AACS World Wide
Web PagesApril, 1994
Introduction 1
Exposure Determination 1
Methods of Compliance 3
Engineering/Work Practice Control 3
Personal Protective Equipment 4
Regulated Waste 5
Hepatitis B Control 5
Communication of Hazards 7
Information and Training of Staff 7
Employee Medical Records 9
Attachments:
A1 - Training Log Form
A2 - Group I Training Verification Form
A3 - Group II and III Training Verification Form
A4 - Incident Report Form
A5 - Health Care Provider Report
A6 - Hepatitis B Consent/Declination Form
A7 - Source Person Consent Form
A8 - Standard Incident Flow Chart
A9 - Out of Area Incident Flow Chart
A10 - Procedures for Custodians and Maintenance Technicians
A11 - Procedures for Bus Drivers and Monitors
A12 - Procedures for Students with Special Needs
BLOODBORNE PATHOGENS EXPOSURE CONTROL PLAN
The Occupational Safety and Health Administration, United States Department of Labor on December 6, 1991 published the final standard on the prevention of occupational exposure to bloodborne pathogens.
Little has been left to state or local discretion. This standard requires an Exposure Control Plan</I> be completed by employers. Each topic in the plan is specified in the standard itself. This plan is to help in clarifying the expectations and procedures for paid and volunteer staff in the Audubon Area Community Services, Inc. (AACS). The purpose of this plan is to protect employees and comply with requirements of the Occupational Safety and Health Administration (OSHA). This Exposure Control Plan</I> shall be a part of the AACS Personnel Policies and Procedure Manual - in the Appendix. This manual is located at each AACS worksite and available for employee and governmental agency review.
In its continuing effort to collaborate with the local school districts in which Head Start centers are located, the Audubon Area Community Services, Inc. Head Start Program will comply with all respective district policies regarding Bloodborne Pathogens Plan for those employees housed within each district's facilities in lieu of and/or in addition to those stated herein. II. Exposure Determination It is the AACS' policy to protect its employees who have potential exposure to bloodborne pathogens, which are microorganisms present in human blood having the potential to cause serious illnesses. The agency's goal is to reduce or eliminate occupational exposures by providing training and personal protective equipment as needed and by using universal precautions. Group I and exposed employees will additionally be offered both pre- and post-exposure testing, counseling, follow-up and Hepatitis B vaccination. An exposure incident is defined by OSHA as a specific contact by an employee involving eye, mouth, other mucous membrane, non-intact skin, or parenteral contact (parenteral means "piercing events" as needle sticks, human bites, cuts, and abrasions) with the blood or any other potentially infectious substance/materials from another person that results during the performance of an employee's official duties. Other Potentially Infectious Fluids include blood, semen, vaginal secretions, any body fluid that is contaminated with blood, all body fluids in situations where it is difficult or impossible to differentiate between body fluids, cerebrospinal fluid, synovial fluid, pleural fluid, pericardial fluid, peritoneal fluid, amniotic fluid, and saliva in dental procedures. The AACS recognizes that its employees have the potential for exposure to other body fluids not included in the plan; therefore, for their protection from non-bloodborne pathogens, personal protective equipment will be provided for such tasks and procedures as indicated.
A. In the following job classifications, all AACS employees are ranked according to likelihood of their occupational exposure to bloodborne pathogens as part of their normal work routine:
GROUP I
This group of employees of Audubon Area Community Services, Inc. may have the greatest likelihood of exposure to bloodborne pathogens. These employees have primary job assignments which involve rendering First Aide or being CPR Responders. This group includes only those designated Head Start teachers/aides and other AACS employees as specified by the respective AACS project director and/or the Executive Director. B. In the following job classifications, some employees could have occupational exposure to bloodborne pathogens, but the potential for exposure is not deemed part of their normal work routine:
GROUP II
Child Care Givers
Preschool Teachers and Associates
Secondary First Aide and CPR Responders whose <B>primary</B> job assignment does not include rendering first
aid
Designated Bus Drivers
Designated Custodians and Maintenance Technicians
Designated Head Start Staff, Teachers, Aides, and Assistants
Designated Program Coordinating Staff
C. In the following job classifications, employees do not normally have occupational exposure to bloodborne pathogens:
GROUP III
Most Administrative Staff
Most Program Coordinating Staff
Most Office Clerical Staff
Most FPP Counselors/Therapists
Most Bus Drivers
Most Teachers, Aides, and Assistants
Most Weatherization Technicians/Laborers
Most SCP Stipended Participants
Most Maintenance Workers
Grounds Workers
Food Service Workers
Volunteer/Temporary Service Staff
D. ALL EMPLOYEES EXPOSED TO BLOODBORNE PATHOGENS - UNIVERSAL COVERAGE
If an unanticipated exposure occurs, the employee and/or volunteer will be provided with appropriate follow-up care regardless of their group classification. Any and all exposures must be reported to the employee's or volunteer's immediate supervisor and line supervisors as indicated.
III. Methods of Compliance
1. Universal Blood and Body Fluid Precautions.
Universal precautions may be summarized by the following principles as they apply to bloodborne pathogens:
All blood and body fluids shall be treated/considered as being potentially infectious.
