ARKANSAS CITY KANSAS USD 470 BLOODBORNE PATHOGENS EXPOSURE CONTROL PLAN

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1 ARKANSAS CITY KANSAS USD 470 BLOODBORNE PATHOGENS EXPOSURE CONTROL PLAN Approved June 2014

2 CONTENTS Page Introduction 3 PURPOSE & SCOPE 3 MANAGEMENT 4 Exposure Control Committee 4 Director of Business Operations 4 Building Supervisors 4 Director of Human Resources/Personnel Clerk 4 School Health Care Professionals 5 Director of Buildings and Grounds 5 Employees 5 EXPOSURE DETERMINATION 6 IMPLEMENTATION 7 Universal Precautions 7 Hand washing 7 Engineering Controls 8 Work Practice Controls 8 Personal Protective Equipment (PPE) 9 Custodial and Laundry 11 HAZARDS COMMUNICATIONS 12 Labeling 12 Employee Education 12 Training schedule and responsibilities for all employees 12 Training Content 13 Training Records 13 VACCINATION AND EXPOSURE FOLLOW UP CARE 14 REPORTING PROCEDURES FOR FIRST AID INCIDENTS 15 POST- EXPOSURE EVALUATION AND FOLLOW- UP 15 MEDICAL RECORDS 17 RECORD KEEPING 17 1

3 ATTACHMENTS EXPOSURE DETERMINATION Category I (Attachment A) 19 Category II (Attachment B) 20 Category III (Attachment C) 21 Custodial (Attachment D) 21 Hepatitis B Vaccination Acceptance Form (Attachment E) 23 Vaccination Declination Form (Attachment F) 24 Vaccination Declination Previously Vaccinated Form (Attachment G) 25 First Aid Incident Report (Attachment H) 26 Post- Exposure Report (Attachment I) Post- Exposure Evaluation by Healthcare Professional (Attachment J) 29 Parental Consent (Attachment K) 30 Occupational Risk Worksheet (Attachment L) 31 Exposure Control Plan Committee Signature of Concurrence 32 (Attachment M) 2

4 USD 470 Arkansas City, Kansas Bloodborne Pathogens Exposure Control Plan INTRODUCTION In March 1992, Occupational Safety and Health Administration s (OSHA) Bloodborne Pathogen Standard, (29 CFR ) took effect. Revisions were published January 18, 2001 to the Federal Register s Occupational Exposure to Bloodborne Pathogens; Needlestick and Other Sharps Injuries. The standard was designed to reduce occupational exposure to blood and other potentially infectious materials (OPIM), resulting in the prevention of more than 200 deaths and 9,000 bloodborne infections every year. While the standard was primarily aimed at hospitals, funeral homes, nursing homes, clinics, law enforcement agencies, emergency responders, and HIV/HBV research laboratories, anyone who can reasonable expect to come in contact with blood or other potentially infectious materials as part of their job is covered by the standard. The Exposure Control Plan requires employers to identify, in writing, tasks and procedures as well as job classifications where occupational exposure to blood occurs without regard to personal protective clothing and equipment. It must also set forth the schedule for implementing other provisions of the standard and specify the procedure for evaluating circumstances surrounding exposure incidents. The plan must be accessible to employees and available to OSHA. Employers must review and update it at least annually more often if necessary to accommodate workplace changes. USD 470 Director of Business Operations shall be responsible for scheduling the annual review of this plan. PURPOSE & SCOPE Purpose: Limit occupational exposure to blood and other potentially infectious materials since any exposure could result in transmission of bloodborne pathogens that could lead to disease or death. Scope: Cover all employees who could be reasonably anticipated as the result of performing their job duties to face contact with blood and other potentially infectious materials (OPIM). A list of all occupations where exposures could occur has not been developed by OSHA. Incidental Good Samaritan acts such as assisting a co- worker with a nosebleed would not be considered occupational exposure and, therefore, such acts are not subject tot the provisions of the Exposure Control Plan 3

