Bloodborne Pathogens Exposure Control Plan

Transcription

1 Bloodborne Pathogens Exposure Control Plan 1

2 Table of Contents Definitions...pg. 3-4 Purpose...pg. 5 Scope...pg. 6 Implementation & Methodology Schedule...pg. 6 Exposure Determination...pg. 6 Compliance Method...pg. 7 Universal/Standard Precautions...pg. 7 Engineering & Work Practice Controls...pg Handwashing Sharps Use and Disposal Contaminated Sharps Containment Work Restrictions Blood or OPIM Spills Cleanup Cleanup Contaminated Objects Self Management Personal Protective Equipment (PPE) Housekeeping Regulated Waste Laundry Procedures Hepatitis B Vaccination and Exposure Evaluation...pg BBP Training...pg Record Keeping...pg. 21 Annual Review...pg. 21 Appendix A) Texas Department of State Health Sharps Reporting Form B) Universal Precautions C) Handwashing D) Glove Removal E) Personal Protective Equipment (PPE) F) Blood or OPIM Spill Cleanup Forms (Form A)-- Hepatitis B Vaccine Refusal/Waiver (Form B)--Bloodborne Pathogen Exposure Incident Report (Form C)--Referral for Evaluation/Treatment of Exposed Employee (Form D)--Employee Consent for Release of Information After Bloodborne Pathogens Exposure Incident (Form E)--Source Individual Identification and Notification (Form F)--Source Individual Consent for Blood Testing and Release of Information (Form G)--Source Individual's Physician's Statement Request (Form H)--Physician's Medical Opinion Regarding Employee's BBP Exposure Incident Evaluation (Form I)--Employee Refusal of Treatment Post BBP Exposure Incident 2

3 Definitions For the purposes of the Exposure Control Plan (ECP), the following definitions apply: Blood Human blood, human blood components, and products made from human blood. Bloodborne Pathogens (BBP) Pathogenic microorganisms that are present in human blood and that can cause diseases in humans and include Hepatitis B Virus (HBV), Hepatitis C Virus (HCV), and Human Immunodeficiency Virus (HIV). Contaminated Means the presence or reasonably anticipated presence of blood or other potentially infectious material on an item or surface. Contaminated Sharps Means any contaminated object that can penetrate the skin including, but not limited to, needles, scalpels, broken glass and broken capillary tubes. ECP-Exposure Control Plan Engineering Controls--Means controls (e.g., sharps disposal containers and selfsheathing needles) that minimize the bloodborne pathogens' hazard from the workplace. Exposure Incident A specific eye, mouth, nose or 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. HBV-- Means Hepatitis B Virus HCV-- Means Hepatitis C Virus. HIV--Means Human Immunodeficiency Virus Occupational Exposure A 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) include: o Semen, 3

4 o Vaginal secretions, o Cerebrospinal fluid (fluid surrounding brain and spinal cord) o Synovial fluid (fluid surrounding joints) o Pleural fluid (fluid surrounding lungs) o Pericardial fluid (fluid surrounding heart) o Peritoneal fluid (fluid surrounding inner abdomen) o Amniotic fluid (fluid surrounding unborn baby) o Saliva in dental procedures o Any body fluid that is visibly contaminated with blood, and o All body fluids in situations where it is difficult or impossible to differentiate between body fluids. Parenteral Piercing the skin, barrier or mucous membrane through such events as needle sticks, human bites, cuts and abrasions. Personal Protective Equipment (PPE) Specialized clothing or equipment worn by an employee for protection against a hazard. General work clothing (uniform, pants, shirts, or blouses) not intended to function as protection against a hazard are not considered to be personal protective equipment. PPE may include such articles as repellent gowns, aprons, gloves, masks and goggles. Sharps An object used or encountered that can be reasonably anticipated to penetrate the skin or any other part of the body and result in an exposure incident and includes needle devices, scalpels, lancets, a piece of broken glass, a broken capillary tube, and an exposed end of dental wire. Sharps injury Any injury caused by a sharps including a cut, abrasion, or needle stick. Source individual Any individual whose blood or OPIM may be a source of occupational exposure to an employee. Universal and Standard Precautions Is an approach to infection control and works on the principle that all blood, body fluids, secretions, excretions (except sweat), nonintact skin and mucous membranes are treated as if known to be infectious for HIV, HBV and other bloodborne pathogens. Work Practice Controls--Means controls that reduce the likelihood of exposure by altering the manner in which a task is performed (e.g., prohibiting recapping of needles, eating in areas where blood or OPIM may be present). 4

5 TISD BLOODBORNE PATHOGENS EXPOSURE CONTROL PLAN Facility Name: Temple Independent School District Date of Preparation: November, 2000 Updated August 2014 Purpose The main purpose of this exposure control plan is to eliminate or minimize the risk of occupational exposure to blood or other potentially infectious materials (OPIM) for Temple Independent School District (TISD) employees through appropriate transmission prevention and control measures. Temple Independent School District is consistent in developing and implementing guidelines and procedures to safeguard the health and wellness of district employees and promote a safe work environment. The Bloodborne Pathogens Exposure Control Plan will be maintained by the TISD Assistant Superintendent of Student Services, the Director of Health Services and the Director of Employee Benefits/Risk Management. In accordance with House Bill #2085, the Texas Adminstative Code Chapter 96 and the Texas Health and Safety Code, ; and with guidance from the OSHA standard 29 CFR , "Occupational Exposure to Bloodborne Pathogens"; the following exposure control plan exists: The exposure control plan (plan) developed by the Department of State Health Services (department), is adopted as the minimum standard to implement Health and Safety Code, The plan is designed to minimize exposure of employees as described in of this title (relating to Applicability) and includes policies relating to occupational exposure to bloodborne pathogens, training and educational requirements for employees, measures to increase vaccination of employees, and increased use of personnel protective equipment by employees. Scope This Standard applies to all TISD personnel who could "reasonably anticipate" exposure to blood or OPIM as a result of performing their job duties. 5