Barriers to prevent contact with potentially infectious fluids shall be used in all cases.
Staff shall appropriately handle needles and other sharp objects.
Handwashing or an interim use of appropriate antiseptic hand cleaner is to be used as soon as possible after any contact with blood or body fluids even when gloves are used.
Staff shall always quickly wash away any blood accidentally splashed into eyes, nose, mouth or on to non-intact skin.
Staff shall use personal protective equipment when required.
Designated staff shall immediately clean up blood and other potentially bloody body fluids. (See attachments A10, A11, A12 for further information.)
2. Staff shall follow agency approved guidelines for disinfection, housekeeping, and waste and sharps disposal.(See attachments A10, A11, A12 for further information.)
3. Training. All agency staff shall receive training on bloodborne pathogens control. See Section IX on specific training requirements by group designation.
IV. Engineering/Work Practice Controls
1. This Exposure Control Plan will be followed by all Audubon Area Community Services, Inc. staff - paid or volunteer - and the plan will be reviewed and updated annually or as revisions are needed.
2. The supervisor at each site shall be responsible for furnishing information to the appropriate project director of Audubon Area Community Services, Inc. regarding any changes in local staff person's job duties which would require initial or additional training and/or vaccinations.
3. Each AACS employee is responsible for adhering to the work practices and guidelines set forth in this plan.
4. Audubon Area Community Services, Inc. generally provides handwashing facilities which are readily accessible to employees. Where handwashing facilities are not available, antiseptic hand cleaner and clean towels or antiseptic towelettes will be provided.
5. Each employee shall wash his/her hands - whether bare or gloved - and any other exposed skin with liquid soap and water after removal of gloves or other personal protective equipment - and flush contaminated mucous membranes with water immediately or as soon as feasible following contact with blood or other potentially infectious materials.
6. Any potentially contaminated needles and other potentially contaminated sharps will not be bent, recapped, or removed from an attached device. Shearing or breaking of contaminated needles is prohibited. Needles and other sharps, including broken glass contaminated with body fluids will be promptly disposed of in puncture-resistant, leak-proof closeable container. They should be securely stored.
7. Eating, drinking, smoking, applying cosmetics or lip balm, and handling contact lenses are prohibited for employees while providing any care or cleanup where there is a reasonable likelihood of occupational exposure to potentially infectious materials.
8. Broken glass will be picked up using a dust pan and broom or other mechanical means other than by hand.
9. Needles and other sharps must not be jammed into the containers in such a way as to over fill them and employees should not reach into these containers by hand.
10. All procedures involving blood or other potentially infectious materials shall be performed in such a manner as to minimize splashing, spraying, spattering, and generation of droplets of these substances.
V. Personal Protective Equipment
1. Provision. Audubon Area Community Services, Inc. will provide, at no cost to the employee, personal protective equipment appropriate for the services provided. Examples of protective equipment should include gloves, one way CPR masks, safety glasses, face masks, or gowns.
2. Accessibility. Audubon Area Community Services, Inc. will ensure that personal protective equipment is readily accessible at the worksite in the appropriate sizes and be single use disposable type when applicable.
3. Cleaning, Laundering, and Disposal. Each location of the agency's operations will be responsible for cleaning, laundering and disposal of personal protective equipment at no cost to the employee.
4. Repair and Replacement. Audubon Area Community Services, Inc will repair or replace personal protective equipment as needed to maintain its effectiveness, at no cost to the employee. When personal protective equipment is removed it will be placed in an appropriate receptacle for disposal. If a garment(s) is penetrated by foreign blood or other potentially infectious materials, the garment(s) will be removed immediately or as soon as possible thereafter. Garments will be placed in a secure bag and be cleaned - if feasible - at no cost to the employee. Laundry at specific locations will be handled in accordance with universal precautions.
5. Gloves. Gloves will be worn when it can be reasonably anticipated that the employee may have hand contact with potentially infectious materials, mucous membranes, and non-intact skin; and when handling or touching contaminated items or surfaces. Disposable single use gloves, such as surgical or examination gloves, will be replaced as soon as practical when contaminated or as soon as feasible whenever their ability to function as a barrier is compromised.
Disposable (single use) gloves will not be washed or decontaminated for re-use. Appropriate sizes will be available along with an alternative for employees who are allergic to the gloves that are normally provided. Utility gloves may be decontaminated for re-use if the integrity of the glove is not compromised. However, they must be discarded if they are cracked, peeling, torn, punctured, or exhibit other signs of deterioration that compromise their ability to function as a barrier.
6. Masks. Mouthpieces will be provided for CPR when needed. Face masks will be used against excessive spurting or splashing of blood or other contaminated body fluids.
7. Eye Protection. Safety glasses or face shields will be available for job duties that could lead to splashes of hazardous materials to the eyes.
8. Gowns. Disposable - used with excessive spurting or splashing of blood or other contaminated body fluids. Non-disposable - used by workers who are involved in burping infants and other job duties that can lead to saliva and other body fluids coming in contact with their clothing. A burping cloth will be available to reduce the chance of contaminating the protective gown.
