CODE:GBEA/JHCC

BLOODBORNE PATHOGENS EXPOSURE CONTROL PLAN


  1. INTRODUCTION

  2. The OSHA/VOSH 1910.1030 Bloodborne Pathogens Standard was issued to reduce the occupational transmission of infections caused by microorganisms sometimes found in human blood and certain other potentially infectious materials (OPIM). Although a variety of harmful microorganisms may by transmitted through contact with infected human blood, Hepatitis B Virus (HBV) and Human Immunodeficiency Virus (HIV) have been shown to be responsible for infecting workers who were exposed to human blood and certain other body fluids containing these viruses, through routes like needle stick injuries and by direct contact of mucous membranes and non-intact skin with contaminated blood/materials, in the course of their work. Occupational transmission of HBV occurs much more often than transmission of HIV. Although HIV is rarely transmitted following occupational exposure incidents, the lethal nature of HIV requires that all possible measures be used to prevent exposure of workers.

    DEFINITIONS

    Blood -- Human blood, human blood components, and products made from human blood.

    Bloodborne Pathogens -- Pathogenic microorganisms that are present in human blood and can cause disease in humans. These pathogens include, but are not limited to, hepatitis B virus (HBV) and human immunodeficiency virus (HIV).

    Contaminated -- The presence or the reasonably anticipated presence of blood or other potentially infectious materials on an item or surface.

    Contaminated Laundry -- Laundry which has been soiled with blood or other potentially infectious materials or may contain sharps.

    Contaminated Sharps -- Any contaminated object that can penetrate the skin including, but not limited to, needles, scalpels, broken glass, broken capillary tubes, and exposed ends of dental wires.

    Decontamination -- The use of physical or chemical means to remove, inactivate, or destroy bloodborne pathogens on a surface or item to the point where they are no longer capable of transmitting infectious particles and the surface or item is rendered safe for handling, use, or disposal.

    Engineering Controls -- Controls (e.g., sharps disposal containers, self-sheathing needles) that isolate or remove the bloodborne pathogens hazard from the workplace.

    Exposure Incident -- A specific eye, mouth, other mucous membrane, non-intact skin, or parenteral contact with blood or other potentially infectious materials that results from the performance of an employee's duties.

    Hand Washing Facilities -- A facility providing an adequate supply of running portable water, soap and single use towels or hot air drying machines.

    HBV -- Hepatitis B Virus.

    HIV -- Human Immunodeficiency Virus.

    Occupational Exposure -- 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 --

    1. The following human body fluids: semen, vaginal secretions, cerebrospinal fluid, synovial fluid, pleural fluid, pericardial fluid, peritoneal fluid, amniotic fluid, saliva in dental procedures, any body fluid that is visibly contaminated with blood, and all body fluids in situations where it is difficult or impossible to differentiate between body fluids;

    2. Any unfixed tissue or organ (other than intact skin) from a human (living or dead); and

    3. HIV-containing cell or tissue cultures, organ cultures, and HIV- or HBV-containing culture medium or other solutions; and blood, organs, or other tissues from experimental animals infected with HIV or HBV.

    Parenteral -- Piercing mucous membranes or the skin barrier through such events as needlesticks, human bites, cuts, and abrasions.

    Personal Protective Equipment -- Specialized clothing or equipment worn by an employee for protection against a hazard. General work clothes (e.g., uniforms, pants, shirts or blouses) not intended to function as protection against a hazard are not considered to be protective equipment.

    Regulated Waste -- Liquid or semi-liquid blood or other potentially infectious materials; contaminated items that would release blood or other potentially infectious materials in a liquid or semi-liquid state if compressed; items that are caked with dried blood or other potentially infectious materials and are capable of releasing these materials during handling; contaminated sharps; and pathological and microbiological wastes containing blood or other potentially infectious materials.

    Source Individual -- Any individual, living or dead, whose blood or other potentially infectious materials may be a source of occupational exposure to the employee. Examples include, but are not limited to, hospital and clinic patients; clients in institutions for the developmentally disabled; trauma victims; clients of drug and alcohol treatment facilities; residents of hospices and nursing homes; human remains; and individuals who donate or sell blood or blood components.

    Sterilize -- Means the use of a physical or chemical procedure to destroy all microbial life including highly resistant bacterial endospores.