6 IMPLEMENTATION SCHEDULE AND METHODOLOGY TISD initiated and completed an implementation schedule that would meet the requirement to provide BBP standards training to all employees and to identify designated employees in the "at risk for exposure" categories. EXPOSURE DETERMINATION The Bloodborne Pathogens Exposure Control Plan includes a process by which the employer performs an "exposure determination" to identify any employee with the potential for occupational exposure to blood or other potentially infectious materials (OPIM). An occupational exposure means that blood or OPIM may come in contact with the employee's mucous membranes (eyes, nose, mouth or skin) or through parenteral contact (skin piercing) while performing job duties. The exposure determination is made without regard to the use of personal protective equipment (PPE). This exposure determination must list all job classifications in which the employee, during the performance of work related duties, has the potential for an occupational exposure regardless of frequency. The following job classifications apply: Health Services staff members that provide direct health care related services in which blood or other potentially infectious materials (OPIM) or contaminated sharps are present Teachers/Aides providing care for handicapped, other health impaired, emotionally disturbed or special needs students Staff providing personal care assistance such at toileting, oral care and personal hygiene to students Teachers/Aides in classes of Science, Biology, Chemistry or Health Occupation Education Teachers/Aides involved in care of Head Start, Pre-K Classes and PREP Program Athletic Trainers, Coaches, and PE teachers who provide assistance to students with potential bleeding or OPIM injuries Custodians who clean and dispose of body waste from classrooms, first aid rooms or other areas contaminated by blood or other potentially infectious materials Plumbers and Building Maintenance employees who work in areas of waste products which can be contaminated by blood or other potentially infectious body fluids Bus Drivers who transport medically fragile, other health impaired, emotionally disturbed, or special needs students Campus Police that deal with injury related emergencies and behavior that may cause exposure to blood or OPIM Industrial technology teachers that teach students with possible risk of injury with a potential for bleeding Secretaries, office aides or designated person to cover the health clinic when health services personnel is unavailable The job descriptions for the above named employees present potential occupational exposure risks to bloodborne pathogens or OPIM. This list is inclusive, but not limited to the employees identified above. 6

7 COMPLIANCE METHODS Methods of compliance are used to reduce the risk to the employee by minimizing or eliminating employee exposure incidents to blood and OPIM from common bloodborne pathogens like Hepatitis B Virus (HBV), Hepatitis C Virus (HCV ) and Human Immunodeficiency Virus (HIV). Compliance methods include the use of: Universal/Standard Precautions Establishing Engineering Controls Implementing Appropriate Work Practice Controls Use of Personal Protective Equipment Utilizing Appropriate Housekeeping Procedures UNIVERSAL/ STANDARD PRECAUTIONS Universal/Standard precautions are practices and procedures that assist in the prevention of contact with blood or other body fluids. As a standard, each source individual's blood, or other body fluids, are treated as if known to be infectious regardless of the perceived status of the source individual. Although exposure to body fluids other than blood is unlikely in the school setting, the following body fluids are also to be treated as potentially infectious: Blood Semen Vaginal Secretions Cerebrospinal Fluid Pleural Fluid Pericardial Fluid Peritoneal Fluid Amniotic Fluid All Blood-contaminated Fluid Any employee with the potential to encounter the fluids listed above is to treat them as being infectious and use necessary personal protection and work practice controls as described in this control plan to prevent transmission. Safe work practices will minimize exposure to blood and OPIM. These practices include the following: Avoid skin exposure to potentially infected fluids Use a barrier (gown, gloves, mask) to keep fluids from contact with your skin Be careful with sharps and dispose of sharps such as needles, lancets or contaminated broken glass in a puncture resistant container. Do Not use bare hands to handle broken glass. Use tongs or other equipment to pick up broken glass contaminated with blood or OPIM Use disposable equipment whenever possible 7

