BLOODBORNE PATHOGEN
EXPOSURE CONTROL PLAN
DOUGLAS COUNTY
This Bloodborne Pathogen Exposure Control Plan was prepared
in compliance with OR/OSHA Safety and Health Code OAR 437 Division 2 (CFR 1910)
General Occupational Safety and Health Rules Subdivision Z: Toxic and Hazardous
Substances Bloodborne Pathogens (1910.1030).
http://www.cbs.state.or.us/external/osha/pdf/pds/pd-154.pdf
FOR CLARIFICATION OR CONSULTATION
REGARDING
WORKSITE EXPOSURE CONTROL PLAN,
PLEASE CONTACT:
DOUGLAS COUNTY HUMAN RESOURCES
Risk Management
1036 SE Douglas, Room 322
Roseburg, OR 97470
Telephone: (541) 440-4405
Fax: (541)
440-6292
TABLE
OF CONTENTS
- OR/OSHA Bloodborne Pathogen Standard: OAR 437, Division
2, Subdivision Z
http://www.cbs.state.or.us/external/osha/pdf/pds/pd-154.pdf
Douglas County Human Resources
Department’s Administrative Guidelines/Policy Statement – in support of exposure
control plan; key definitions
This listing provides job
classifications involved and the types of potential exposure contact.
The training program includes a
detailed review of Douglas County’s written exposure plan and training
materials.
These controls outline the basic
controls employees should follow: work practices, hand/skin washing procedures,
PPE, location of PPE, limitations of PPE, cleaning and discarding PPE.
Housekeeping procedures that minimize
the potential for employees to come into contact with blood or body fluids that
may be left on environmental surfaces, clothing, or waste materials.
Any regulated waste (liquid/semi-liquid
blood or OPIM, contaminated items that would release blood or OPIM in a liquid
or semi-liquid state if compressed, items caked with blood or OPIM and are
capable of releasing these materials during handling)
Methods by which clothing, gloves,
and equipment are to be cleaned and/or disinfected.
Surveillance, investigation of
exposure and medical follow-up; declination form for hepatitis B vaccination;
BBP incident report
Medical records, training records,
safety checklist and Sharps Injury Log
DOUGLAS
COUNTY
BLOODBORNE
PATHOGEN EXPOSURE CONTROL PLAN
SECTION 1 - POLICY
STATEMENT
INTRODUCTION
As an employer, Douglas County is
responsible under the Occupational Safety and Health Administration to provide
a hazard-free work environment for employees. This responsibility is
supplemented by specific regulations of 29 CFR 1910.1030 - Occupational
Exposure to Bloodborne Pathogens. The standard covers employers that have
employees who could be reasonably anticipated, as a result of the performance
of job duties, to have occupational exposure to blood, human body fluids or
other potentially infectious materials.
Employers shall establish an exposure control plan to eliminate or
minimize employee exposures. This exposure control plan will identify those
employees by tasks performed, training, engineering controls, housekeeping,
handling infectious waste, medical surveillance and recordkeeping.
This plan has been developed based
on the following two principles:
1. Risk
Assessment. Duties and tasks
required to be performed by county employees in each of the job classifications
where it is reasonably anticipated employee exposure to blood or other
potentially infectious materials have been analyzed.
2. Risk
Management. Standard operating
procedures for the use of engineering and work practice controls, personal
protective equipment (PPE) and housekeeping; employee training and information
programs including labels and signs; a medical surveillance program that
includes vaccinations against hepatitis B; and a recordkeeping system have been
developed.
RESPONSIBILITIES
The Douglas County Risk Manager is
designated the responsibility to maintain our overall plan and oversee plan
implementation. The Douglas County Safety Manager is
designated the responsibility to provide training to affected employees.
Communicable Disease Coordinators: An employee or employees from each affected department will be
assigned by the department head to serve as department coordinator for this
plan. This employee(s) is to ensure
that the requirements of this policy are followed and proper records are
kept. The Coordinator will work with
the Risk Manager to ensure implementation of the plan and will be part of the
annual program plan process.
Departments that have covered employees include the Sheriff’s Office,
Adult Parole and Probation, Health and Social Services Department, Public
Works, Park, Building Facility, Juvenile, Fleet, Salmon Harbor and Fair are
listed on pages nine through fourteen.
Department Heads will notify the Risk Manager as to
who the coordinators are for ongoing communication about the plan.
Safety Committees:
Both the Central Safety Committee and affected department safety
committees will review the plan procedures and will include the safety and
health requirements as part of their routine inspection review.
Employees are responsible to follow this procedure and bring
any problems or concerns to their supervisor, Safety Manager, Risk Manager or
safety committee representatives.
PLAN REVIEW AND MONITORING
The plan will be monitored by the
Risk Manager. All employees designated
in this plan as having occupational exposure are to follow the established
procedures to ensure their protection against bloodborne pathogens.
This plan will be reviewed
annually by the Risk Manager, to ensure that the plan is adequate. If major changes are needed prior to the
annual plan review, then the Risk Manager in conjunction with department
coordinators will initiate the review process and appropriate changes will be
implemented.
LOCATION OF THIS
PLAN
Copies of this plan will be kept
by department heads, department coordinators, safety manager, and risk
manager. Employees will be notified of
the specific locations during their annual training and information sessions.
EXPOSURE
PLAN OVERVIEW
The Bloodborne Pathogen Plan provides guidance and information to all
County employees with occupational exposure to blood, human body fluids or
other potentially infectious materials (OPIM) that is reasonably anticipated as
a result of the performance of their work duties.
The training required by the plan will be provided by departments to
their staff with assistance from the Safety Manager. This training will occur at the time of initial assignment where
exposure might take place, and annually thereafter reflecting changes and
implementation of safer medical devices.
THIS PLAN INCLUDES THE FOLLOWING PROCEDURES
Universal Precautions are to be used when any employee
has potential contact with blood or other infectious body fluids. These are:
1. Treat all blood or body fluids as potentially infectious by
the use of barrier precautions. This
includes, but is not limited to PPE’s; i.e., gloves, appropriate clothing,
barrier shield
2. Washing of
hands after contact with blood or OPIM and removal of gloves.
3. Prevention
of cutting or needle stick injuries by the use of puncture resistant containers
for disposal and appropriate procedures during potential contact with
needles/sharps.
4. Use of
mouthpieces and/or resuscitation bags to minimize exposure to saliva during resuscitation
procedure.
5. Clean and
disinfect surfaces as soon as possible when they become contaminated with blood
or OPIM.
The personal
protective equipment (PPE) listed in this plan are to be kept by each
employee or must be available for immediate use.
All containers of contaminated material will have a Biohazard Symbol label.
Sharps
Injury Log will be maintained and submitted to Risk Management on an
annual basis.
Housekeeping is
important to reduce potential infection so the worksite will be maintained in a
clean and sanitary condition. Each area
or location has a decontamination method(s) and schedule.
Hepatitis B vaccination will be
provided to all staff designated in Section 2 of this plan. The vaccination
will be offered after receiving the initial training and within 10 days of
assignment. The vaccinations will be offered to any employee who may have an
exposure not anticipated, as post medical follow-up.
If an exposure incident
does occur, an investigation will be conducted as soon as it is reported. This investigation will gather information
to help prevent future exposure incidents.
Medical
records shall be kept confidential and maintained for 30 years plus
the length of employment.
KEY DEFINITIONS
Blood
Blood refers to human blood and
components thereof.
