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Topic: Bloodborne Pathogens Exposure Date Issued: 3/1/92
Control Plan - Public Works
Section: Injury Illness Prevention Program Date
Revised: 6/10/93, 10/29/93
Number: XX.17.J. 1/13/95
PURPOSE:
To
establish policy and procedures to comply with state and federal regula-
tions
and to eliminate or minimize employee occupational exposure to blood
and
other potentially infectious materials.
LEGAL
BASIS:
California
Code of Regulations, Title 8, General Industry Safety Orders,
Section
5193, Bloodborne Pathogens Standard.
29 Code
of Federal Regulations, 1910.1030, Occupational Exposure to Blood-
borne
Pathogens.
DEFINITIONS:
"Blood"
means human blood, human blood components, and products made from
human
blood.
"Bloodborne
Pathogens" means pathogenic microorganisms that are present in
human
blood and can cause disease in humans.
These pathogens include, but
are not
limited to, Hepatitis B virus (HBV) and Human Immunodeficiency
Virus
(HIV).
"Contaminated
Laundry" means laundry which has been soiled with blood or
other
potentially infectious materials or may contain sharps.
"Contaminated
Sharps" means any contaminated object that can penetrate the
skin
including, but not limited to, needles, scalpels, broken glass, broken
capillary
tubes, and exposed ends of dental wires.
"Decontamination"
means the use of physical or chemical means to remove,
inactivate,
or destroy bloodborne pathogens on a surface or item to the
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Exposure Control Plan
point
where they are no longer capable of transmitting infectious particles
and the
surface or item is rendered safe for handling, use, or disposal.
"Engineering
Controls" means controls (e.g. sharps disposal containers,
self-sheathing
needles) that isolate or remove the bloodborne pathogens
hazard
from the workplace.
"Exposure
Incident" means a specific eye, 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.
"Handwashing
Facilities" means a facility providing an adequate supply of
running
potable water, soap and single use towels or hot air drying ma-
chines.
"HBV"
means Hepatitis B Virus.
"HIV"
means Human Immunodeficiency Virus.
"Occupational
Exposure" means 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) means:
(1) The
following human body fluids: semen, vaginal secretions, cerebrospi-
nal
fluid, synovial fluid, pleural fluid, peritoneal fluid, amniotic fluid,
saliva
in dental procedures, any other body fluid that is visibly contami-
nated
with blood such as saliva or vomitus, and all body fluids in situa-
tions
where it is difficult or impossible to differentiate between body
fluids
such as in emergency response;
(2) Any
unfixed tissue or organ (other than intact skin) from a human (liv-
ing or
dead); and
(3)
HIV-containing cell or tissue cultures, organ cultures, and HIV- or
HBV-containing
culture medium or other solutions; and blood, organs, or
other
tissues from experimental animals infected with HIV or HBV.
"Parenteral"
means piercing mucous membranes or the skin barrier through
such
events as needlesticks, human bites, cuts, and abrasions.
"Personal
Protective Equipment" is specialized clothing or equipment worn
or used
by an employee for protection against a hazard.
"Regulated
Waste" means liquid or semi-liquid blood or OPIM; contaminated
items
that would release blood or OPIM in a liquid or semi-liquid state if
compressed;
items that are caked with dried blood or OPIM and are capable
of
releasing these materials during handling; contaminated sharps; and
pathological
and microbiological wastes containing blood or OPIM. Regulat-
ed
Waste includes medical waste regulated by Health and Safety Code Chapter
6.1.
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"Source
Individual" means any individual, living or dead, whose blood or
other
potentially infectious materials may be a source of occupational
exposure
to an employee.
"Sterilize"
means the use of a physical or chemical procedure to destroy
all
microbial life including highly resistant bacterial endospores.
"Universal
Precautions" is an approach to infection control. According to
the
concept of Universal Precautions, all human blood and certain human
body
fluids are treated as if known to be infectious for HIV, HBV, and
other
bloodborne pathogens.
"Work
Practice Controls" means controls that reduce the likelihood of expo-
sure by
altering the manner in which a task is performed (e.g. prohibiting
recapping
of needles by a two-handed technique).
EXPOSURE
DETERMINATION:
The
state of California (Cal/OSHA) requires employers to perform an expo-
sure
determination, the purpose of which is to identify job classifications
in
which employees may incur occupational exposure to blood or other poten-
tially
infectious materials (OPIM). The
exposure determination must be
made
without regard to the use of personal protective equipment, that is,
employees
are considered to be exposed even if they wear personal protec-
tive equipment. The exposure determination is required to
list all job
classifications
in which employees may be expected to incur an occupational
exposure,
regardless of frequency.
Cal/OSHA
also requires a listing of job classifications in which some em-
ployees
may have occupational exposure, and the job tasks or procedures
that
would cause them to have occupational exposure.
For a
listing of job classifications with occupational exposure, listed by
department,
see Appendix A.
IMPLEMENTATION
METHODOLOGY:
Cal/OSHA
requires that the Exposure Control Plan include the methods of
implementation
for the various requirements of the standard.
The following
complies
with this requirement:
1. Compliance methods
All
County employees are required to observe universal precautions in order
to
prevent contact with blood or OPIM. All
blood must be treated as if it
were
infectious for HBV, HIV, and other bloodborne pathogens. Where it is
difficult
to differentiate between body fluid types, all body fluids shall
be
considered potentially infectious materials.
Engineering
and work practice controls will be utilized to eliminate or
minimize
employee exposure to blood and OPIM.
Where occupational exposure
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remains
after institution of these controls, personal protective equipment
shall
also be utilized.
Engineering
controls are physical or mechanical systems provided to elimi-
nate
hazards at their source, such as sharps containers or self-sheathing
needles. In this department, the following
engineering controls will be
utilized:
* Sharps containers and litters grabbers
will be used by staff working
in Litter Control and in Drainage. Each
County employee on the Litter
Control crew will have a red sharps
container and a litter grabber
available for use. In the Drainage
division, the supervisor and the
lead worker will each have a red sharps
container and a litter grabber
available for use.
Engineering
controls will be examined, maintained, and replaced on a regu-
lar
schedule to ensure their effectiveness.
Follows is the a schedule for
reviewing
the effectiveness of engineering controls:
* The red sharps containers will be checked
once a week to see if they
are full, and replaced when they are
filled.
Work
practice controls are specific procedures employees must follow on the
job to
reduce their exposure to bloodborne pathogens or infectious materi-
als. Examples are hand washing, avoiding
recapping of needles, and good
personal
hygiene. Employees in all County
departments will wash their
hands
after contact with potentially infectious materials and after remov-
ing
personal protective equipment. All
County employees will practice good
personal
hygiene. No recapping of needles is
allowed in any County facili-
ty.
Work practice controls that will be utilized are:
* Staff will never pick up needles with
their bare hands. They will use
appropriate tools such as litter grabbers or shovels to move
needles.
* Road crews finding needles/syringes will
contact litter crew personnel
for pick up and disposal of the needles
and syringes.