    Universal Precautions -- An approach to infection control. According to the concept of Universal Precautions, all human blood and certain human body fluids are treated as if known to be infectious for HIV, HBV, and other bloodborne pathogens.

    Work Practice Controls -- Controls that reduce the likelihood of exposure by altering the manner in which a task is performed (e.g., using practices to minimize contact with bloodborne pathogens).

  3. PURPOSE

  4. The purpose of this exposure control plan is to:

    1. eliminate or minimize employee occupational exposure to blood or certain other body fluids;

    2. comply with the OSHA Bloodborne Pathogens Standard, 29 CFR 1910.1030.

  5. EXPOSURE DETERMINATION

  6. The school district is required to perform an exposure determination concerning which employees may be likely to incur occupational exposure to blood or other potentially infectious materials. The exposure determination is made without regard to the use of personal protective equipment (i.e. employees are considered to be exposed even if they wear personal protective equipment).

    Those employees not designated as a first aid responder who occasionally do provide assistance in a situation requiring first aid would not be considered as "reasonably expected" to provide this service a majority of the time. For workers whose exposure is infrequent, timely postexposure prophylaxis would be considered rather than routine pre-exposure vaccination. Such noted employees will be informed that the vaccine may be provided by their existing health care benefits.

    Logan City School District has determined that the following job classifications may be expected to incur such occupational exposure.

    1. JOB CLASSIFICATIONS

      1. ALL EMPLOYEES IN JOB CLASSIFICATION:

      2. Job ClassificationTask/Procedures
        school health nurses,
        health aides,
        first aid providers or designees,
        clerical staff,
        playground supervisors,
        CPR providers,
        Persons who, in the normal course of their duties administer shots (e.g. for allergies, insulin, etc.)
        or perform invasive health procedures (trach suctioning, tube feedings, or blood glucose monitoring for diabetes).
        Responding to accidents or injuries to students with blood flow.
        special education teachers,
        special education assistant,
        teachers,
        special education bus drivers
        Tending to special education pupils needs such as body fluids, saliva, body waste that is visually contaminated with blood.


      3. SOME EMPLOYEES IN JOB CLASSIFICATION HAVE DUTIES WHICH MAY PLACE THEM AT RISK OF OCCUPATIONAL EXPOSURE:

      4. Job Classification Task/Procedures
        athletic coaches,
        trainers,
        physical education teachers,
        school bus drivers,
        designated teachers or administrators
        Responding to accidents or injuries to students with blood spills with blood flow.
        Tending to students in response to accidents or blood spills or tending to student needs where blood flow is extensive.
        designated custodial staff Tending to cleaning and disposal of bloody or contaminated wastes.
        school security officer In restraining or dispersing hostile or violent individuals or groups.


  7. METHODS OF COMPLIANCE

    1. UNIVERSAL PRECAUTIONS

    2. All blood or other potentially infectious materials (as described in II. Exposure Determination) shall be handled as if contaminated by a bloodborne pathogen. Under circumstances in which differentiation between body fluid type is difficult or impossible, all body fluids shall be considered potentially infectious materials.

    3. HAND WASHING

    4. Readily accessible hand washing facilities with warm running water, antiseptic hand cleanser, and paper towels will be in each building designated health care unit or readily accessible to the designated area. When the provision of hand washing facilities is not feasible, the employer will provide antiseptic hand cleaner and towels or antiseptic towelettes.

      Employees must wash their hands with soap and warm water immediately or as soon as feasible after removal of gloves or other protective equipment; and wash or flush exposed mucous membranes with water immediately or as soon as feasible following contact of such body areas with blood or OPIM.

    5. ENGINEERING AND PRACTICE CONTROLS

      1. Needles

      2. Contaminated needles and other contaminated sharps will not be bent, recapped, removed, sheared or purposely broken.

      3. Containers for Sharps

      4. All contaminated sharps (including needle and syringes, lancets, etc.) are to be discarded immediately or as soon as feasible in puncture resistant, leak proof containers which are labeled with the biohazard warning, color coded red, and sealed prior to disposal.

        Broken glass contaminated with blood shall be stored in a sharps container.

        Containers are to be easily accessible to personnel and located as close as is feasible to the immediate areas where sharps are used or found. Contaminated disposable sharps shall be discarded, as soon as possible after use, in the disposable sharps containers.