Bloodborne Pathogens
Bloodborne Pathogens refers to
pathogenic micro-organisms present in human blood which could cause disease in
humans. These pathogens include
hepatitis B virus (HBV), hepatitis C virus (HCV), and human immunodeficiency
virus (HIV).
Contaminated
Contaminated refers to the presence
or suspected presence of blood or other potentially infectious materials on an
item or surface; such as:
Laundry
Laundry refers to material which has
been soiled with blood and/or other potentially infectious materials.
Sharps
Sharps refer to any contaminated
object that can penetrate the skin; such as:
Needles,
scalpels, broken glass
Decontamination
Decontamination refers to the means
by which the use of physical or chemical is utilized to remove, inactivate or
destroy bloodborne pathogens on a surface / item so that they are no longer
capable of transmitting infectious particles and are now rendered safe for
handling or disposal.
Engineering Controls
Engineering Controls refer to the
controls / methods by which bloodborne pathogens hazards are isolated / removed
from the workplace. Effective controls
include the following: sharps disposal
containers, self-sheathing needles, safer medical devices such as sharps with
engineered sharps injury protections and needleless systems.
Exposure Incident
Exposure incident refers to contact
with blood or other potentially infectious materials that result from the
performance of an employee’s duties.
Areas of exposure may include:
Eyes, mouth, other mucous membrane,
non-intact skin, or parenteral contact.
Hand Washing
Facilities
Hand washing facilities refers to an
area providing an adequate supply of running potable water, soap and single use
towels and/or hot air drying machines.
Licensed Healthcare
Professional
Licensed healthcare professional
refers to a person who is legally permitted the scope of practice to allow the
independent performance of activities required regarding hepatitis B
vaccination and post-exposure evaluation and follow-up.
HBV
HBV refers
to hepatitis B virus.
HCV
HCV refers
to hepatitis C virus
HIV
HIV refers
to human immunodeficiency virus.
Needleless Systems
Needleless systems refer to a device
that does not utilize needles for the following:
·
The
collection or withdrawal of body fluids after initial venous / arterial access
is established.
·
The
administration of medication or fluids
·
Any
additional procedure involving the potential for occupational exposure to
bloodborne pathogens due to percutaneous injuries from contaminated sharps.
Occupational Exposure
Occupational Exposure refers to
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.
Other Potentially
Infectious Materials (OPIM)
Other
potentially infectious materials refer to the following:
·
Human
Body Fluids: i.e., semen, vaginal secretions, cerebrospinal fluid, synovial
fluid, pleural fluid, pericardial fluid, peritoneal fluid, amniotic fluid,
saliva, or any other bodily fluid that is visibly contaminated with blood
and/or all body fluids in situations where it is difficult or impossible to
differentiate between body fluids.
·
Any
unfixed tissue or organ (other than intact skin) from a human (living or dead)
·
HIV –
containing cell or tissue cultures, organ cultures, and HIV – or HBV –
containing culture medium or other solutions
Parenteral
Parenteral refers to the piercing
mucous membranes or the skin barrier through such events as needle sticks,
human bites, cuts and abrasions.
Personal Protective
Equipment (PPE)
PPE refers to specialized clothing
or equipment worn by an employee for protection against a hazard. General work clothes are not considered to
be PPE.
Regulated Waste
Regulated waste refers to liquid or
semi-liquid blood or other potentially infectious materials that are capable or
releasing these materials during handling.
Sharps with Engineered
Sharps Injury Protections
Injury protectors refer to a
non-needle sharp or a needle device used for withdrawing body fluids by access
of a vein or artery, or administering medications or other fluids with a
build-in safety feature or mechanism that effectively reduces the risk of
needle stick injury.
Source Individual
Source individual refers to any
individual, living or dead, whose blood or other potentially infectious
materials may be a source of occupational exposure to the employee; such as,
clinic patients, clients who are institutionalized as developmentally disabled,
trauma victims, clients who are using drugs, human remains.
Sterilize
Sterilize refers to the use of a
physical or chemical procedure to destroy all microbial life including highly
resistant bacterial endospores.
Universal Precautions
Universal precautions refers to an
approach to infection control whereby all human blood and certain body fluids
are treated as if known to be infectious for HIV, HBV and other bloodborne
pathogens.
Work Place Controls
Work place controls refers to the
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)
SECTION 2 - JOB
CLASSIFICATIONS - Tasks, Procedures and Duties with Potential Exposure
The
following job classifications are included in the County's overall Bloodborne
Exposure Control Plan. This listing
provides job classifications involved and the types of potential exposure
contact.
JOB CLASSIFICATIONS JOB
TASK WITH POTENTIAL EXPOSURE
SHERIFF’S OFFICE
(Note: Refer to
GENERAL ORDER NO.460 for site specific plan)
|
1. All sworn
Deputies, Deputy Medical Examiner
and some management |
•Suspect
body search, •Property
search: car, residential, belongings, •Physical
force with suspect (contact), •Assaulting
or combative arrest, •At crime
scenes - assault or homicide, •Transporting
prisoners or suspects that are bleeding (i.e. suspect bite by K-9 or injured
and bleeding, •Physical
contact, human bites, •Cleaning
cars and materials contaminated with blood or body fluids, •First
aid and CPR assistance at accident scene or with fellow officer. •Assist
in performance of autopsies RISKS: potential needle sticks, knife contact, non-intact contact and mucous
membrane contact with blood and/or body fluids. |
|
2. All Evidence Deputies |
•Contact
with blood and body fluid soaked or stained clothing and other evidence, •Potential
contact with sharps taken as evidence. RISKS:
potential needle sticks, knife contact, body fluids contact by handling
evidence. |
|
3. All Correction Officers, all Correction Supervisors and some Administrative Positions |
•Body
searches, •Inmate
clothing and belongings searches, •Physical
force with an inmate (contact), •Physical
contact, human bites, •First
aid and CPR. RISK:
potential needle sticks, knife skin contact, non-intact skin contact
and mucous membrane contact with blood or body fluids. |
|
4. All Correction Nurses |
•Give
injections, •Physical
examinations, •Draw
blood for testing, •Disinfect
surfaces and clean-up blood or body fluids, •First
aid and CPR. RISKS:
potential needle sticks, non-intact skin contact and mucous membrane
contact with blood and/or body fluids. |
|
5. All Correction
Cooks |
•Cleaning
materials contaminated with blood due to cut injury from inmate working in
the kitchen, •First
aid until advance emergency aid arrives. RISKS:
potential non-intact skin contact and mucous membrane contact with
blood and/or body fluids. |
|
6. All Animal Control / All Weighmasters |
•Suspect
body search, •Property
search: car, residential, belongings, •Physical
force with suspect (contact), •Assaulting
or combative arrest, •At crime
scenes - assault or homicide, •Transporting
prisoners or suspects that are bleeding (i.e. suspect bite by K-9 or injured and
bleeding, •Physical
contact, human bites, •Cleaning
cars and materials contaminated with blood or body fluids, •First
aid and CPR assistance at accident scene or with fellow officer. RISKS:
potential needle sticks, knife contact, non-intact contact and mucous
membrane contact with blood and/or body fluids. |
|
HEALTH DEPARTMENT 1. All Community Health Nurses, Nurse Practitioners, Health Assistants
|
•Give
injections, •Physical
examinations including pelvic exams, •Draw
blood and OPIM for testing, •Disinfect
surfaces and clean-up blood or
body fluids, •First
aid and CPR, •Perform
wide range of medical duties involving potential contact with blood and OPIM. RISKS: potential needle sticks,
non-intact skin contact and mucous membrane contact with blood and/or body