* Drainage crews needing to dispose of
needles/syringes will use litter
grabbers and red sharps containers
provided by the crew supervisor or
lead worker.
* Staff will wear gloves for performing
first aid procedures, and wash
their hands after they remove the gloves.
* Staff will was their hands as soon as
possible after contact with
blood or other potentially infectious
materials.
* Staff will practice good personal hygiene.
Departments
must provide handwashing facilities to employees who incur
exposure
to blood or OPIM. Cal/OSHA requires
that these facilities be
readily
accessible after incurring exposure.
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If
handwashing facilities are not feasible, the department must provide an
antiseptic
cleanser in conjunction with clean cloth/paper towels or anti-
septic
towellettes. If these alternatives are
used, then employees must
wash
their hands with soap and running water as soon as feasible.
* Antiseptic towellettes or antiseptic
cleaner and clean towels will be
available for use when handwashing
facilities are not immediately
available. These will be located with
each first aid kit.
Supervisors
shall ensure that after the removal of gloves or other personal
protective
equipment, employees shall wash hands immediately or as soon as
feasible
with soap and water.
Supervisors
shall ensure that employees wash hands and any other 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.
2. Contaminated Needles and Sharps
Contaminated
needles and other contaminated sharps shall not be recapped,
removed,
bent, sheared, or purposely broken.
Recapping or removal of nee-
dles is
not permitted by any Santa Cruz County departments.
3. Containers for Reusable Sharps
Contaminated
sharps that are reusable must be placed immediately, or as
soon as
possible, after use into appropriate containers. Containers for
reusable
sharps must be puncture resistant, labeled with a biohazard label,
and
leak proof.
4. Work Area Restrictions
In work
areas where there is a reasonable likelihood of exposure to blood
or
OPIM, employees may not 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 or bench tops where blood or OPIM are present.
All
procedures involving blood or OPIM will be performed in a manner which
will
minimize splashing, spraying, spattering, and generation of droplets
of
these substances. Mouth
pipetting/suctioning of blood or OPIM is pro-
hibited.
5. Specimens
Specimens
of blood or OPIM will be placed in a container which prevents
leakage
during the collection, handling, processing, storage, transport, or
shipping
of the specimens.
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The
container used for this purpose will be properly labeled or color-coded
and
closed prior to storage, transport, or shipping. The standard provides
for an
exemption for specimens from the labeling/color coding requirement
if a
facility utilizes universal precautions in the handling of all speci-
mens
and the containers are recognizable as containing specimens. This
exemption
applies only while the specimens remain in the facility.
All
specimens which could puncture a primary container will be placed with-
in a
secondary container which is puncture resistant. If outside contamina-
tion of
the primary container occurs, the primary container shall be placed
within
a secondary container. Secondary containers
shall meet all the
requirements
for primary containers.
6. Contaminated Equipment
Department
Heads or their designees are responsible for ensuring that
equipment
which has become contaminated with blood or OPIM is examined
prior
to servicing or shipping and is decontaminated as necessary, unless
the
decontamination of the equipment is not feasible.
7. Personal Protective Equipment (PPE)
PPE
Provision
Department
Heads are responsible for ensuring that the following provisions
are
met:
All PPE
used in each department will be provided without cost to employees.
PPE
will be chosen based on the anticipated exposure to blood or OPIM. The
protective
equipment will be considered appropriate only if it does not
permit
blood or OPIM to pass through or reach the employees' clothing,
skin,
eyes, mouth, or other mucous membranes under the normal conditions of
use and
for the duration of time for which the protective equipment will be
used.
PPE provided in this department is:
* Disposable gloves for use during first aid
procedures will be located
with each departmental first aid kit. The
Public Works Safety Special-
ist is responsible for ensuring that
gloves are available. Staff will
report whenever gloves are used, so they
can be replaced.
PPE Use
Department
Heads and their designees shall ensure that all employees use
appropriate
PPE unless a supervisor shows that an employee temporarily and
briefly
declined to use PPE, when, under rare and extraordinary circum-
stance,
it was the employee's professional judgement that in that specific
instance
its use would have prevented the delivery of healthcare or posed
an
increased hazard to the safety of the worker or co-worker. When the
employee
or supervisor makes this judgement, the circumstances must be
investigated
and documented in order to determine whether changes could be
instituted
to prevent such occurrences in the future.
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PPE
Accessibility
Department
Heads and their designees shall ensure that appropriate PPE in
the
appropriate sizes is readily accessible at the work site or is issued
without
cost to employees. Hypoallergenic
gloves, glove liners, powderless
gloves,
or other similar alternatives shall be readily accessible to those
employees
who are allergic to the gloves normally provided.
PPE
Cleaning, Laundering and Disposal
All PPE
will be cleaned, laundered and/or disposed of by the department at
no cost
to the employees. All necessary repairs
and replacements will be
made by
the department at no cost to employees.
All
garments which are penetrated by blood shall be removed immediately or
as soon
as feasible. All PPE will be removed
prior to leaving the work
area.
When
PPE is removed, it shall be placed in an appropriate designated area
or
container for storage, washing, decontamination or disposal.
Gloves
Gloves
shall be worn where it is reasonably anticipated that employees will
have
hand contact with blood, non-intact skin, mucous membranes, or OPIM,
when
performing vascular access procedures, and when handling or touching
contaminated
items or surfaces.
Disposable
gloves are not to be washed or decontaminated for re-use and are
to be
replaced when they become contaminated, if they are torn or punc-
tured,
or when their ability to function as a barrier is compromised.
Eye and
Face Protection
Masks
in combination with eye protection devices, such as goggles or glass-
es with
solid side shield, or chin length face shields, are required to be
worn
whenever splashes, spray spatter, or droplets of blood or OPIM may be
generated
and eye, nose, or mouth contamination can reasonably be antici-
pated.
Situations which this department which would require such protection
are as
follows:
Additional
Protection
Additional
protective clothing (such as lab coats, gowns, aprons, clinic
jackets,
or similar outer garments) shall be worn in instances when gross
contamination
can reasonably be anticipated (such as autopsies and orthope-
dic
surgery).
8. Housekeeping
Decontamination
will be accomplished by utilizing appropriate materials
such as
bleach solutions or EPA registered germicides.
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Exposure Control Plan
* Bleach solution or EPA registered
germicide is used from the County
warehouse and shall be used in cleaning
of contaminated areas.
* Employees shall wear rubber boots, rubber
gloves and eye protection
when such cleaning is required.
* If a blood spill occurs following an
accident or first aid situation,
the supervisor of the work area will
oversee procedures for decontami-
nation.
Each
department will set up an appropriate schedule for cleaning and decon-
taminating
its facilities that are contaminated with blood or OPIM. Facili-
ties of
this department will be cleaned and decontaminated according to the
following:
* No routine decontamination is required in
Public Works facilities.
Decontamination will be done after spills
of blood or other potential-
ly infectious materials.
All
bins, pails, cans, and similar receptacles which may be contaminated
shall
be inspected and decontaminated on a regularly scheduled basis.