VI. Regulated Waste. Contaminated items that would release blood or other potentially infectious materials in a liquid or semi-liquid state or items that are caked with dried or other potentially infectious materials which could release their materials during handling, will be placed in bags and disposed of as regular trash. Broken glass contaminated with blood or other potentially infectious materials will be placed in a disposable puncture-resistant container and disposed as regular trash.
Other sharps (i.e., needles, knives) will be placed in puncture-resistant containers located in areas designated at each facility. Containers will be maintained upright during use and will not be allowed to overfill. They will be leak-proof on sides and bottom and must be closed and taped prior to transport. These containers will be disposed of after they are full. (Please notify the supervisor's office for disposal information and directions.)
VII. Hepatitis B Control.
1.Vaccination
The supervisor or designee of the project director will schedule an appointment for with the designated health care provider within ten (10) days - for each employee who is classified in Group I who has received the required training program. Vaccination, treatment, and counseling will be provided at no cost to the employee.
Hepatitis B vaccine will be given in a series of injections in the upper arm.
a. Pre-vaccination. Group I and exposed employees who give their consent qualify for the pre-vaccination program consisting of the initial injection, a second injection one month from the initial injection, and a third injection six months from the initial injection. A post-effectiveness test will also be given to determine if antibodies have developed. If an individual does not receive immunity from the three injections, two additional injections can be given thirty (30) days apart to promote adequate antibody response. Protection against both the illness and development to carrier state lasts at least nine (9) years. Booster injections are not at this time being recommended. However, should booster injections be required in the future, they shall be made available at no cost to the employee.
If the eligible employee consents to be vaccinated, they will be evaluated by a licensed health professional to ascertain that there are no medical contraindications to the vaccinations. These include: hypersensitivity to yeast or an adverse reaction to a previous dose of Hepatitis B vaccine. The health care provider would notify the Center for Disease Control (CDC) Branch Department for Health Services in Atlanta, Georgia in these cases and will advise on how to proceed. If no contraindications exist, the employee will receive three (3) (or remaining doses in case of reaction to first) of Hepatitis B vaccine.
If an eligible employee declines the Hepatitis B vaccination, a waiver must be signed. Employees may change their mind at any time and obtain vaccination. b. Post-Vaccination. Hepatitis B vaccinations will be offered to employees upon a properly reported incident of exposure to blood or other body fluids containing blood. Post exposure vaccine will (if possible) be given within twenty-four (24) hours of the incident unless employee refuses to obtain it, has already received the series, anti-body testing reveals immunity or the vaccine is contraindicated due to medical reasons. The series is the same as for pre-vaccination. In addition, an injection of serum immune-globulin will be administered. If the exposed person has begun the Hepatitis B vaccinations series, but has not completed the series, then one dose Hepatitis B immune globulin should be given immediately and vaccinations series completed.
A post effectiveness test will be given to determine if antibodies have developed. Additionally, the exposed person's status with regard to immunization against tetanus should be determined and a booster dose given if more than five years have elapsed.
c. Post Exposure Evaluation Follow-Up. Any employee must report any exposure to bloodborne pathogens immediately or as soon as possible to their supervisor so that prompt testing and treatment may begin. The following steps and procedures are required:
- The employee must report the date, time, and type of exposure to his/her immediate supervisor.
- The supervisor shall initiate or insure that an Incident Report (Attachment A4) is completed, with a copy of the report to be maintained in the employee's personnel file at the Central Office.
- Documentation will include the nature and route of exposure and the circumstances related to it. The identity of the source individual will be obtained in accordance with current state and local laws.
- The supervisor shall attempt to obtain consent for the testing of the source individuals blood. If consent is not given, documentation is required as to why.
- The supervisor shall obtain consent or waiver for the testing of the exposed employee's blood. If consent is obtained, the employee will be counseled as to where to take the form to receive treatment and testing as prescribed by the health care provider.
- The supervisor shall immediately complete an Employer's First Report of Injury or Illness Report (OSHA 101 Report) for the Worker's Compensation and forward to the Payroll Manager at the Central Office. The incident will be reported to worker's compensation insurance company even if employee refused to be treated according to the guidelines. An incident report for the agency must also be completed.
- Test results for both employee and the source individual are confidential and will be handled in accordance with OSHA standards.
- The employee will be given appropriate counseling and post exposure treatment in accordance with current recommendations of the United States Public Health Services and by a qualified health professional.
- Potential illness information will be given to exposed employees and they will be instructed to report any problems to the appropriate personnel.
- If the exposed person refuses treatment and testing, and a reportable disease is involved, Audubon Area Community Services, Inc.'s designated person shall report the incident to the Cabinet for Human Resources/Division of Epidemiology.
- Exposure incidents that occur while employee is on an overnight job assignment out of the area will follow reporting procedures outlined in Incident Flow Chart for overnight trips. (See Attachment A9)
- Incidents Reports will be filed and retained in the respective employee's personnel record.
2. Health Care Provider Responsibilities. Each AACS-paid and approved health care provider shall:
- Initiate treatment in accordance with recommended guidelines, based on the type of exposure.
- Report the incident to the Cabinet for Human Resources/Division of Epidemiology, if a reportable condition is involved.
