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POLICY
4114.1 |
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PERSONNEL 4114.1 BLOODBORNE PATHOGEN EXPOSURE PLAN The Manchester Board of Education establishes this written policy to eliminate or minimize exposure to bloodborne pathogens and to meet the requirements of the Connecticut Division of Labor, Occupational Safety and Health Administration. Adopted:
January 11, 1993 Manchester Board of Education BLOODBORNE PATHOGEN EXPOSURE CONTROL PLAN Section I - Purpose 1.1 This policy is to eliminate or minimize employee exposure to communicable diseases that include, but are not limited to, hepatitis B virus (HBV), hepatitis C (HCV), and human immunodeficiency virus (HIV) and to meet the requirements of the Connecticut Division of Labor Occupational Safety and Health Administration (OSHA). Section II Definitions: 2.1 Blood means human blood, human blood components, and products made from human blood. 2.2 Bloodborne Pathogens means pathological microorganisms that are present in human blood and can cause disease in humans. These pathogens include, but are not limited to, hepatitis B virus (HBV), hepatitis C (HCV), and human immunodeficiency virus (HIV). 2.3 Contaminated means the presence, or the reasonable anticipated presence, of blood or other potentially infectious materials. 2.4 Contaminated Laundry means laundry, which has been soiled with blood or other potentially infectious material or may contain sharp items. 2.5 Contaminated Sharps means any contaminated object that can penetrate the skin including, but not limited to, needles, broken glass, knives, scalpels, and jagged metal. 2.6 Decontamination means the use of physical or chemical means to remove, inactivate, or destroy bloodborne pathogens on a surface or item to the point where it is no longer capable of transmitting infectious particles, and the surface or item is rendered safe for handling, use, or disposal. 2.7 Engineering Controls means controls (e.g. sharps disposal containers, self-sheathing needles) that isolate or remove the bloodborne pathogens hazard from the workplace. 2.8 Exposure Incident means a specific eye, mouth, other mucous membrane, non-intact skin, or parenteral contact with blood, or other potentially infectious material, that results from the performance of an employee's duties.
2.10 Licensed Health Care professional is a person whose legally permitted scope of practice allows him or her to independently perform the activities required by paragraph (f) Hepatitis B Vaccination and post-exposure evaluation and follow-up. 2.11 Occupational Exposure means reasonable 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. 2.12 Other Potentially Infectious Materials means the following human body fluids: urine, feces, vomit, saliva, semen, vaginal secretions, cerebrospinal fluid, amniotic fluid, 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. 2.13 Parenteral means piercing mucous membranes or the skin barrier through such events as needle sticks, human bites, cuts, and abrasions. 2.14 Personal Protective Equipment is specialized clothing, or equipment, worn by an employee for the protection against a hazard. General work clothes (e.g., uniforms, pants, shirts or blouses) are not intended to be personal protection equipment. 2.15 Regulated Waste means liquid or semi-liquid blood or other potentially infectious materials; items that are caked with dried blood or potentially infectious materials and are capable of releasing these materials during handling: and contaminated sharps. 2.16 Work Practice Controls means controls that reduce the likelihood of exposure by altering the manner in which a task is performed (e.g. prohibiting recapping of needles by a two-handed technique). 2.17 Source Individual means any individual, living or dead, whose blood, or other potentially infectious material, may be a source of occupational exposure to the employee. 2.18 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, HCV, and other bloodborne pathogens. Section III - Exposure Determination 3.1 The
Board of Education job classifications in which all employees in those
job classifications are occupationally exposed via reasonable anticipated
skin, eye, mucous membrane, or parental contact with blood or other
potentially infectious materials include: Section IV Method of Compliance 4.1 Universal Precautions Universal precautions shall be observed to prevent contact with blood or other potentially infectious materials. Under circumstances in which differentiation between body fluid types is difficult or impossible, all body fluid types shall be considered potentially infectious materials. 4.2 Engineering and work practice control Engineering and work practice controls shall be used to eliminate or minimize employee exposure. These controls will be reviewed at least annually to ensure their effectiveness. 