fluids. |
|
2. All Laboratory Managers |
•Disinfect
equipment, •Handle
wastes, •Autoclave
equipment, •Perform
tests on OPIM. RISKS:
potential needle sticks, non-intact skin contact and mucous membrane contact
with blood and/or body fluids. |
|
3. All Mental Health Nurses |
•Give
injections, •Minimal
physical examination. RISKS: potential needle sticks, non-intact
skin contact, and mucous membrane contact with blood and/or body fluids. |
|
4. All Mental
Health Treatment Employees |
•Physical
confrontation with mentally ill can
include being bitten, hit or non-intact skin contact. RISKS: non-intact skin contact and
mucous membrane contact with blood and/or body fluids. |
|
5. All Outreach Workers |
•Physical
contact with clients can include being bitten, hit or non-intact skin
contact. RISK: non-intact skin contact and
mucous membrane contact with blood and/or body fluids. |
|
6. All Maintenance Technicians and Custodians |
•Cleaning
and working on facility surfaces and furniture which may have blood/body
fluid contamination including floors, counter tops, •Potential
contact with sharps and blood/body fluid soaked materials when cleaning
public rest rooms. •Trash
collection and disposal. RISKS: potential needle sticks, non-intact
skin contact, and mucous membrane contact with blood and/or body fluids. |
|
PUBLIC WORKS (Note:
Public Works has a site specific plan.) 1. All
Solid Waste Employees |
•Puncture
from potentially contaminated needles and sharps when working in waste and on
machinery, •Skin
contact with blood and OPIM machinery. RISKS: potential needle sticks,
non-intact skin contact, and mucous membrane contact with blood and/or body
fluids. |
|
2. All Surfacing Crew Employees |
•Puncture
from potentially contaminated needles and sharps when working in waste, on
machinery and roadside maintenance procedures. RISKS: potential needle sticks,
non-intact skin contact, and mucous membrane contact with blood and/or body
fluids. |
|
3. All Road Maintenance Crew Employees |
•Puncture
from potentially contaminated needles and sharps when working in waste, on
machinery, roadside maintenance procedures and litter collection
(adopt-a-highway program). RISKS: potential needle sticks,
non-intact skin contact, and mucous membrane contact with blood and/or body
fluids. |
|
PARK DEPARTMENT (Note:
the Park’s Department has a site specific plan.) 1. Maintenance Technicians and Caretakers |
•Puncture
from potentially contaminated needles and sharps when working in trash
collection, •Cleaning
materials and surfaces contaminated with blood of body fluids, •Removal
of potentially contaminated needles and sharps from park areas. RISKS: potential needle sticks,
non-intact skin contact and mucous membrane contact with blood and/or body
fluids. |
|
BUILDING FACILITY
1. All Maintenance Technicians and Custodians |
•Cleaning
facility and jail surfaces and furniture which may have blood/body fluid contamination
including floors, counter tops, •Potential
contact with sharps and blood/body fluid soaked materials when cleaning
public rest rooms. •Trash
collection and disposal. RISKS: potential needle sticks,
non-intact skin contact, and mucous membrane contact with blood and/or body
fluids. |
|
JUVENILE 1. All Detention
/ Shelter Employees |
•Client
body search, •Property
search - belongings, •Physical
force with client, •Physical
contact, human bites •First
Aid and CPR assistance to clients or
fellow employees. •Monitoring
medical procedures i.e., diabetic clients RISKS:
Potential needle sticks, non-intact skin contact and mucous membrane
contact, blood and/or body fluids. |
|
FLEET 1. All Mechanics - working on equipment at landfill |
•Puncture
from potentially contaminated needles and sharps when working on machinery at
landfill, •Skin
contact with blood and OPIM machinery RISKS: potential needle sticks,
non-intact skin contact, and mucous membrane contact with blood and/or body
fluids. |
|
PAROLE AND PROBATION 1. All Transfer Site Attendants 2. All Workcrew Field Staff |
•Puncture
from potentially contaminated needles and sharps when working with waste and
cleaning brow log. RISKS: potential needle sticks,
non-intact skin contact, and mucous membrane contact with blood and/or body
fluids. •Puncture
from potentially contaminated needles and sharps when working in landfill
activities and trash collection, •Cleaning
materials and surfaces contaminated with blood of body fluids, •Removal
of potentially contaminated needles and sharps from public areas. •First
Aid and CPR assistance to clients or
fellow employees. RISKS: potential needle sticks,
non-intact skin contact and mucous membrane contact with blood and/or body
fluids. |
|
SALMON HARBOR 1. All Maintenance Personnel |
•Cleaning
facility and surfaces and furniture which may have blood/body fluid contamination
including floors, counter tops, •Potential
contact with sharps and blood/body fluid soaked materials when cleaning
public rest rooms. •Trash
collection and disposal. RISKS: potential needle sticks,
non-intact skin contact, and mucous membrane contact with blood and/or body
fluids. |
|
FAIR 1. All Operations Managers, Maintenance Workers, Technicians and Groundskeeper |
•Cleaning
facility surfaces and furniture which may have blood/body fluid contamination
including floors, counter tops, •Potential
contact with sharps and blood/body fluid soaked materials when cleaning
public rest rooms. •Trash
collection and disposal. RISKS: potential needle sticks,
non-intact skin contact, and mucous membrane contact with blood and/or body
fluids. |
All Other Employees including those who are First Aid
Trained:
Any County employee that has a workplace exposure incident due
to providing First Aid or for other reasons is covered by the post medical
surveillance provisions in this plan.
SECTION 3 - EMPLOYEE
TRAINING
INTRODUCTION
A training program will include a
detailed review of Douglas County's written exposure plan and training
materials. The training program will
include these items as required by Oregon OSHA standard.
1. An
accessible copy of the blood borne standard and an explanation of its contents.
2. A general
explanation of the epidemiology and symptoms of bloodborne diseases.
3. An
explanation of the modes of transmission of blood borne pathogens.
4. An
explanation of the County exposure control plan and the means by which
employees can obtain a copy of the written plan.
5. An
explanation of the appropriate methods of recognizing tasks and other
activities that may involve exposure to blood or OPIM.
6. An
explanation on the use and limitation of methods that will prevent or reduce
exposure including appropriate engineering controls, work practices and PPE.
7. Information
on the types, proper use, location, removal, handling, decontamination and
disposal of PPE.
8. An
explanation of the basis for selection of PPE.
9. Information
on the hepatitis B vaccine, including information on its efficacy, safety,
method of administration, the benefits of being vaccinated, and that the
vaccine and vaccination will be offered free of charge.
10. Information
on the appropriate actions to take and persons to contact in an emergency
involving blood or OPIM.
11. An
explanation of the procedure to follow if an exposure incident occurs,
including the method of reporting the incident and medical follow-up that will
be made available.
12. Information
on the post-exposure evaluation and follow-up that the County is required to
provide for the employee following an exposure incident.
13. An
explanation of the signs and labels and / or color coding.
14. An
opportunity for interactive questions and answers with the training instructor.
The training program will be given
initially AND annually through each affected department with assistance
from the County Safety Manager and the use of other training materials that
would be relevant. (See: Section 10 for employee training
materials.)
The training is to be documented
and a written record kept in the employee's department personnel file or
training file. Each affected
employee will be provided with the County training program outline and review
of all relevant materials for job duties.
Any questions about the training
materials and program should be directed to the employee's supervisor and / or
the County Safety Manager.
