- Administrative Policy 3-14 Blood Borne Diseases
Administrative Policy 3-14 Blood Borne Diseases
SUBJECT: GENERAL EMPLOYEE EXPOSURE CONTROL PLAN FOR BLOOD BORNE DISEASES
PURPOSE: To provide guidance and procedures to minimize exposure of employees to blood borne diseases, such as the HIV (AIDS) virus and the HBV (Hepatitis B) virus.
BACKGROUND: The OSHA Blood Borne Pathogens Standard, Section 1910.1030, 29 CFR Part 1910, was enacted to provide protection mainly for health care and emergency responder personnel. Police and Fire personnel have developed exposure control plans for their individual departments. However, potential exposure to blood and other body fluids may not be limited to Fire and Police emergency response personnel. Exposure may result from first-aid treatment or assistance provided to co-workers or other individuals who have been injured; or from a variety of other sources.
A. Employees are to assume that all blood and other body fluids are contaminated (diseased), including the blood of fellow employees, and take precautions to protect themselves accordingly.
B. Employees are to avoid, to the maximum extent possible, any situation that may result in contact with blood or other body fluids.
C. Although the primary purpose of this policy is to prevent employees from contracting the HIV, HBV, HCV viruses, following the guidelines will prevent the transmission of other diseases as well.
"Blood" means human blood, human blood components, and products made from human blood.
"Contaminated" means the presence or the reasonably anticipated presence of blood or other potentially infectious materials on an item or surface.
"Contaminated Blood" means blood containing the Hepatitis B (HBV), Hepatitis C (HCV) or the AIDS (HIV) virus.
"Decontamination" means the use of physical or chemical means to remove, inactivate, or destroy blood borne pathogens on a surface or item to the point where they are no longer capable of transmitting infectious particles and the surface or item is rendered safe for handling, use, or disposal.
"Exposure Incident" means an incident where an employee, while performing assigned duties, experiences direct contact with blood or other potentially infectious body fluids in the eyes, nose, or mouth; or on skin which is not intact due to cuts, rashes, abrasions, etc.; or from penetration of the skin by a contaminated object.
"Formal Course" means a training session of no less than one hour conducted by a person knowledgeable of the OSHA Blood Borne Pathogens Standard and this administrative policy utilizing an approved or standardized lesson plan, training videos, and/or other appropriate training aids.
3. Modes of Transmission - HIV, HCV, and HBV Viruses
The Hepatitis B, Hepatitis C and AIDS viruses are transmitted in a similar manner. All are transmitted through sexual contact or contact with the blood or certain other infectious materials from an individual infected with the virus. These materials include body fluids such as semen, vaginal secretions, cerebrospinal fluid, synovial fluid, amniotic fluid, pleural fluid, pericardial fluid, peritoneal fluid, and any body fluid that is visibly contaminated with blood, and any unfixed organ or tissue from a human (living or dead). Saliva, vomit, urine and feces will not transmit these viruses unless contaminated with blood or other potentially infectious body fluids. Blood is the single most important source of HIV, HBV, and HCV in the workplace setting. The contaminated blood must have a route of entry into the body for the virus to be transmitted. Possible routes of entry include eyes, mouth, nose and skin. Contaminated blood on the surface of the skin may enter the body through open wounds, or through cracked , chapped or abraded skin. Sharp objects contaminated with blood may introduce the disease into the body by puncturing the skin.
4. Personal Protective Equipment - General Rules
A. Disposable gloves should be used wherever blood or blood contaminated items is present to prevent direct contact with the hands.
B. Surgical masks, eye wear and appropriate protective clothing are recommended if there is massive bleeding, large amounts of blood present, or there is a chance of blood being spurted or splashed. Masks and eyewear, such as safety glasses, should be worn together or a full-face shield used instead. Protective clothing includes aprons, shoe covers, and full body suits.
C. Resuscitation equipment: CPR masks with one-way valves or other resuscitation devices that do not require direct contact with the mouth of the victim are to be used whenever CPR is to be given.