5 MANAGEMENT Exposure Control Plan Committee. The committee is composed of the following individuals: Director of Business Operations School Nurses Director of Human Resources/Personnel Clerk Director of Buildings and Grounds The Exposure Control Plan Committee responsibilities are to: Develop the plan based on information from the Kansas Department of Health and Environment Bloodborne Pathogens Exposure Control Plan Review and revise the Exposure Control Plan at least annually Update the plan as needed when new OSHA regulations need to be added to the plan New positions are established, new tasks implemented that affect occupational exposure for employees, and/or when new departments are added that may involve procedures having occupational exposure to bloodborne pathogens Assist building supervisors in auditing their employees for compliance with the plan Review exposure incidents for the development of engineering controls and work practices needed to reduce incidents Director of Business Operations Schedule the annual review of the Exposure Control Plan Serve on the Exposure Control Plan Committee and support the review of the plan for annual and intermittent revisions as indicated through changes in personnel, program duties and responsibilities Building Supervisors Review department policies and procedures that place the employees at risk for exposure and submitting revisions to Human Resources Classify employees in relation to their potential occupational exposure. Monitor employees for compliance in following the exposure control plan Report exposures to the Director of Human Resources to be recorded on worker compensation forms, referring employees for immediate exposure follow- up, and coordinating 6- month follow- up exams Informing candidates during the interview and at hiring of the potential for exposure Director of Human Resources (HR)/Personnel Clerk responsibilities are to: Provide oversight on plan development and maintenance Assist building supervisors as needed in classifying each of their employees regarding potential occupational exposure 4

6 Assure that position descriptions reflect the exposure classification Maintain employee records for compliance with BBP exposure control plan, exposure incident reports and follow- up. Compile and maintain a list of position numbers and titles by exposure classification and inform them of their qualification for Hepatitis B vaccine Compile and maintain a list of job duties and/or skills that place the position into specified exposure classification Obtain and maintain relevant contracts with health care providers Provide access to the district s most current exposure control plan Maintain an up- to- date list of employees requiring training Assure that annual training updates are completed Maintain employee medical records School Nurse responsibilities are to: Serve on the Exposure Control Plan Committee and support the review of the plan for annual and intermittent revisions as indicated through changes in personnel, program duties and responsibilities Coordinate review of methods and content of training program Assist in educating and training employees about OSHA standard and the Exposure Control Plan Act in the capacity of the safety compliance officer ensuring the implementation of the Exposure Control Plan Serve as the subject matter expert to assure compliance with occupational requirements Director of Buildings and Grounds responsibilities are to: Serve on the Exposure Control Plan Committee and support the review of the plan for annual and intermittent revisions as indicated through changes in personnel, program duties and responsibilities. Act in the capacity of the safety compliance officer ensuring the implementation of the Exposure Control Plan Serve as the subject matter expert to assure compliance with occupational requirements Employees. The employee s responsibilities are to: Take the bloodborne pathogen training and pass a test prior to assignment to task each year Know how to access the Exposure Control Plan Follow the Exposure Control Plan Report any exposures promptly to his or her supervisor Follow department directives if/when personal protective equipment needs cleaning or replacement. 5

7 EXPOSURE DETERMINATION For purposes of this plan occupational exposure means reasonable anticipated occupational exposure to blood or other potentially infectious materials as a consequence of the performance of the job duties. The exposure determination is made without regard to the use of personal protective equipment. Each Building Supervisor and the Director of Human Resources/Personnel Clerk will be responsible for classifying each of their employees in relation to their potential occupational exposure All job positions will be classified as one of the following: Category I: All employees in the job classifications listed on Attachment A have possible occupational exposure. Category II: Some employees in the job classifications listed on Attachment B may have an occasional occupational exposure. Category III: Some employees are unlikely to have occupational exposure. These job classifications are listed on Attachment C. Employees of the district who are placed in Category II or III and feel they have a legitimate concern about their exposure may complete Attachment L and submit it to the Director of Business Operations for consideration by the Exposure Control Committee. 6

