Exposure Determination - OSHA requires employers to perform an exposure determination concerning which employees may incur occupational exposure to blood or other potentially infectious materials. An “exposed worker” is defined, for the purposes of this document, as an individual exposed while performing normal Job duties. The concept of “all clients should be assumed to be infectious” is to be followed. Waste that contains blood or other body fluids is considered to be potentially infectious and is to be treated as such by the use of Universal Precautions. Body fluids are always treated as infectious. The exposure determination is made without regard to the use of personal protective equipment (i.e. employees are considered to be exposed even if they wear personal protective equipment). This exposure determination is required to list all job classifications in which all employees may be expected to incur such occupational exposure, regardless of frequency.
The job classifications and associated task/procedure in these categories are as follows:
JOB CLASSIFICATION TASK/PROCEDURE
Law Enforcement Holding infants/children
Fire Fighters Handling materials containing any oral/nasal
secretions
Refuse Collectors Dealing with urine/feces
Handling soiled clothing/linen
Sewer Plant Operator Handling human waste
Janitor/Housekeeper Contact with any blood or blood stained material
Handling disposable/non-disposable materials
Cleaning
All Other City Employees Possible exposure while performing job duties
Compliance Methods
Universal precautions will be observed on all calls in order to prevent any contact with blood or other potentially infectious materials. All blood or other potentially infectious materials will be considered infectious regardless of the perceived status of the source individual.
Work practice controls will be utilized to eliminate or minimize exposure to employees. Where occupational exposure remains after institution of these controls, personal protective equipment shall also be utilized. All personnel will utilize these control methods:
-- will have gloves available
-- will have face & eye protection available
-- will have moisture proof gowns/aprons available
-- proper handwashing will be followed*
The above controls will be examined and maintained on a regular schedule by the department head.
Cleaning materials are also available in all work areas.
*After removal of personal protective gloves, employees shall clean hands and any other potentially contaminated skin area immediately or as soon as feasible with soap and water. If employees incur exposure to their skin or mucous membranes, then those areas shall be washed or flushed with water as appropriate or as soon as feasible following contact.
Work Area
Restriction
In areas where there is a reasonable likelihood of exposure to blood or to other potentially infectious materials, employees are not to eat, drink, apply cosmetics or lip balm, smoke, or handle contact lenses.
All procedures will be conducted in a manner which will minimize splashing, spraying, splattering, and generation or droplets of blood or other potentially infectious materials.
Specimens
Specimens of blood or potentially infectious materials should have been placed in a container, which prevents leakage during the collection, handling, and transport of the specimens. The container used for this purpose should be labeled or color coded in accordance with the requirements of OSHA standard.
If outside contamination of the primary container occurs, the primary container shall be replaced within a secondary container, which prevents leakage during the handling, transport, or shipping of the specimen.
Refuse workers should notify the hospital/nursing home if they notice a leaking container at that facility.
Contamination
Linens with these materials are to be bagged in a “Contaminated” laundry bag at the laundry facility.
Personal Protective
Equipment
Personal protective equipment will be chosen based on the anticipated exposure to blood or other potentially infectious materials. The protective equipment will be considered appropriate only if it does not permit blood or other potentially infectious materials to pass through or reach the employee’s clothing, skin, eyes, mouth, or other mucous membranes under normal conditions of use and for the duration of time which the protective equipment will be used.
PERSONAL PROTECTIVE
EQUIPMENT TASK
Gloves Working with blood/body fluids
Gowns Working with blood/body fluids
Eye Protectors Working with blood/body fluids
Masks Working with blood/body fluids
All personal protective equipment will be cleaned and disposed of by the employer at no cost to employees. All repairs and replacements will be made by the employer at no cost to employees.
All garments which are penetrated by blood shall be removed immediately or as soon as feasible. All personal protective equipment will be removed prior to leaving the area. The following protocol has been developed to facilitate leaving the equipment at the work area:
Gloves are to be thrown in the trash immediately after use. If any blood of body fluids have been exposed to the gloves, they need to be thrown in a container used for this purpose. It will be labeled or color coded on accordance with the requirements of OSHA standard.
Gloves shall be worn where it is reasonably anticipated that employees will have hand contact with blood, other potentially infectious materials, non-intact skin, and mucous membranes. Gloves will be used for all procedures.