General training materials are
available to inform any concerned or interested employees about the County's
Blood borne Pathogen policy and risks from hepatitis B, hepatitis C and HIV.
SECTION 4 - ENGINEERING
CONTROLS
INTRODUCTION
A variety of control measures have
been implemented to reduce employee exposure by either removing the hazard or
isolating the worker from exposure.
This section of the plan outlines the basic controls employees should
follow.
UNIVERSAL
PRECAUTIONS are to be used when any employee has potential
contact with blood or OPIM. This can be
as a result of providing first aid, contact with criminal suspect or removing
improperly discarded needles or blood soaked materials. These procedures apply to blood and OPIM
containing visible blood. The following
are general control procedures that need to be applied during all blood or body
fluid contacts.
GENERAL
PROCEDURES - APPLY TO ALL EXPOSURES
CONTROL
|
Universal Precautions 1. Use of
barrier precautions (PPE); i.e. gloves, appropriate clothing, barrier shield 2. Washing of
hands (see page 18, outline on hand washing procedures) 3. Prevention
of cutting or needle stick injuries by • the use of puncture resistant containers for disposal. • the use of self sheathing needles and needless systems. • immediately disposing of needles after giving injections or
drawing blood. DO NOT RECAP NEEDLES. • picking up needles found with remote tool devices or other
techniques to reduce contact 4. Use of
mouthpieces and resuscitation bags to minimize exposure to saliva/blood
during
resuscitation procedure. 5. Clean
surfaces as soon as possible when they become contaminated. 6. Employee
training (initial and annual), on-going
audit of operations by supervisory staff, and at least annual
safety committee inspections (see audit form pages 35-36). Each department included
will maintain the employee training certificate. 7. Cleaning
blood and OPIM from surfaces. See
Section 5 on Housekeeping |
|
|
Additionally, departments
with affected employees should have specific procedures directly related to
specific tasks performed by employees.
WORK
PRACTICES
INTRODUCTION
Work practice controls deal with the manner in which a task is performed
in order to reduce exposures including engineering controls and / or the use of
PPE.
1. The following activities are prohibited
when blood or other infectious body fluids are present in the immediate area in
order to eliminate or minimize indirect transmission. It is important not to conduct the following activities if there
is potential exposure to blood or body fluids:
eating, drinking, smoking, applying cosmetics or lip balm, handling
contact lenses.
2. Food and drink cannot be
kept in refrigerators, freezers, shelves, cabinets or on counter tops or bench
tops where blood or other potentially infectious materials are present. Not only can foodstuffs become contaminated
but food containers may also become contaminated, resulting in unsuspected
contamination of the hands.
3. Hands must be washed immediately after
gloves or other PPE are removed. If
water is not available, then use alcohol wipes until you can wash with warm
water and soap.
4. Hand and other skin surfaces must be
washed thoroughly with soap and water or mucous membranes flushed with water
immediately or as soon as feasible, if contaminated with blood or other body
fluids following contact. If water is not immediately available, disinfectant wipes need to be used
until you can wash with warm water and soap.
5. Proper disposal and handling of sharps
and infectious wastes will be done per this policy.
6. Use of appropriate PPE will be required
as outlined in this directive.
7. All infectious wastes and contaminated
police evidence must be labeled as a biohazard or placed in red color-coded
bags. Swabs, PAT sticks and lightly
stained gauze or cotton balls are not considered
regulated waste and may be discarded in plastic lined trash without special
labeling.
Syringes, safety syringes and needleless systems used for
direct patient care. Safety devices such as sheathing needles and needleless
systems will be used for staff protection.
These devices will be reviewed by non-managerial staff representatives
and chosen by consensus for ease of use and engineering controls.
Labels and signs are to be used to apprise employees of occupational
hazards where they need to use universal precautions; and are to be posted on
containers of regulated wastes, refrigerators or freezers that are used to
store blood or other potentially infectious materials; and, on containers used
to store, dispose of, transport, or ship blood or other potentially infectious
materials. The labels must contain the biohazard symbol and be fluorescent
orange or orange red with lettering or symbols in a contrasting color. Red bags
or red containers may be substituted for labels.
HAND/SKIN WASHING PROCEDURES
The following procedures must be
used when washing hands/body as part of our universal precaution measures. Wash
hands after removal of gloves or whenever there is contact with blood or
OPIM. If water is not immediately
available, then alcohol or antiseptic towelettes may be used followed by soap
and water as soon as available.
1. Remove
latex or vinyl gloves after first washing the gloves with soap and water or use
an alcohol wipe if water is not available.
(Note: if leather gloves are used,
latex or vinyl gloves need to be worn underneath. If the leather is washable it can be washed, if not, they should
be properly discarded.)
2. Pull
glove from skin using outer top part of glove so the other glove does not
contact the skin. To pull off the glove with the ungloved hand place your
fingers at the top interior of the glove and pull off the glove. Or you can use the interior of the pulled
off glove still on your fingers to remove the second glove. Discard gloves as per directions on Page 21:
Cleaning and disposing of PPE.
3. Follow procedures on
Page 21 for non-disposable gloves.
4. Use
soap and warm water to wash; hot water removes oil from the skin. The hands and forearms should be washed.
Rub your hands vigorously - friction by rotary motion - and rinsing under
running water aids in the mechanical removal of bacteria. Wash all surfaces, including:
back of hands, wrists, between fingers, under finger nails. Your hands should
be washed well for 15 to 20 seconds.
Rinse well and dry hands with paper towel. Turn off the water using a
paper towel instead of bare hands.
5. If body contamination occurs, shower as soon as possible.
6. Flush splashes to nose, mouth or skin with water. Irrigate eyes with clean water, saline or sterile
irrigants. (Reference CDC 7/2003)
7. Wash cuts with soap
and water. (Reference CDC 7/2003)
Note: Frequent
hand washing destroys the natural oils and causes drying and cracking of the
skin. Keeping the skin intact, helps to
prevent the invasion of bacteria and possible secondary infections. Hand lotion should be applied. If you have open cuts or wounds, waterproof
bandages should be used if you cannot avoid exposure.
PERSONAL PROTECTIVE
EQUIPMENT (PPE)
INTRODUCTION
Personal protective equipment
(PPE) is a direct line of defense for workers whose exposure occurs through
non-intact skin or mucous membrane contact with blood or other potentially
infectious materials As a result, the following protection is expected to be
worn by our employees.
The personal protective equipment
necessary for each task INVOLVING POTENTIAL OR ACTUAL EXPOSURE for the
following examples are provided based on the application of universal
precautions.
TASK
/ ACTIVITY GLOVES
GOWN2 MASK1 EYEWEAR
1. Sheriff Staff Activities
• Suspect Searches Yes No2 No No
• Evidence Searches Yes No2 No No
• Handling Evidence Yes No2 No No
• Arrest when situation is
known Yes No No No
• Searching/Handling sharp Yes6 No No No
instruments6
*puncture resistant glove over
disposable
•Autopsy Yes Yes Yes Yes
2. Medical and First Aid Activities
EMERGENCY MEDICAL and FIRST AID
• Bleeding control with
spurting Yes Yes Yes Yes
blood
• Bleeding control with minimal Yes No No No
bleeding
• CPR Yes No2 No¨ No
¨Clear plastic face masks with
one-way valves for mouth -to-mask
ventilation.