8 IMPLEMENTATION Methods of Compliance Effectively eliminating or minimizing exposure to bloodborne pathogens in this district requires that several areas be addressed: 1. Using Universal Precautions 2. Emphasizing hand washing and hand washing facilities 3. Establishing engineering control including needle safety, sharps containers, use and evaluation of sharps with engineered sharps injury protections 4. Implementing appropriate work practice controls 5. Using necessary personal protective equipment (PPE) 6. Implementing appropriate custodial and laundry procedures 1. Universal Precautions The term universal precautions refers to a method of infection control in which all human blood and other potentially infectious materials are treated as if known to be infectious for HIV, HBV, and HCV. Universal Precautions direct that body fluids/materials are treated as if infectious. The district must provide at no cost, and require employees to use appropriate personal protective equipment such as gloves, gowns, masks, eye protection, mouthpieces and resuscitation bags which employers must clean, repair and replace when necessary. All employees in the district will observe universal precautions to prevent contact with blood or other potentially infectious materials. 2. Hand washing The objective of hand washing is to decrease the number of microorganisms on the hands to prevent and/or reduce the spread of infection. There are two primary methods used to accomplish this objective: 1) kill microorganism with antiseptic hand cleansing products and 2) physical removal of organisms from hands by the use of soap and running water (this is what is meant by the term hand washing. Hand washing facilities are provided for all students and employees of the district. Because washing one s hands with soap and running water is one of the most effective ways to prevent the spread of disease, employees should wash their hands with soap and water whenever exposure occurs. Although hand washing may be advisable in other situations, employees must thoroughly wash their hands, or any other exposed or contaminated skin with soap and water in the following situations: a, Immediately after the removal of gloves or other personal protective equipment. b. Following contact of hands or skin with blood or OPIMs (Other Potentially Infectious Material) c. At other times deemed necessary. 7

9 In some situations, such as on athletic facilities or field trips, hand washing facilities may not be available. In this case, the person in charge of the event shall ensure that hand sanitizer is available. After using hand sanitizer, employees should wash their hands with soap and water as soon as it is feasible. 3. Engineering Controls Engineering and work practice controls will be used to eliminate or minimize all employee exposure. Where exposure potential remains, personal protective equipment shall also be used. The following engineering controls will be used in the district: a. Any student or employee who may use a needle for injection, e.g., injections of insulin will discard needles in a sharps container. b. Sharps containers shall be disposed of according to the protocol of the Cowley County Health Department. c. The district will maintain appropriate receptacles for the deposit of contaminated clothing, and other articles. d. Engineering controls will be examined, maintained or replaced on a regularly scheduled basis. 4. Work Practice Controls Work practice controls are those controls that reduce the likelihood of exposure by altering the manner in which the task is performed. The following work practice controls will be used in the district: a. Contaminated needles will not be bent, recapped or removed and will be disposed of in appropriate puncture- resistant containers. b. Eating, drinking, applying cosmetics, applying lip balm and the handling of contact lenses is prohibited in areas where there is a reasonable likelihood of occupational exposure. c. Food and drink cannot be kept in any area where blood or OPIMs are present. d. Procedures involving blood or OPIMs will be performed in a manner to minimize splashing, spraying, or spattering. e. Specimens of blood or OPIMs should not be brought to or taken to the school. If specimens of blood or OPIMs are present in the school they should be in leak proof containers, appropriately labeled, and closed prior to storing or transporting. f. Equipment, which may become contaminated with blood, or OPIMs shall be decontaminated as soon as is feasible after the contamination occurs. 8

10 Minimally bloody contaminated items used for first aid and care for lacerations, nosebleeds, etc. shall be contained in a plastic lined trash container and disposed of in unmarked bags without special attention. Items such as gauze bandages, band aids, cotton balls, and sanitary napkins are not required to have special hazard labels. g. Special attention is required for items contaminated with large amounts of blood, such as those used to control bleeding wounds or other human body spills with visible blood, that are saturated to the point where a considerable amount of liquid can be squeezed from the dressing. These items should be placed in a designated red bag and/or labeled with the biohazard sign and disposed of as hazardous waste. h. Any hazardous contaminated waste is to be placed in the boiler room at elementary schools and the middle school. At the high school, the waste needs to be placed in the laundry room. The Director of Buildings and Grounds should then be contacted for proper disposal. 5. Personal Protective Equipment (PPE) It shall be the responsibility of each building principal to ensure that appropriate personal protective equipment (gloves, goggles, masks, gowns) is available and readily accessible for each employee s use at no cost to the employee. The principal shall also ensure that all employees use personal protective equipment when there is occupational exposure. In the event that an employee, exercising his or her personal judgment, fails to use protective equipment, the circumstances will be investigated and documented in order to determine whether changes can be instituted to prevent future occurrences. It shall be the responsibility of any employee who uses personal protective equipment to place the equipment in the appropriately designated receptacle for storage, washing, decontamination, or disposal after its use. These receptacles are located in the custodial office or in a place designated by the support staff supervisors. The school district shall be responsible for storing, cleaning laundering, decontaminating, repairing, replacing, or disposing of such equipment. All PPE is stored in health offices, building offices, and support staff supervisors offices. The equipment may be obtained by contacting nurses, secretaries, or supervisors. The following PPE is available in the district for use by its employees: a. Gloves Gloves shall be worn by any employee when it is reasonably anticipated that there will be hand contact with blood, OPIMs, or non- contact skin. Gloves shall also be worn when handling or touching contaminated items or surface. If an employee requires a smaller or larger size glove or develops an allergy to the current gloves provided to employees, the department 9