Disposable gloves are not to be washed or decontaminated for re-use and are to be replaced as soon as they become contaminated or as soon as feasible if they are torn, punctured, or when their ability to function as a barrier is compromised. Utility gloves may be decontaminated for re-use provided that the integrity of the glove is not compromised. Utility gloves will be discarded if they are cracked, peeling, torn, punctured, or exhibit other signs of deterioration or when their ability to function as a barrier is compromised.
Masks in combination with eye protection devices, such as goggles or glasses with solid side shield, or chin length face shields, are required to be worn whenever splashes, spray, splatter, or droplets or blood or other potentially infectious materials may be generated and eye, nose, or mouth contamination can reasonably be anticipated.
The OSHA standard also requires appropriate protective clothing to be used.
Housekeeping
Personnel will promptly clean up spills of blood and blood-contaminated fluids by using an EPA approved germicide or 1:100 solution of household bleach in the following manner while wearing gloves (1 part bleach to 9 parts water). Visible material should be first removed with disposable towels. If splashing is anticipated, protective eyewear should also be worn. Then decontaminate the area with the germicide solutions. Hands should be washed following removal of gloves. Soiled cleaning equipment should be cleaned and decontaminated or placed in an appropriate container and disposed of in a leakproof, red/orange biohazard bag. All surfaces exposed to potentially infectious materials will be cleaned after each single use.
Laundry Procedures
Disposable gown, gloves, and masks will be places in a leak-proof red/orange biohazard bag. Soiled items should be handled as little as possible and with minimum agitation to prevent gross microbial contamination of the air and persons handling the items. Soiled items should be bagged at the location setting and then disposed of at the E.R.
Non disposable linin soiled with blood should be placed and transported in biohazard bags that prevent leakage. Normal laundry cycles should be used according to the washer and detergent manufacturer’s recommendations.
All spillage or injury from handling infectious materials will be reported to the Administrator/Supervisor, who will report to the City Council.
Protective clothing contaminated with blood or other body fluids, to which universal precautions apply, should be placed and transported in bags or containers to prevent leakage. Personnel involved in the bagging, transport, and laundering of contaminated clothing should wear gloves. Protective clothing, station and work uniforms should be washed and dried according to the manufacturer’s instructions. Boots and leather goods may be brushed-scrubbed with soap and hot water to remove contamination.
Hepatitis B. Vaccine
All employees who have been identified as having exposure to blood or other potentially infectious materials will be offered the Hepatitis B vaccine at no cost to the employee. The vaccine will be offered within ten (10) working days of their initial assignment to work involving the potential for occupational exposure to blood or other potentially infectious materials unless the employee has previously had the vaccine or who wished to submit to antibody testing whish shows the employee to have sufficient immunity.
Employees who decline the Hepatitis B vaccine will sign a waiver. Employees who initially decline the vaccine but who later wish to have it may then have the vaccine provided at no cost. It is the City of Hillsboro who is responsible for assuring that the vaccine is offered and the waivers are signed. A nurse from the Health Department will administer the vaccine.
Post-Exposure
Evaluation and Follow-Up
Immediate response is required when a needle stick, injury, or exposure to blood/body fluids and waste materials occurs and there is potential for transmission or exposure to Hepatitis B or HIV.
1. General Guidelines for Management
a. Hands or other skin surfaces should immediately be scrubbed thoroughly with soap and water, eyes or mouth should be flushed immediately with water.
b. Inform department head, who will inform the Hillsboro City Council of the occupant of the incident.
c. The source shall be identified, if possible.
d. Blood shall be drawn as soon as possible after the event for Hepatitis B surface antigen and HIV antibody tests for the source person, and, also for the exposed worker, to establish a baseline.
e. Testing shall be done at a location where appropriate pre-test counseling is available and post-test counseling and referral for treatment is provided.
f. An incident report is to be completed by the worker as soon as possible.
g. As part of the confidential medical record, the City of Hillsboro will document the circumstances of exposure. Relevant information including the activity in whish the worker was engaged as the time of exposure, the extent to which appropriate work practices and protective equipment were used and a description of the source of exposure.