5. Disinfecting, Decontamination and Disposal
A. Washing of hands and other skin surfaces: Hands and other skins surfaces shall be washed immediately and thoroughly if contaminated with blood or other potentially infectious body fluids. Even if gloves are worn, the hands should be washed. Wash skin surfaces with warm water and soap. When hand-washing facilities are not available, disposable antiseptic towelettes or alcohol wipes, which should be available in first-aid kits, are to be used.
B. Cleaning and decontaminating spills of blood: While wearing gloves, the employee cleaning up blood will first remove visible materials with disposable towels or other appropriate means. If splashing is anticipated, protective eyewear and protective clothing should be worn. Should employees need assistance in decontamination, the Fire Department is to be contacted for assistance. After visible materials are removed, the area should be decontaminated using an EPA-approved germicide or a one to ten solution of household bleach to water.
C. Plastic bags properly color-coded and/or labeled for biological waste will be available in first-aid kits. All contaminated items, including disposable cleaning supplies and equipment, will be placed in one or more of these bags and disposed of properly.
D. Decontamination of Surfaces: Floors, counters, vehicles, and other areas that have potential surface contamination of blood or other body fluid may be decontaminated by cleaning with a bleach solution (one unit of bleach to ten units of water) or with other chemicals designed to destroy blood borne pathogens.
E. Decontamination and laundering of clothing: Clothing soaked with blood or other body fluids should be removed as soon as possible to prevent the fluids from contacting the skin or, at least, to minimize the time of contact with the skin. Protective clothing or other work clothing contaminated with blood or other body fluids should be placed and transported in bags or containers that prevent leakage. Personnel involved in the bagging, transport, and laundering of contaminated clothing should wear gloves. Protective clothing and work uniforms should be washed and dried according to the manufacturer's recommendations or instructions. Clothing that is taken home for washing should be laundered separately and clothing taken to cleaners should be identified as being contaminated with potentially infectious waste. Boots and leather goods may be brushed with soap and hot water to remove contamination.
F. Infectious Waste Disposal: Infectious waste may be disposed of at the landfill or incinerated at an appropriate facility. Small amounts of contaminated waste may be disposed of with the regular trash at the landfill. However, care must be taken to ensure no one is exposed to the waste and the waste must be properly packaged and labeled. Infectious waste incinerators are operated by the local hospitals and permission would have to be obtained in order to use these incinerators.
Contact the Safety and Risk Officer if assistance is needed in disposing of infectious waste. Where possible, waste should be decontaminated with bleach or other agents manufactured specifically for this purpose prior to disposal.
6. Rules for Performing First-Aid
Only employees properly trained and certified to perform CPR and first aid will, under normal circumstances, be allowed to provide treatment for injured employees or other persons. Only in potentially life-threatening situations should an untrained employee without proper personal protective equipment attempt to perform first aid where exposure to blood or other potentially infectious body fluids is likely.
All first aid stations and first-aid kits will be stocked with protective equipment and clothing, such as eyewear, masks, and gloves to protect the employee performing first aid from contact with blood and other body fluids. They will also contain items for decontamination and disposal of contaminated materials, such as antiseptic towelettes, decontamination chemicals, and plastic bags. CPR masks with one-way valves will be available for use in performing cardio-pulmonary resuscitation.
7. General employees with Potential Exposures and Nature of Exposures: General employees do not routinely work with blood or other body fluids known or suspected to be contaminated with blood borne pathogens. However, some employees may be inadvertently exposed to such fluids. The following detail employee groups who may be so exposed and the likely nature of such exposures:
A. Wastewater Collection/Wastewater Maintenance employees are exposed to raw sewage that may contain condoms, tampons, diapers, syringes, and other potentially contaminated items, as well as body fluids disposed of through the sanitary sewer system. Exposures may occur while rodding or flushing clogged sewer mains, cleaning manholes, or while maintaining or repairing lines or manholes.