- The licensed health professional shall retain all medical records relating to exposure incident.
- The health care professional will notify the Center for Disease Control Branch (CDC) of the Public Health Department in Atlanta, Georgia if the employee or source individual is either HBV (Hepatitis B Virus) or HIV (Human Immunodeficiency Virus) positive.
VIII. Communication of Hazards - Warning Signs
As a means to minimize exposure incidents, anything labeled Biohazard or red bags/containers used as a substitute for labels is to be considered contaminated waste.
IX. Informing and Training Staff Concerning Bloodborne Pathogens Control
1. Audubon Area Community Services, Inc. will provide all new employees with an orientation on the policy of the bloodborne pathogens, ensuring that all employees identified as Group I participate in an annual training at no cost to the employee.
New staff identified as having the potential for exposure must receive training prior to undertaking tasks where exposure may take place. Audubon Area Community Services, Inc. is obligated to provide additional training if an employee's change in duties increases the chance of exposure.
Staff designated in Group II and Group III shall receive training on bloodborne pathogens within one year of initial employment. This training will be required at least one time for all employees in Group II and Group III regardless of years employment to ensure the comprehension of the need for adherence to the exposure control plan.
Only qualified persons - those familiar with infection control theory and practice and/or persons who are knowledgeable in the subject matter covered by the elements contained in the OSHA required training program as it relates to the workplace - will be authorized to conduct the educational sessions.
2. Initial and annual training programs must contain (at a minimum) the following components:
A. STAFF TRAINING FOR GROUP I
A general explanation of the OSHA Standard for Bloodborne Pathogens. A general explanation of the epidemiology, terminology, prevalence, transmission and symptoms of the infection with bloodborne pathogens.
An explanation of the appropriate methods for recognizing tasks and other activities that may involve exposure to blood and other potentially infectious materials.
An explanation of the Audubon Area Community Services, Inc. exposure control plan and the location of the plan.
An explanation of the use and limitations of that which will prevent or reduce exposure including appropriate engineering controls, work practices, personal protective equipment, and universal precautions.
Information on types, proper use, location, removal, handling, decontamination and disposal of personal protective equipment including potentially infectious waste.
An explanation of the basis for selection protective equipment.
Information on Hepatitis B vaccine, including its efficiency, safety, method of administration, benefits of being vaccinated, the vaccination series, cost, and option to decline vaccination.
Information on the appropriate actions to take and persons to contact in an emergency involving blood or other potentially infectious materials.
An explanation of the procedure to follow if an exposure incident occurs, including the method of reporting the incident and the medical follow-up that will be made available.
Information on the post-exposure evaluation and follow-up that Audubon Area Community Services, Inc. provides for an employee following an exposure incident. An explanation of the signs and labels.
B. TRAINING FOR GROUP II and GROUP III
A general explanation of the OSHA Standards for Bloodborne Pathogens.
A general explanation of the epidemiology, terminology, prevalence, transmission, and symptoms of infection with bloodborne pathogens.
An explanation of the Audubon Area Community Services, Inc. Exposure Control Plan and the location of the plan.
An explanation of the appropriate methods for recognizing tasks and other activities that may involve exposure to blood and other potentially infectious materials.
Information on the appropriate actions to take and persons to contact in an emergency involving blood or other potentially infectious materials.
A general explanation of signs, labels, universal precautions, and personal protective equipment locations.
An explanation of the procedure followed when an exposure incident occurs.
General information on the evaluation and follow-up that Audubon Area Community Services, Inc. provides for an employee following an exposure incident.
X. Recordkeeping/Employee Medical and Training Records
All personal health record will be kept confidential in the health care provider's office - where medical treatment is received/provided.
All records maintained under this program are confidential. Each employee has the right to access their personal/medical records as well as any exposure records in the agency's possession.
Written permission is required from employees for non-supervisory access to medical records. Records will, however, be available to OSHA upon its duly authorized request. These records shall be kept with the AACS for the duration of employees' employment with the AACS plus thirty (30) years thereafter. Should a location or AACS facility close, the AACS Central Office shall retrieve all such records. OSHA shall be informed at least three (3) months before the disposal of any records.
Training records will be maintained for three (3) years in the employee personnel file, and updated yearly following the annual training period for Group I employees. Training records for employees in Group II and Group III shall be maintained as part of personnel records at the Central Office.
All training attendance forms will contain the following information:
1) the date of training session; 2) type of training; 3) the name(s) and qualifications of trainer(s); 4) names and job titles of all persons attending the training.
The Exposure Control Plan will be made available to employees and volunteers at each AACS location or facility's main office or supervisor's office.
Audubon Area Community Services, Inc.
TRAINING LOG FOR BLOODBORNE PATHOGENS
Date: _____________________________ Group(s):______________________________
Location: ________________________________ Number of Hours: __________
Trainer(s): ____________________________________________________________________
Attendance Record
PRINT FULL NAME
JOB TITLE
SIGNATURE
Documentation or sign-in sheets may be attached to this form in lieu of this form.
A1
Audubon Area Community Services, Inc.