8 Dispose of items soiled with potentially infected fluids in leak proof bags or containers appropriately labeled Wash hands thoroughly (minimum seconds) with soap and running water Clean up spills of potentially infected fluids with soap and water and disinfect spill areas with a bleach-water solution (diluted 1 part bleach to 10 parts water) or other appropriate disinfectant. ENGINEERING AND WORK PRACTICE CONTROLS Engineering and work practice controls are used to eliminate or minimize exposure to employees. Where occupational exposure remains after institution of these controls; personal protective equipment is used. Supervisors and workers regularly examine and maintain engineering and work practice controls within the work environment to insure compliance measures are intact. Engineering and Work Practice Controls include the following: a. Handwashing Hand washing is the single most effective means of preventing the spread of infection. Hand washing facilities are available to employees who incur exposure to blood or other potentially infectious materials. If a handwashing facility is not immediately accessible, the use of a hand sanitizer, waterless disinfectant or antiseptic towelette may be implemented and the hands are to be washed with soap and running water as soon as feasible. Hand washing facilities are available for staff use at the following areas: all restrooms, nurse s office and food preparation sites. Antiseptic hand cleaners are available for staff use in the nurse s office and throughout the facility. Employees shall wash hands or any other exposed skin with soap and water, or flush mucous membranes with water immediately or as soon as feasible following contact of such body areas with blood or OPIM. Eye wash is available in nurse s office. Employees shall wash their hands immediately or as soon as feasible after removal of gloves or other personal protective equipment. **DO NOT REUSE GLOVES 8

9 The following hand washing procedure is suggested: 1. Wet hands under running water. 2. Lather hands well with soap. Wash fingers, in between fingers, under fingernails, palms, back of hands, and wrists for at least 15 seconds. 3. Rinse hands thoroughly. 4. Dry hands thoroughly with SINGLE USE paper towels. 5. Turn off faucet with paper towel. b. Sharps Use and Proper Disposal Contaminated needles and other contaminated sharps are not to be bent, recapped, removed, sheared, or purposely broken. Engaging in this practice increases the potential risk for a sharps injury and possible exposure to infectious materials. All injuries or exposures involving sharps should be reported to the campus nurse/supervisor/control officer. A determination will be made regarding the circumstance of the exposure. If needed, the injury will be reported to the Texas Department of State Health Services (Infectious Disease Control Department) and a Contaminated Sharps Injury Reporting Form will be completed and submitted to the local Health Department. Encourage diabetic students to dispose their injection needles and any needles that are used to check blood sugar into an appropriate sharps container. 9

10 Contaminated Sharps Discarding and Containment Never throw sharps in with the regular trash. Contaminated sharps are discarded immediately or as soon as feasible in containers that are closable, puncture resistant, leak-proof on sides and bottom, and biohazard labeled or color-coded. During use, containers for contaminated sharps are easily accessible to personnel; located as close as is feasible to the immediate area where sharps are being used or can be reasonably anticipated to be found. Disposal containers are to be maintained upright throughout use; are not allowed to overfill; and are replaced routinely. Any broken glassware, which may be contaminated, is not picked up directly with the hands. Contaminated sharp objects are to be cleaned up with tongs, brushes, brooms and dustpans. If the outside area of the container becomes contaminated, the primary container shall be placed within a secondary container which is puncture resistant, leak proof and labeled or color coded. Outside contamination may be brought about by accidental spillage or contact with blood or OPIM. Full sharps containers will be disposed following approved environmentally safe guidelines. Contact TISD Health Services Department for disposal recommendations. Appropriate labeled color-coded, leak-proof and puncture resistant sharps containers are available at the following locations: Nurse s office/athletic Trainer s office. If needed, a biohazard disposal container may also be located in the custodial area. c. Work Area Restrictions In work areas where there is a reasonable likelihood of exposure to blood or other potentially infectious materials: Employees are not to eat, drink, apply cosmetics or lip balm, smoke, or handle contact lenses. Food and beverages are not to be kept in refrigerators, freezers, shelves, cabinets, or on counter/bench tops where blood or other potentially infectious materials are present. Employees shall wear gloves where it is reasonably anticipated that employees will have hand contact with blood or OPIM. Employees shall wash their hands or other skin immediately or as soon as feasible after removal of gloves or other personal protective equipment. 10

11 Mouth suctioning of blood or OPIM is prohibited (unlikely to occur in the school setting). Conduct all procedures in a manner which will minimize splashing, spraying, splattering, or generation of droplets of blood or OPIM. Remove all garments that are penetrated by blood immediately and place in an appropriated designated area or container for storage, cleaning, decontamination, or disposal. Remove all personal protective equipment prior to leaving the work area and place in an appropriated designated area or container for storage, cleaning, decontamination, or disposal. d. Blood or OPIM Spill Cleanup Immediately report the spill of blood or OPIM incident to the custodial staff so that it can be cleaned, decontaminated and removed promptly. A significant blood or OPIM spill incident is one in which there will be biohazardous material for disposal. Biohazardous waste shall only include items that are blood-soaked, caked with blood or contain liquid blood that could be wrung out of the item. This also includes items such as sharps, broken glass or plastic on which there is fresh blood or other potentially infectious materials. Use gloves. Do not reuse disposable gloves. If utility gloves are used, decontaminate after use with soap and water and appropriate disinfectant Use disposable paper towels and other absorbent materials to absorb spill Clean spill area with soap and water Utilize proper disinfectant cleaners and follow recommended procedures Wash hands with soap and running water e. Cleanup of Contaminated Objects or Equipment Equipment which may become contaminated with blood or other potentially infectious materials is examined prior to servicing or shipping and decontaminated as necessary unless the decontamination of the equipment is not feasible. Employers place a biohazard label on all portions of contaminated equipment that remain to inform employees, service representatives, and /or the manufacturer, as appropriate. f. Practice Self-Management Whenever possible and appropriate, employees should practice self-management of injuries and should teach students the same. The principle of self-management is based on the person whose blood or other body fluids are exposed; should themselves, if possible, manage, treat, clean and dispose of contaminated materials, thereby avoiding contact by a second party. g. Personal Protective Equipment (PPE) Where occupational exposure remains after institution of engineering and work controls, personal protective equipment shall be used. All necessary personal protective equipment used is provided without cost to employees. PPE is chosen based on the anticipated exposure to blood or other potentially infectious materials related to job duties. The type and 11