B. Wastewater Treatment Plant employees are also exposed to raw sewage which is collected from the sanitary sewer system for processing at the plant. Exposures may occur during sludge press operations; while samplings; during cleaning of facilities and equipment; during repair and maintenance activities on pumps, pipes, and other processing equipment; during laboratory analysis of samples; etc.
C. Sewer Construction employees are exposed to raw sewage while replacing sewer mains. They are exposed when they remove and replace service line connections, during "pipe bursting" (slip-lining) operations, while removing old sewer lines or working in the proximity of them, etc.
D. Meter Readers may be exposed to raw sewage, which is frequently found in water meter boxes, during repair, removal and replacement of meters.
E. Solid Waste Collection and Solid Waste Disposal personnel may be exposed to diapers, sanitary napkins, tampons, condoms, syringes, used bandages, and other potentially contaminated items picked up in residential or commercial waste.
F. Lakes, Park Maintenance, Athletic Maintenance, and Cemetery personnel may be exposed to contaminated items or debris left in trash containers or on grounds for which they are responsible for maintaining. Personnel involved in servicing and cleaning public restroom facilities may be exposed while doing so.
G. Senior or Recreation Center employees may be exposed to blood or other body fluids while assisting patrons who sustain injuries while at City facilities.
H. Employees certified to perform CPR and first aid may be exposed to blood or other body fluids while performing providing medical assistance to fellow employees or member of the general public.
8. Exposure Control for Identified Employees:
A. Employees exposed to raw sewage must avoid getting it in their eyes, mouths and noses, and on skin that is broken due to cuts, abrasions, rashes, or chaffing. Gloves should always be worn when working in sewage or with materials or equipment contaminated with raw sewage. Leather gloves may be worn. However, if hands are to be submersed in sewage, leather gloves lined with deposable latex, vinyl, nitrile, or polyethylene gloves or abrasion resistant rubber, butyl, neoprene, or nitrile are to be used. Wear of long sleeve apparel is recommended to protect skin. Goggles or full-face shields should be worn to protect the eyes.
If employees must work in standing sewage, impervious boots, hip boots, waders, or full body protection should be worn depending upon the depth of the liquid and the potential for splashing or spurting. If hands must be submerged in the sewage, impervious gloves with long cuffs should be worn. Full-face protection consisting of goggles and mask covering the nose and mouth or a face shield is required.
All personal protective clothing and equipment are to be cleaned and decontaminated immediately after the job is completed. Should sewage contact skin surfaces, employees should wash it off as soon as possible.
B. Employees who handle solid waste either by servicing containers or picking up debris in parks or other public areas should wear leather or other puncture resistant work gloves to prevent coming into direct contact with possible contaminated objects or surfaces. Safety glasses, goggles or face shields should be worn to protect the eyes. Long sleeve apparel is recommended. These precautions also apply to Equipment Maintenance employees who must enter the bodies of sanitation vehicles to perform maintenance or make repairs. Solid Waste Disposal personnel are to take similar precautions when they get out of equipment in areas where solid waste is on the surface of the ground or while servicing parts of equipment that have been in contact with solid waste. Should liquids confirmed or suspected to be blood or other potentially infectious body fluids come into contact with the employees skins, protective equipment, or clothing, it must be washed and disinfected immediately. If such liquid should get into the eyes, nose, or mouth or on the broken skin of an employee, the supervisor is to be immediately notified and medical evaluation of the exposure is to be completed. Medical treatment will also be obtained when an employee receives a puncture wound from syringes or other potentially contaminated sharps.
Should containers or debris be contaminated with amounts of blood or other body fluids that could result in splashing or other direct contact with the fluids if handled, employees are to call a supervisor to evaluate the possible exposure and determine if the work can safely be performed or if a home-owner or proper authorities should be notified to correct an unsafe condition.
C. Employees who perform first aid and CPR must wear vinyl or latex gloves to prevent direct contact with body fluids. If CPR is performed, masks with one-way valves must be used. If there is a possibility that blood or other body fluids will splash or spurt, surgical masks and goggles or a full-face shield should be worn. Other protective clothing such as sleeves, aprons, shoe covers may be needed depending upon the extent of possible exposure. The same procedures apply for employees at recreation or senior centers when assisting injured patrons.
