The purpose of this procedure is to ensure that all employees who may have an occupational exposure to blood borne pathogens, or other potentially infectious materials, may eliminate or minimize these exposures, as per 29 CFR 1910.1030 Occupational Exposure To Blood borne Pathogens.
OBJECTIVES
The objectives of this plan are to establish a written guideline to address the following:
1. Introduction
2. Exposure Determination and Assessment Procedure
3. Hepatitis B Vaccinations
4. Exposure Procedure
5. Universal Precautions and Engineering and Workplace Controls
6. Personal Protective Equipment
7. Regulated Waste Disposal
8. Pre-Exposure Hepatitis B Vaccination
9. Training
10. Definitions
1. INTRODUCTION
The Occupational Exposure to Blood borne Pathogens Standard, 29 CFR 1910.1030 deals with occupational exposure to blood borne pathogens, and other potentially infectious materials.
This standard requires employers to make a determination as to occupational exposure and to identify, inform and train all affected employees as to the effective use of universal precautions, engineering and workplace controls, infection control procedures and protective equipment or devices for use on the job.
2. EXPOSURE DETERMINATION AND ASSESSMENT PROCEDURE
It is the intent of this safety procedure that all departments will on an ongoing basis assess and compile data about which employees may be expected to incur an occupational exposure to blood or other potentially infectious materials, in the workplace.
Based upon a review by competent medical authority, Appendix A lists the city job classifications in which it has been determined that there are reasonable risks of an occupational exposure to blood or other potentially infectious materials.
Classification A includes job positions wherein ALL employees may have an occupational exposure and classification B lists all job positions in which SOME employees may have an occupational exposure to blood and other potentially infected materials.
1. HEPATITIS B VACCINATION
Employees in Classification A are required to receive a Hepatitis B vaccination series, due to their exposure potential. Usually, only one vaccination series is needed for an entire lifetime, though booster vaccinations are available as needed.
However, department heads retain the discretion to offer Hepatitis B vaccinations to additional employees should a review of the position by competent medical authority indicate an employee may have an occupational exposure to blood or other potentially infectious materials and require a pre-exposure Hepatitis B vaccination.
2. EXPOSURE PROCEDURE
IF YOU BELIEVE YOU HAVE BEEN EXPOSED TO A BLOOD BORNE PATHOGEN, REPORT TO A RECEIVING FACILITY WITHIN 2 HOURS!
I. For Employees
1. Report immediately to one of the following locations.
Weekdays from 8:00 A.M. to 5:00 P.M.: Weekends and Evenings:
Concentra Industrial Clinic U of U Medical Center
1735 South Redwood Road, Ste. 115 50 North Medical Drive
Phone: 973-4434 Phone: 585-8000
It is critical that notice be provided immediately following the exposure incident, as significant exposures often require blood testing of the employee and the source individual. At the same time, there exists only a brief window of time (approximately 2 hours) in which employees may be treated most effectively with antiviral agents for HIV. Also, treatment with Hepatitis B immune globulin should be evaluated and started as soon as possible.
•If the exposure has been determined to be significant, you should have blood drawn for testing.
2. Notify Your Supervisor
1. Complete the required forms, including
•Employee Consent Forms for HBV/HIV Testing and appropriate counseling
•Emergency Worker Incident Report Form. This form is to be faxed or mailed to Concentra Industrial Health Clinic.
1. Report the Injury to the City’s Workers’ Compensation TPA
Additional Information
•If an employee chooses to seek an opinion and treatment from their personal physician, it may be at their own expense. The City’s Designated Agent must still be kept informed of the status of the exposure incident and they will update the State Health Department’s Communicable Disease Specialist as needed.
•Also, where testing and treatment is recommended, but not completed by the employee, any future medical condition that may arise and is alleged to have occurred through the exposure incident may be presumed to have resulted from cause other than the exposure incident. Public Safety and Emergency Medical Services Providers may be exempt from this requirement under U.C.A. 26-6A-1 through 14.