11 will provide an appropriately sized glove, or powder- less/allergen- free gloves for employees with allergies. It is the responsibility of the employee to report glove problems to their immediate supervisor for appropriate equipment and work assignment. Disposable (single use) gloves are available for employee use in situations where such use is warranted or directed. While wearing gloves, the handling of personal items should be avoided. This includes such items as combs and pens that could become soiled or contaminated with blood or other body fluids. Gloves that have become contaminated with blood or other body fluids to which universal precautions apply should be removed as soon as possible, taking care to avoid skin contact with the exterior surface of the gloves. These gloves should be deposited by the employee in the appropriate container for disposal immediately following use. Hand washing after removing the gloves is important and should be done at the first available opportunity. Utility gloves are assigned to some employees. These gloves may be decontaminated for reuse, and should be deposited in the appropriate container for washing and decontamination. Any employee to whom utility gloves are assigned shall be responsible for regularly inspecting these gloves for punctures, cracking or deterioration. The employee shall dispose of such gloves when their ability to function as a barrier is compromised. The employee shall report the disposal of gloves to the Building and Grounds supervisor, who shall ensure that a new pair of utility gloves is assigned to the employee. To further reduce the possibility of spreading contamination, gloves will be available in two colors. Yellow gloves will be designated as dirty and will be used to clean toilets, floors, and other especially unsanitary areas. Green gloves will be designated for use in clean areas such as drinking fountains and desktops. b. Eye/face protection Any time there is a risk of splashing or vaporization of contaminated fluids, goggles and/or other eye protection should be used for eye protection. Bloodborne pathogens can be transmitted through the thin membranes of the eyes, so it is important to protect them. Splashing could occur while cleaning up a spill, during laboratory procedures, or while providing first aid, or medical assistance. Face shields may be worn in addition to goggles to provide additional face protection A face shield will provide additional protection against splashes to the nose and mouth. 10

12 6. Custodial and Laundry It shall be the responsibility of the Director of Operations and the Director of Buildings and Grounds to see that each work site and building in the district is maintained in a clean and sanitary condition. All equipment and working surfaces shall be cleaned and decontaminated with an appropriate disinfectant as soon as feasible and after contact with blood or OPIMs. Protective coverings used to cover equipment and working surfaces shall be removed and decontaminated, or replaced as soon as feasible when they become overtly contaminated. Visible material will first be removed with disposable towels that will ensure against direct contact with blood. All bins, pails, cans, and waste paper baskets shall be inspected, cleaned, and decontaminated on a regularly scheduled basis, or as soon as feasible upon visible contamination. Broken glassware shall not be picked up by hand but by using a broom and dustpan, tongs, or other mechanical means. Broken glass must be placed in a sharps container, which is leak proof and puncture resistant. The following cleaning schedule and method of decontamination will be implemented in the district as listed on Attachment D. All contaminated and regulated waste will be disposed of in compliance with state and federal regulations. The school district will use Universal Precautions with all soiled or contaminated laundry. Linens contaminated with large amounts of blood will be bagged on location in water- dissolvable bags and placed into red/biohazard bag. Such items shall not be sorted or rinsed but removed from the first bag and placed directly into the washer. After washing and prior to drying, the item can be spot treated. Any employee who may come into contact with contaminated items or laundry shall wear gloves. 11