9. Preventative Hepatitis Vaccinations.
All general employees will be offered the series of Hepatitis B vaccinations at no cost to them. Acceptance of the vaccinations is voluntary on the part of each employee. Those choosing not to accept the vaccinations, will be required to sign a "declination statement" which will be kept on file with the employee's medical records in the Human Resources Department. The Safety and Risk Officer will schedule employees who opt to receive the vaccinations. Employees who initially decline the vaccinations may later decide to receive them. In such cases, they are to contact the Safety and Risk Officer who will arrange for the vaccinations.
10. Medical Procedures for Employee Exposures Incidents
Any employee who comes into contact with potentially contaminated blood or other potentially infectious body fluid in such a manner conducive to transmission of a disease, will be referred immediately for medical evaluation by a licensed health care professional. At the time of initial treatment, the employee will be given the first of the series of three hepatitis B vaccinations and will be scheduled for the remaining two vaccinations unless the employee declines to be vaccinated or has previously been vaccinated. The employee will be evaluated and monitored by the health care professional as necessary to determine if any disease was transmitted to the employee.
If possible, the person who is the source of the exposure should be asked to submit to a blood test to determine if his or her blood is contaminated with a virus. The source person must provide signed, written consent before the test is performed that would allow release of the test results to the exposed employee or employee's physician. A court order would be required if the source person does not voluntarily consent to being tested.
Such rick exposures will be reported on the "Report of Injury" form and medical expenses will be paid under the City's Workers' Compensation Program.
11. Evaluation of Exposure Incidents
All incidents involving risk exposure of City employees will be investigated and evaluated by the Safety & Risk Officer and appropriate supervisory and management personnel to determine changes in procedures which may be appropriate to eliminate future risk exposures of a similar nature.
12. Potential Exposure Incidents
Employees are to report any situation that could result in exposure incidents for City employees to their immediate supervisors. Employees should avoid such situations where an exposure incident could result. No employee will be disciplined for refusal to work in a situation where an exposure incident could reasonably result.
13. Medical Records
A. Medical records pertaining to exposure incidents or potential exposure of City employees, and records of Hepatitis B vaccinations will be maintained in the Human Resources Department in individual files separate from the personnel files.
B. Medical records will be considered personal and confidential and staff, supervisory and management personnel may not have access to the files unless there is a valid necessity to do so, and then, only upon the approval of the Human Resources Director or the written authorization of the affected employee.
C. Each employee or the employee's designated representative (with the employee's expressed written consent) will have access to his or her individual records.
D. Records will be maintained throughout an individual's employment with the City. After employment has terminated, the records will be maintained for the period of time specified by applicable state or federal law.
A. Only employees properly trained, and required to maintain current certification in first aid and CPR, will be designated to perform CPR and first aid.
B. All employees who are designated and certified to perform first aid and CPR will be trained on the contents of this Administrative Policy and the OSHA Blood Borne Pathogens Standard; on the hazards, modes of transmission, and symptoms of the HIV, HBV, and HCV viruses; and on the proper use of protective equipment, protective clothing, and decontamination kits before being allowed to perform first-aid or CPR.
C. Employees identified in paragraph 7 of this policy will be required to attend the first available blood borne pathogens course after their dates of hire and annually thereafter. All other general employees will be scheduled to attend the first available blood borne pathogens training course. Follow-up training for these employees will be scheduled at the discretion of the employee and his/her supervisor. Training will include the contents of this policy; the hazards, modes of transmission, and symptoms of the HIV, HBV and HCV viruses; use of personal protective equipment and clothing, and on avoiding risk exposures.
REFERENCE: Code of Federal Regulations, Title 29, Part 1910.1030
RESCISSION: This policy supersedes Administrative Policy No. 3-14, dated July 22, 1997, and will remain in effect until rescinded.
DEPARTMENT: Human Resources
December 1, 2000