4.3 Personal Protective equipment Board of Education employees will be instructed on selection and use of personal protective equipment. Personal protective equipment shall be used by all Board of Education employees to ensure compliance with universal precautions and shall be provided and maintained by the departments of those employees at risk of occupational exposure to blood borne pathogens. Personal protective equipment shall include, but not be limited to: Non-porous water-resistant gowns to be used when it can be reasonably anticipated that the employee will be in contact with blood or other potentially infectious material which may splash. antiseptic hand cleaner to be used when sink and running water is not available. latex gloves to be worn when it can be reasonably anticipated that the employee will have hand contact with blood or other potentially infectious material. utility gloves to be worn when it can be reasonably anticipated that the employee will have contact with blood or other potentially infectious material while cleaning. The gloves may be decontaminated for reuse if the integrity of the glove has not been comprised. They must 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. face masks and eye protection to be worn when it can be reasonably anticipated that the employee may be exposed to contaminated material, which may splash on their face or in their eyes. bag
valve masks to be used for CPR other
ventilation resuscitation equipment *If the
employee is allergic to any of the protective equipment, the employer
will 4.4 Personal Hygiene Employee's shall wash their hands and other skin with soap and water, or flush mucous membranes with water immediately or as soon as feasible, following contact of such body areas with blood or other potentially infectious materials. When antiseptic hand cleaners are used in the field, hands shall be washed with soap and running water as soon as feasible. Fingernail biting and other personal habits that cause lesions to the skin should be avoided. 4.5 Contaminated Personal Protection Equipment/Disposable Waste If a garment(s) is penetrated by blood, potentially infectious materials, the garment(s) shall be removed immediately, or as soon as feasible. When personal protective equipment is removed, it shall be placed in an appropriately designated area, container, or red "Bio-medical waste" bag for storage, washing, decontamination or disposal. 4.6 Contaminated Sharps Contaminated needles and other contaminated sharps shall not be recapped or removed unless taken as evidence. Immediately or as soon as possible, contaminated sharps shall be placed in appropriate containers. These containers shall be puncture resistant, labeled or color coded, and leak proof on the sides and bottom. These containers shall be kept locked in each school health nurse's office. 4.7 All levels of Emergency Responders All procedures involving blood or other potentially infectious materials shall be performed in such a manner to minimize splashing, spraying, spattering, and generation of droplets of these substances. 4.8 Contaminated Patient Property All contaminated or potentially infected materials that are the personal property of the student shall be placed in a properly labeled container (red bio-medical waste bag) which prevents leakage during collection, handling, processing, storage, transport or shipping. 4.9 Housekeeping Department supervisors shall assure that all equipment, environmental and working surfaces shall be cleaned and decontaminated after contact with blood or other potentially infectious materials. Contaminated objects and work surfaces shall be disinfected after completion of emergency calls and immediately after any spill of blood or infectious materials. Contaminated immersible objects, such as, but not limited to; stethoscope, scissors, blood pressure cuff, airway management equipment, jewelry and eye glasses, shall be cleaned and disinfected in a designated basin using a freshly prepared solution of ½ cup of sodium hypochlorite to one (1) gallon of water. Non-immersible contaminated surfaces, such as, but not limited to; vehicle interiors and exterior, shall be disinfected by using a designated spray container, utilizing a freshly prepared solution of 1/8 cup of sodium hypochlorite to one (1) quart of water. Entire contaminated surfaces shall be covered with a fine film of solution for at least ten (10) minutes before rinsing clean, and drying. School nurses shall decontaminate all material saturated with potential infectious material by soaking them in a freshly prepared 1/8 cup of hypochlorite to one (1) quart of water for 10 minutes. After decontamination materials will be placed in a double-bagged receptacle. Facial tissues containing blood or other potential infectious materials may be flushed. 4.10 Contaminated laundry Contaminated laundry shall be handled as little as possible with a minimum of agitation. Employees who have contact with contaminated laundry shall wear protective gloves and other appropriate personal protective equipment. Employees will be instructed on appropriate handling and cleaning of contaminated laundry. 