2. HIV Testing Results
a. If source has AIDS or other evidence of infection, declined, or has a positive HIV test:
i. The exposed worker should be evaluated and tested for HIV.
ii. Exposed worker should be counseled regarding the risk of infection and potential spread of infection.
iii. Exposed worker should be advised to report and seek medical evaluation for any acute and/or febrile illness that occurs within twelve (12) weeks after the exposure.
iv. If exposed worker is seronegative – recommendation to exposed worker and/or physical is to rested 6 weeks, 12 weeks, and 6 months after exposure.
v. During this follow-up period (especially the first 6-12 weeks after exposure, when most infected persons are expected to seroconvert), exposed workers should follow U.S. Public Health Service recommendations for preventing transmission of HIV.
vi. It is vital that worker’s confidentiality be protected.
b. If source is seronegative and has no other evidence of HIV infection, no further follow-up of the exposed worker is necessary.
c. If source is seronegative and at high risk of infection, repeat test for HIV should be obtained at 12 weeks from the exposure.
d. If source cannot be identified, decisions regarding follow-up should be individualized, based on the type of exposure and the likelihood that the client was infected.
3. Hepatitis B Testing Results
a. If source is negative for HBV, no further testing is indicated.
b. If source is positive for HBV:
i. Test results are to be given to the personal physician of the exposed worker.
ii. Recommendations would be for the exposed worker to receive HBIG promptly and to begin the series of Hepatitis B vaccine, is exposed worker has not received HBV vaccine previously.
iii. In Hepatitis B vaccinated worker, serologic testing to assess immune status is recommended, unless testing within the previous 24 months has indicated adequate levels of antibody (anti-HBS).
Management of Human
Bites
Occasionally employees suffer human bites. When such bites occur, routine medical therapy (including an assessment of tetanus vaccination status) should be implemented as soon as possible, since such bites frequently result in infection with organisms other than HIV and HBV. Victims of bites should be evaluated as described above for exposure to blood or other infectious body fluids.
Management of HBV or
HIV Infected Workers
Transmission of HBV from workers to other individuals has been documented. A worker who is HBsAG positive and who has transmitted Hepatitis B virus to another individual during the performance of his or her job duties should be excluded from performance of those job duties which place other individuals at risk for acquisition of Hepatitis B infection.
Workers with impaired immune systems resulting from HIV infection or other causes are at increased risk of acquiring or experiencing serious complication of infectious disease. Of particular concern is the risk of severe infection following exposure to other persons with infectious diseases that are easily transmitted if appropriate precautions are not taken. Any worker with an .impaired immune system should be counseled about the potential risk associated with providing health care to persons with any transmissible infection and should continue to follow existing recommendations for infection control to minimize risk of exposure to other infectious agents. Recommendations of Immunization Practices Advisory Committee and Institutional policies concerning requirements for vaccinating workers with “live-virus” vaccines should also be considered. The question of whether workers infected with HIV can adequately and safely be allowed to perform their duties or whether their work assignments should be hanged must be determined on an individual basis. These decisions should be made by the worker’s personal physician, in conjunction with the employer’s medical advisors.
Training
Training for all employees will be conducted prior to initial assignment to tasks where occupational exposure may occur. Training will be conducted in the following manner:
Training for all employees will include the following explanation of:
1. The OSHA standard of Bloodborne Pathogens
2. Epidemiology and symptomatology of bloodborne diseases
3. Modes of transmission of bloodborne pathogens
4. This Exposure Control Plan (i.e. 0 points of the plan, lines of responsibility, how the plan will be implemented, etc.)
5. Procedures which might cause exposure to blood or other potentially infectious materials at this facility
6. Control methods which will be used at the scene and during transport to control exposure to blood or other potentially infectious materials
7. Personal protective equipment available in the vehicles and who should be contacted if exposed to potentially infectious material
8. Post-exposure evaluation and follow-up
9. Signs and labels used at this facility
10. Hepatitis B vaccine program at the facility
Training will be conducted using videotapes, written material, City of Hillsboro, etc. The Health Department Administrator and E.M.S. Administrator will be responsible for arranging and conducting training.
All employees will receive annual refresher training. This training is to be conducted within one year of the employee’s previous training.
Record Keeping
All records required by the OSHA standard will be maintained by the City of Hillsboro and Marion County Health Department.