Any
broken glassware which may be contaminated will not be picked up di-
rectly
with the hands. A mechanical means
(brush, dust pan, tongs or for-
ceps)
shall be used.
Reusable
sharps that are contaminated with blood or OPIM shall not be
stored
or discarded in a manner that requires employees to reach by hand
into
the containers where these sharps have been placed.
9. Regulated Waste Disposal
Contaminated
sharps shall be discarded immediately or as soon as feasible
in
containers that are closable, puncture resistant, leak proof on sides
and
bottom and properly labeled.
During
use, containers for contaminated sharps shall be easily accessible
to
personnel and located as close as is feasible to the immediate area
where
sharps are used or can be reasonably anticipated to be found (e.g.,
laundries,
trays at dental work stations).
The
containers shall be maintained upright throughout use, replaced rou-
tinely
and not be allowed to overfill.
When
moving containers of contaminated sharps from the area of use, the
containers
shall be closed immediately prior to removal or replacement to
prevent
spillage or protrusion of contents during handling, storage, trans-
port,
or shipping.
The
container shall be placed in a secondary container if leakage of the
primary
container is possible. The second
container shall be closeable,
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constructed
to contain all contents and prevent leakage during handling,
storage,
transport, or shipping. The second
container shall be properly
labeled
to identify its contents.
Reusable
containers shall not be opened, emptied, or cleaned manually or in
any
manner which would expose employees to the risk of percutaneous injury.
Other
Regulated Waste
Other
regulated waste shall be placed in containers which are closeable,
constructed
to contain all contents, and prevent leakage of fluids during
handling,
storage, transportation or shipping.
The
waste bag or container must be labeled, color-coded and closed prior to
removal
to prevent spillage or protrusion of contents during handling,
storage,
transport, or shipping.
NOTE: Disposal of all regulated waste shall be in
accordance with applica-
ble
State and local regulations.
10. Laundry Procedures
Laundry
contaminated with blood or other potentially infectious materials
will be
handled as little as possible and with a minimum of agitation.
Contaminated
laundry shall be bagged or containerized at the location where
it was
used and shall not be sorted or rinsed in the location of use.
Contaminated
laundry shall be placed and transported in bags or containers
labeled
or color-coded as directed earlier in this plan.
If the
department utilizes Universal Precautions in the handling of all
soiled
laundry (i.e. all laundry is assumed to be contaminated) no labeling
or
color-coding is necessary if all employees recognize the container as
requiring
compliance with Universal Precautions.
Whenever contaminated laundry is wet and
presents a reasonable likelihood
of
soak-through or leakage from the bag or container, the laundry shall be
placed
and transported in bags or containers which prevent soak-through
and/or
leakage of fluids to the exterior.
Each
department shall ensure that employees who have contact with contami-
nated
laundry wear protective gloves and other appropriate PPE.
11. Hepatitis B Vaccine and Post-Exposure
Evaluation and Follow-Up
General
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Exposure Control Plan
Santa
Cruz County shall make available the Hepatitis B vaccine and vaccina-
tion
series to all employees who have occupational exposure, and post-expo-
sure
follow-up to employees who have had an exposure incident.
Santa
Cruz County shall ensure that all medical evaluations and procedures
including
the Hepatitis B vaccine and vaccination series and post exposure
follow-up,
including prophylaxis are:
a)
Made available at no cost to employees;
b)
Made available to employees at a reasonable time and place;
c)
Performed by or under the supervision of a licensed physician or
by or under the supervision of
another licensed healthcare pro-
fessional; and
d)
Provided according to the current recommendations of the U.S.
Public Health Service.
All
laboratory tests shall be conducted by an accredited laboratory at no
cost to
the employee.
Hepatitis
B Vaccination
The
Occupational Safety and Health Division (OSH) of the Personnel Depart-
ment is
in charge of the Hepatitis B vaccination program.
Hepatitis
B vaccination shall be made available after the employee has
received
training information on the Hepatitis B vaccine, including infor-
mation
on its efficacy, safety, method of administration, the benefits of
being
vaccinated, and that the vaccine and vaccination will be offered free
of
charge. The vaccination must be made
available within 10 working days
of
initial assignment to all employees who have occupational exposure,
unless
the employee has previously received the complete Hepatitis B vacci-
nation
series, antibody testing has revealed that the employee is immune,
or the
vaccine is contraindicated for medical reasons.
Participation
in a pre-screening program shall not be a prerequisite for
receiving
Hepatitis B vaccination.
If the
employee initially declines Hepatitis B vaccination, but at a later
date,
while still covered under the standard, decides to accept the vacci-
nation,
the vaccination shall then be made available.
All employees
who decline the Hepatitis B vaccination shall sign a Cal/
OSHA-required
waiver indicating their refusal (Appendix B).
If
routine booster doses of Hepatitis B vaccine are recommended by the U.S.
Public
Health Service at a future date, such booster doses shall be made
available.
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Form
#1, Appendix C should be used for recordkeeping, and forwarded to the
Occupational
Health Program at 1080 Emeline when an employee has completed
the
vaccine series and been tested for immunity. Form #1, accompanied by
the
signed Declination form from Appendix B should be forwarded for employ-
ees who
decline vaccination.
Post-exposure
Evaluation and Follow-up
All
exposure incidents shall be reported, investigated, and documented.
When an
employee incurs an exposure incident, it shall be reported immedi-
ately
to the employee's supervisor and/or the Departmental Safety Liaison.
Following
a report of an exposure incident, the Department Head or Depart-
ment
Head's designee is responsible for ensuring that the exposed employee
immediately
receives a confidential medical evaluation and follow-up, in-
cluding
at least the following elements:
a) Documentation of the route(s) of exposure
and the circumstances under
which the exposure incident occurred
(Form #2 Appendix C should be
used for this purpose.)
b) Identification and documentation of the
source individual, unless it
can be established that the
identification is infeasible or prohibited
by State or local law. Forms 3A and 3B
should be used to obtain con-
sent for source blood testing or to
document that testing was request-
ed and source refused testing.
1.
The source individual's blood shall be tested as soon as feasible
and after consent is obtained in
order to determine HBV and HIV
infectivity. If consent is not obtained, the Department
Head or
designee shall establish that
legally required consent cannot be
obtained. When the source individual's consent is not required
by law, the source individual's
blood, if available, shall be
tested and the results documented.
2.
When the source individual is already known to be infected with
HBV or HIV, testing for the source
individual's known HBV or HIV
status need not be repeated.
3.
Results of the source individual's testing shall be made avail-
able to the exposed employee, and
the employee shall be informed
of applicable laws and regulations
concerning disclosure of the
identity and infectious status of
the source individual.
c) Collection and testing of blood for HBV and
HIV serological status.
The collection and testing will comply
with the following:
1.
The exposed employee's blood shall be collected as soon as feasi-
ble and tested after consent is
obtained;
2.