12 characteristics of the PPE shall depend upon the task, location and degree of exposure anticipated. PPE is considered appropriate only if it does not permit blood or other potentially infectious materials to pass through or reach the employee's clothing, skin, eyes, mouth, or other mucous membranes under normal conditions of use and for the duration of the time which the protective equipment is used. Examples of personal protective equipment provided by the district includes: Gloves Eyewear (with side shields) Gowns Face shields Masks Utility gloves Guidelines for PPE include: Use disposable equipment whenever possible. All personal protective equipment is removed prior to leaving the work area and placed in the designated receptacle. All personal protective equipment is fluid resistant. All personal protective equipment is cleaned, laundered, and disposed of by the employer at no cost to employees. The employer makes all repairs and replacements at no cost to employees. Disposable Gloves are worn where it is reasonably anticipated that employees may have hand contact with blood, other potentially infectious materials, mucous membranes, and non-intact skin; and when handling or touching contaminated items or surfaces. Disposable gloves shall be replaced as soon as practical when contaminated or as soon as feasible if they are torn, punctured, or when the ability to function as a barrier is compromised. Disposable gloves shall not be washed or decontaminated for reuse. Latex sensitive employees are provided with suitable alternative personal protective equipment. All employees will be given a Ziploc bag with 2 pair of gloves at the start of each year and replaced as needed. Proper Glove Removal Grasp the exterior of one glove with your other gloved hand. Carefully pull the glove off your hand, turning it inside-out The contamination is not on the inside. Ball the removed glove up and hold it in your other gloved hand. Slice your ungloved figer into the opening of the other glove. Avoid touching the exterior. Carefully ull the glove off your hand turning it inside-out again. All contamination is 12 contained. Discard appropriately.

13 Utility Gloves may be decontaminated for re-use provided that the integrity of the glove is not compromised. Utility gloves are discarded if they are cracked; peeling, torn, punctured, exhibits other signs of deterioration, or when their ability to function as a barrier is compromised. Masks in combination with eye protection devices, such as goggles, glasses with solid side shield, or chin length face shields, are required to be worn whenever splashes, spray, splatter, or droplets of blood or other potentially infectious materials may be generated and eye, nose, or mouth contamination can reasonably be anticipated. Surgical Caps or Hoods and /or fluid resistant shoe covers or boots are worn in instances when gross contamination can reasonably be anticipated. Disposable gloves, goggles, protective body clothing (i.e., gowns and mask) and resuscitation masks are found in Nurse s Office. **Note: Resuscitation bags and Pocket Masks may be used to avoid direct contact during resuscitation efforts. Pocked Masks are available in the nurses office. h. Housekeeping Employers shall ensure that the worksite is maintained in a clean and sanitary condition. All contaminated work surfaces are decontaminated after completion of procedures and immediately or as soon as feasible after any spill of blood or other potentially infectious material Protective coverings (e.g., plastic wrap, aluminum foil, etc.) used to cover equipment and environmental surfaces are removed and replaced as soon as feasible when they become contaminated. Decontamination will involve the cleanup of all material by absorption using paper toweling( or other absorbent material), water and soap and final disinfection with an EPA-approved disinfectant. A one to ten part bleach and water solution may be used. The solution will be made freshly prior to use and discarded daily. The custodial staff will make themselves available for all blood and body fluid spill cleanup. Cleanup Kits should include: gloves, paper towels, disinfectants dustpan plastic contaminate bag. All bins, pails, cans, and similar receptacles used for contaminated objects disposal are inspected and decontaminated regularly. Any broken glassware or sharp objects, which may be contaminated, are never picked up directly with the hands. Cleanup will be done with tongs, brushes, brooms and dustpans. Brushes, dustpans and tongs used for contaminated cleanup must be washed, disinfected or discarded after use. Preparing a 1:10 Parts Bleach Solution Gather Supplies Quart-sized or larger plastic spray bottle or appropriate container with a lid Plastic Measuring Cup Damp cloth Household bleach Water 13