13 HAZARD COMMUNICATIONS Labeling Containers of used needles, items saturated with blood, or OPIMs shall be appropriately labeled with a BIOHAZARD label, or shall be red in color. All BIOHAZARD labels will have a fluorescent orange or orange- red background and have the biohazard symbol and the word BIOHAZARD in a contrasting color. Any receptacle used for the disposal or deposit of contaminated materials for laundering or discard will be RED in color, appropriately labeled or lined with red bags. Any equipment, which is contaminated, will be appropriately labeled. EMPLOYEE EDUCATION An online training program is available for all employees for potential occupational exposure in the workplace. The school nurse is available for additional information and training upon request. Training schedule and responsibilities for all district employees: Initially upon hiring Yearly, subsequent to training upon initial hiring New employees will receive training within 30 days of hiring date Employees with occupational exposure will be provided with additional training if a new task or procedure affects the employee s occupational exposure by the school nurse Training will be ensured by the Director of Human Resources/Personnel Clerk Appropriate content of the training is the responsibility of the school nurse The school nurse will assure that supervisors are provided training in all aspects of implementation of the Exposure Control Plan, including specific training for the employees at risk. A variety of methods and media maybe used to train employees. 12

14 Training Content Training for employees will include an explanation of the following: Overview of the OSHA standard for bloodborne pathogens and the location of the standard for review as needed Modes of transmission of bloodborne pathogens The department exposure control plan and the means by which employees can obtain a copy of the plan Procedures that may involve exposure to blood and other potentially infectious materials Control measures to prevent exposure to blood and other potentially infectious materials including engineering controls, work practices, and PPE Information on the types, selection, proper use, location, removal, handling, decontamination and disposal of PPE Pre- exposure hepatitis B vaccination program including information of vaccine efficacy, safety, method of administration, and benefits of being vaccinated Post exposure reporting, medical evaluation, and follow- up Hazardous labels and signs used by Kansas Department of Health and Environment Employees have an opportunity to ask questions Training records will be maintained for three years from the date on which the training occurred by the Director of Human Resources/Personnel Clerk. Records will include the following: Date of training session Summary of training session Names and qualification of persons conducting the training Names and job titles of all persons attending the training session 13

15 VACCINATION AND EXPOSURE FOLLOW- UP CARE Vaccination The school district will make the Hepatitis B Vaccine series available to any employee who has occupation exposure and falls within Category I of the exposure determination. The district will make the Hepatitis B Vaccine available to employees in categories II and III within 7 working days of possible exposure. Those employees who are not first aid responders (Category I) for their building but do become exposed to BBP are to be offered post- exposure vaccination. The Hepatitis B Vaccination and any medial evaluation required before the vaccine can be administered will be provided to the employee at no cost. No employee shall be required to participate in the pre- screening program as a prerequisite for receiving the Hepatitis B Vaccination. The vaccine will be offered after the employee has received training on bloodborne pathogens and within 10 working days (or as soon as the vaccine is available from the Cowley County Health Department) of an employee s initial assignment to work. Employees who decline the Hepatitis B Vaccine will sign a waiver form as required by the OSHA standard. A copy of the required waiver form is attached to this plan as Attachment F/G. The Director of Human Resources/Personnel Clerk shall be responsible for assuring the vaccine is offered, and that the necessary waiver is signed and appropriately filed for any employee who declines to accept the Hepatitis B Vaccination, which was offered. Any employee who initially declines the Hepatitis B Vaccination may later request the vaccination. The district will provide the vaccination for the employee at that time. The Cowley County Health Department will administer the vaccine to the USD 470 employee. The Director of Human Resources/Personnel Clerk will arrange the appointment for the vaccination for the employee with the local health department. Although booster doses of Hepatitis B Vaccine are not currently recommended by the US Public Health Service, if such booster doses are recommended in the future, the district will make the booster doses available at no cost to all employees who have occupational exposure. 14