The employee will be offered the option of having his/her blood
collected for testing for HIV/HBV
serologic status. If the em-
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of 33 Bloodborne Pathogens
Exposure Control Plan
ployee consents to baseline blood
collection, but does not give
consent at that time for HIV
serologic testing, the sample shall
be preserved for at least 90
days. If, within 90 days of the
exposure incident, the employee
elects to have the baseline sam-
ple tested, such testing shall be
done as soon as feasible.
3.
Additional collection and testing shall be made available as
recommended by the U.S. Public
Health Service.
d) Post-exposure prophylaxis, when medically
indicated, as recommended by
the U.S. Public Health Service;
e) Counseling; and
f) Evaluation of reported illnesses.
Items a
and b should be done or arranged by the Department Head, Safety
Liaison,
or designee. That same individual is
responsible for ensuring
that
the employee is referred to a medical provider for items c,d,e, and f.
The
exposed employee should be sent to the healthcare provider with the
completed
Form #2 as well as Forms #4 and #6.
Each
employee who incurs an exposure incident will be offered post-exposure
evaluation
and follow-up in accordance with the Cal/OSHA standard. If an
incident
occurs at night or during a weekend, emergency treatment should be
sought
at the most convenient hospital emergency room. The employee should
then be
referred to the County Occupational Health Physician for follow-up
on the
next working day. If an incident occurs
during a standard County
business
day, the Occupational Health Physician should be contacted immedi-
ately
regarding treatment options.
Information
Provided to the Healthcare Professional
The
Department Head, Safety Liaison, or designee shall ensure that the
healthcare
professional evaluating an employee after an exposure incident
is
provided the following information:
(The Exposure Incident Report Form,
Form
#2, in Appendix C should be used for this purpose.)
a) A written description of the exposed
employee's duties as they relate
to the exposure incident;
b) Written documentation of the route(s) of
exposure and circumstances
under which exposure occurred;
c) Results of the source individual's blood
testing, if available; and
d) All medical records relevant to the
appropriate treatment of the em-
ployee including vaccination status.
Healthcare
Professional's Written Opinion
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To
comply with this section regarding Hepatitis B vaccinations, the health-
care
professional supervising the department's vaccination program will
provide
each occupationally exposed employee with a completed copy of the
Employee
Information Sheet on Bloodborne Pathogens, Form #5, Appendix C,
when
the vaccine is initially discussed and the employee begins or declines
the
vaccine series.
To
comply with this section regarding exposure incidents, the Santa Cruz
County
Occupational Health Program will obtain a written opinion from the
healthcare
professional who does the post-exposure evaluation and follow-
up, and
provide the employee with a copy of that written opinion within 15
days of
the completion of the evaluation.
Appendix C, Form #6 should be
used
for this purpose. The written opinion
must be limited to the follow-
ing
information:
a) That the employee has been informed of the
results of the evaluation;
and
b) That the employee has been told about any
medical conditions resulting
from exposure to blood or OPIM which
require further evaluation or
treatment.
Note: All other findings or diagnoses shall remain
confidential and shall
not be
included in this report.
12. Labels and Signs
Department
Heads or their designees shall ensure that biohazard labels are
affixed
to containers of regulated waste, refrigerators and freezers con-
taining
blood or OPIM, and other containers used to store, transport or
ship
blood or OPIM.
The
label shall include the universal biohazard symbol and the legend
BIOHAZARD. In the case of regulated waste, the words
BIOHAZARDOUS WASTE
may be
substituted for the BIOHAZARD legend.
The label should be fluores-
cent
orange or orange-red.
Regulated
waste red bags or containers must also be labelled.
13. Information and Training
Department
Heads or their designees shall ensure that training is provided
to
employees at the time of initial
assignment to tasks where occupational
exposure
may occur, and that it be repeated within 12 months of the previ-
ous
training. Training shall be provided at
no cost to the employee and at
a
reasonable time and place. Training
shall be tailored to the education
and
language level of the employees, and offered during the normal work
shift.
The person conducting the training shall be knowledgeable in the
subject
matter. The training will be
interactive and cover the following
elements:
a) An accessible copy of the standard and an
explanation of its contents;
Number XX.17.J
Page 14
of 33 Bloodborne Pathogens
Exposure Control Plan
b) A discussion of the epidemiology and
symptoms of bloodborne diseases;
c) An explanation of the modes of transmission
of bloodborne pathogens;
d) An explanation of the Santa Cruz County
Bloodborne Pathogen Exposure
Control Plan with specifics relevant to
the employee's department, and
a method for obtaining a copy;
e) The recognition of tasks that may involve
exposure;
f) An explanation of the use and limitations
of methods to reduce expo-
sure, for example, engineering controls,
work practices, and PPE;
g) Information on the types, proper use,
location, removal, handling,
decontamination, and disposal of PPEs;
h) An explanation of the basis for selection
of PPEs;
i) Information on the Hepatitis B vaccination,
including efficacy, safe-
ty, method of administration, benefits,
and that it will be offered
free of charge;
j) Information on the appropriate actions to
take and persons to contact
in an emergency involving blood or OPIM;
k) An explanation of the procedures to follow
if an exposure incident
occurs, including the method of reporting
the incident and medical
follow-up that will be made available;
l) Information on the post-exposure evaluation
and follow-up that the
employer is required to provide for the
employee following an exposure
incident;
m) An explanation of the signs, labels, and
color coding systems;
n) An opportunity for interactive questions
and answers with the person
conducting the training session.
Employees
who have received training on bloodborne pathogens in the 12
months
preceding the effective date of this policy need only receive train-
ing in
provisions of the policy that were not covered.
Additional
training shall be provided to employees when there are any
changes
of tasks or procedures affecting the employee's occupational expo-
sure.
14. Recordkeeping
Medical
Records
The Occupational
Health section of the Occupational Safety and Health Divi-
sion of
the Personnel Department is responsible for maintaining medical
records
related to occupational exposure as indicated below. These records
will be
kept at the Health Services Agency, 1080 Emeline, Santa Cruz.
Medical
records shall be maintained in accordance with Title 8, California
Code of
Regulations, Section 3204. These records shall be kept confiden-
tial,
and not disclosed without the employee's written consent. They must
be
maintained for at least the duration of employment plus 30 years. The
records
shall include the following:
a) The name and social security number of the
employee.
Number
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Bloodborne
Pathogens Exposure Control Plan
Page 15 of 33
b) A copy of the employee's HBV vaccination
status, including the dates
of vaccination and any medical records
related to the employee's abil-
ity to receive the vaccination (Form #1).
c) A copy of all results of examinations,
medical testing, and follow-up
procedures included in the post-exposure
evaluation and follow-up
described above (Forms #3 and #4).
d) A copy of the information provided to the
healthcare professional,
including a description of the employee's
duties as they relate to the
exposure incident, and documentation of
the routes of exposure and
circumstances of the exposure (Form #2).
e) A confidential copy of the healthcare
professional's opinion (Form
#6).
Form #1
must be forwarded to Occupational Health by the healthcare profes-
sional
supervising each department's Hepatitis B vaccination program.