EMPLOYEE IN-SERVICE TRAINING VERIFICATION
FOR BLOODBORNE PATHOGENS
Group I
Employee:___________________________ Title:__________________________________
This document verifies that the above mentioned employee has received the initial training set forth in the Audubon Area Community Services, Inc. Exposure Control Plan for Bloodborne Pathogens for Group I on ______________________________.
Verified by:________________________________ Title:______________________________________
ANNUAL TRAINING
DATE RECEIVED VERIFIER
A2
Audubon Area Community Services, Inc.
EMPLOYEE IN-SERVICE TRAINING VERIFICATION
FOR BLOODBORNE PATHOGENS
Group II and III
This document verifies that _____________________________________________________ has received the training set forth in the Audubon Area Community Services, Inc. Exposure Control Plan for Bloodborne Pathogens
for Groups II and III on __________________________________.
Verified by:_________________________________________
Title: _________________________________________
A3Audubon Area Community Services, Inc.
BLOODBORNE PATHOGEN EXPOSURE AND INCIDENT REPORT
File this report promptly when an incident or unusual happening occurs at your location during Agency activities or hours.
Person(s) Involved: Child Parent Staff Visitor Other
Specify
Name(s):
Center:
Incident/Exposure Date:
Time:
Classroom:
Nature of Injury: (*indicates definite potentially infectious materials involved)
Contusion, Abrasion, Laceration* Strangulation, Inhalation Fracture, Dislocation
Unconscious Eye/Nose/Mouth Injury* Sprain or Strain
Burn* Non-Visible Automobile Accident
CPR or Heimlich performed* Potentially Infectious Materials
Involved* Human Bite*
Description (when & how):
Immediate Action Taken (clean-up, decontamination, examination, and/or treatment):
Transported to Hospital Name of Facility:
Examined by Physician Name of Physician:
Parent Notified Appropriate supervisory personnel notified
Who?
Date/Time:
Report prepared by:
Date:
NOTE: Employee exposed or injured must submit a Worker's Compensation Claim.
***************************************************************************************************************************
If potentially infectious materials are involved complete below:
Materials involved:
Type of Fluid:
Source of Fluid:
Protective Equipment used: YES NO
If no, why not?
Type of Exposure (i.e., blood to eye):
I understand the potential risks related to the exposure incident which occurred and agree to receive an examination and/or treatment for the exposure, as recommended by the Health Care Physician.
Treatment to include serological (blood) testing for Hepatitis B and HIV virus, if indicated.
Referral Scheduled (Facility, Date, Time):
I understand the potential risks related to the exposure incident which occurred and Do Not Agree to have an examination or treatment for the exposure.
Employee Signature Date
Executive Director/Supervisor Signature Date
White - Central Office Yellow - Center AACS Rev. 3/94
A4
Audubon Area Community Services, Inc.
BLOODBORNE PATHOGENS EXPOSURE CONTROL PLAN
HEALTH CARE PROVIDER REPORT
Employee:
Social Security Number: ________-________-________
Type of Exposure:
Location on Body:
Wound Appearance:
Exposure Source:
Known
Unknown
Infection Evident from Source: Yes
No
Blood Test Ordered:
Treatment Provided:
Additional Care Needed: Yes No
Explain:
Follow-Up Visit Date:
Not Needed:
This individual was treated by me and understands the reasons for the care and follow-up recommended.
This individual refused treatment and understands the consequences of refusing the care recommended.
Licensed Heath Care Provider Date
A5
Audubon Area Community Services, Inc.
HEPATITIS B VIRUS VACCINE
CONSENT/DECLINATION FORM
BLOODBORNE PATHOGENS
I have been informed of the symptoms and modes of transmission of bloodborne pathogens including hepatitis B virus (HBV). I know about the facility's infection control program and understand the procedure to follow if an exposure incident occurs.
I understand that the hepatitis B vaccine is available, at no cost, to employees whose jobs involve the risk of directly contracting blood or other potentially infectious material. I understand that vaccinations shall be given according to recommendations for standard medical practice in the community.
Hepatitis B Vaccine Consent
I consent to administration of the hepatitis B vaccine. I have been informed of the method of administration, the risks, complications, and expected benefits caused by this vaccine.
Signature of Employee Date
__________________________________________ _____________________________________________
Print Employee's Name Witness Signature
Hepatitis B Vaccine Declination
I understand that due to my occupational exposure to blood or other potentially infectious materials I may be at risk of acquiring hepatitis B virus (HBV) infection. I have been given the opportunity to be vaccinated with hepatitis B vaccine, at no charge to myself. However, I decline hepatitis B vaccination at this time. I understand that by declining this vaccine, I may continue to be at risk of acquiring hepatitis B, a serious disease. If in the future I continue to have occupational exposure to blood or other potentially infectious materials and I want to be vaccinated with hepatitis B vaccine, I can receive the vaccination series at no charge to me.
Signature of Employee Date
__________________________________________ _____________________________________________
Print Employee's Name Witness Signature
A6
Audubon Area Community Services, Inc.
CONFIDENTIAL
Source Individual Explanation of and Consent or Declination
to Human Immunodeficiency Virus (HIV) and Hepatitis B Virus (HBV)
Testing Following Employee Exposure.
