginia Tech employees.


Infection Control FAQs

The Infection Prevention Program is similar in that it mirrors the ECP in format. However, the Infection Prevention Program is inclusive of more infectious diseases than those addressed by the ECP. The Infection Prevention Program also covers pathogenic organisms used in research at Virginia Tech and addresses diseases that employees can catch from animals (zoonotic diseases).

Anyone who may be exposed to infectious disease while working at Virginia Tech should be familiar with the Infectious Prevention Program. Those individuals would include anyone with patient care responsibilities (Schiffert Health Center staff, athletic trainers, rescue squad), animal care responsibilities (veterinary, farm, and wildlife faculty and staff), police officers, and employees who work with infectious organisms in a research setting.

Is training mandatory? If so, when? Training is recmmended but not mandatory. Persons working with wild animals during field work, especially wild mice, should attend this training. Otherwise, supervisors or PI's are responsioble for training personnel on the hazards represented by animal species or microbial cultures that employees might be exposes to in the work place.

Class length: 1 hour.

Available online: No.

When is refresher training required? Never.

Upcoming classes: Available upon request. Supervisor should contact Sarah Owen, Industrial Hygienist for biological agents, at 540-231-4034 or sowen@vt.edu

Rinse the affected area as soon as possible. Wash with soap and water or flush with plain water. Let your supervisor know about the exposure and fill out the Employer’s Accident Report.

You will also need to contact Environmental Health & Safety (either Juliet Dadras at 540-231-8733 or mjdadras@vt.edu, Sarah Owen at 540-231-4034 or sowen@vt.edu) about the exposure so that Virginia Tech’s Occupational Health physician can determine what testing or treatment you will need. You will also need to fill out Environmental Health & Safety Exposure to Infectious Agent Report.

If you need emergency treatment for the exposure, please see a medical care provider as soon as possible and contact Environmental Health & Safety after the emergency has been taken care of. Be sure to tell the care provider that you may have had exposure to an infectious agent before you arrive for treatment.


Documents


Contact Information

Sarah Owen, Industrial Hygienist

Phone: 540-231-4034
Email: sowen@vt.edu