B5 Ollie

Question 1

Biological Agent - COSHH Definition

Answer 1

A micro-organism, cell culture, or human endoparasite, whether or not genetically modified, which may cause infection, allergy or toxicity or otherwise create a hazard to human health:
Fungi 
Bacteria 
Viruses
 Protozoa

Question 2

Fungi

Answer 2

Plant-like organis ms
No chlorophyll
Many produce mass of thread-like hyphae(moulds ) Reproduce through the production of spores
Some produce mycotoxins (e.g. Aflatoxin)
Include yeasts
Examples:
As pergillum flavus (Farmer’s Lung)
Rhizomes stolonifer (breadmould)

Question 3

Bacteria

Answer 3

Consist of microscopic cells – structure different from mammalian cells
Typical diameter 1 micrometer
Variety of shapes :
Spirils
Cocci
Rods
Multiply by binary fission
Some produce resistant spores Most are susceptible to antibiotics Examples:
Eschereciacoli Legionella Pnuemophila

Question 4

Viruses

Answer 4

Smallest micro-organis ms 20 to 300 nanometers diameter
Not composed of cells , just DNA (or RNA), carbohydrate and protein Multiply by taking over the internal mechanism within cells
Do not produce spores
Not affected by antibiotics – but vaccines can us ually be produced Examples:
Common cold
Influenza
Hepatitis
HIV

Question 5

Protozoa

Answer 5

Single celled animals
Similar to human cells
Typically 20 micrometers diameter Some produce 
cysts
Examples:
Cryptosporidium parvum Plasmodium vivax

Question 6

Special Properties of Biological Agents (1)

Answer 6

Rapid multiplication:
Mean generation time in E.coli may be 10 minutes
1 cell can form billions in a few hours under optimum conditions

Rapid mutation:
Mutations occur during multiplication
Advantageous mutations selected
Micro-organis m quickly adapt
Bacterial resistance to antibiotics
Viral resistance to vaccines

Question 7

Special Properties of Biological Agents (2)

Answer 7

Incubation period :
Time between infection and development of symptoms : Legionella - 2 to 10 days
:Leptospirosis - 2 to 20 days
:Hepatitis B - 4 to 20 weeks

Question 8

Special Properties of Biological Agents (3)

Answer 8

Infectious:
Infectious disease:
One caused by a biological agent that can be transmitted from one person to another (or from one animal to a different one) through the presence of a replicating agent
Infectious diseases known as communicable diseases or transmissible diseases
A person suffering from an infectious disease is s aid to be infectious

Question 9

COSHH Regulation 6 - Risk Assessment (1)

Answer 9

Risk assessments to consider:
Hazardous properties of the substance
Information on health effects provided by the supplier The level and duration of exposure
The circumstances of the work
Activities s uch as maintenance
Any relevant workplace exposure limit

Question 10

COSHH Regulation 6 - Risk Assessment (2)

Answer 10

The effect of preventative and control measures
The results of relevant health surveillance
The results of monitoring
The risk presented by exposure to substances in combination The approved classification of any biological agent
Additional information

Question 11

Hazard Groups -1 and 2

Answer 11

Group 1:
Unlikely to cause human disease
e.g. Saccharomyces cerevis iae (brewers yeast)

Group 2:
Can cause disease and may be a hazard
Unlikely to s pread to community
Us ually effective prophylaxis or treatment available e.g. Legionella, Clostridiumtetani

Question 12

Hazard Group -3

Answer 12

Group 3:
Can cause severe human disease and is a serious hazard May s pread to the community
Usually effective prophylaxis or treatment available
e.g. HIV, Rabies virus , Anthrax, Hepatitis B

Question 13

Hazard Group -4

Answer 13

Group 4:
Causes severe human disease and is a serious hazard Likely to spread to the community
Usually no effective prophylaxis or treatment available e.g. Ebola, Marburg, Smallpox

Question 14

COSHH Regulation 7(10) - Prevention or control of 
hazardous substances (Schedule3)(1)