II. For Supervisors
1. Direct the employee to the appropriate facility for treatment.
Weekdays from 8:00 A.M. to 5:00 P.M.: Weekends and Evenings:
Concentra Industrial Clinic U of U Medical Center
1735 South Redwood Road, Ste. 115 50 North Medical Drive
Phone: 973-4434 Phone: 585-8000
When employees report a potentially significant exposure to blood borne pathogens, the supervisor shall immediately, or as soon as possible, direct the employee to report to one of the above facilities. Antiviral agents have the best chance of preventing an HIV infection if administered within 2 hours of the exposure.
2. Direct the employee to complete the following:
•Employers first report of injury (this can be done on line or over the telephone).
•Employee Consent Forms for HBV/HIV testing and appropriate counseling
•The Emergency Worker Incident Report Form (this form will be mailed or faxed to the City’s designated receiving facility
5. UNIVERSAL PRECAUTIONS AND ENGINEERING AND WORKPLACE CONTROLS
Universal precautions shall be observed by all employees to prevent contact with blood or other infectious materials. All blood or other potentially infectious materials shall be considered infectious regardless of the perceived status of the source individual. Engineering and work practice controls shall be utilized to eliminate or minimize workplace exposures. Where the potential for occupational exposure remains after implementation of these controls, personal protective equipment shall also be provided.
Hygienic Procedures
All blood or body fluids shall be assumed to be potentially infectious. The procedures below shall be followed and enforced at all times.
Employees shall, whenever possible, avoid direct contact with any body fluids. Gloves, bandages, and other disposable protective coverings shall be used when handling potentially infectious materials. Any infectious materials shall be promptly cleaned and disinfected after use. Disinfectants, disposable materials, and soaps shall be provided by the City and made available.
Hand Washing Guidelines
Hand washing should be done frequently by employees and shall be required (i.e. before and after food preparation, after use of the toilet, after contact with any body fluids, etc.). The best method of hand washing involves the use of soap and water and should be done for at least 10 to 15 seconds. Where soap and water are not available, a waterless antiseptic cleanser, or an antiseptic towelette may be used.
Hand washing is the single most important means of preventing the spread of infection. The principle is that of using friction to mechanically remove microorganisms. Wash hands as follows:
1. Wash hands with soap and running water.
2. Rinse hands under running water.
3. Dry hands well with a paper towel.
4. If possible, use paper towel to turn off faucet. All manually controlled faucets should be considered contaminated.
5. Dispose of single use or linen towels in appropriate containers.
Disposable Glove Guidelines
Disposable gloves shall be worn where there may be contact with body fluids or infectious materials.
When removing protective gloves after they have become contaminated, use the following procedure for safe removal:
1. With both hands gloved, peel one glove off from top to bottom and hold it in the gloved hand.
2. With the exposed hand, peel the second glove from the inside, tucking the first glove inside the second.
3. Dispose of the entire bundle promptly in an appropriate container.
4. Never touch the outside of the glove with your bare skin.
5. Whenever you remove your gloves, wash your hands with soap and water, or waterless disinfectant soap as soon as possible.
Other Precautionary Guidelines
All cuts and open wounds shall be covered following basic first aid procedures. Employees who may have an occupational exposure shall wear protective coverings, bandages, etc. Gloves or exposure resistant protective equipment shall be worn over these coverings where there is the possibility of an exposure incident.
The sharing of personal items, such as combs, brushes, toothbrushes, etc., should be avoided. Whenever possible, disposable items should be used and not shared by others.
Disinfectants may be utilized where hand washing is impractical.
Hand soap, waterless hand washing agents (antiseptic), disposable towels, tissues and gloves, shall be available to employees who may have an occupational exposure to blood or other potentially infectious materials.
Soiled surfaces with blood or other potentially infectious materials shall be promptly cleaned with disinfectants after use. All items used in cleaning, i.e. rags, sponges, etc., are to be properly disposed of after each use. Disposal instructions are found in the next section.
If the interior of a City vehicle or other drivable equipment is contaminated, the driver or supervisor shall contact Fleet Management to arrange for proper cleaning.
Procedures for Cleaning up Body Fluid Spills
Wear disposable gloves that shall be discarded following cleanup. When disposable gloves are not available or unanticipated contact occurs, hands and other affected areas shall be washed with soap and water immediately after contact.
Clean and disinfect the soiled area immediately using paper towels, soap and water.