14 Go Outside or to a Well Ventilated Room Full strength bleach emits toxic fumes and should never be used in small or enclosed spaces. Ideally, you should mix your solution outside. If that is not an option, go to a large well ventilated room and open the windows if possible. Measure Ingredients To make a 1:10 solution, you need 1 part bleach for every 9 parts water. A good amount to start with is: ¼ cup bleach 2 ¼ cup water Carefully pour the bleach into the spray bottle or container, then add the water. Mixing the solution in this order will prevent the bleach from splashing up on you. If you do get any bleach on your skin, wipe it off immediately with the damp cloth. If you need to make a larger amount of disinfectant solution, increase the amounts of bleach and water accordingly, using the same proportions as above (½ cup bleach with 4 ½ cups water, ¾ cup bleach with 6 ¾ cup water, etc). Mix the Solution Place the lid on the container and gently invert the container back and forth a few times to mix. Your solution is now ready to use. Never add any other ingredients to you bleach solution because many substances including vinegar create harmful fumes when mixed with chlorine bleach. Discard Unused Solution Chlorine bleach solution begins to lose its disinfectant power quickly when exposed to heat, sunlight, and evaporation. In order to be sure your solution is still strong enough to kill germs, you should mix a fresh batch each day and discard whatever amount you don t use at the end of the day. i. Regulated Waste Disposal Regulated contaminated waste other than sharps is placed in appropriate containers that are closable, leak resistant, labeled with a biohazard label or color-coded as appropriate, and closed prior to removal. If outside contamination of the regulated waste container occurs, it is placed in a second container that is also closable, leak proof, labeled with a biohazard label or color-coded, and closed prior to removal. All regulated waste is properly disposed of in accordance with federal, state, county, and local requirements. Gloves and other materials used for the purpose of waste disposal should be discarded in plastic bags or lined trashcan. Plastic bags should be changed daily and disposed of routinely. Double bagging can be used when there is a high risk of contamination. Red bags are available at sites where there is reasonable anticipation of the presence of items contaminated with blood or OPIM. 14

15 Gloves should be kept in all areas of high risk, such as, health clinics, maintenance areas, police/security stations and any classroom where risk of spills is particularly high. j. Laundry Procedures Although soiled linen may be contaminated with pathogenic microorganisms, the risk of disease transmission is negligible if it is handled, transported, and laundered in a manner that avoids transfer of microorganisms to students, personnel, and environments. Contaminated laundry shall be handled as little as possible. Gloves must be worn when handling contaminated laundry. It shall be bagged or containerized at the location where it was used/soiled and shall not be sorted or rinsed in the location of use. Containers must be leak proof if there is reasonable likelihood of soak-through or leakage. All Personal Garments which are penetrated by blood or OPIM are removed immediately or as soon as feasible and placed in a plastic bag and sent home for laundering. Items Laundered For School Use,or in the school setting, should be washed with detergent in a hot water cycle (160 F) before reuse. If low temperature (<158 F) laundry cycles are used, chemicals suitable for low-temperature washing at proper use concentration should be used. 15

16 HEPATITIS B VACCINATION AND POST EXPOSURE EVALUATION PROCEDURE All employees who have been identified as having a reasonable anticipation of occupational exposure to blood or other potentially infectious materials will be offered the Hepatitis B Vaccine (HBV), at no cost to the employee. The Human Resources Department will notify the Director of Health Services when a new employee joins the school district, or a current employee changes jobs within the district in order to insure evaluation of the employee's "at risk" status and qualification for the HBV. The vaccine will be administered to district employees under the supervision of a licensed physician or licensed healthcare professional. The vaccine is offered, in addition to bloodborne pathogens training, within 30 working days of the initial work assignment start date. The employee will meet the exemption criteria for immunization if the employee has previously received the complete hepatitis B vaccination series; or antibody testing has revealed that the employee is immune; or that the vaccine is contraindicated for medical reasons. Employees will be notified via or school mail of their status as an identified "at risk employee". The Exposure Control Officer/ Director of Health Services will notify the "at risk employee" of the vaccine administration schedule dates and location of the vaccination clinic. An employee may decline the Hepatitis B vaccination, in which case, the employee will sign a declination statement. (See Form A) The employee may, at a later date, request the vaccine; the school district shall grant the request at no cost to the employee. Records regarding HBV vaccinations or declinations are to be kept by the district's Director of Health Services. Post Exposure Evaluation and Follow up All significant employee exposure incidents involving the presence of blood or OPIM shall be reported to the campus nurse, exposure control officer or Director of Health Services by the end of the work day in which the incident occurred. The employee will be offered a confidential medical evaluation and follow-up. The incident description must include a determination of whether or not, in addition to the presence of blood or other potentially infected materials, an "exposure incident," as defined by the standard, has occurred. An occupational exposure incident means that blood or OPIM may have come in contact with the employee's mucous membranes (eyes, nose, mouth or skin) or 16

17 through parenteral contact (skin piercing) while performing job duties. The exposure determination is made without regard to the use of personal protective equipment (PPE). This determination is necessary in order to ensure that the proper post-exposure evaluation, prophylaxes ad follow-up procedures are made available immediately if there has been an exposure incident as defined by the standard. (See Form B) After immediate BBP exposure action is complete (immediately wash exposed area or flush mucous membranes with running water and notification made to the Campus Nurse, Employee Supervisor, or Exposure Control Officer); the following steps will be taken if it is determined that the employee has experienced a BBP exposure incident: 1. The Exposed Employee Will Complete the Following Forms and Activity: A. Employee is to complete the "Bloodborne Pathogen Exposure Incident Report" (Form B). Available from Campus Nurse. Documentation of the routes of exposure and the circumstances related to the incident are imperative. B. Employee is to complete the "Employee Work Related Injury Packet" (Worker's Comp). Available from Campus Secretary. Must be completed in addition to the BBP Exposure Incident Packet C. Employee or Exposure Control Officer will contact the Director of Employee Benefits/Risk Management for prior approval to schedule an appointment for medical evaluation. (This needs to happen before the doctor s appointment (unless it is an emergency situation). D. Employee will schedule an appointment in the Occupational Medicine Department (OMD)/Work Related Injury Department(WRID) of their choice. Local OMD/WRID are located at Baylor Scott and White, (OMD)/ (WRID) or Doctor s E. If exposed employee refuses evaluation or treatment, "Employee must complete "Refusal of Treatment Post BBP Exposure Incident" (Form I). F. All injuries or exposures involving "sharps" should be reported to the Campus Nurse/Employee Supervisor/Exposure Control Officer for review of circumstances so as to prevent future injury; and to determine if the Texas Department of State Health Services, Infectious Disease Control, Contaminated Sharps Injury Reporting Form (Appendix B) needs to be completed and submitted to the local Health Department. Click here for link to web site for form completion. This form will be completed by the campus nurse. Once completed, it will be printed and submitted to the local health authority. (Bell County Region 7). G. Employee will complete "Employee Consent for Release of Information After Bloodborne Pathogens Exposure Incident Evaluation" (Form D). Available from Campus Nurse Form must be signed by the exposed employee and sent to Exposure Control Officer. 17