        Overfilling of sharps containers creates a hazard when needles protrude from openings. Nearly full containers must be promptly disposed of (or emptied and decontaminated in the case of reusable sharps) and replaced.

      5. Contaminated Supplies

      6. Minimally contaminated items used for minor first aid care (lacerations, nose bleeds, etc.) will be handled with universal precautions as if they were infectious waste. They will be contained in plastic lined containers, closed, and disposed of with daily trash in a larger, heavy duty plastic bag of sufficient strength to preclude bursting and tearing during handling, storage or transport.

        Items such as gauze bandages, band aids, cotton balls, and sanitary napkins are not required to have special hazard labels, but again must be handled with universal precautions.

        Special attention is required to dispose of regulated waste of items that are caked with dried blood or other potentially infectious materials and supplies used to control bleeding wounds, emergency births or other human body fluid spills when such items are saturated to the point where liquid can be squeezed from the dressing in considerable amount. These items must be either placed in a red bag, marked with a biohazard label, or soaked in a disinfectant solution to decontaminate them. They may then be double bagged and included with normal waste disposal. The red bags will be collected from each school, on a regular basis by a designated collector and brought to Logan Regional Hospital or Utah State University for disposal.

      7. Work Practice Controls

      8. Eating, drinking, smoking, applying cosmetics or lip balm, and handling contact lenses are prohibited in work areas where there is a reasonable likelihood of exposure to blood or other potentially infectious materials.

        Food and drink shall not be kept in refrigerators, freezers, shelves, cabinets or on counter tops or bench tops where blood or other potentially infectious materials are present.

        Mouth pipetting/suctioning of blood or other potentially infectious materials is prohibited.

        Employees shall use practices to minimize splashing, spraying, spattering, and generation of droplets during procedures involving blood or other potentially infectious materials.

      9. Personal Protective Equipment (PPE)

      10. The school district is responsible for ensuring that personal protective equipment is selected and provided without cost to employees. Protective equipment includes but is not limited to gloves and mouthpieces or pocket masks for all personnel designated as first aid/CPR responders or otherwise exposed to blood or OPIM.

        1. PPE Provision

        2. Appropriate equipment will be selected by the school nurse coordinator and purchased with district funds in a quantity sufficient enough to supply anticipated need. Personal protective equipment will be considered "appropriate" only if it does not permit blood or other potentially infectious materials to pass through to or to reach the employee's work clothes, street clothes, undergarments, skin, eyes, mouth, or other mucous membranes under normal conditions of use and for the duration of time which the protective equipment will be used.

        3. PPE Use

        4. Each school is responsible for monitoring to ensure equipment is appropriately used and the supply is adequate. The school principal or his/her designee is responsible for day-to-day monitoring to assure staff are utilizing the equipment supplied.

        5. PPE Accessibility

        6. The principal or his/her designee shall ensure that appropriate PPE is readily accessible at each site or is issued to designated staff and replaced as necessary to maintain its effectiveness.

        7. Protection for Hands

        8. Gloves shall be worn in the following situations:

          When it can be reasonably anticipated that hands will contact blood or other potentially infectious materials, mucous membranes, and non-intact skin; when handling or touching contaminated items or surfaces.

        9. Protective Equipment

        10. When personal protective equipment is removed, it shall be placed in an appropriately designated area or container for storage, washing, decontamination or disposal.

          Disposable Gloves

          • Disposable gloves are available in each school.

          • Hypo-allogenic gloves, glove liners, powderless gloves, or other similar alternatives shall be readily accessible to those employees who are allergic to the gloves normally provided.

          • Replace as soon as feasible when gloves are contaminated, torn, punctured, or when their ability to function as a barrier is compromised.

          • Do not wash or decontaminate single-use gloves for re-use.

          Utility Gloves (customarily worn by custodial personnel)

          • Decontaminate for re-use if the gloves are in good condition.

          • Discard when gloves are cracked, peeling, torn, punctured or show other signs of deterioration (whenever their ability to act as a barrier is compromised).

        11. Additional Protection

        12. Other personal protective equipment, gowns, face shield, masks and eye protection is generally not required in the school setting but will be made available for individual cases as deter-mined necessary by the school nurse.

        13. Housekeeping

        14. All schools in the Logan City School District will be inspected and cleaned with an EPA approved disinfectant cleaning product and decontaminated as necessary. See the chart below.