Answer 14

In addition for biological agents (where not reasonably practicable to prevent exposure):
Suitable signage (biohazard sign)
Specifying decontamination and disinfection procedures
Safe collection, storage and disposal of contaminated waste

Question 15

COSHH Regulation 7(10) - Prevention or control of
 hazardous substances (Schedule3)(2)

Answer 15

Testing for presence outside primary confinement areas
Specifying procedures for use and transport
Vaccines where possible
Adequate hygiene measures – facilities , prohibition of eating, drinking and smoking
Containment for Group 3 and 4 agents

Question 16

COSHH Regulation 7(10) - Prevention or control of
 hazardous substances (Schedule3)(3)

Answer 16

Applies to a and b below:
a) Exposure results from a deliberate intention to work with agent e.g. research laboratory

b) Exposure arises out of a work activity which is incidental and not from direct work
e. g. hospital (opportunistic infection)

Notto c below:

c) Infection does notarise out of work activity its elf e.g. one employee catches infection from another

Question 17

RIDDOR 2013 - Reportable Diseases

Answer 17

Listed inSchedule 3 of RIDDOR:
The person at work is currently carrying out activities listed in Schedule 3 (COSHH)
The employer (or responsible person) has received written confirmation from a registered medical practitioner
Notify enforcing authority forthwith Form F2508A

Question 18

RIDDOR 2013 - Dangerous Occurrence

Answer 18

Any accident or incident which resulted or could have resulted in the release or es cape of a biological agent likely to cause severe human infection or illness
Guidance:
Hazard Group 3 and 4 biological agents e.g. HIV and hepatitis B, C and D.

Question 19

Factors in Risk Assessment

Answer 19

Hazard category, (Groups 1, 2, 3 and 4 of COSHH Schedule 3)
Activities and people at risk
Likelihood and nature of resultant disease
Modes of transmission

Question 20

Activities and People at Ris k (1)

Answer 20

Individual susceptibility:
Age
Gender
Immune s tatus (e.g. Availability of vaccines ) Sensitisation
State of health
Presence/absence of controls e.g. PPE
Results of health surveillance

Question 21

Activities and People at Risk (2)

Answer 21

Number of persons exposed
Duration of exposure
Activities carried out (e.g. Maintenance, cleaning) Training, competence, information

Question 22

Likelihood and Nature of Resultant Disease

Answer 22

Virulence:
The ability of an infectious agent to cause disease
A function of the likelihood of the agent to cause infection and the seriousness of the effect that may
result Most virulent organisms are in Hazard Group 4
e.g. Smallpox - mortality rate 35%
Accidental exposure at University of Birmingham 1978

Question 23

Modes of Transmission (1)

Answer 23

Droplet infection:
Coughing or sneezing on another person Inhalation of aerosols
e.g. Common cold, influenza, legionella Direct contact:
Touching an infected person,
sexual contact e.g.HIV, hepatitis B
Indirect contact:
Touching an infected s ubs tance/object (fomite) e.g. HIV, hepatitis B, dys entery

Question 24

Modes of Transmission (2)

Answer 24

Faecal-oral transmission:
Usually from contaminated food or water
Contamination with faeces
e.g. Hepatitis A, salmonella, cryptosporidium, E.coli Vectors:
Transmission though another animal, usually an insect e.g. Lyme disease (ticks ), malaria (mosquito)

Question 25

Biological Agents - Routes of Entry

Answer 25

Inhalation: Droplets , whole agent, spores e.g. Influenza, legionella Injection: e.g.HIV,hepatitis B Ingestion: Swallowing contaminated material e.g. Salmonella, cryptosporidium Absorption: Undamaged skin usually impermeable to biological agents Sexual transmission e.g. HIV

Question 26

Cryptosporidosis

Answer 26

Caused by a protozoan Cryptosporidium parvum Between 3 and 5 micro-metres in diameter Carried in the intestines of fish, reptiles , birds and mammals Transmitted via infected food or water Over 5000 human cases per year in UK Incubation period 2-14 days Symptoms are usually short term mild diarrhoea.