Disinfect the soiled area either with an EPA approved tuberculosidal disinfectant or a solution of 10 percent household bleach (about one and three fourth cups of liquid sodium hypochlorite to one gallon of water). If bleach is used, a fresh solution must be made for each application.
Clothing soaked with another’s blood or body fluids shall be isolated and washed separate from other clothing in a 10 percent household bleach solution.
Following exposure to blood or other potentially infectious materials, paper towels and disposable gloves shall be placed in red plastic bags, secured and disposed of in a designated regulated waste disposal site for removal by the City’s designated vendor.
Procedure for the Cleaning of Equipment/Facilities
Only authorized and trained workers shall clean up potentially infectious material. Workers shall wear appropriate personal protective equipment (PPE) including general-purpose utility gloves during all cleaning of blood or other potentially infectious materials and during decontamination procedures.
Initial clean-up of blood or other potentially infectious materials shall be followed with the use of an approved hospital disinfectant chemical germicide that is a tuberculocidal, or with a solution of 10 percent household bleach (about one and three fourths cup of liquid sodium hypochlorite to one gallon of water).
Use a disinfectant solution to clean equipment or facilities as soon as possible when there is an overt contamination, or after any spill of blood or other potentially infectious materials, and at the end of the work shift if the surface may have become contaminated since the last cleaning.
Procedure for Needles and Other Sharps
Contaminated needles and other contaminated sharps shall not be bent, recapped, removed, sheared or purposely broken. If this is necessitated by the medical procedure, then the recapping or removal of the needle must be done by use of a mechanical device, or by a one-handed technique.
Sharps containers shall be available to all employees who may come into contact with needles or other sharps as an occupational exposure. Sharps containers shall be closeable, constructed to contain all contents and prevent leakage of fluids during handling, labeled and color-coded; to be closed prior to removal to prevent spillage and protrusion of contents during handling.
Never pick up any needles by hand. Use pliers or some other tool to prevent accidental puncture to your skin or glove.
Human Bites
In case of Human bites, take the following action:
Ø Squeeze the area of the wound and encourage the wound to bleed.
Ø Wash the area thoroughly with an antibacterial soap, or with isopropyl alcohol.
Ø Notify your supervisor, complete the appropriate reports and seek medical attention.
Work Area Restrictions
In work areas where there is a reasonable likelihood of exposure to blood or other potentially infectious materials, employees are not to eat, drink, apply cosmetics or lip balm, smoke, or handle contact lenses.
Food and beverages are not to be kept in refrigerators, freezers, shelves, cabinets, or on counter tops or bench tops where blood or other potentially infectious materials are present.
6. PERSONAL PROTECTIVE EQUIPMENT
All personal protective equipment for employees who may have occupational exposures to blood or other potentially infectious materials shall be provided to employees based upon their anticipated occupational exposure.
Protective equipment shall be considered effective only if it does not permit blood or other potentially infectious materials to pass through or reach the employees’ clothing, skin, eyes, mouth, or other mucous membranes under normal conditions of use for the duration of time that the protective equipment is used.
Personal protective equipment may include the following:
•Protective gloves
•Protective eyewear; i.e. non-prescription glasses, goggles or face shields
•Protective masks
•Tyvek or similar coveralls or protective apron/gown
•Protective boots or other footwear
•Protective one way valve (microshield) for CPR
If blood or other infectious materials penetrate your PPE, try to remove the equipment as soon as possible.
Protective one-way valves or pocket masks are designed to isolate you from contact with a victim’s saliva and body fluids. Always try to avoid unprotected mouth-to-mouth resuscitation.
Protective gloves shall be worn when it becomes reasonably anticipated that you may have hand contact with blood or any potentially infectious materials. Since gloves can be torn or punctures, cover any hand cuts with bandages before putting on gloves. Dispose of all torn, punctured or contaminated gloves; never try to wash for reuse.
7. REGULATED WASTE DISPOSAL
Biohazardous waste, or regulated medical waste, may include clothing, bandages, gloves, sharps, or body parts that contain blood, or other potentially infectious materials. These shall be stored in a labeled container and placed in a properly marked, red bag with the biohazard symbol.