16 REPORTING PROCEDURES FOR FIRST AID INCIDENTS Whenever an employee is involved in a first aid incident, which results in potential exposure, the employee shall report the incident to their principal or supervisor before the end of the work shift during which the incident occurred. That supervisor or principal will then contact a school nurse. The information shall be reduced to writing, using the form shown on Attachment G. If the school nurse assesses that an exposure has occurred as defined in the OSHA standard and this policy, a report will be submitted (Post- Exposure Report, Attachment H). The incident report needs to include the following: Names of all first aid providers involved Description of the circumstances of the incident Date/time of incident Upon completion of the report, the nurse will notify the Director of Human Resources/Personnel Clerk and will forward the incident form to the Director of Business Operations and Director of Human Resources/Personnel Clerk at the Central Office. The district will maintain a list of such first aid incidents, which will be provided to KDHR upon request. If an exposure incident has occurred, post- exposure evaluation and follow- up procedures will need to be initiated as soon as possible, but within 7 days. POST- EXPOSURE EVALUATION AND FOLLOW- UP An exposure incident occurs when there is contact with any body fluid that is visibly contaminated with blood. Whenever an employee has an exposure incident in the performance of his or her duties, an opportunity for a confidential post- exposure evaluation and follow- up will be provided to the employee at the expense of the district. Post- exposure evaluation and follow- up shall be performed by a physician at the Ark City Clinic according to recommendations of the US Health Service current at the time the evaluation and procedure takes place. The district will make sure that any laboratory tests required by the evaluation or follow- up procedure will be conducted at an accredited laboratory at no cost to the employee. Whenever an exposure incident occurs, the exposed employee shall report the incident to their principal or supervisor and complete the First Aid Incident Report (Attachment H). The principal or supervisor will then contact a school nurse. If the nurse assesses that an exposure has occurred, Post- Exposure Report (Attachment I) will be completed. The nurse will explain to the employee his or her right to a post- exposure evaluation. 15

17 A post- exposure evaluation and follow- up will include the following element: Documentation of the circumstances under which the exposure incident occurred, including the route(s) of the employee s exposure. Identification and documentation of the source individual whose blood or OPIMs caused the exposure, unless identification is infeasible or prohibited by law. Unless the source individual is known to be infected with a HIV, HBV, or HCV, the school district through a school nurse will seek the consent of the source individual, risk levels, and sero- status of the source person for blood testing for HIV, HBV, HCV. Failure to obtain consent will be documented by the district. If the source individual consents, results of the source individual s blood will be made available to the exposed employee, along with information on laws concerning the disclosure of the identity of an infectious status of the source individual. If the exposed employee consents, blood testing of his or her blood will be completed as soon as possible. If the employee consents to baseline blood collection, but not to HIV, HBV, and HCV serologic testing, the blood sample will be retained for 90 days. The employee may request testing of the sample at any time during the 90- day period. The exposed employee will be offered post- exposure prophylaxis in accordance with current recommendations of the US Public Health Service. These recommendations are currently as follows: If the source individual has AIDS, is HIV positive, or refused to be tested, the employee should be counseled regarding the risk of infection and evaluated clinically and serological for evidence of HIV infection as soon as possible after the exposure. The employee should be advised to report and seek medical evaluation for any acute febrile illness that occurs within 12 weeks after exposure. Retesting on a periodic basis may be necessary. During the follow- up period, especially the first 6-12 weeks after exposure, the employee should follow recommendations for preventing the transmission of the virus. The exposed employee will be offered counseling concerning precautions to take during the period after the exposure incident. The employee will also be given information on what potential illnesses to be alert for and to report any related experiences to appropriate personnel. Reports should be made to a school nurse. 16

18 The Director of Human Resource/Personnel Clerk will obtain and provide the employee with a copy of the health care provider s written opinion within 15 days of the completion of the evaluation. This opinion will be limited to the following information: Documentation that the employee has been informed of the results of the evaluation Whether Hepatitis B Vaccine is indicated and if vaccination was given Any medical conditions resulting from exposure to blood or other potentially infectious materials that require further evaluation or treatment All other findings or diagnoses shall remain confidential and shall not be included in the report. MEDICAL RECORDS The Director of Human Resources/Personnel Clerk will establish and maintain a confidential medical record in a separate locked file for each employee with occupational exposure. This record will include: The name and social security number of the employee A copy of the employee s Hepatitis B Vaccination status, including the dates the vaccination was given, any medical records relative to the employee s ability to receive the vaccination, or the employee s signed waiver A copy of all results of examinations, medical testing, and follow- up procedures A copy of the health care professional s written opinion following post- exposure evaluation and follow- up A copy of any information provided to the health care professional under the evaluation and follow- up procedures The medical records of employees maintained under this policy will be kept confidential and will not be disclosed to any person, except as required by law, without the employee s written consent. Medical records required under this plan will be maintained for the duration of the employee s employment, and for 30 years thereafter. RECORD KEEPING The Director of Human Resources/Personnel Clerk will maintain the following records Training records Notify Category I employees who qualify for HBV series Hepatitis B Vaccination records Incidents of noncompliance with ECP Exposure incidents and medical follow- up Completed Post- Exposure Report Forms 17