18 2. If possible, the "source individual" needs to be identified and documented on the Source Individual Identification and Notification Form (Form E). Available from Campus Nurse Identification and documentation of the source individual will be done unless the employer can establish that identification is not feasible or prohibited by state or local law. Form E is to be completed by the campus nurse or Employee Supervisor and sent to the Exposure Control Officer. The source individual will be contacted by the campus nurse(or Exposure Control Officer) and a "Source Individual Consent for Blood Testing and Release of Information Form " (Form F) will be completed by the source individual and returned to the TSD Exposure Control Officer. If the source individual is a minor enrolled in TISD; the campus nurse (or Exposure Control Officer) will contact the parent/guardian of the minor student and obtain a "Source Individual Consent for Blood Testing and Release of Information Form " (Form F) to determine source individual's HIV/HBV infectivity. The source individual will be referred to their health care provider for testing. The parent/guardian is responsible for the cost of the blood testing. If the source individual is already known to be infected with HBV or HIV, testing of blood does not need to be repeated. Hepatitis B vaccination status of source individual will be verified if received at this time; however, blood testing will be recommended to establish antibody response. The results of the testing of the source individual are made available to the physician providing the employee's BBP exposure evaluation/treatment as reported on the "Source Individual's Physician's Statement Request" (Form G). Form G will be sent to the source individual's physician by the TISD Exposure Control Officer. All tests are kept confidential. The results of testing of the source individual are made available to the exposed employee with the employee informed about the applicable laws and regulations concerning disclosure of the identity and infectivity of the source individual. The employee will be informed about the applicable laws and regulations concerning disclosure of the identity and infectivity of the source individual. A test result is confidential. A person that possesses or has knowledge of a test result may not release or disclose the test result or allow the test results to become known. (Section ) 18

19 In the event that the source individual or parent/guardian of a minor child declines testing after personal or telephone contact, the (Exposure Control Officer) will send the Source Individual Consent for Blood Testing and Release of Information Form" (Form F) to document that the source individual or parent/guardian has been notified of the exposure and risk to employee. 3. The exposed employee will be referred to the OMD/WRID of their choice and offered the option of having his/her blood collected for testing of HIV/HBV serological status. If the employee does not consent to HIV testing at the time of the initial blood collection for baseline testing; the blood sample is preserved for at least 90 days to allow the employee to decide if the blood should be tested for HIV serological status. If the employee decides during that time to proceed with testing, then testing is done as soon as feasible. The employee is offered post exposure prophylaxis in accordance with the current recommendations of the U.S. Public Health Service. The employee is given appropriate counseling concerning infection status, results and interpretations of tests, and precautions to take during the period after the exposure incident. The employee is informed about what potential illnesses can develop and to seek early medical evaluation and subsequent treatment. The following person(s), Assistant Superintendent of Student Services, the Director of Health Services and the Director of Employee Benefits/Risk Management (are) designated to assure that the policy outlined here is effectively carried out and maintains records related to this policy. Employers must retain an accurate record for each employee with an occupation exposure, for at least 30 years past the duration of employment. A copy of the following forms may be sent to the employee s OMD/WRID health care provider to assist in evaluation/treatment of exposed employee. Employee's written Exposure Incident Statement (Form B) Employee's Hepatitis B Vaccination Status Employee's Hepatitis B Vaccination Declination Statement (Form C, if appropriate) Source Individual's Hepatitis B Immunization Record (if available) Source Individual's HBV and/or HIV blood testing results (if available) A copy of the TISD BBP Exposure Control Plan 4. The Exposure Control Officers will provide the exposed employee with a copy of the evaluating healthcare professional s written opinion (Physician's Medical Opinion Regarding Employee's BBP Exposure Incident Evaluation /Form H) within 30 days of the completion of the evaluation. The Exposure Control Officer will provide Form H to the physician responsible for evaluation and/or treatment for completion. 19