• Oral/nasal suctioning,
manually Yes No No3 No3
cleaning airway
TASK
/ ACTIVITY GLOVES GOWN2 MASK1 EYEWEAR
2. Medical and First Aid Activities -
Continued:
ROUTINE TYPE MEDICAL SERVICES
• Blood drawing Yes No No No
• Measuring blood pressure No No No No
• Measuring temperature No No No No
• Giving an injection No3 No No No
• Starting an intravenous (IV)
line Yes No No No
• Vaginal and rectum exams Yes Yes (lab coat) No No
• Handling and cleaning instruments
Yes Yes2 No Yes
with microbial contamination
3. Maintenance, Cleaning or Removing Potentially
Infectious Materials
• Cleaning Bathrooms Yes No No Yes4
• Cleaning up surfaces with Yes No No Yes2
body fluids
• Picking up needles/sharps Yes5 No No No
• Picking up waste/garbage Yes5 No No No
4. Waste Management Employees, Surfacing
Crew, Road Maintenance, Fleet Services Mechanics
• Working in trash pit Yes Yes* No Yes4
• Cleaning Equipment Yes Yes* No Yes
• Working on equipment Yes5 Yes* No Yes4
• Picking-up Sharps Yes5 No No No
• Picking-up litter Yes Yes* No No
* Coveralls
Note: other
special equipment and tools are needed:
• Safety shoes with puncture resistant sole
inserts
• Special tools (shovels, bars) during
equipment cleaning, picking up sharps, and litter
KEY TO THE NUMBER CODES
USED IN THE CHART
1. Refers
to protective masks to prevent exposure of mucous membranes to blood or other
potentially contaminated body fluids.
2. If splashing or soiling of the employee’s clothing is likely to
occur then disposable fluid resistant coveralls should be worn.
3. Where
there is contamination on the skin of a violent patient.
4. Goggles
are needed because of the irritant and corrosive character of various cleaning compounds
and splash potential; safety glasses,
because of potential flying materials.
5. Picking up or potentially contacting
needles/sharps should include use of puncture resistant gloves. If wet material, employee will wear latex
biohazard glove under the puncture resistant gloves.
6. A
probing instrument shall also be used where possible to reduce contact with
sharps.
LOCATION OF PERSONAL
PROTECTIVE EQUIPMENT
Proper PPE is to be kept by each employee or
in the work area available for use.
Supervisors / work area will have supplies of
PPE available at all times.
PPE must be maintained, cleaned and kept in
sanitary condition.
LIMITATIONS OF PERSONAL PROTECTIVE EQUIPMENT
All
personal protective equipment shall be removed prior to leaving the work area
as per OAR 1910.1030, Page Z.10.
Gloves. Disposable gloves should not be washed or
disinfected for reuse. They also should
not be used when visibly soiled, punctured, or when their ability to function
as a barrier is compromised.
Hypoallergenic
gloves, glove liners, powderless gloves or other similar alternatives will be
provided for those allergic to gloves that are routinely provided.
Utility
gloves may be decontaminated and reused, but should be discarded if they are
peeling, cracked, or discolored, or if they have a puncture(s), tears, or other
evidence of deterioration.
Face and eye protection. These items also must be maintained in good
repair and clean. The equipment should
be discarded if it does not function as per the manufacturer's use and
maintenance instructions.
Protective clothing. Coveralls, lab coats, aprons, or similar
clothing is appropriate if there is a potential for soiling of clothes with
blood or OPIM; however, fluid proof / resistant clothing shall be worn if there
is a potential for splashing, spraying of /or soaking with blood or OPIM. If any garment is penetrated by potentially
infectious material, the garment shall be removed immediately or as soon as feasible
and the contaminated skin area cleaned.
CLEANING AND DISPOSING OF
PPE
1. Disposable latex or
vinyl gloves or clothes should be disposed of in the regular trash after use
unless soaked with blood or OPIM.
2. Goggles
should be cleaned with soap and water and then wiped down with alcohol or other
germicides if contaminated with blood or OPIM.
3. Puncture resistant
gloves that become soiled must be discarded, unless they are coated with a
plastic material that is cleanable.
4. Contaminated laundry
shall be handled as per instructions in Section 7 – Laundry.
SECTION 5 - HOUSEKEEPING
Thorough housekeeping is vital in
the reduction potential for employees to contact blood or body fluids left on
environmental surfaces, clothing, or contact with waste materials.
The following procedures apply:
1. The work
areas will be maintained in a clean and sanitary condition. The schedule below will be kept for cleaning
based on location within the facility, type of surface to be cleaned, type of
soil present, and the tasks and procedures being performed.
2. Environmental
and working surfaces including equipment shall be properly cleaned and
disinfected after contact with blood or other potentially infectious
materials. GLOVES shall be worn
during cleaning and decontamination procedures.
|
AREA/LOCATION OF EQUIPMENT |
DECONTAMINATION
METHOD
|
|
Environmental work surfaces contaminated by blood or
infectious body fluids: counter tops,
floors, work surfaces, car seats, jail cell area, walls, floors, etc. |
VISIBLE MATERIAL SHALL BE REMOVED FIRST AND THEN
DECONTAMINATED WITH CHEMICAL GERMICIDES (each department has various
disinfectants which are to be used). Schedule: At least before
re-use, or as soon as feasible if they are contaminated. |
|
Contaminated clothing or personal protective equipment
that is not disposable. (Note:
risk of actual disease transmission from contaminated clothing is
negligible). Note: If
clothing is soaked/dripping with blood or OPIM, then bag clothing in red color
coded bag and launder or dispose as infectious waste. |
Clothing: handle as little as possible, transport in
labeled bags. LAUNDER - normal
laundry cycle; PPE - disinfect according to manufacturer recommendations. Schedule: Proper bagging or handling immediately or as soon as feasible. • Wearing gloves,
remove clothing. • Place clothing
in bag or red color coded bag depending on the
level of contamination. • Take to laundry or dispose of clothing depending on
level of contamination. |
Basic
cleaning products used by County’s custodial staff are effective environmental
disinfectants. The instructions for the
chemical products are to be followed for proper dilution and application
methods. All
surfaces that have been in contact with the body fluids should be wiped with a
disinfectant. Any EPA-approved tuberculocidal disinfectant can be used. A 1:10 dilution of household bleach (or ¼
cup of bleach per gallon tap water) can also be used (this solution should not
be mixed in advance because it loses its potency). After the disinfectant is applied, the surface should either be
allowed to air dry, or remain wet for 10 minutes before being dried with a
disposable towel or tissue.
SECTION
6 - REGULATED - INFECTIOUS WASTES
INTRODUCTION
Any regulated waste (which is any
liquid or semi-liquid blood or OPIM, contaminated items that would release
blood or OPIM in a liquid or semi-liquid state if compressed, items that are
caked with dried blood or OPIM and are capable of releasing these materials during
handling) shall immediately be discarded in the proper containers. These containers must be able to contain all
contents and prevent leakage of fluids during handling, storage, transport, or
shipping.
Note: Contaminated police evidence is not considered a
waste but must be handled appropriately in labeled containers.
GENERAL
PROCEDURES
1. Blood and
other body fluids can be discarded down the sanitary sewer in Oregon.
2. Sharps that are
found in the general environment or during a search of criminal suspect shall
be discarded in a container that can be closed, puncture resistant, labeled
and/or color coded.
Procedures
for picking-up sharps/needles:
•
have sharps container ready,
• use latex gloves with
puncture-resistant gloves as top cover,
• use pliers or other hand tool to
pick-up the needle,
• dispose needle in sharps container.