Facility __________________________________________________________________________
Explanation
A member of our facility/staff was accidentally exposed to your blood or body fluid. In order to comply with recommendations of the Centers for Disease Control and needlestick protocol, we are requesting your consent to test your blood for the antibody to the human immunodeficiency virus (HIV) and the hepatitis B virus (HBV). This test will show whether or not you yourself have been exposed to HIV or HBV. It will not show whether or not you actually have AIDS or hepatitis (or an AIDS/HBV related illness).
Your consent will enable our facility to provide the necessary care and assist in the proper medical management of the exposed employee. It is important that you understand the following:
1. We cannot test for HIV without your consent.
2. You will not be charged for this test.
3. This signed consent form and the test results will be kept confidential and will NOT be placed in your medical record.
4. Should the results be positive, you will be notified by your doctor for counseling and appropriate medical advice.
Consent/Declination
I have been informed about the implications and limitations of the test for the antibody to HIV and HBV. I have been able to ask questions about the test. Those questions were answered to my satisfaction. I understand the benefits and risks of the test.
I hereby consent to have my blood tested for the HIV/HBV antibody.
I hereby decline to have my blood tested for the HIV/HBV antibody.
_____________________________________________ ______________________________
Source Individual's Signature Date
___________________________________________________________________________________
Print Name of Source Individual
If source individual is under eighteen (18) years of age:
____________________________________________ ______________________________
Parent or Guardian (print name) Date
_____________________________________________
Witness
_____________________________________________ ______________________________
Parent or Guardian (signature) Date
A7
Audubon Area Community Services, Inc.
STANDARD INCIDENT FLOW CHART
An exposure incident is defined by OSHA as a specific eye, mouth, other-mucous membrane, non-intact skin, or parenteral contact (parenteral means piercing mucous membranes or the skin barrier through such events as needlesticks, human bites, cuts, and abrasions) with blood or potentially infectious materials that results from the performance of an employee's duties.
Other potentially infectious fluid include: blood, semen, vaginal secretions, and any body fluid that is contaminated with blood, all body fluids in situations where it is difficult or impossible to differentiate between body fluids and other fluids defined by OSHA standards.
Exposed Employee Plan of Action:
1. Wash exposed skin/membrane as soon as possible
2. Clean up area if any fluids
3. Notify principal or supervisor of incident as soon as possible
4. Seek recommended health care for post exposure based on employee immune status within twenty-four (24) hours after exposure
5. Submit worker's compensation form and send to the Central Office
6. Follow through with recommended health care Supervisor/Project Director or Contact Person Plan of Action:
1. Complete an incident report
2. Obtain consent or declination for testing and/or treatment as indicated
3. Ascertain source individual consent for testing of blood is feasible
4. Notify designated health care facility for appointment for employee and/or source individual
5. Complete worker's compensation form and send to the Central Office.
6. Assure employee follows through with health care provider's recommendations
NOTE: In case of exposure, the supervisor, project director or contact person shall immediately request the source individual's blood to be tested. Consent forms must be completed and source individual may refuse testing. If source individual refuses to be tested, the situation will be treated as if source person is HBV (Hepatitis B Virus) and HIV (Human Immunodeficiency Virus) positive.
Each AACS supervisor is responsible for the above flow chart of required actions to be taken immediately. The Executive Director or project director's office can be reached for assistance in following the required procedures at (270) 686-1600.
A8
Audubon Area Community Services, Inc.
OUT OF AREA INCIDENT FLOW CHART
An exposure incident is defined by OSHA as a specific eye, mouth, other-mucous membrane, non-intact skin, or parenteral contact (parenteral means piercing mucous membranes or the skin barrier through such events as needlesticks, human bites, cuts, and abrasions) with blood or potentially infectious materials that results from the performance of an employee's duties.
Other potentially infectious fluid include: blood, semen, vaginal secretions, and any body fluid that is contaminated with blood, all body fluids in situations where it is difficult or impossible to differentiate between body fluids and other fluids defined by OSHA standards.
If an exposure occurs to a non-immune HBV (Hepatitis B Virus) carrying employee on a trip that will result in that person being our of the area longer than the twenty-four (24) hour period after exposure, the following plan of action shall be taken:
Exposed Non-Immune Employee Action Plan:
1. Wash exposed skin/membrane area as soon as possible
2. Clean up area of any fluids if applicable
3. Notify supervisor or project director of incident as soon as possible
4. If incident occurs after normal operating hours and the supervisor or project director is unattainable, then the following individual may be contacted:
Ronald Logsdon, Executive Director Office: 270/686-1610 Home: 926-8892
5. The employee shall provide to the contact person the following information:
name
type of exposure
date and time of exposure
expected date and time of return to facility
source individual contact information
name and phone number of available medical provider to administer initial follow-up care
6. The employee is responsible for obtaining the appropriate reports and information needed to complete documentation with their supervisor or project director.