20 Health care professionals providing evaluation/treatment are instructed to limit their written opinions to: Whether Hepatitis B vaccine is indicated as treatment Whether the exposed employee received the vaccine Evaluation following an exposure incident Whether employee has been informed of the results of the evaluation Whether employee has been told about any medical conditions resulting from exposure to blood or OPIM which require further evaluation or treatment ( all other findings or diagnosis shall remain confidential and shall not be included in written report) Whether the healthcare professional's written opinion is provided to the employee within 30 days of completion of the evaluation BBP Training Training for all employees is conducted prior to initial assignment to tasks where occupational exposure may occur. All employees with potential for occupational exposure will be oriented to infection control guidelines within 30 days of their employment and annual refresher training will be conducted within one year of the employees previous training. Training for employees is coordinated by a person knowledgeable in the subject matter. Online Training for all employees is through the TISD Eduphoria Course Management Program. Employees will automatically be enrolled in the BBP Course at the start of each school year. New employees will be enrolled at the time of their hire and annually thereafter. Completion of training is required for all employees. The Professional Development Department/Technology is responsible for establishing and maintaining employee-training records for 3 years. Training should include an explanation of the following: Chapter 96. Bloodborne Pathogen Control OSHA Bloodborne Pathogen Final Rule Epidemiology and Symptomatology of bloodborne diseases Modes of transmission of bloodborne pathogens Temple Independent District Exposure Control Plan (i.e., points of the plan, lines of responsibility, how the plan will be implemented, where to access plan, etc.) Procedures which might cause exposure to blood or other potentially infectious materials at this facility 20

21 Control methods which are used at the facility to control exposure to blood or other potentially infectious materials Personal protective equipment available at this facility (types, use, location, etc.) Hepatitis B vaccine program at the facility Procedures to follow in an emergency involving blood or other potentially infectious materials Procedures to follow if an exposure incident occurs (to include U.S. Public Health Service Post Exposure Prophylaxis Guidelines) Post exposure evaluation and follow up Signs and labels used at the facility A contact number or to direct questions Record Keeping TISD Department of Health Services will collect and maintain employee Hepatitis B Vaccination records. All records will be kept in accordance to confidentiality guidelines. This includes evidence of vaccination or declination forms. (See Forms) The Exposure Control Officers will collect data related to BBP exposure incidents and send to Employee Benefits/Risk Management. Risk Management is responsible for establishing and maintaining confidential medical records for at least 30 years past the duration of employment. *Note: the OSHA standard on bloodborne pathogens requires medical records to be retained for each employee with occupational exposure for at least the duration of employment plus 30 years and requires that training records be maintained for 3 years from the date on which the training occurred. The TDH draft Texas Bloodborne Pathogen Standard, (October 19, 1993 version) contains no specific requirements on length of record retention. Annual Review The TISD Bloodborne Pathogens Control Committee will review the Exposure Control Plan (ECP) annually. Any updating or revisions will be documented as they occur. The committee will consist of the Assistant Superintendent of Student Services, the Director of Health Services and the Director of Employee Benefits/Risk Management. Signature Date Signature Date Signature Date 21

22 APPENDIX 22

23 TEXAS DEPARTMENT OF HEALTH Form E (7/00)) TDH Infectious Disease Epidemiology & Surveillance Division Contaminated Sharps Injury Reporting Form The facility where the injury occurred should complete the form and submit it to the local health authority where the facility is located If no local health authority is appointed for this jurisdiction, submit to the regional director of the Texas Department of Health regional office in which the facility is located. Address information for regional directors can be obtained on the Internet at tdh state tx us/brlho/regions.htm., The local health authority, acting as an agent for the Texas Department of Health will receive and review the report for comp eteness. and submit the report to: IDEAS, Texas Department of Health West 49th Street, Austin, Texas Copies of the Contaminated Sharps Injury Reporting Form can be obtained on the Internet at http //www tdh state.tx.us/ideas/report/sharps him or from the Texas Department of Health, Public Health Regional Offices. Please complete a form for each exposure incident involving a sharp. Facility (agency/institution),where injury occurred (Use block letters to fill in boxes.) Street address (no P.O. Boxes) City County - Zip code I Street address of reporter if different from fac ility (agency/institution)) where injury occurred (no P.O. Boxes) Date filled out (mm/dd/yy)) By (reporter) I Phone number 7 1. Date of injury (mm/dd/yy)) Time of injury Sex of injured person - - F am F pm F Male F Female 2. Type and brand of sharp involved (Fill in one circle and/or boxes as appropriate.) Needle (nonsuture)) F Vacuum tube collection Glass F - Insulin syringe with needle F Other nonsuture needle F Blood tube F Tuberculin syringe with needle F Other tube F - gauge needle factory-attached to syringe Surgical instrument or other sharp (no glass) F Slide F Other syringe with needle F Lancet F Ampule F Prefilled cartridge syringe (ie, Tubex-type syringe) F Suture needle F Other glass F Blood gas syringe F Scalpel F Syringe, other F Trocar F Needle connected to IV line F Staples F Winged steel needle F Wire F V catheter. loose F Other surgical instrument/nonglass sharp Bra nd (fill in brand name or unknown ) 3. Original intended use of sharp (Fill in one circle.) F injection. IM F Cutting (surgery) F injection. SC/ID F Start IV or set up heparin lock F Suturing. skin F Other injection/aspiration IV F Suturing. deep F Heparin or saline flush F Draw venous sample F Obtain body fluid/tissue sample F Draw arterial sample F Finger stick/heel stick F Drilling F Electrocautery F Wiring F Contain specimen/pharmaceutical F Other F Unknown/NA Appendix A 23