Regulated medical waste means semi-liquid blood or other potentially infectious materials; contaminated items that would release blood or other potentially infectious materials in a liquid or semi-liquid state if compressed; items that are caked with dried blood or other infectious materials that are capable of releasing these materials during handling; contaminated sharps; and pathological and microbiological wastes containing blood or other potentially infectious materials.
This storage bag shall be placed in a properly designated area, until removed by the City’s designated regulated waste hauler, as contracted by the City’s Purchasing Division.
8. PRE-EXPOSURE HEPATITIS B VACCINATION
For all employees identified in Appendix A, under Classification A, (job classifications in which ALL employees may have an occupational exposure to blood or other potentially infectious materials), employees shall be offered a Hepatitis B vaccination at no cost.
Within 10 working days of the initial assignment, this vaccination shall be offered to new employees who may have an occupational exposure, unless the employee has previously received the vaccine and wishes to submit to antibody testing to show sufficient immunity, or the employee may provide official medical records to document taking the full series of Hepatitis B vaccinations, or unless the employee chooses to decline the vaccination.
A Patient Informed Consent Form for Hepatitis B vaccination form may be found in appendix B, and shall be used to document Hepatitis B vaccinations. All employees receiving the vaccination shall complete this form.
All employees identified in Appendix A, under Classification B, shall receive required annual training, and personal protective equipment, but are not required to receive the Hepatitis B vaccination. Employees in classification B may elect to receive the Hepatitis B vaccination.
9. TRAINING
All affected employees shall be trained annually during working hours as per the OSHA General Industry Standards, 29 CFR 1910, 1030, Occupational Exposure To Blood borne Pathogens.
10. DEFINITIONS
Exposure Incident (or significant exposure) – means a specific eye, mouth, or other mucous membrane, non-intact skin, or parenteral contact with blood or other potentially infectious materials that results from the performance of an employee’s duty.
HBV – means Hepatitis B virus.
HIV – means Human Immunodeficiency Virus.
Occupational Exposure – means reasonably anticipated skin, eye, mucous membrane, or parenteral contact with blood or other potentially infectious materials that may result from the performance of an employee’s duties to blood borne pathogens, including but not limited to the Hepatitis B virus and the Human Immunodeficiency Virus.
Other Potentially Infectious Materials – means:
1. The following human body fluids: semen, vaginal secretions, cerebrospinal fluid, synovial fluid, pleural fluid, pericardial fluid, peritoneal fluid, amniotic fluid, saliva in dental procedures, any body fluid that is visibly contaminated with blood, and all body fluids in situations where it is difficult or impossible to differentiate between body fluids;
2. Any unfixed tissue or organ (other than intact skin) from a human (living or dead) and;
3. HIV containing cell or tissue cultures, organ cultures and HIV or HBV containing culture medium or other solutions: and blood, organs, or other tissues from experimental animals infected with HIV or HBV.
Parenteral – A piercing of mucous membranes or skin barrier by means of a needle stick, human bite, cut and/or abrasion.
Regulated Waste – means a liquid or semi-liquid blood or other potentially infectious materials.
Source Individual – means any individual, living or dead, whose blood or other potentially infectious materials may be a source of occupational exposure to the employee.
Universal Precautions – is an approach to infection control. According to the concept of Universal Precautions, all human blood and certain human body fluids are treated as if known to be infectious for HIV, HBV, and other blood borne pathogens.
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Questions concerning this procedure can be addressed by:
1. Your Department Safety Officer
2. Risk Management
451 South State Street, Room 505
Salt Lake City, Utah 84111
(801) 535-7788
The following is a listing of ALL Salt Lake City Corp. job classifications that may have a potential occupational exposure to blood or other potentially infectious materials as defined by 29 CFR 1910.1030:
Classification A: Lists employee job classifications in which ALL employees in these job classifications my have an occupational exposure to blood or other potentially infectious material. All employees in this classification must receive training and be offered a pre-exposure Hepatitis B vaccination.
Classification B: Lists employee job classifications in which SOME employees in these job classifications may have an occupational exposure to blood or other potentially infectious materials. Employees in this classification must receive training but will not receive a Hepatitis B vaccination.
Classification A: All Employees May Have an Occupational Exposure
Salary Class Position Title
Example
902 Fire Fighter
Classification B: Some Employees May Have an Occupational Exposure
Salary Class Position Title
Added to file February 2, 2001