7. The employee is responsible for filing all appropriate documents and follow through with recommended health care.
8. Supervisor/Project Director/Contact Person Action Plan:
a) Person shall obtain information listed in employee section #6 and any other pertinent information they feel is necessary.
b) Contact medical provider given by employee in regard to employee and billing arrangements.
c) The contact person shall ensure that appropriate steps are initiated to complete guidelines set forth in the Exposure Control Plan for Bloodborne Pathogens and briefly outlined in the Standard Incident Flow Chart found in the document.
Immune to HBV Employee Action Plan:
1. The employee should follow guidelines set forth in the Standard Incident Flow Chart.
A9
Audubon Area Community Services, Inc.
BLOODBORNE PATHOGENS PROCEDURES
FOR CUSTODIANS AND MAINTENANCE TECHNICIANS
The following procedures must be followed when dealing with potentially infectious body fluids and instruments or tools that have come in contact with these fluids.
Potentially infectious materials include the following body fluids: blood, semen, vaginal secretions, and body fluid that is visibly contaminated with blood, all body fluids in situations where it is difficult or impossible to differentiate between body fluids, and other fluids defined by OSHA standards.
1. Employee must wear disposable latex gloves when dealing with body fluids.
2 Employee must wear safety glasses or face shield when using sewer augers.
3. Equipment and tools that come into contact with body fluids must be washed and disinfected after each use. (Examples: sewer augers, plungers, pliers, dust pans, brooms, etc.)
4. When picking up other items around grounds; such as diapers, condoms, sanitary napkins, carry a plastic bag approved for infectious waste and dispose of articles in bag. Bags must be sealed after each use.
5. All infectious waste containers can be disposed of in your facility dumpster.
6. Employees dealing with body fluids shall keep a clean change of clothing in their facility, so if their clothing is contaminated with body fluids, they can change clothes. Put the soiled clothes in an infectious waste plastic bag and seal. Wash body parts which came into contact with body fluids with liquid soap and water. Clothes will be sent to approved cleaner for cleaning.
BROKEN GLASS:
will be picked up using a dust pan and broom or other mechanical means other than by hand especially broken glass that has been contaminated with body fluids. Contaminated glass shall be placed in a puncture resistant container with a lid and taped shut for disposal. Contaminated glass containers should be labeled with a biohazard label or properly decontaminated by adding a bleach and water solution before disposal [5.25% sodium hypochlorite (household bleach) diluted between 1:10 to 1:100 with water].
Contaminated glass shall be sprayed with disinfectant prior to removal from frame if hand contact cannot possibly be avoided.
SHARPS:
Sharps are to be put into approved container. When picking up sharps found in facilities and on facilities' grounds, take the sharp container with you and dispose of sharp directly into container. Never try to recap a needle prior to disposal in a container.
Sharps containers are not to be overfilled and should have a closeable lid taped shut prior to being stored or picked up for disposal.
Sharps containers cannot be put in dumpster. They will be picked up and disposed by other means designated by supervisor.
Sharps container will be stored in a secured area until proper disposal.
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VOMITUS:
Employee shall put on gloves prior to cleaning up or handling materials contaminated with vomitus regardless of whether or not visible blood is present. Employee should sprinkle vomitus with absorbent for easier cleanup.
Vomitus should be picked up by mechanical devices and placed in leak-proof disposable bag along with disposable gloves when task is finished.
If blood is visible or suspected, all disposable contaminated items will be disposed of in leak-proof bags.
Clean contaminated surface and non-disposable items with appropriate disinfectant.
After removal of gloves, wash hands with liquid soap and water or use appropriate antiseptic handwash as an interim until able to wash hands thoroughly. Hand lotion should be applied to prevent chapping.
URINE/FECES:
Employee shall put on gloves prior to physical contact with individual or contaminated surface.
Use appropriate cleaner to disinfect contaminated surface and non-disposable items.
Dispose of contaminated materials in bags.
After removal of gloves, wash hands with liquid soap and water or use appropriate antiseptic handwash as an interim until able to wash hands thoroughly. Hand lotion should be applied to prevent chapping.
BLOOD:
Employee shall put on gloves prior to physical contact with individual or contaminated surface. If possible, bleeding individual should attend to own wound care and self cleanup.
Employee should try to limit contact with blood in order to reduce potential for accidental exposures even though universal precautions are being used.
Materials contaminated with blood shall be disposed of in leak proof bags along with gloves after task is completed.
Contaminated surface and non-disposable materials must be cleaned with approved cleaner.
After removal of gloves, wash hands with liquid soap and water or use appropriate antiseptic handwash as an interim until able to wash hands thoroughly. Hand lotion should be applied to prevent chapping.
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Audubon Area Community Services, Inc.
BLOODBORNE PATHOGENS PROCEDURES
FOR BUS DRIVERS AND MONITORS
VOMITUS:
Employee shall put on gloves prior to cleaning up or handling materials contaminated with vomitus regardless of whether or not visible blood is present.
If a person gets sick, they will be handed paper towels to clean self when applicable. Used towels are to be placed in disposable bag when finished. A disposable bag may be given to individual if further vomitus is anticipated.
Employee should sprinkle vomitus with absorbent/disinfectant for easier cleanup.
Vomitus should be picked up by mechanical devices and placed in leak-proof disposable bag along with disposable gloves when task is finished.