Question 27

Cryptosporidosis -Controls

Answer 27

Avoid drinking untreated water Ensure high standards of water treatment (e.g. In swimming pools ) High standards of hygiene at all times Wash raw vegetables /fruit before eating Treat animals promptly if they have diarrhoea Ensure people do not prepare food for 48hours

Question 28

Farmer’s Lung

Answer 28

Infection due to inhalation of fungal spores e.g. As pergillus flavus , Micropolys porafeani Moulds grow on jute, flax, hemp, straw and hay Spores may set off a hypersensitivity reaction in the inhaler, leading to external allergic alveolitis Symptoms include fever, chills , headache ,chest pain, shortness of breath Can lead to meningitis , blindness and endocarditis (heart infection).

Question 29

Farmer’s Lung - Controls

Answer 29

Design and maintenance of machinery to prevent dust Ventilation/LEV Regular cleaning/house keeping-vacuum or wet clean Personal hygiene – clean work-clothes at end of each day Personal clothing and hair should be kept clean, e.g. by wearing a coverall and headgear RPE and other PPE Information and training Health s urveillance e.g. questionnaires and lung function tests

Question 30

Psittacosis

Answer 30

Caused by Chlamydophila psittaci (bacterium) Passed from birds (parrots , pigeons , ducks ) to humans Inhalation of faeces /feathers /dus t in aerosol Lasts several months in bird dander 61 cases in humans (England and Wales)2008 Incubation period 5-14 days Flu-like symptoms : fever,chills , cough, weakness

Question 31

Psittacosis -Controls

Answer 31

``` Preventative husbandry: Clean cages daily, remove faeces Disinfection of cages for new animals Working methods to reduce dust e.g. vacuum, wet cleaning LEV to remove aerosols PPE e.g. gloves and body protection RPE if high risk (e.g. on-farm s laughter of poultry) Information and training ```

Question 32

Hepatitis A

Answer 32

Virus transmitted by infected food and drink, and is associated with poor sanitation Sewage workers and healthcare workers are most at risk Incubation period 15-40 days Symptoms fever, nausea and sickness Jaundice appears a week later and may persist for up to three weeks Serious complications are unusual

Question 33

Hepatitis A - Controls

Answer 33

Similar to preventing food pois oning Good standards of hygiene especially where faecal contamination is possible (e.g. in hospitals ) Ens ure adequate cooking of food/s erve hot Immunisation – vaccine effective for up to 10 years

Question 34

Hepatitis B,C,D(1)

Answer 34

Serum hepatitis Transmitted via body fluids (Blood borne viruses): Direct contact e.g. Cuts Splashes to the eyes , nose or mouth Contact with contaminated sharps Sexual transmission Passed to the infant from the mother at birth

Question 35

Hepatitis B,C,D(2)

Answer 35

``` Incubation period 2 to 6 months Symptoms: Fever Malaise Jaundice Liver damage Liver cancer 5-20% mortality rate Groups atrisk: Healthcare workers Social workers Refuse handlers etc ```

Question 36

Human Immunodefficiency Virus (HIV) (1)

Answer 36

Virus that leads to AIDS (Acquired Immune Deficiency Syndrome) Symptoms: Opportunistic infection, wasting Transmission by exchange of body fluids (Blood borne virus ) Those most at risk include healthcare workers , cleaners , refuse collectors

Question 37

Human Immunodefficiency Virus (HIV) 21)

Answer 37

Most new cases due to sexual transmission between hetero sexuals /s hared needles 5 occupational cases in UK (HPA 2011) HIV destroys helper T-cells Time from infection to development of AIDS 8 years Test for presence of virus ; HIV positive

Question 38

BloodBorneViruses (BBVs)-Controls

Answer 38

Protect cuts /abrasions with waterproof dressings Good hygiene practice and facilities e.g. hand-was hing Decontamination and disposal, use of dispos ables Ensure that all staff are given appropriate information and training PPE – gloves , eye shields , visors , aprons , face masks , rubber boots /overs hoes Emergency procedures Control of sharps