Form #4
must be forwarded to Occupational Health by the facility that
treated
the employee following the exposure.
Forms
#2 and #3 (A or B) must forwarded to Occupational Health by the em-
ployee's
department.
Form #6
must be forwarded to Occupational Health by the healthcare profes-
sional
who treated the employee following the exposure.
Training
Records
Department
Heads or their designees are responsible for maintaining the
following
training records. These records will be
kept by this department
with
copies forwarded to the OSH Division of the Personnel Department.
Training
records shall be maintained for three years from the date of
training. The following information shall be
documented:
a) The dates of the training sessions;
b) The contents or a summary of the training sessions;
c) The names and qualifications of persons
conducting the training;
d) The names and job titles of all persons
attending the training ses-
sions.
Availability
Employee
training records shall be provided upon request for examination
and
copying to employees, to employee representatives, to the Chief of the
Division
of Occupational Safety and Health (DOSH), and to the National
Institute
for Occupational Safety and Health (NIOSH).
Employee
medical records shall be provided upon request for examination and
copying
to the subject employee, to anyone having written consent of the
Number XX.17.J
Page 16
of 33 Bloodborne Pathogens
Exposure Control Plan
subject
employee, to the Chief of DOSH, and to NIOSH in accordance with
Section
3204.
15. Evaluation and Review
Department
Heads or their designees are responsible for annually reviewing
this
program and its effectiveness, and for updating this program as need-
ed.
16. Dates
The
exposure control plan shall be completed within 60 days of the effec-
tive
date of the standard (3/8/93).
Information,
training, and recordkeeping provisions of the standard shall
take
effect within 90 days of the effective date of the standard (4/8/93).
Sections
regarding engineering and work practice controls, PPE, Housekeep-
ing,
Hepatitis B vaccination and post-exposure evaluation and follow-up,
and
labels and signs, shall take effect 120 days after the effective date
of the
standard (5/8/93).
NOTE
Job
tasks in which Public Works employees may have occupational exposure to
blood
or other potentially infectious materials:
Roads
Division
Working
in DI (drop inlet) boxes or culverts where needles/syringes are
found.
Litter
detail - picking up garbage at side of roads.
Doing
road work when needles/syringes are found.
Unloading
trucks at disposal site.
Being
the first responder to a scene of a vehicle accident.
Cleaning
the road after a vehicle accident.
Drainage
Working
on levees, under bridges or in culvert openings.
Cleaning
up homeless campgrounds.
Disposal
Site
Cleaning
out the tracks of equipment.
Walking
on ground.
Walking
on ground where medical waste has been dumped.
Sanitation
Cleaning
out pumps that have become clogged.
Finding
needles when manhole covers are opened.
Working
in the sewer system.
Walking
on the ground around pump stations.
Fleet
Maintenance
Repair
equipment used by sanitation, roads or drainage.
Working
on heavy equipment which has been around potentially infectious
materials.
Number XX.17.J
Page 18
of 32 Bloodborne Pathogens
Exposure Control Plan
Appendix A
EXPOSURE
DETERMINATION
Unless
otherwise stated, the listed job classifications as of the date of
this
policy, are those in which all employees have potential occupational
exposure. For those classifications in which only some
employees have
potential
exposure, the job tasks or procedures that might cause occupa-
tional
exposure are listed. (Contact Personnel
Services Division for most
current
listing.)
The
following Santa Cruz County departments have employees with potential
occupational
exposure to blood or other infectious materials:
District
Attorney
General
Services
Health
Services Agency
Human
Resources Agency
Municipal
Court
Personnel
POSCS
Probation
Public
Works
Sheriff
Superior
Court
District
Attorney
Attorney
I, II, III, IV
Chief
DA Inspector
DA
Inspector I,II
General
Services
Building
Equipment Mechanic
Building
Equipment Supervisor
Building
Maintenance Superintendent
Building
Maintenance Supervisor
Building
Maintenance Worker I, II, III
Custodian
Custodian
Leadworker
Maintenance
Custodian
Maintenance
Electrician
Maintenance
Electromechanical Worker
Maintenance
Plumber
Senior
Building Equipment Mechanic
Supervising
Custodian
Number
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Bloodborne
Pathogens Exposure Control Plan
Page 19 of 32
Appendix A
(continued)
Health
Services Agency
Account
Clerk (who work in the clinic or
laboratory areas and may have
first contact with patients entering the
Agency who might be bleeding)
Assistant
Chief of Public Health
Assistant
Health Officer
Chief
of Public Health
Chief
Radiologic Technologist
Clerk
II,III (who work in the clinic registration area and may have first
contact with patients entering the Agency
who might be bleeding)
Clinic
Business Office Supervisor
Clinic
Nurse I, II, III
Clinic
Physician
Community
Health Worker I, II
Custodian
Custodian
Leadworker
Detention
Nurse Assistant Program Manager
Detention
Nurse Program Manager
Detention
LVN
Detention
Nurse Supervisor
Detention
Registered Nurse
Director
of Laboratory Services
Housekeeper
Laboratory
Technician
Laboratory
Assistant
LVN
Medical
Director - HS Clinics
Medical
Care Eligibility Worker
Medical
Care Program Eligibility Supervisor
Medical
Care Program Benefits Supervisor
Medical
Care Service Worker
Medical
Services Director/Health Officer
Nurse-Midwife
Physician
Assistant/Nurse Practitioner
Public
Health Assistant
Public
Health Investigator
Public
Health Lab Tech Supervisor
Public
Health Microbiologist
Public
Health Nurse I, II, III
Public
Health Program Manager
Radiologic
Technologist
Senior
Account Clerk (who work in the clinic
area and may have first con-
tact with patients entering the Agency
who might be bleeding)
Senior
Environmental Health Specialist (who inspects laboratories and phy-
sicians' offices)
Senior
Public Health Investigator
Senior
Public Health Microbiologist
Senior
Public Health Program Manager
Number XX.17.J
Page 20
of 32 Bloodborne Pathogens
Exposure Control Plan
Appendix A
(continued)
Health
Services Agency (continued)
Senior
Receptionist (who works in the clinic
registration area and may
have first contact with patients entering
the Agency who might be
bleeding)
Clerical
Supervisor II (who works in the clinic
registration area and may
have first contact with patients entering
the Agency who might be
bleeding)
Supervising
Custodian
Typist
Clerk (who works in Medi-Cruz and may
have first contact with
patients entering the Agency who might be
bleeding).