If blood is visible or suspected, all disposable contaminated items will be disposed of in leak-proof bags.
Clean contaminated surface and non-disposable items with appropriate disinfectant.
After removal of gloves, wash hands with liquid soap and water or use appropriate antiseptic handwash as an interim until able to wash hands thoroughly. Hand lotion should be applied to prevent chapping.
URINE/FECES:
Employee shall put on gloves prior to physical contact with individual or contaminated surface.
Use appropriate cleaner to disinfect contaminated surface and non-disposable items.
Dispose of contaminated materials in bags.
After removal of gloves, wash hands with liquid soap and water or use appropriate antiseptic handwash as an interim until able to wash hands thoroughly. Hand lotion should be applied to prevent chapping.
BLOOD:
Employee shall put on gloves prior to physical contact with individual or contaminated surface.
If possible, bleeding individual should attend to own wound care and self cleanup.
Employee should try to limit contact with blood in order to reduce potential for accidental exposures even though universal precautions are being used.
Materials contaminated with blood shall be disposed of in leak-proof bags along with gloves after task is completed.
Contaminated surface and non-disposable materials must be cleaned with approved cleaner.
After removal of gloves, wash hands with liquid soap and water or use appropriate antiseptic handwash as an interim until able to wash hands thoroughly. Hand lotion should be applied to prevent chapping.
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Audubon Area Community Services, Inc.
BLOODBORNE PATHOGENS PROCEDURES
FOR STAFF WORKING WITH SPECIAL NEEDS STUDENTS
DIAPERING:
Employee shall put on gloves prior to changing diapers, soiled underwear, menstrual pad, or cleaning up urine or feces.
As the employee provides these services from person to person, they shall change gloves and wash hands as described in this guideline prior to contact with next individual.
Surfaces used for these tasks must be cleaned with appropriate cleaner prior to a different individual coming into contact with that surface or a disposable plastic back sheet can be used on surface and changed after each individual. This work area needs to be cleaned with approved cleaner at the end of the day or if direct contamination occurs.
Soiled materials will be disposed of in designated waste cans along with disposable gloves.
After removal of gloves, wash hands with liquid soap and water or use appropriate antiseptic handwash as an interim until able to wash hands thoroughly. Hand lotion should be applied to prevent chapping.
Male urinal bottles shall be disinfected prior to use by another or individual bottles established for each male.
SALIVA:
Surfaces that have visible contamination with saliva shall be disinfected with approved cleaner prior to direct physical contact with another individual. Surfaces would include but are not limited to: orally manipulated toys, instruments, eating and drinking utensils, mats, straps, etc.
Gloves should be worn or another barrier used to avoid direct skin contact with saliva.
FEEDING:
Employees shall wear gloves when feeding an individual if:
- Employee hand to saliva contact is anticipated.
- Employee contact is anticipated with other potentially infectious fluids such as with tube feedings.
Employees shall change gloves prior to feeding another child who falls into the categories above. Dispose of gloves properly.
Feeding tray, utensils, etc. will be appropriately disinfected prior to being used by another.
After removal of gloves, wash hands with liquid soap and water or use appropriate antiseptic handwash as an interim until able to wash hands thoroughly. Hand lotion should be applied to prevent chapping.
BLOOD:
Employees will use latex gloves when dealing with situations that result in contact with blood or other body fluids possibly containing blood.
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Employee should try to limit contact with blood in order to reduce potential for accidental exposures even though universal precautions are being used.
Custodial staff person is to be contact immediately in regards to surface contamination for prompt decontamination measures.
After removal of gloves, wash hands with liquid soap and water or use appropriate antiseptic handwash as an interim until able to wash hands thoroughly. Hand lotion should be applied to prevent chapping.
LAUNDRY:
Soiled laundry shall be placed in a bag/container in a designated area of each room.
Laundry workers must wear gloves and handle contaminated laundry as little as possible.
Contaminated laundry shall not be placed directly on the floor. Laundry will be placed in appropriate containers until place directly in washer.
Contaminated laundry shall be washed and dried in accordance with manufacturer's instruction. Bleach will be utilized when feasible.
Universal precautions will be utilized when dealing with contaminated laundry.
VOMITUS:
Employee shall put on gloves prior to cleaning up or handling materials contaminated with vomitus regardless of whether or not visible blood is present.
When employee is not responsible for cleaning of vomitus - then appropriate individual will be contacted as soon as possible.
If contact with vomitus was unavoidable, the employee shall wash exposed area as soon as possible with liquid soap and water or use an antiseptic hand cleaner.
Apply gloves to complete additional task involving vomitus.
The employee responsible for environmental cleanup will use following steps:
- Apply absorbent for easier cleanup.
- Vomitus should be picked up by mechanical means and deposited into leak proof disposable bags.
- If blood is suspected or visible, all disposable contaminated materials must go into leak-proof bags.
- Contaminated surface and non-disposable items shall be cleaned with appropriate disinfectant.
After removal of gloves, wash hands with liquid soap and water or use appropriate antiseptic handwash as an interim until able to wash hand thoroughly. Hand lotion should be applied to prevent chapping.
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