Question 39

BBVs -Immunisation

Answer 39

``` No effective vaccine available for HIV Vaccine available for hepatitis A : Two doses , 2nd after 6-12 months Vaccine available for hepatitis B ( NOT C ) : Also protects agains t hepatitis D Three doses , 2nd after 1 month, 3rd after 6 months Titre checked after third inoculation Boosters required every 3 to 5years Take about 6 months to become effective ```

Question 40

Controlling Sharps

Answer 40

Eliminate use Introduce methods to prevent contact Dis posable sharps /no re-sheathing, tongs , pick-up s ticks , ban use of bare hands Disposal procedures e.g. Sharps boxes PPE, training and information Report near-misses and accidents

Question 41

Legionellosis

Answer 41

Diseases caused by legionella bacteria Most important legionnaires disease - caused by bacterium Legionella pneumophila Form of pneumonia, symptoms headache ,fever, respiratory discomfort Elderly (especially men), immuno- suppressed suppressed, diabetics most at risk

Question 42

Legionnaires Disease-ACOP

Answer 42

``` Appoint responsible person Prepare inventory Risk assessments to consider: Controls in place Type of installation Frequency of use Water temperatures Nutrient sources Location of susceptible groups Breakdowns Record and review ```

Question 43

Legionnaires Disease - Controls

Answer 43

Eliminate aerosol production. e.g. remove s pray taps / showers not used Temperature control: hot water systems >60oC in calorifier/50oC hot taps Cold water systems <20oC Monitor temperatures Cleaning of water tanks Flushing and disinfection of showers Disinfection e.g. chlorine dioxide Remove dead-legs Training and information to staff

Question 44

Leptospirosis (1)

Answer 44

Weil’s Disease Susceptible groups include: Farm workers Slaughterhous e workers Sewage workers Caus ed by bacterium Leptos piraicterohaemorrhagiae Released in urine of rats , survives in environment for more than 1 month

Question 45

Leptospirosis (2)

Answer 45

``` Enters through open cuts , gut, conjunctiva of eye Incubation period 4-19 days Symptoms: Fever High temperature Headache Vomiting Muscle pain Jaundice Meningitis Liver and kidney failure ```

Question 46

Leptospirosis -Controls

Answer 46

``` Pest control and litter removal Waterproof plasters over cuts Protective clothing and footwear Prompt treatment of cuts Good personal hygiene e.g. hand-washing Avoid eating/smoking in areas of potential contamination Warning cards ```

Question 47

Eschericia coli

Answer 47

Found in human gut E.coli 0157 potentially mos t harmful - infectious dose <100 cells Main reservoir cattle High risk - petting farms /contaminated food Enters food chain through faecal contamination Causes hemorrhagic colitis - abdominal pain, cramps , bloody diarrhoea 5% of cases - haemolyticuremic syndrome, anaemia, kidney failure

Question 48

Eschericiacoli -Control

Answer 48

Good hygiene standards throughout food chain Strict procedures to prevent contamination of meat with faeces in abattoirs Good hygiene standards in cooking/food preparation

Question 49

Eschericia coli - Control (petting farms )

Answer 49

Hand-was hing facilities (better than gels or wipes ) Hand-was hingafter touching animals Separate areas for eating Cleaning of items in contact with floor (e.g. Footwear) Education/information e.g. do not lick fingers after touching animals

Question 50

MRSA (Methicillin Resistant Staphylococcusaureus )

Answer 50

S.aureus commonly found in nose May cause boils , wound infections , septicaemia MRSA antibiotic resistant strain Mainly a problem in hospitals /nursing homes

Question 51

MRSA - Controls

Answer 51

Screen patients for MRSA Hand was hing (staff and visitors ) before and after handling patients High standards of hygiene in hospitals Isolation of infected persons