24 Universal Precautions Appendix B 24

25 Handwashing Appendix C 25

26 Glove Removal Appendix D 26

27 Personal Protective Equipment Appendix E 27

28 Blood Spill or OPIM Cleanup Appendix F 28

29 FORMS 29

30 Temple Independent School District Health Services Instructions for Completing Employee BBP Exposure Incident Forms In the event that an employee experiences a true BBP exposure incident as a result of performing job related duties; the campus nurse will help the employee complete the appropriate forms and notify the Health Services Exposure Control Officer. An exposure to blood, body fluids or other potentially infectious material involving the mucosa of the eye(s), mouth, nose or other mucous membrane and skin that is not intact should be treated as BBP exposure incident. Work Related Injury Forms to be Completed A. All on the job employee exposure incidents will be considered as a Work Related Injury and the appropriate forms must be completed. Workman s Comp forms are to be completed by the employee and are available from the campus secretary or the office of the Director of Employee Benefits/Risk Management. The Director of Employee Benefits/Risk Management (Jane Hays) must be notified for approval prior to scheduling a doctor s appointment. Appointments for a Work Related Injury may be made at either Baylor Scott & White or Doctor s Express. B. The Occupational Medicine/Work Related Injury Department at Baylor Scott & White is located on the ground floor at the back of the main hospital. The employee will call the department at to schedule an appointment. The Urgent Care/Doctor s Express facility is located at 3614 H.K. Dodgen Loop (next to Cracker Barrel) and the phone number is After notifying Employee Benefits, the employee will call either facility to schedule an appointment. C. If a sharps injury has occurred, the campus nurse or Director of Health Services must complete the Contaminated Sharps Injury Reporting Form (Appendix A) online at and selecting Contaminated Sharps Reporting Form. Completed sharps reporting forms are sent to the local Health Department. Bloodborne Pathogen Reporting Forms to be Completed Include by Employee: A. The exposed employee will complete the Bloodborne Pathogen Exposure Incident Report (Form B). The form must be signed by the exposed employee. Documentation should include the routes of exposure and the circumstances related to the incident. The campus nurse will document in SKYWARD any assessment/treatment provided as an employee office visit. Make note if the employee scheduled an appointment or if they refused to seek evaluation. If the employee refuses to seek evaluation/treatment, the bottom portion of form B must be completed and signed by the exposed employee. In addition, the exposed employee must complete Refusal of Treatment Post BBP Exposure Incident (Form I). Form I will be sent to the Exposure Control Officer. B. The employee will complete Employee Consent for Release of Information After Bloodborne Pathogens Exposure Incident Evaluation (Form D) and return it to the Exposure Control Officer. 30

31 BBP Forms to be Completed by Source Individual/Exposure Control Officer/Campus Nurse as indicated: A. If known, the Source Individual Identification and Notification Form (Form E) will be completed by the campus nurse/supervisor/exposure control officer. Completed form will be sent to the Exposure Control Officer. B. If source individual is identified, the campus nurse will provide the source individual or parent/guardian of a minor source individual the Source Individual Consent for Blood Testing and Release of Information (Form F). The form will be completed by the source individual or minor's parent/guardian and returned to the campus nurse. (ultimately form F must be sent to the Exposure Control Officer. Over the phone consent/refusal is not allowed. A signature is required for consent/refusal. The Exposure Control Officer will contact the source individual's health care provider and send a Source Individual's Physician's Statement Request (Form G). This form will be completed by the source individual's health care provider (person doing the blood testing) and returned to the Exposure Control Officer. If the Source Individual is already known to be infected with HBV or HIV, testing of blood DOES NOT need to be repeated. It is recommended that Hepatitis B vaccination status of the Source Individual be verified by blood testing to establish antibody response. Additional immunizations will be determined by Source Individual's health care provider. Only the results of the blood testing of the Source Individual will be made available to the employee's health care provider and employee. All tests results are kept confidential. If the Source Individual or parent/guardian of a minor source individual, declines testing, Form F must be completed to indicate the source individual and or parent/guardian is aware of the risk to the exposed employee. C. The Exposure Control Officer will complete the Referral for Evaluation/Treatment of Exposed Employee (Form C) and submit with all completed paperwork to the Director of Risk Management. The exposed employee will be recommended to obtain a health evaluation due to the BBP exposure. The employee will select evaluation/treatment from the Work Related Injury facility of their choice. The Exposure Control Officer will proved the selected facility/healthcare provider with the Physician's Medical Opinion Regarding Employee's BBP Exposure Incident Evaluation (Form H); and all other required information needed to complete the employee's evaluation and treatment, as listed below: 1. Bloodborne Pathogen Exposure Incident Report (Form B) 2. Employee Hepatitis B Vaccination Record (if available) 3. Employee Hepatitis B Vaccine Refusal/Waiver (Form A) (if applicable) 4. Referral for Evaluation/Treatment of Exposed Employee (Form C) 5. Employee Consent for Release of Information After BBP Exposure Incident Evaluation (Form D) 6. Source Individual s Hepatitis B Vaccination Status (if available) 7. Source Individual Consent for Blood Testing and Release of Information (Form F) 8. Source Individual's Physician's Statement Request (Form G) 9. Copy of the BBP Exposure Control Plan Revised 8/