BLOODBORNE PATHOGEN

EXPOSURE CONTROL PLAN

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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

www.co.douglas.or.us/hr

 

Telephone:  (541) 440-4405

          Fax:   (541) 440-6292

 

 

 

TABLE OF CONTENTS

 

 

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:                                                                                                                   

 

             TITLE:                                                                                                                                                                                                                                                                                                                           DATE:                                                                                     

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>