If a
needle is evidence, special plastic containers or tubes will be used for
storage and the container shall be marked with bio-hazard label.
3. When
transporting containers of contaminated sharps and other regulated wastes from
the use area, the containers shall be closed to prevent spillage or protrusion
of contents during handling, storage, transport, or shipping.
4. The
method of removing contaminated waste containers will include:
• trained department
staff who will be assigned to ensure proper handling and disposal of sharp
containers and any bags containing
infectious waste materials,
• the containers or bags
will be picked-up when they are either filled to capacity (not overfilled) or
the person collecting the materials
calls the waste handler,
• the containers will be handled
separately from the routine waste disposal system,
• name and phone number of biohazard
waste disposal company is kept by the department coordinators.
SECTION 7 - LAUNDRY
Employees who have contact with
contaminated laundry must wear protective gloves and other appropriate PPE and
handle it as little as possible with a minimum of agitation.
All PPE supplied to our employees
will either be disposable or, if cleaning is needed, it will be the County’s
responsibility to have the equipment professionally cleaned or laundered. Personal clothing that becomes contaminated
with blood or OPIM should be handled in the same manner:
1. In crime or
accident incident where clothing is severely soaked with blood and damaged, the
clothing may be discarded as an infectious waste by placing the articles in a red-colored
coded plastic bag. The biohazards will
be discarded in accordance with this policy (see Section 6).
2. For minor
stains to a person's clothing, follow the laundry procedures outlined in item
number six below. For severely
contaminated clothing, either professional cleaning or disposal is
recommended.
3. Contaminated
clothing can be reused after proper cleaning.
This can be done at a professional laundry or in home laundry.
4. For
commercially laundered clothing - the laundry establishment should be informed
that the clothing is potentially contaminated.
The items need to be in red color coded-labeled bags or containers.
5. Contaminated
laundry shall be placed and transported in bags that are labeled or color
coded. Whenever this laundry is wet and
presents potential of soaking through or leaking from bag, it shall be placed
and transported in leak proof bags.
6. If the
contaminated clothing is not professionally laundered, then a normal laundry
cycle should be used according to the washer and detergent manufacturers’
recommendations. The use of regular
laundry detergent in amount recommended for that type of clothing is
acceptable. Two washes are recommended; the first in cold water to remove soilage,
the second in hot water to sanitize.
Bleach is recommended when fabric permits. Sun drying or automatic dryers will additionally sanitize
clothing.
7. Any
questions about laundry and professional laundry services for the employee’s
clothing should be directed to supervisors and/or to risk management.
SECTION 8 - MEDICAL
SURVEILLANCE PROGRAM
HEPATITIS B VIRUS (HBV)
VACCINATION must be made available to employees after they have received
the required training and within 10 working days of initial assignment. It is our
goal to minimize or eliminate significant risk using vaccination, engineering
and work practice controls and PPE.
Employees will be trained in the importance of the vaccinations.
The vaccine is a synthetic
material derived from yeast so there is no human blood exposure. It takes three shots: initial, one month and
six months. One month to six months
after the vaccination series, an antibody test will be done to determine if the
level of protection is adequate. A
booster will be given according to the Centers for Disease Control
recommendations.
1. All the
medical evaluation procedures are performed by licensed health care providers
that are either county staff or outside medical providers. Employees listed in
Section 2 - Job Classification will be included in this program.
2. Medical
surveillance program is provided without cost to employees and is in accordance
with the current standard recommendations for medical practice by the Centers
for Disease Control (CDC) at the time these evaluations and procedures take
place.
NOTE:
All medical information received by the Douglas County Human Resources
Department will be kept confidential.
3. All current
employees occupationally exposed to blood borne pathogens will be immediately
offered the vaccination and vaccination series / post exposure evaluation. Vaccinations will be offered to all
employees who have had previous HBV vaccination if their antibody testing
reveals insufficient immunity.
Employees will be provided an explanation sheet about the vaccination
and will be asked to sign a statement agreeing to the vaccination.
4. The
Hepatitis B vaccination program is voluntary; however, the County encourages
all potentially exposed employees to participate. If an employee chooses to not accept the vaccination, they
must sign a declination statement on the employee HBV vaccination notification
form. If after declining the
vaccination, the employee decides to be vaccinated, then it will be given to
the employee without cost.
5. The
vaccination program will be managed by the department's designated staff
coordinator. It will be the
responsibility of the designated coordinator to track and schedule the
follow-up HBV vaccinations.
6. The health
care professional responsible for the employee's hepatitis B vaccination will
be provided a copy of the bloodborne pathogen rules.
<click here to down load pdf of the
EMPLOYEE DECLARATION form to copy and print>
EMPLOYEE
DECLARATION DECLINING THE HEPATITIS B VACCINATION
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 the 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.
EMPLOYEE
SIGNATURE
DATE
DEPARTMENT
COORDINATOR
PLEASE
ANSWER THE FOLLOWING IF THE EMPLOYEE IS DECLINING THE HBV VACCINATION BECAUSE
OF A PREVIOUS VACCINATION SERIES:
Date of
Previous Vaccine Series
Vaccination
Provided by
Employee
Signature
POST EXPOSURE INVESTIGATION
PROCEDURES
INTRODUCTION
The
County will conduct an investigation following a reported incident that will
contain the following elements required by the OR-OSHA standard:
1.
Documentation of the route
of exposure and the circumstances under which an
exposure
incident occurred;
2. Identification
and documentation of the source individual*;
3. Collection
and testing of blood for HBV and HIV serological status,
4. Post-exposure
prophylaxis when medically indicated, as recommended by CDC,
Counseling,
5. Evaluation of potential illnesses that may occur due to the
exposure.
*The
source individual's blood shall be tested as soon as feasible and after consent
is obtained in order to determine HBV and HIV infectivity. If the source will
not consent, medical treatment will be conducted without this information. Oregon law does not permit source testing
without consent, unless the
exposed person is a pregnant female during her first and second
trimesters. A court order can be issued
under these circumstances.
If any County employees have
unprotected exposure to blood or other body fluids (including a skin exposure
involving large amounts of blood, or prolonged contact with blood especially
when the exposed skin is chapped, abraded, or afflicted with dermatitis, or a
needle/sharp exposure to blood or body fluids) during the course of their work,
the following procedures must be followed.
Responsibility falls on the shoulders of several people including the
employee.
REPORTING
1. Report the
incident/accident immediately to your supervisor who will begin the
process of investigating the incident and scheduling a confidential medical
evaluation. This includes any skin
abrasion (bite, scratch, cut, puncture, etc. or mucous membrane exposure) which
occurs on-the-job while being exposed to any blood or body fluids. The supervisor will contact the department
coordinator and risk manager.
INVESTIGATION
2. The
supervisor, employee, department coordinator and risk manager will ensure that
the circumstances of exposure is recorded and investigated. The enclosed incident form
will be used to ensure that relevant information including the routes of
exposure, the activity in which the work was engaged at the time of exposure,
the extent to which appropriate work practices and protective equipment were
used, and a description of the source exposure shall be recorded.
TREATMENT
3.
Treatment will be sought as soon as practical but at least
within 24 hours of the incident. Treatment involves information, if possible,
about the source person and employee’s medical condition and vaccination
status.