Question 52

Clostridium difficile

Answer 52

Present in gut, especially children – spore former Antibiotics kill other natural gut bacteria; gives C.difficile advantage Multiplies and releases toxin Symptoms ; diarrhoea and fever Spread on hands of healthcare s taff Controls:similar to MRSA

Question 53

Noroviruses

Answer 53

Winter vomiting dis eas e Naus ea, vomiting, diarrhoea, duration 12 to 60 hours Especially common in hospitals , nursing homes , schools Spread mainly faecal-oral, but also in vomit Control: Disinfection of contaminated areas Good hygiene procedures High standards of personal hygiene

Question 54

Zoonoses

Answer 54

Infections that normally affect animals but can be transmitted to humans ``` Examples: Leptospirosis Psitacosis Brucellosis Anthrax Lymedisease ```

Question 55

Zoonoses -General Controls

Answer 55

Caused by bacterium Brucella abortus and Brucella mellitens is Infection from unpas teuris ed milk, cuts , direct contact, maybe inhalation Atrisk: vets,farm workers,lab workers,slaughter houseworkers Symptoms: fever,malaise,weakness and fatigue Symptoms intermittent and may become chronic In cattle causes spontaneous abortion

Question 56

Brucellosis -Controls

Answer 56

Eradicate from cattle Testing of cattle Pasteurisation of milk Control of imports Disinfection of contaminated areas

Question 57

General Hierarchy of Control (1)

Answer 57

``` Eradication Reduced virulence Change of work method to minimise or suppress generation of aerosol ls Isolation and segregation Containment approach (Schedule 3 COSHH) Control for specific examples Sharps control ```

Question 58

General Hierarchy of Control (2)

Answer 58

``` Immunisation Decontamination and dis infection Effluent and was te collection Storage and disposal (controlled) Personal hygiene measures Personal protective equipment Biohazard signs Base line testing and health surveillance ```

Question 59

Containment - COSHH 2002

Answer 59

If Group 2 agent must have minimum contain level 2 If Group 3 agent must have minimum level 3 If Group 4 agent must have minimum level 4 If exposed to Group 3 or 4 agent, employer must keep list of employees and details (40years) If using Group 2, 3 or 4 agent for first time, employer must notify HSE 20 working days in advance (with details) Consignment of Group 4 agents , employer to notify HSE 30 days in advance

Question 60

General Laboratory Work - Containment Level 1

Answer 60

Food, drink and smoking should be prohibited Laboratory coats worn/cleaned, other PPE removed if leaving laboratory Doors closed Easy clean surfaces and good hygiene standards Decontamination procedures in place, contaminated materials labelled and appropriately s tored No mouth pipetting

Question 61

General Laboratory Work - Containment Level 2

Answer 61

``` Inadditionto CL1: Restricted access Specified dis infection procedure Mechanical ventilation should create - negative pressure ``` Procedures creating aerosols in safety cabinet (Class 1) Benches must be routinely decontaminated Wash basins to be located at exit

Question 62

General Laboratory Work - Containment Level 3

Answer 62

Inadditionto CL2: List of employees Separate laboratory HEPA filtration Laboratory must be sealed for disinfection Biohazard sign on entry Laboratory coats must be autoclaved before laundering Class II or III safety cabinet

Question 63

General Laboratory Work - Containment Level 4

Answer 63

Employees over 18 Extraction requires double HEPA filtration Airlock Class III safety cabinet High performance RPE in event of an accident Means of outside communication Infectious material should be destroyed within the laboratory unit

Question 64

Spillage Procedure - Blood and Body Fluids

Answer 64

Gloves ,eye protection and a disposable apron to be worn Disposable plastic over shoes or rubber boots if s pill extensive Contamination should be wiped up with paper towels soaked in a suitable disinfectant (e.g. hypochlorite solution) If broken glass is present, treat with hypochlorite, then remove glass with forceps to sharp’s bin Dispose of towels and gloves to yellow bags labeled with the biohazard label Hands must be washed following clearing up