19 Location and duration of record keeping: Employee education training records will be maintained for 3 years from the time of training Hepatitis B Vaccination records will be kept in Human Resources/Personnel Clerk in a locked file for the duration of employment plus 30 years Counseling in regard to non- compliance will be documented All exposure incidents, follow- up consultation, and recommendations will be maintained by the Personnel Clerk for duration of employment plus 30 years Post Exposure Report Forms will be retained by the Personnel Clerk for duration of employment plus 30 years 18

20 ATTACHMENT A EXPOSURE DETERMINATION Category I All employees in the following job classifications have possible occupational exposure: Activities Director and Assistant Activities Director Building Custodians Bus Drivers Coaches, Assistant Coaches, and Athletic Trainers of all sports except Golf, Tennis, and Cross Country Elementary Secretaries Maintenance Middle School and High School Front Office Secretaries Middle School and High School Lunch Supervisors Physical Education Teachers School Nurses and Assistants Shop Teachers 6 th Grade Center Secretary Special Education Bus Aides Two designated First- Aid Responders per building 19

21 ATTACHMENT B EXPOSURE DETERMINATION CATEGORY II All employees in the following job classifications may have an occasional occupational exposure: Activity Director s Secretary/Bookkeeper Coaches, Assistant Coaches and Athletic Trainers of Golf, Tennis, Cross Country Elementary Administrators Elementary Teachers High School Administrators Middle School Administrators Middle School Secretaries/Bookkeepers not in front office Noon Aides Playground Aides Teacher Aides 20

22 ATTACHMENT C EXPOSURE DETERMINATION CATEGORY III Job classifications in which some employees are unlikely to have occupational exposure: Auto/Bus Mechanics Bus Stop Monitors Central Office Administrators Central Office Secretaries/Bookkeepers Food Service Employees High School Administrators High School Teachers High School Secretaries/Bookkeepers not included as Front Office Secretaries in Category I Middle School Teachers Security Employees Warehouse Employees 21

23 ATTACHMENT D CUSTODIAL Equipment Area Scheduled Cleaning Cleaner/Disinfectant Health Office Daily OSHA Approved Restrooms Daily OSHA Approved Sharps Containers Disposed of as needed Sped Handicap Bus Daily OSHA Approved Receptacles Daily OSHA Approved 22

24 ATTACHMENT E HEPATITIS B VACCINATION ACCEPTANCE FORM On, I (name) (date) received information concerning the risk of occupational exposure to blood or other potentially infectious material in the position of (position) which has been determined as job classification exposure Category. I have received a copy of the Hepatitis B information packet which has been explained to me and I understand this information.. I have been informed and understand (1) that Hepatitis B vaccination may reduce the potential risk of occupationally contracted viral hepatitis infection, and (2) the risks of the Hepatitis vaccination which may include pain itching bruising at the injection site, sweating, weakness, chills, flushing and tingling, and (3) to obtain adequate immunity to viral Hepatitis B, it will be necessary to receive all three vaccinations of the vaccine series which are administered one month and six months after the initial vaccination, and (4) that the vaccination will be provided to me without charge by USD 470 Arkansas City, Kansas. If at such future time the US Public Health Service recommends a booster dose(s) of Hepatitis B vaccine, such booster dose(s) shall also be provided to me at no cost if I am employed by the facility in a job classification that involves some risk of an occupational exposure to blood or other potentially infectious materials. If I leave the employment of this facility before the serious is completed, it is my responsibility to contact my own medical provider to complete the vaccine series. I hereby consent to the administration of the Hepatitis B vaccination and voluntarily acknowledge that: I do not have an allergy to yeast I am not pregnant or nursing. I am not planning to become pregnant within the next six months. I have not had a fever, gastric symptoms, respiratory symptoms, or other signs of illness in the last 48 hours. I do not have the following know allergies: Food: Drug: Other: YOU MAY WISH TO CONSULT WITH YOUR PHYSICIAN BEFORE TAKING THE VACCINE. (Employee name and Social Security Number) (Witness) (Date) (Date) 23

25 ATTACHMENT F - - PLACE IN EMPLOYEE MEDICAL FILE VACCINATION DECLINATION FORM Date: Employee Name: Employee Social Security Number: I understand that due to my occupational exposure to blood or other potentially infectious materials I may be at risk of acquiring Hepatitis B viral (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 to 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 the Hepatitis B Vaccine, I can receive the vaccination series, at no charge to me, at that time. Employee signature Date Position 24