INFORMATION
4. Information that the County must provide to
the health care professional responsible for the employee's care after an
exposure incident shall be provided by the risk manager and includes:
a. Copy of the blood borne pathogen
regulations (if the healthcare professional
does not already have a copy)
b. A description of the exposed employee's
duties as they relate to the exposure
incident.
c. Documentation of the route or routes of
exposure and circumstances under
which the exposure occurred.
d. Results of the source individual's blood
testing, if available.
e. All medical records relevant to the
appropriate treatment of the employee including vaccination status.
SOURCE TESTING
5. Treatment options and source testing
involve:
a. Once an exposure has been determined, a
blood sample will be drawn after consent is obtained from the source individual
unless identification is infeasible.
The blood will be tested for hepatitis B, hepatitis C and antibody to
HIV as soon as feasible. The
arrangement to obtain consent and testing will be performed by the risk manager
in conjunction with hospital, coroner or treating physician.
The source
can decline and there is no recourse unless the employee is a pregnant female
in the first or second trimester. A
court order can be issue only under those conditions.
TEST
RESULTS
b. Results of the source individual’s
testing shall be made available to the exposed employee, and the employee shall
be informed of applicable laws and regulations concerning disclosure of the identity
of the infectious status of the source individual. This will be done by the health care provider.
EMPLOYEE'S BLOOD
c. An exposed employee's blood shall
be collected as soon as feasible and tested after consent is obtained. If baseline blood is drawn, but the employee
does not consent for HIV serologic testing, the sample shall be preserved for
at least 90 days by the health care provider. If within 90 days of the exposure
incident, the employee elects to have the sample tested, such testing will be
done as soon as feasible. Additional
HIV follow-up testing shall be offered based on CDC recommended schedule. Currently, that includes a six week, twelve
week and six month HIV test.
TREATMENT
OPTIONS
6. For an exposure to a source individual found
to be positive for hepatitis B, and the employee has not previously been given
hepatitis B vaccine, the employee should receive the vaccine series. A single dose of hepatitis B immune globulin
will be given within seven days of exposure along with the first HBV
vaccination. If the employee has
previously received vaccine, they will be tested for antibodies to
hepatitis B and would be given one dose of vaccine and one dose of immune
globulin if the antibody level in the blood sample is inadequate.
Note: This
may vary depending on the judgment of the treating physician and CDC
recommendations.
7. For an exposure to a source
individual (who although found negative to hepatitis B at the time of exposure,
may still be within an incubation period wherein he/she reports as negative but
could still be infectious) and that
employee has not been vaccinated, the hepatitis B immune globulin may be
provided to this employee at this time.
8. The treatment for the employee who receives
an exposure from a known source who refuses testing or who is not
identifiable will be determined on a case-by-case basis. Current CDC procedures should be
followed.
9. Treatment for employees who were exposed to
a known HIV infected person will be determined by a treating physician
based on best available information from the CDC.
CLAIMS
10. A
Workers' Compensation Claim 801 Form will be filed.
11. The
risk manager will arrange for medical care of the exposed employee including
follow-up testing
and counseling.
OR-OSHA
300
12. Safety manager may record the incident on the OR-OSHA 300 log of
injury and illness if the incident qualifies per OR-OSHA’s definition of a
workplace injury.
ADDITIONAL
DATA
13. The
employee's treating health care provider must submit a written opinion to the
County regarding both the HBV vaccination program and data on post-incident
medical follow up.
The
information to be submitted to the risk manager and then to the employee within
15 days of receipt is:
a.
The health care professional’s
written opinion for hepatitis B vaccination shall be
limited to whether HBV vaccination is
indicated for an employee, and if employee has received such vaccination.
b.
The written opinion for a post-exposure
evaluation and follow-up shall be limited to the following information:
•
Employee has been informed of
the results of the evaluation.
•
Employee has been informed about
any medical conditions resulting from
exposure
which require further medical evaluation or treatment.
Note: All
other findings or diagnoses shall remain confidential and shall not be included
in
the written report
.<click here to down load .pdf of the BBP INCIDENT
REPORT form with directions>
BLOODBORNE
PATHOGEN INCIDENT (ACCIDENT) REPORT
Immediate supervisor should complete this form promptly with employee
input.
Please print clearly and forward to the Risk manager
1._______________________________________________ 2.
Employee Immediate Supervisor
3._______________________________________________ 4.
Date of Incident/Accident Time
5.______________________________________________________________________________________________ Incident/Accident Location and case
number (if applicable)
6. Describe the incident in complete detail (route of exposure,
circumstances; describe type of controls in place at time of incident including
engineering controls and personal protective equipment worn; identify unsafe
conditions and/or actions; relevant police reports).
___________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
7. Describe employee's
injury (part of the body/type of injury)
__________________________________________________________________________________________________________________________________________________________________________________________________
8. Describe first
aid/medical treatment (when and by whom)
__________________________________________________________________________________________________________________________________________________________________________________________________
9. When was the incident reported
____________________________ To whom ________________________________
If not immediately reported, WHY?
_____________________________________________________________
10. List Names of Witnesses
_________________________________________________________________________________________________
11. Is the source individual
known? Yes____No____ If so,
please provide name/address so that consent for blood testing can be obtained.
Name:
__________________________________ Address:
DID THE SOURCE CONSENT TO
BLOOD DRAW AND TESTING? Yes____ No ______
Was a court order obtained
for female in first /second trimester pregnancy? Yes _____ No _____
12. What corrective action
was taken or is planned to prevent similar accidents from occurring in the
future?
__________________________________________________________________________________________________________________________________________________________________________________________________
13. Referral to medical
evaluator? Yes ______ No _______ Date: _________________
If not explain:
____________________________________________________________________________________
NOTE: THE OREGON HEALTH DIVISION “SOURCE CONSENT” FORM WILL BE SENT BY
THE EMPLOYEE’S TREATING PHYSICIAN TO THE SOURCE OR HIS/HER MEDICAL PROVIDER TO
ATTEMPT TO OBTAIN PERMISSION FOR SOURCE HIV/HBV BLOOD TESTING. THE MEDICAL EVALUATOR HAS BEEN INFORMED AS
TO OUR POLICY AND THE OSHA RULES. ALL
MEDICAL DATA IS CONFIDENTIAL.
NAME OF INVESTIGATOR:
For additional comments
please use additional paper
INSTRUCTIONS ON COMPLETING
THE INCIDENT (ACCIDENT) REPORT FORM
The information request on this incident form is required by
the OSHA regulations. The form is to
allow the investigator a method of summarizing the findings so a written record
of the County’s investigation can be retained as part of our overall OSHA
compliance plan.
ITEM #: INSTRUCTIONS
1.
Employee: Enter the name of the employee reporting an exposure
incident. An exposure incident as
defined by this plan and the OSHA rules means:
a specific eye, mouth, other mucous membrane, non-intact skin, or
skin piercing contact (parenteral contact) with blood or other potentially
infectious materials that results from the performance of an employee’s duties.
2. Supervisor: Enter the name of the
employee's immediate supervisor.
3. Incident
Date: Enter the date of the
specific exposure incident.
4. Time: Time
of day the specific exposure incident occurred.
5. Location
case number: Physical location of
the employee at the time of the exposure incident.
6. Description
of the Incident: A detailed
description of the incident is required by the OSHA rule. The investigator needs to include the following
information:
• The route of exposure, circumstance which resulted in the
exposure.
• Controls that were in place at time of the incident
including: engineering controls and personal protection equipment worn.
• Identify any unsafe conditions or action by the employee.
7. Employee's injury: Describe what part
of the body the employee had contact with blood or OPIM and injuries that may
have been suffered.
8. First
aid given: Describe any first aid that was provided to the exposed
employee.