X-ray
technician (C/M)
Human Resources Agency
Welfare Fraud Investigator I,II
Chief
Welfare Fraud Investigator
Municipal
Court
Deputy
Court Clerk
Municipal
Court Room Clerk
Senior
Municipal Court Room Clerk
Supervising
Deputy Court Clerk I, II
Supervising
Municipal Court Room Clerk
Personnel
Hazardous
Materials Program Analyst
OSH
Program Manager (Sr Personnel Analyst)
POSCS
Lifeguard
Instructor
Lifeguard
Manager
Lifeguard
Park
Caretaker
Park
Maintenance Manager
Park
Services Officer I, II
Parks
Maintenance Supervisor
Parks
Maintenance Worker I, II, III
Parks
Rec Cultural Worker I, II, III, IV
Program
Manager/POSCS
Recreation
Services Supervisor
Probation
Assistant
Superintendent Juvenile Hall
Juvenile
Hall Superintendent
Chief
Probation Officer
Appendix A
(continued)
Number
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Bloodborne
Pathogens Exposure Control Plan
Page 21 of 32
Probation
(continued)
Cook
Housekeeper
Deputy
Probation Officer I, II, III
Group
Supervisor I, II
Institutional
Supervisor
Probation
Aide
Probation
Division Director
Public
Works
Cashier
- Disposal Site
Disposal
Site Supervisor
Disposal/Drain
Supervisor
Heavy
Equipment Mechanic
Heavy
Equipment Operator-Disposal
Line
Maintenance Crew Coordinator
Public
Works Maintenance Worker I, II, III, IV (who work on the Drainage
crew and encounter needles on the levees)
Public
Works Manager-Disposal Site
Public
Works Manager-Drainage
Public
Works Safety Specialist
Public
Works Supervisor
Pump
Maintenance Specialist
Sanitation
Maintenance Worker I, II, III
Sanitation
Supervisor
Sanitation
Superintendant
Solid
Waste Inspector I, II
Senior
Disposal Site Worker
Transfer
Truck Driver
Trusty
Work Crew Supervisor
Sheriff
Cook
Deputy
Sheriff
Deputy
Sheriff Trainee
Head
Cook
Sheriff-Coroner
Sheriffs
Chief Deputy
Sheriffs
Detention Officer
Sheriffs
Lieutenant
Sheriffs
Property Clerk
Sheriffs
Sergeant
Supervising
Detention Officer
Number XX.17.J
Page 22
of 32 Bloodborne Pathogens
Exposure Control Plan
Appendix A (continued)
Superior
Court
Assistant
Administrator-Superior Court
Senior
Superior Court Clerk
Superior
Court Clerk
Superior
Court Clerk Trainee
Legal
Clerk (who handles evidence contaminated with blood or OPIM)
Supervising
Legal Clerk
Number
XX.17.J
Bloodborne
Pathogens Exposure Control Plan
Page 23 of 32
Appendix B:
The
employer shall assure that employees who decline to accept Hepatitis B
vaccination
offered by the employer sign the following statement as re-
quired
by subsection (f)(2)(D):
RECORD OF HEPATITIS B VACCINE
DECLINATION
I understand that due to my occupational
exposure to blood or other poten-
tially
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
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 po-
tentially
infectious materials in the course of my employment with Santa
Cruz
County, and I want to be vaccinated with Hepatitis B vaccine, I can
receive
the vaccination series at no charge to me.
Employee
Name
_______________________________
Employee
Signature _______________________________
Social
Security Number
_______________________________
Employer Representative
_______________________________
Number XX.17.J
Page 24
of 32 Bloodborne Pathogens
Exposure Control Plan
Appendix C: Form #1
RECORD OF HEPATITIS B
VACCINATION
{6
Name
________________________________________
Birthdate
________________________________________
Medical
Record Number ________________________________________
Social
Security Number
________________________________________
Department
________________________________________
Job
class
________________________________________
Information
and training completed:
_____ General explanation of the epidemiology
and symptoms of bloodborne disease
_____ Explanation of the modes of transmission
of bloodborne pathogens.
_____ Hepatitis B vaccine information:
efficacy, safety, method of administration, benefits
of being vaccinated, vaccine and
vaccination offered free of charge.
Healthcare
professional's written opinion:
_____ Hepatitis B vaccination is indicated for
this employee. The employee has
potential
occupational exposure to blood or
other infectious materials.
_____ Hepatitis B vaccination is not indicated
for this employee.
Disposition:
_____ Vaccine series started.
_____ Vaccine declined. Declination form signed.
_____ Employee previously received complete
vaccine series
_____ Antibody testing has revealed that
employee is immune.
_____ Vaccine is contraindicated for medical
reasons.
___________________
______________________________________________
Date Signature of healthcare
professional
I have
received and read the Employee Information Sheet on Bloodborne Pathogens.
___________________
______________________________________________
Date
Signature of employee
Dates
of vaccinations:
Type Date Antibody testing (Anti HBs)
___________________ _________________ ______________________________
___________________ _________________ ______________________________
___________________ _________________ ______________________________
___________________ _________________ ______________________________
___________________ _________________ ______________________________
___________________ _________________ ______________________________
___________________ _________________ ______________________________{2
Number XX.17.J
Bloodborne
Pathogens Exposure Control Plan
Page 25 of 32
Appendix C: Form
#2
EXPOSURE INCIDENT
REPORT FORM{6
Definition
of Exposure Incident: A specific eye,
mucous membrane, non-intact skin, or parenteral
(piercing
mucous membranes or skin barrier) contact with blood or other potentially
infectious
materials
that results from the performance of an employee's duties.
Employees
must report all exposure incidents immediately to supervisors or to
departmental
safety
liaisons. Treatment to prevent certain diseases must be given within the first
24 hours
following
an exposure.
Supervisors,
departmental safety liaisons, or their designees are responsible for
investigation
and
documentation of all exposure incidents, as well as completion of all
appropriate forms.
Steps
to follow after an exposure incident:
1. Contact Occupational Health at 454-5463 or
454-2938 to report the Exposure Incident and
arrange follow-up.
2. Complete the Exposure Incident Report Form
(Form #2, Appendix C) Send copy to
Occupational
Health.
3. Request blood testing on the source
individual. Use Form #3A for consent if
the source
is an adult. Use Form #3B if the source
is a minor. Send copy of consent form
to
Occupational Health.
4. Send the source with the completed consent
form to a local facility to have blood drawn.
5. Complete the top portions of Forms #4 and
#6.
6. Send the exposed employee along with Forms
#2, #4, and #6 to a medical facility.
During the standard County work
week, the employee should be evaluated by the County
Occupational Health Physician.
If an exposure occurs at night or
during a weekend, emergency treatment should be
sought at the most convenient
hospital emergency room. The employee
should then
be referred to the Occupational
Health Physician on the next working day.
7. As for any work-related injury, obtain the
workers' compensation packet and complete as
directed in the instructions.
________________________________________________________________________________________________
Employee's
Name ______________________________ Department
__________________________________
Birthdate ______________________________ Job Class
__________________________________
Social
Security Number _______________________
Description
of exposed employee's duties as they relate to the exposure incident:
Type of
body fluid: (e.g. Blood, saliva
contaminated with blood,etc.)
Route
of exposure:
____ through a body opening (mucous membranes such as eyes, nose,
mouth)
____ parenteral (piercing skin barrier, e.g. needlestick, bite, cut)
____ through a break in the skin (e.g. cuts, sores, abrasions, rash)
____ other (description:
___________________________________________________________)
Circumstances
under which exposure incident occurred:{2
Number XX.17.J
Page 26
of 32 Bloodborne Pathogens
Exposure Control Plan
EXPOSURE
INCIDENT REPORT FORM (cont.)