4.11 Regulated waste disposal The Town's Health Department will be responsible for the disposal of regulated waste for school system. Such regulated waste is limited to contaminated sharps. Contaminated sharp containers shall be ordered for School Health Services and the cost billed to the Board of Education. Containers shall be closable, puncture resistant, leak proof on sides and bottom, labeled and red in color. The Health Department will collect contaminated sharps containers following procedures outlined in OSHA Standard 40 CFR Parts 22 and 259 and 29 CFR 1910.1030. FDA regulates sharps disposal containers as medical devices under FDA21 CFR8603. Section V - Hepatitis B Vaccination, Post-Exposure, Evaluation and follow-up 5.1 Hepatitis B Vaccination The Hepatitis B vaccination shall be made available after the employee has received the training required in Section VI and within ten (10) working days of initial assignment to all employees who have occupational exposure, unless the employee has previously received the complete hepatitis B vaccination series, antibody testing has revealed the employee is immune, or the vaccine is contraindicated for any medical reason. If the employee initially declines the Hepatitis B vaccination, but at a later date, while still covered under OSHA 29 CFR 1910:1030 standard decides to accept the vaccination, the Board of Education shall make available the Hepatitis B vaccination at that time. 5.2 Hepatitis B Vaccination Declination Employees who decline to accept the Hepatitis B vaccination offered by the Board of Education shall sign the Declination Statement. This statement shall be sent to the Coordinator of School Health Services. At any time the employee wishes to have the Hepatitis B vaccine the employee shall notify the Coordinator of School Health Services so that arrangements for the administration of the vaccine. The first dose of the vaccine must be given within 10 working days of the request. 5.3 Post Exposure Evaluation and Follow-up Following a report of an exposure incident, the Town's protocol concerning bloodborne disease exposure will be implemented. Section VI Communication of Hazards to Employees 6.1 Labels - warning labels that are fluorescent orange or orange-red and include the BioHazard Symbol shall be affixed to all containers of regulated waste. 6.2 Signs - fluorescent orange or orange-red in color containing the BioHazard Symbol and information on the type of BioHazard will be posted anywhere BioHazard material is stored. 6.3 Information and training - The Board of Education shall ensure that employees with risk of occupational exposure to bloodborne pathogens participate in a training program. The training shall be provided as follows: *At the
time of initial assignment to tasks where occupational exposure may
occur. Section VII Record Keeping 7.1 Medical
records shall be maintained and stored in a locked file cabinet with 7.2 Medical
records shall be maintained for at least the duration of employment
plus 7.3 Training
records shall include: dates of training, summary of training, name(s) 7.4 Training
records will be maintained for three years from the date training 7.5 Records
shall be made available upon written request for examination to the
RELEASE OF CONFIDENTIAL HIV-RELATED INFORMATION NOTICE I understand that this information has been disclosed to me from records whose confidentiality is protected by State law. State law prohibits me from making any further disclosure of this information without the specific written consent of the person to whom it pertains, or as otherwise permitted by said law. A general authorization for the release of medical or other information is NOT sufficient for this purpose. Date________________________ Name______________________________ Address______________________ _____________________________ Witness___________________________ Date______________________
Board of Education PROCEDURES
CONCERNING SIGNIFICANT BLOOD-BORNE
Occupational exposure: occurs when an employee in the course of his occupational duties has had a significant exposure to blood or body fluids of another individual. Non-significant exposure: an exposure incident with minimal contact to blood or body fluids. Contact was to clothing or intact skin where it is highly unlikely any blood or body fluid pathogen had a port of entry to the employee's circulatory system post exposure prophylaxis (PEP) not warranted. Significant exposure: an exposure incident such as a specific eye, mouth, or other mucous membrane, non-intact skin, or parenteral (needle-sticks, human-bites, cuts, abrasions) contact with blood, or other potentially infectious materials. Consider basic PEP regimen. Highly Significant exposure: an exposure incident that meets CDC high-risk guidelines; a deep injury to employee with a significant volume of source case blood (a large diameter hollow needle, previously in a source case's vein or artery). Recommend basic PEP or expanded PEP regimen based on status of source case. See attached algorithm for determining the need for HIV post exposure prophylaxis after an occupational exposure (MMWR, May, 1998.) PROCEDURES The employee will: 1. Notify supervisor of significant exposure as soon as possible (immediately or within 1-2 hours, or maximum of 24 hours of the incident). 2. Complete a written department exposure form within 24 hours of exposure. The following information must be included in the form: a. Parties