9. Date
of Reported Incident: When did
the employee inform management of the incident and to whom.
10. Witnesses: List the names of other County employees who may have witnessed
the incident.
11. Source: Is there a known source and will the person consent to blood
testing? Is a court order required?
12. Corrective
actions: What are the recommended procedural or program changes to reduce
or prevent reoccurrence of this exposure incident.
13. Referral: Has medical referral been
done? If not, explain.
• At the bottom of
the page, list the name of the investigator(s), job title(s) and date of
report.
MEDICAL SURVEILLANCE,
INVESTIGATION, AND MEDICAL FOLLOW-UP CHECKLIST
1. Hepatitis B
Vaccinations
STEP 1: Identify
all employees covered in Section 2 and offer current employees HBV
vaccinations. All new employees must be
offered vaccination within 10 days.
STEP 2: Decline -
have employee read and sign the Declaration Statement - make two copies -
original is kept in the employee's personnel file and one is given to the
employee.
STEP 3: Schedule
employees for the first HBV vaccination shot and set out time for the next two
vaccinations at one month and the last at six months.
STEP 4: Follow-up
with employees to ensure that the series of vaccinations is completed, and
at months seventh or eighth the
antibody immunity level is determined.
Booster vaccination will be provided based on CDC recommendations which
are not finalized.
2. Actions Relating to an Exposure Incident.
STEP 1: Employee
immediately reports an incident to his/her supervisor.
STEP 2: Supervisor
notifies the risk manager who sets out three different sets of actions as shown
in Step 3-medical treatment; Step 4-source testing, if feasible; and Step
5-incident investigation.
STEP 3: Insure
immediate treatment within 24 hours, no later than seven days (CDC
7/2003) for the employee. This will be
handled through our medical facilities or the employee’s private treating
physician.
a. Initial blood test for HBV, HCV and HIV
antibody,
b. Tested at six weeks, twelve weeks and six
months later for HBV, HCV and HIV if the person had not been vaccinated,
c. Specific treatment will be determined by the
treating physician,
d. Ensure that counseling is provided by our
medical staff or through the employee’s treating physician.
STEP 4: If source
is known, make arrangements for source testing. This is through the source's treating physician or, if the source
does not have a treating physician, the County Medical Officer. The test results would be given to the
employee’s treating physician and to the employee.
STEP 5: Begin
an investigation of the incident which includes accident investigation and
determination if procedure or operational changes are needed. Be certain to have the qualifying incident
recorded on the OR-OSHA 300 log of injuries and illness if qualifies.
STEP 6: Ensure
that a written statement from the treating physician is obtained and shared
with the employee.
STEP 7: Ensure
that medical follow-up and all corrective actions identified are completed.
SECTION 9 - RECORDKEEPING
1. Medical Records shall be established and maintained for each
employee with occupational exposure.
The Human
Resources Department will maintain the current employee medical records during
length of employment with the County and retain the records after employment
for a minimum of 30 years. The records
will be confidential and will contain the following information as required by
the OR-OSHA standard.
• Name and social security number,
• Copy of employee vaccination status
and any medical records that are relative to employee’s ability to receive the
vaccination,
• Copy of the results of
examinations, medical testing, and follow up procedures as the result of a
post-exposure incident medical treatment,
• Copy of medical professional's written
opinion,
• A copy of the information provided to
the medical professional other than this policy.
2. Training
Records. Each department will maintain
the training records for minimum of three years. This includes:
• Dates of the training sessions
• Contents or summary of the training
• Names and qualifications of the
persons conducting the training
• The names and job titles of all
persons attending training sessions
3. Sharps Injury
Log: A Sharps Injury Log will be
established and maintained for the recording of percutaneous injuries from
contaminated sharps. The information in
the Sharps Injury Log will be recorded and maintained in such a manner as to
protect the confidentiality of the injured employee. The Sharps Injury Log will contain, at a minimum: the type and
brand of device involved in the incident; the department or work area where the
exposure incident occurred; an explanation of how the incident occurred. (See attached form.) The Sharps Injury Log must be maintained for
five years.
BLOODBORNE SAFETY AUDIT
CHECKLIST
The following checklist can be
used by both the central and department safety committees and managers in
reviewing the implementation and effectiveness of the County Plan. Problems will be reviewed and changes in the
Plan will be completed as necessary.
YES / NO EXPLANATION
1. WRITTEN PLAN
_____ Reviewed annually
_____ Updated to reflect significant
modifications in tasks or procedures
_____ Available for employees to review
COMMENTS:
2. METHODS
OF CONTROL
_____ Universal Precautions used every
time potential for exposure could occur.
_____ Is
the blood or OPIM from some people treated as infectious while the blood or
OPIM of others (i.e. elderly or children) treated as not infectious?
_____ Are needles immediately discarded
in sharps containers?
_____ Are tools used to pick up sharps or
needles found during the course of work?
_____ Are disposal containers replaced
within appropriate time frames?
_____ Are hand washing facilities used
after removing gloves?
_____ If sharps containers leak, are they
placed in secondary containers?
COMMENTS:
3. PERSONAL
PROTECTIVE EQUIPMENT
_____ Is an adequate supply of gloves,
goggles, resuscitation bags or shields available in clinic areas, correction facilities, First Aid kits and in vehicles?
_____ Is this equipment used properly?
Are they the correct size for the workers?
_____ After use, is the PPE discarded or
cleaned properly?
_____ Is the correct, recommended
disinfectant used?
COMMENTS:
4. HOUSEKEEPING
_____ Is the written schedule for cleaning
and disinfecting being followed?
_____ Is the recommended disinfectant
being used?
_____ Is spill containment equipment
provided and used?
_____ Are reusable containers
decontaminated according to schedule?
_____ Are regulated wastes properly contained
and discarded? Are the wastes labeled
with the biohazard symbol?
_____ Is contaminated clothing properly
laundered?
COMMENTS:
5. LABELING/WARNING
_____ Are biohazard labels attached to
all containers of regulated waste?
_____ Do employees recognize and know the
meaning of the biohazard symbol or red bags?
COMMENTS:
6. HEPATITIS
B VACCINATION
_____ Have employees covered by the Plan
been given information that the HBV vaccination is available?
_____ Are the vaccinations offered at
reasonable time and place?
COMMENTS:
7. POST EXPOSURE INCIDENT PROCEDURES
_____ Does each employee know what to do
and to whom to report if he/she is
stuck by a needle, sharp or exposed to OPIM?
_____ Are post incident procedures immediate
and confidential?
_____ Are exposed employees given prompt
medical evaluations and counseling?
_____ Are the circumstances that
surrounded the exposure incident documented and investigated?
COMMENTS:
8. EMPLOYEE INFORMATION AND TRAINING
_____ Have all employees covered by the
plan received initial training? Annual training?
_____ Are training records kept for three
years?
_____ Do the records include the dates of
the training sessions, contents of the training sessions, the names and qualifications
of the trainers and the names and job titles of employees attending the
sessions?
_____ Does the training convey the idea
that a number of other blood borne diseases other than HBV and HIV exist?
COMMENTS:
9. RECORDKEEPING
_____ Are medical records kept
confidential?
_____ Are exposure incidents reported on
the OR-OSHA 300 log?
_____ Is the Sharps Injury Log being
recorded and submitted to the Human Resources Department annually?
COMMENTS:
SHARPS INJURY LOG FORM
<click here to down load the .pdf file of the SHARPS
INJURY LOG FORM to save and print>
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