26 ATTACHMENT G VACCINATION DECLINATION PREVIOUSLY VACCINATED FORM Date: Employee Name: Employee Social Security Number: I understand that due to my occupational exposure to blood or other potentially infectious materials that I may be at risk of acquiring Hepatitis B Virus infection. I have been given the opportunity be vaccinated with the Hepatitis B Vaccine at no charge to me. I decline the Hepatitis B Vaccine at this time because I received the complete Hepatitis B Vaccine series in the past. Employee signature Date Position 25

27 ATTACHMENT H FIRST AID INCIDENT REPORT Employee name Date and Time of the First Aid incident Names of all First Aid providers: Description of the incident and circumstances that resulted in the need for first aid procedure: Describe any personal protective equipment (PPE) in use at the time of the exposure incident. Did the PPE fail? If yes, how? Did an exposure incident occur? Post- exposure evaluation and follow- up were/were not offered. (If the affected employee believes that an exposure incident has occurred, the employee should be offered post- exposure evaluation and follow- up and the post- exposure evaluation and follow- up form should also be completed.) The affected employee was offered the full Hepatitis B Vaccination series: Date Time (The Hepatitis B Vaccine must be offered as soon as possible, but no later than 7 days after the incident occurs. The vaccine must be made available whenever a first aid incident occurs, whether or not an exposure incident as occurred.) Signature of person completing report Date and Time of report This report is to be filed in the employee s medical record. Also a copy in Incident Report file. 26

28 ATTACHMENT I POST- EXPOSURE REPORT Employee Name (who had an exposure incident) Hepatitis B Vaccination status of the employee Date, time and location of the exposure incident Describe the exposure incident Was personal protective equipment in use at the time of the exposure? Did the PPE fail? If yes, how? Describe the route of the employee s exposure Information on the source individual: a. The identity of the source individual is/is not known. b. The source individual is/is not known to be infected with HIV, HBV, HCV c. The school district, through sought the consent of the source individual to do blood testing. The source individual did/did not consent to blood test released to the school district and to the affected employee. d. The source individual did/did not consent to having the results of the blood test released to the school district and to the affected employee. e. Was the consent form signed? Yes/No f. made the results of the source individual s blood test available to the affected employee on. was informed of his/her right to post- exposure evaluation and follow- up by on. was informed that the Ark City Clinic would perform the evaluation at the Ark City Clinic, at the expense of the district, and that the Director of Human Resources /Personnel Clerk would arrange an appointment for the evaluation. 27

29 ATTACHMENT J (page 1 of 2) (POST EXPOSURE REPORT- continued) declined/accepted the offer and the appointment was/was not made. The School Nurse or designated person offered post- exposure prophylaxis in accordance with the current recommendations of the US Public Health Service on. The School Nurse or designated person offered counseling with concerning precautions to take during the period after the exposure incident. Such counseling also included information of potential illnesses. was instructed to report any related experiences to the school nurse. School Nurse or designee Date 28

30 ATTACHMENT J (page 2 of 2) POST- EXPOSURE EVALUATION BY HEALTHCARE PROFESSIONAL Employee Name: Hepatitis B Vaccination is indicated for this employee: Yes/No If yes, indicate if employee has previously received or is currently receiving the vaccination series: yes/no Or the date employee declined the vaccination series Enter date completed: Employee has been informed of the results of the post- exposure evaluation Employee has been informed of any medical conditions resulting from exposure incident, which may require further evaluation or treatment Other relevant medical information is present: yes/no See employee health record. Employee signature Date USD 470 School Nurse signature Date 29

31 ATTACHMENT K PARENTAL CONSENT I acknowledge the need and give consent for appropriate communications between the school nurse and USD 470 and the healthcare provider related to the student s outcomes from any lab results and pertinent issues related to the student s diagnoses, condition, or treatment. Student s name Student s date of birth Parent/Guardian printed name Parent/Guardian signature Date 30

32 ATTACHMENT L OCCUPATIONAL RISK WORKSHEET At my work I am... Bitten by a student Scratched by a student Clean up students body fluids Clean up students dressings Perform medical procedures Handle contaminated objects Never Rarely Sometimes Regularly Employee printed name Employee signature Date 31

33 ATTACHMENT M EXPOSURE CONTROL PLAN COMMITTEE SIGNATURE OF CONCURRENCE Date

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