{6Identification
of source: ______________________________________ Birthdate: __________________
Important
note to exposed employee: This information is made available to you pursuant
to
Section 5193, Title 8, California Code of Regulations. Other laws prohibit you from
disclosing
the identity and infectious status of the source individual to anyone.
____ source is known to be HIV positive and consents that that
information be disclosed
to the exposed
employee (consent attached).
____ source is known to be infectious for Hepatitis B.
____ source is high risk for infection with bloodborne pathogens.
____ source is not high risk for infection with bloodborne pathogens.
____ source blood has been sent for testing for HBV/HIV (consent attached)
(laboratory used:
_________________________________________________
____ legally required consent could not be obtained for testing of
source blood.
Employee
Hepatitis B vaccination status:
____ employee not vaccinated
____ employee
vaccinated on the following dates: ________________________________
____ HBV immunity documented
(date of blood test showing immunity_______________)
____________________________________________________ _____________________
Signature
of supervisor/safety liaison/designee date
_________________________________________________________________________________________________
{6Employee
referred to: ______________________________________________________________
(name
and location of medical facility)
I
understand that because of this exposure I might become infected with a
bloodborne pathogen
such as
the Hepatitis B virus, the Hepatitis C virus, or the HIV virus. I understand
that there
are
medical treatments that could decrease or eliminate the chances of my getting
such infections.
I will
therefore seek medical treatment as soon as possible. I understand that this medical
care
will be provided at no cost to me.
________________________________________________________ _______________
(signature of employee) (date)
I
understand that because of this exposure I might become infected with a
bloodborne pathogen
such as
the Hepatitis B virus, the Hepatitis C virus, or the HIV virus. I understand that
there
are medical treatments that could decrease or eliminate the chances of my
getting such
infections,
and that such treatments are available at no cost to me. In spite of this, I
refuse
testing or medical treatment.
________________________________________________________ _______________
(signature of employee) (date)
To supervisor or safety liaison: When completed, please forward a copy of
this form to Occupa-
tional
Health Program, 1080 Emeline, Santa Cruz, 95060. Attn: Dr. Kathleen Loughlin.{2
Number XX.17.J
Bloodborne
Pathogens Exposure Control Plan
Page 27 of 32
Appendix C: Form #3A
CONSENT
OR DECLINATION FOR SOURCE BLOOD TESTING FOLLOWING AN EXPOSURE INCIDENT
To: ___________________________________
(name of source)
A Santa
Cruz County employee
_________________________________,
(name
of employee)
of the _________________________________,
(department)
was
exposed to your blood or other body fluids on __________________.
(date)
Federal
and state laws require that when an employee is exposed to the blood of
an
individual, the employer must seek the consent of that individual to testing
for HIV
(Human Immunodeficiency Virus) and Hepatitis B, for the purpose of
protecting
the health and safety of the exposed employee.
The
results of the blood tests would remain confidential. They are only
disclosed
to the exposed employee and to his/her healthcare provider, in
accordance
with Section 5193, Title 8 of the California Code of Regulations.
These
results would only be used to determine appropriate medical care for the
exposed
employee. The blood tests would be done
at no cost to you.
You may
also have access to the results of your blood tests. The results of
the
hepatitis test can be given to you by telephone. Results of the HIV
antibody
test can only be given to you confidentially, in person.
Do you
consent to the testing of your blood?
____ I
consent that my blood be tested for Hepatitis B infectivity.
____ I
consent that my blood be tested for HIV (Human Immunodeficiency
Virus),the probable causative agent
of AIDS.
____ I
do not consent to blood testing for Hepatitis B.
____ I
do not consent to blood testing for HIV.
____ I
choose to disclose that I am HIV positive.
____ I
choose to disclose that I am infectious for Hepatitis B.
_______________________________________________
(signature) (date)
Test
results and billing should be sent to:
Kathleen Loughlin, M.D.
Occupational Health Program
Health Services Agency
1080 Emeline Avenue
Santa Cruz, CA 95060
Appendix C: Form #3B
Number XX.17.J
Page 28
of 32 Bloodborne Pathogens
Exposure Control Plan
CONSENT OR DECLINATION FOR SOURCE
BLOOD TESTING OF A MINOR
FOLLOWING AN EXPOSURE INCIDENT
To: __________________________________
(parent or guardian of source)
A Santa Cruz County employee _________________________________,
(name
of employee)
of the
_________________________________,
(department)
was
exposed to the blood or other body fluids of your dependent,
___________________________ on
__________________.
(name of source) (date)
Federal
and state laws require that when an employee is exposed to the blood of
an
individual, the employer must seek the consent of that individual to testing
for HIV
(Human Immunodeficiency Virus) and Hepatitis B, for the purpose of
protecting
the health and safety of the exposed employee.
The
results of the blood tests would remain confidential. They are only
disclosed
to the exposed employee and to his/her healthcare provider, in
accordance
with Section 5193, Title 8 of the California Code of Regulations.
These
results would only be used to determine appropriate medical care for
exposed
employee. The blood tests would be done
at no cost to you.
You may
also have access to the results of the blood tests. The results of the
hepatitis
test can be given to you by telephone.
Results of the HIV
antibody
test can only be given to you confidentially, in person.
Do you
consent to the testing of your child's blood?
____ I
consent that my child's blood be tested for Hepatitis B infectivity.
____ I
consent that my child's blood be tested for HIV (Human Immunodeficiency
Virus),the probable causative agent
of AIDS.
____ I
do not consent to testing my child's blood for Hepatitis B.
____ I
do not consent to testing my child's blood for HIV.
____ I
choose to disclose that my child is HIV positive.
____ I
choose to disclose that my child is infectious for Hepatitis B.
_______________________________________________
(signature of
parent/guardian) (date)
Test
results and billing should be sent to:
Kathleen Loughlin, M.D.
Occupational Health Program
Health Services Agency
1080 Emeline Avenue
Santa Cruz, CA 95060
Appendix C: Form #4
Number XX.17.J
Bloodborne
Pathogens Exposure Control Plan
Page 29 of 32
EXPOSURE INCIDENT MEDICAL
TREATMENT REPORT FORM
{6 Please
complete and return to:
Employee's
Name ______________________________
Birthdate ______________________________ Kathleen Loughlin, M.D.
Social
Security No. ______________________________ Occupational Health Program
Department ______________________________ Health Services Agency
Job
Class
______________________________ 1080 Emeline Avenue
Santa Cruz, CA 95060
____________________________________________________________________________________________
Post-exposure
prophylaxis was given as follows:
______ Hepatitis B immune globulin (HBIG) was
given as prophylaxis against Hepatitis B.
(0.06 cc/kg = _______________ cc given)
______ Immune serum globulin (ISG) was given as
possible prophylaxis against Hepatitis C.