to the exposure 3. Contact or go to Corp Care (647-4796), 1075 Tolland Turnpike, as soon as possible or within 24 hours of exposure. (Literature strongly suggests post-exposure prophylaxis, PEP, be initiated within 1-2 hours post-exposure, no later than 24-36 hours). On a weekend or a holiday, the employee should go to Prompt Care or the Emergency Department at Manchester Memorial Hospital. If they go to the emergency department the employee should contact Corp Care the next working day to notify them of the exposure and to arrange for appropriate recommended follow-up. All employees will be tested if the "personal protection barrier was broken" or if it is believed an exposure occurred. The employee shall tell the medical staff at either facility that they are Town of Manchester employee and that they have had an exposure to blood/body fluid. A patient record should be opened for any town employee who has had a blood/body fluid exposure. The physician at Corp Care (or Prompt Care, Emergency Department) will make a determination as to the significance of the exposure at the initial visit. This will be based on the nature of the event including the type of exposure, body fluid employee is exposed to, and risk to the employee. 4. If it is determined that a significant exposure has occurred, the Town of Manchester will pay for the initial screen and 4 follow-up screens, without prejudice, through its workers' compensation carrier. Employees should call 1-800-652-4762 to report a Worker's Compensation claim with CIRMA and arrange for bills for blood screens to be sent to the Finance Department. In all cases employees should fill out department exposure forms. If it is determined that a significant exposure has not occurred, the Town of Manchester will pay for the initial screen and 1 follow-up, without prejudice, through its workers' compensation carrier. If it is determined that a significant exposure has not occurred, the employee may ask for voluntary continuation of testing and counseling at the intervals of initial, 6 weeks, 3 months, 6 months, and 12 months. The employee should not report a Worker's Compensation claim with CIRMA. Should the employee wish to undergo further testing, he/she will be responsible to arrange payment with Corp Care or seek follow-up through their private physician. Nothing herein shall prevent the Town from disclaiming the significant exposure as a compensated injury under Worker's Compensation statutes. 5. The employee of their supervisor should notify Coordinator School Health Services at 647-3486, that an exposure has occurred including date, time of incident, employee's name, source individual's name, address, phone, and if source was seen at Manchester Memorial Hospital. This will facilitate follow-up on the source case. Corp Care (or Manchester Memorial Hospital's Emergency Dept.) will: 1. Determine
if significant exposure occurred Board of Education will: a. If the source case is brought into Manchester Memorial Hospital, the employee should notify the emergency room staff and physician that an exposure has occurred. The staff will attempt to obtain permission from the source case for HBV, HCV, and HIV testing and/or release of information pertaining to HBV, HCV, and HIV status to the Board of Education employee. If testing is done and the individual (source case) is released prior to test results being received, their treating physician will offer them their test results. If the source case refuses testing or release of information pertaining to HBV, HCV, HIV status, the Board of Education's Medical Advisor will become involved and will determine if criteria is met to pursue a court order. b. If the source case is not brought to Manchester Memorial Hospital but has a family physician, the family physician will be notified and asked to obtain consent for testing and/or release of information of HBV, HCV, HIV status to exposed Town employee. If the source case refuses to give consent for testing and/or to release the information pertaining to HBV, HCV, HIV status, the Board of Education Medical Advisor will become involved and will determine if criteria is met to pursue a court order.
BLOOD-BORNE
PATHOGEN POST-EXPOSURE PROPHYLAXIS MEDICATION AZT
(Retrovir, zidovuedine) 3TC
(Epivir, Laminivudine) IDV
(Indinavir, Crixivan, Saquinavir) PEP should be started quickly, preferably 1-2 hours post exposure. Animal studies have demonstrated that PEP is ineffective if started after 24-36 hours. How this interval carries over to humans is unknown. However, early treatment of acute HIV infection (the initial sero-conversion period) is showing beneficial effects, therefore PEP may be beneficial if started later. The recommended duration of PEP is 4 weeks. There should be an initial HIV test of the employee, and follow-up testing at 6 weeks, 12 weeks, and 6 months. If PEP is employed, initial and subsequent CBC, renal, and liver function blood work should be done. PEP should be considered and implemented in direct consultation with those who have experience in anti-retroviral therapy and HIV transmission. If the source case's HIV status is unknown, PEP should be decided on a case by case basis - based on employee exposure, the exposure risk, and the probability of infection in the source case (high risk group). Hepatitis
B Vaccine Declination I understand that due to my occupational exposure to blood or other potentially infectious materials, I may be at risk of acquiring hepatitis b virus (HBV) infection. I have been given the opportunity to be vaccinated with Hepatitis B vaccine, at no charge to myself. However, I decline Hepatitis B vaccination at this time. I understand that by declining this vaccine, I continue to be at risk of acquiring hepatitis b, a serious disease. If in the future I continue to have occupational exposure to blood or other potentially infectious materials and I want to be vaccinated with Hepatitis B vaccine, I can receive the vaccination series at no charge to me.
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©2005
Manchester, CT - Board of Education
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