          #160;
          AREASCHEDULECLEANER
          health service unit or area dailyEPA approved disinfectant cleaning product
          all bathroomsdaily & as necessaryEPA approved disinfectant cleaning product


          All contaminated work surfaces will be decontaminated after completion of procedures and immediately or as soon as feasible following the occurrence of any blood or OPIM spill, as well as at the end of the work shift if surfaces have become contaminated since the last cleaning. Materials used for decontamination include the following:

          1. Chlorine bleach in properly labeled spray bottles noting 1 to 10 solution for decontaminating surface. Diluted solutions must be changed daily.

          2. EPA approved, tuberculocidal, viricidal disinfectant cleaner.

          3. All housekeeping bins, pails, cans, waste containers and similar receptacles and cleaning equipment are inspected following each use, and cleaned and decontaminated as necessary by the user. The building custodial supervisor is responsible for weekly monitoring of this equipment to ensure compliance.

            Broken glassware which may be contaminated with blood or OPIM will be picked up with dustpans and hand brooms to avoid personal contact. DO NOT pick up directly with the hands.

        15. Laundry Procedures

        16. All laundry will be considered as if contaminated with blood or other potentially infectious materials and will be handled as little as possible, using universal precautions and protective gloves. Contaminated laundry will be contained at the location where it was used or contaminated and shall not be sorted or rinsed in the location of use. Laundry will be contained in color coded orange bags for transportation to the in-school washer and dryer site. Orange bags will be used only for this purpose, and all staff will be informed of this code.

          1. Soiled laundry will be washed on-site in hot water, with detergent and disinfectant solution, and dried in a dryer on the "hot" setting.

          2. Student's personal clothing items replaced because they are soiled with urine, feces, vomit, etc., will be handled with precaution, individually bagged and sent home with the student for home care. Soiled items that are visibly contaminated with blood or OPIM or items that are soiled as the result of an incident that may have contaminated the item with blood or OPIM will be handled with precautions and sealed in an orange colored, heavy-duty plastic bag before being sent with the student for home care.

  8. PROCEDURES FOR EVALUATION AND FOLLOW-UP OF EXPOSURE INCIDENTS

  9. An exposure incident is a specific eye, mouth, other mucous membrane, non-intact skin, or parenteral contact with blood or other potentially infectious materials that result from the performance of an employee's duties.

    Employees who experience an exposure incident must immediately report their exposure to the Department Head/Principal or their designee and the district nurse. When an employee reports an exposure incident the report will include the following information:

    1. the date of the incident;

    2. documentation of the route of exposure and the circumstances under which the exposure incident occurred;

    3. a written description of the employee's duties as they relate to the exposure incident;

    4. Identification and documentation of the source individual, including consent for blood testing to determine HBV and HIV infectivity. If consent cannot be obtained the principal/designee will document the reason that legally required consent cannot be obtained;

    5. when the source individual is already known to be infected with HBV or HIV, testing will not be repeated. This information will be provided by employees healthcare provider, hospital services or the local health department with the written consent of the source individual;

    6. all employee health records relevant to the appropriate treatment of the employee, including vaccination status;

    7. a copy of 29 CFR 1910.1030.

    8. Medical evaluation of exposure incidents and follow-up will be accomplished by employees healthcare provider, hospital services or the local health department as delineated.

      1. The exposed individual's blood will be collected by employees healthcare provider, hospital services or the local health department within 24 hours of the exposure incident.

      2. The employee will be offered the option of having their blood collected for testing of HIV/HBV status. In the event that the employee does not consent to HIV serological testing, the blood sample will be preserved by the laboratory for 90 days to allow the employee to decide if they want the blood test.

      3. If the employee reports an exposure incident but declines either postexposure evaluation or the recommendation of the examiner, this will be documented in the employees personnel file and stored for 30 years after termination of employment.

  10. HEPATITIS B VACCINATION POLICY

  11. General Statement of Policy

    All employees who have been identified as having exposure to bloodborne pathogens(see II. Exposure Determination) will be offered the hepatitis B vaccination series at no cost to them. In addition, these employees will be offered postexposure evaluation and follow-up at no cost should they experience an exposure incident on the job.