(0.06 cc/kg =
_______________ cc given)
______ Zidovudine (AZT) was started as possible
prophylaxis against HIV.
(dose:
____________________________________)
____________________________________________________________________________________________
______ Employee was counseled about the risks of
acquiring and transmitting diseases
caused by bloodborne pathogens and
ways to minimize those risks.
______ Employee was advised to report the
occurrence of illnesses that might indicate the
onset of diseases caused by
bloodborne pathogens.
____________________________________________________________________________________________
______ Employee's blood was tested for:
______HBV (Results: HBsAg _______________ HBsAB _______________)
______HIV
______ Employee consents to baseline blood
collection, but does not want HIV testing at
the present time. The blood samploe will be preserved for 90
days. During the 90
day period, the employee may request
that the test be done.
Signature of medical provider
_______________________________________________
Address
_______________________________________________
____________________________________________________________________________________________
I
consent that the results of my HIV testing be released to Dr. Kathleen
Loughlin, Santa Cruz
County
Occupational Health Program, for the purpose of following up on this exposure
inci-
dent. The information will be held confidential as
required by law.
_______________________________________________
(employee's
signature)
I do
not consent to the release of my HIV test results to Dr. Loughlin, Santa Cruz
County
Occupational
Health Program. I understand that
without my test results, the Occupational
Health
Program will not be able to recommend appropriate follow-up and counseling for
me.
_______________________________________________
(employee's signature){2
Appendix C: Form #5
Number XX.17.J
Page 30
of 32 Bloodborne Pathogens
Exposure Control Plan
EMPLOYEE INFORMATION SHEET ON
BLOODBORNE PATHOGENS
A
pathogen is any microorganism that can cause disease in humans. Blood-
borne
means that the pathogens are present in human blood. Bloodborne
pathogens
include the Hepatitis B virus (HBV) and the Human Immunodeficien-
cy
Virus (HIV). Other diseases (such as Hepatitis C, syphilis, and malaria)
can
also be spread by exposure to infected blood, but HBV and HIV are the
most
significant. People today tend to focus
on AIDS and the HIV virus,
but
Hepatitis B is really a more significant problem. Hepatitis B is just
as
deadly as AIDS and is much easier to catch. There is also a vaccine
available
that can prevent Hepatitis B, whereas no vaccine is available
against
AIDS.
Hepatitis
B
Hepatitis
means inflammation of the liver.
Hepatitis B is a liver inflam-
mation
caused by the Hepatitis B virus (HBV).
Each year in the U.S. there
are
approximately 280,000 HBV infections. Each year 8700 healthcare workers
become
infected with HBV and 200 die from Hepatitis B. In some people,
Hepatitis
B infection leads to cirrhosis and liver cancer.
The
symptoms of HBV infection are like those of the flu. After exposure to
the
virus, it can take 2 to 6 months for Hepatitis B to develop. Initially
a
person may be tired, nauseous, lose appetite, and have abdominal pain. As
the
disease progresses the infected person may develop yellow skin and eyes
(jaundice)
and dark urine. Some people infected
with HBV have no symptoms
at all.
Others become so ill they must be hospitalized. Some die.
HBV is
spread by exposure to infected blood and other body fluids such as
semen
and vaginal secretions. The infected
material enters through breaks
in the
skin or mucous membranes. While most Hepatitis B is transmitted
sexually,
the virus can also enter through cuts in the skin, needlesticks,
splashes
into eyes or mouth, or areas of dermatitis where normal skin bar-
riers
have broken down.
Human
Immunodeficiency Virus
The
Human Immunodeficiency virus (HIV) attacks the body's immune system,
causing
the disease know as AIDS (Acquired Immune Deficiency Syndrome).
People
can carry the HIV virus for years without having any symptoms. Even-
tually
the virus attacks the immune system and makes the person more sus-
ceptible
to other diseases such as pneumonia and cancer which may be fatal.
Symptoms
of HIV infection can include weakness, fatigue, fever, sore
throat,
and diarrhea.
HIV is
primarily transmitted through sexual contact, but may also be trans-
mitted
through contact with blood and some other body fluids. The infected
material
enters through breaks in the skin or mucous membranes. There is no
vaccination
available to protect against HIV.
Appendix C: Form #5
(cont.)
Hepatitis
B vaccination
Number
XX.17.J
Bloodborne
Pathogens Exposure Control Plan
Page 31 of 32
A new
OSHA/Cal OSHA standard covering bloodborne pathogens requires employ-
ers to
offer the Hepatitis B vaccination free of charge to all employees
who are
exposed to blood or other potentially infectious materials as part
of
their job duties.
The
vaccine series consists of 3 shots in the arm, given over a 6 month
period.
The vaccine does not contain live virus, so no one can catch hepa-
titis
from the vaccination. The vaccine is
very safe and effective and is
prepared
from recombinant yeast cultures rather than human blood. Over 2
million
healthcare workers have already been vaccinated. More than 90% of
the
people who receive the vaccine develop immunity. A blood test can show
whether
a person has become immune. Those who show immunity in the blood
test
are protected against HBV infection for
several years.
An
exposed worker who does not want to receive the vaccine must sign a form
declining
the vaccine. Someone who initially declines vaccination may
choose
to receive it at a later date if still working for the County in a
job
with exposure to infectious materials.
The
Bloodborne Pathogens Standard requires that employees be given copies
of the
evaluating healthcare professional's written opinion regarding the
need
for Hepatitis B vaccine. Below is your
copy of that written opinion.
_______________________________
Name of employee
Healthcare
professional's written opinion.
______ Hepatitis B vaccination is indicated for
this employee. The
employee has potential occupational
exposure to blood or other
infectious materials.
______ Hepatitis B vaccination is not indicated
for this employee.
Disposition:
______ Vaccine series started.
______ Vaccine declined. Declination form signed.
______ Employee previously received complete vaccine
series.
______ Antibody testing has revealed that the
employee has immunity
against Hepatitis B.
______ Vaccine is contraindicated for medical
reasons.
____________________
____________________________________
Date Signature of healthcare professional
Number XX.17.J
Page 32
of 32 Bloodborne Pathogens
Exposure Control Plan
Appendix C: Form #6
WRITTEN OPINION OF EVALUATING
HEALTHCARE PROFESSIONAL
Please
complete and return to:
Occupational Health Program
Health Services Agency
1080 Emeline Avenue
Santa Cruz, CA 95060
Attn: Kathleen Loughlin, M.D.
I
performed a medical evaluation on:
_______________________________
(employee's
name)
on: _______________________________
(date)
____
The patient has been informed of the results of the evaluation.
____
The patient has been informed of any medical conditions resulting
from exposure to blood or other
potentially infectious ma-
terials which require further
evaluation or treatment.
All
other findings or diagnoses shall remain confidential and shall not be
included
in this report.
Signature
of medical provider:
___________________________________
Address: ___________________________________
___________________________________
Telephone number:
___________________________________
Upon
receipt of this completed form, Occupational Health will provide the
exposed
employee with a copy.
PAM2017J
RFT F1 01/10/01