    Employees also have the option of refusing the hepatitis B vaccine and vaccination series. They must sign a waiver documenting their refusal and that they understood the significance of their action. The employee may reconsider his or her declination and must then be given the vaccine upon request.

    All medical evaluations and procedures including the hepatitis B vaccination series, whether prophylactic or postexposure, will be made available to the employee at a reasonable time and place. This medical care will be performed by or under the supervision of a licensed physician, physician's assistant or nurse practitioner. Medical care and vaccination series will be according to the most current recommendation of the U.S. Public Health Service. A copy of the bloodborne pathogens standard will be provided to the health care professional responsible for the employee's hepatitis B vaccination. A licensed health care provider will provide this service for Logan City School District employees.

    All laboratory tests will be conducted by an accredited laboratory at no cost to the employee.

    Hepatitis B Vaccination

    The vaccination is a series of three injections. The second injection is given one month from the initial injection. The final dose is given six months from the initial dose. At this time a routine booster dose is not recommended, but if the U.S. Public Health Service at some future date recommends a booster, it will also be made available to exposed employees at no cost. Logan City School District employees are encouraged to consult with their primary healthcare providers when making a decision about having hepatitis B vaccine.

    The vaccination will be made available to employees after they have attended training on bloodborne pathogens and within 10 working days of initial assignment to a job category with exposure. The vaccination series will not be made available to employees who have previously received the complete hepatitis B vaccination series; to any employee who has immunity as demonstrated through antibody testing; or to any employee for whom the vaccine is medically contraindicated.

  12. RECORD KEEPING PROCEDURES

  13. Employee Health Records

    The Logan City School District must establish and maintain an employee health record of each employee identified as at risk of occupational exposure. The record shall be maintained for the duration of employment plus 30 years in accordance with 29 CFR 1910.20. The Human Resources Department is responsible for maintaining medical records. This record includes the following information:

    1. the name and social security number for the employee;

    2. a copy of the employee's hepatitis B vaccination status, including dates of all the hepatitis B vaccinations;

    3. any medical records relative to the employee's ability to receive vaccination;

    4. documentation of informed consent or refusal of HBV vaccination;

    5. a copy of examination results, medical testing, and the follow-up procedures as required by the postexposure evaluation;

    6. the employer's copy of the health care professional's written opinion; and

    7. a copy of the information provided to the health care professional, including the exposed employees duties as they relate to the exposure incident, documentation of the route(s) of exposure and circumstances under which exposure occurred.

    All employee health records must be kept confidential and shall not be disclosed or reported, except with the employee's expressed written consent to any person within or outside the work place, except as required by regulation or law.

  14. VIII. EMPLOYEE TRAINING

  15. Employees will be trained regarding bloodborne pathogens at the time of initial assignments to tasks where exposure may occur and annually thereafter. All other employees will receive copies of Universal Precautions during their initial orientation, and will be encouraged to attend annual bloodborne pathogen training. Additional training will be provided whenever there are changes in task or procedure which affect employee's occupational exposure; this training will be limited to the new exposure situation.

    The following content will be included:

    1. explanation of the bloodborne pathogens standard;

    2. general explanation of the epidemiology, modes of transmission and symptoms of bloodborne diseases;

    3. explanation of this exposure control plan and how it will be implemented;

    4. procedures which may expose employees to blood or other potentially infectious materials;

    5. control methods that will be used in the Logan City School District to prevent/reduce the risk of exposure to blood or other potentially infectious materials;

    6. explanation of the basis for selection of personal protective equipment;

    7. information on the hepatitis B vaccination program including the benefits and safety of vaccination;

    8. information on procedures to use in an emergency involving blood or other potentially infectious materials;

    9. what procedure to follow if an exposure incident occurs;

    10. explanation of postexposure evaluation and follow-up procedures;

    11. an explanation of warning labels and/or color coding;

    12. a review of UNIVERSAL PRECAUTIONS.

    13. Training Records

      Training records shall be maintained by the Human Resource Office for 3 years from the date on which the training occurred. The following information shall be included:

      • dates of training sessions;

      • contents or a summary of the training sessions;

      • names and qualifications of trainer(s); and

      • names and job titles of all persons attending.

      Training records shall be provided upon request for examination and copying to employees, to employee representatives, and to the Commissioner of the Utah Department of Labor and Industry in accordance with 29 CFR 1910.20.

      Effective: September 12, 1995