5072

Revised 10/2004

 

Bloodborne Pathogens

 

INTRODUCTION

 

Fermilab is committed to providing a safe and healthful work environment for all employees.  The following Exposure Control Plan (ECP) is provided to eliminate or minimize occupational exposure to bloodborne pathogens.  In addition, the ECP assists the Laboratory to ensure compliance with applicable standards through determination of employee exposure and implementation of various methods of exposure control including the following:

 

•         Universal precautions

•         Engineering and work practice controls

•         Personal protective equipment

•         Housekeeping

•         Hepatitis B vaccination

•         Post-exposure evaluation and follow-up

•         Communication of hazards to employees and training

•         Record keeping

•         Procedures for evaluating circumstances surrounding an exposure incident

 

 

STANDARDS

 

29 CFR 1910.1030         OSHA Occupational Exposure to Bloodborne Pathogens

29 CFR 1910.20             Access to Employee Exposure and Medical Records

 

RESPONSIBILITIES

 

Directorate

 

Overall responsibility for the ECP rests with the Director's Office.  The Director assures that adequate resources are available to carry out the plan as described in this chapter.

 

Divisions/Sections

 

Division/Section management is responsible for obtaining and maintaining all necessary personal protective equipment (PPE), engineering controls (e.g., sharps containers), labels, and red bags as required by this plan.  In addition, division/section management is responsible for ensuring that the required annual training is conducted by qualified trainers and documented.

 

The Environmental Safety & Health (ESH) Section – Medical Department

 

The ESH-Medical Department is responsible for the following:

 

§         Maintenance of the ECP.

§         Annual review of the ECP (and whenever necessary to include new or modified tasks and procedures),

§         Providing training on the Hepatitis B Vaccination to affected employees,

§         Overseeing the development and updating of the Bloodborne Pathogens lesson plan to be used by division/section personnel to deliver the required training.

§         Ensuring that all required medical actions are performed, and

§         Maintaining employee health records.

 

The Fermilab Medical Department is located on the Ground Floor of Wilson Hall (X 3232).

 

Affected Employees

 

Those employees who are determined to have occupational exposure to blood or Other Potentially Infectious Materials (OPIM) must comply with the procedures and work practices outlined in this plan.

 

 

EMPLOYEE EXPOSURE DETERMINATION

 

The following is a list of Fermilab job classifications, that are deemed to have a potential occupational exposure to bloodborne pathogens:

 

JOB TITLE

DEPARTMENT/ LOCATION

Physician

ESH/Medical Office

Nurse I

ESH/Medical Office

Nurse II

ESH/ Medical Office

Fire Chief

ESH/Fire Department

Lieutenant

ESH/Fire Department

Captain

ESH/Fire Department

Fire Fighter

ESH/Fire Department

Security Captain

ESH/Security Department

Housekeeping Manager

LS/Accommodations

Day Care Teacher

LS/Day Care Center

Day Care Attendant

LS/Day Care Center

Day Care Administrator

LS/Day Care Center

Lifeguards

LS/Recreation

 

In addition to these employees, it is recognized that all janitorial and housekeeping staff have a potential occupational exposure to bloodborne pathogens.  This work is currently carried out by contract service vendors who are responsible for implementation of necessary BBP precautions.

 

Divisions/Sections may include additional individuals in the plan based on unusual job assignments.

 

 

METHODS OF IMPLEMENTATION AND CONTROL

 

Universal Precautions

 

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.  All employees will utilize universal precautions.

 

Exposure Control Plan

 

Employees covered by the BBP standard receive an explanation of this ECP during their initial training session.  It is also reviewed in their annual refresher training.  All employees have an opportunity to review the plan at any time by contactingthe Fermilab Medical Department, or by logging onto the ESH web page.

 

The ECP will be reviewed and updated in concert with annual refresher training.  This review will include consideration of appropriate commercially-available and effective safer medical devices designed to eliminate or minimize occupational exposure to bloodborne pathogens.  Input will be solicited from potentially-exposed non-managerial personnel including those responsible for direct patient care who may be exposed to injuries from contaminated sharps.  This solicitation will include the identification, evaluation and selection of effective controls.  Documentation of reviews will be maintained with the documentation of training.  Training records pertaining to ES&H-related training shall be forwarded to the ES&H Section for filing and maintenance as required by chapter 4010 of this manual.

 

Engineering Controls and Work Practices

 

Engineering and work practice controls will be used to prevent or minimize exposure to bloodborne pathogens.  Specific controls are listed below.

 

MEDICAL OFFICE

           Gloves for phlebotomy/venipuncture

           Gloves for wound care

           Gloves for clean-up activities

           No pouring off/transfer of serum to 2nd collection tube

           No recapping of needles

           Appropriate disposal of sharps ASAP

           Use of tool/scoop to pick up broken glass

           Gloves for clean-up of bodily fluids

 

 

DAY CARE CENTER

           Gloves for wound care

           Gloves for clean-up activity

           Appropriate disposal of sharps ASAP

 

LIFEGUARDS

           Gloves for wound care & clean-up activities

 

FIRE DEPARTMENT

           Gloves for wound care

           Gloves when starting IVs

           Gloves for clean-up activities

 

Sharps disposal containers are inspected and maintained by the nurses or replaced every three (3) months, or whenever necessary to prevent overfilling.  Sharps disposal containers at the Day Care Facility are inspected and maintained by the Day Care Manager and/or teachers, and replaced whenever necessary to prevent overfilling.

 

Personal Protective Equipment (PPE)

 

PPE is provided to Fermilabemployees at no cost.  PPE available to employeesmay include gloves, eye protection, lab coats, disposable CPR masks, etc.

Training in the use of the appropriate PPE for the tasks employees will perform is provided in the general BBP training program.

 

 

MEDICAL OFFICE

Location of PPE:

Storage closet adjacent to Exam Room 2

Available thru:

Any member of medical staff

 

DAY CARE CENTER

Location of PPE:

Storage Closet at north end of facility.

Available thru:

Supervisor or staff member.

 

FIRE DEPARTMENT

Location of PPE:

On emergency vehicles (squad & engines), in the first aid lockers,

Available thru:

Supervisor or the duty captain.

 

LIFEGUARDS

Location of PPE:

Storage closet

Available thru:

Supervisor or Lifeguard

 

All employees using PPE must observe the following precautions.

 

1)      Wash hands immediately or as soon as feasible after removal of gloves or other PPE.

2)      Remove PPE after it becomes contaminated, and before leaving the work area.

3)      Used PPE may be disposed of in appropriate containers such as:

a)      Red, hard-sided containers with biohazard symbol

b)      Red biohazard bags

c)      Contaminatedlaundering containers (Red bag, or garbage bag with red biohazard symbol)

d)      Areas to be decontaminated (Marked with yellow warning tape)

 

4)      Wear appropriate waterproofgloves (like vinyl, or latex)when it can be reasonably anticipated that there may be hand contact with blood or OPIM, and when handling or touching contaminated items or surfaces; replace gloves if torn, punctured, contaminated, or if their ability to function as a barrier is compromised.

5)      Utility gloves may be decontaminated for reuse if their integrity is not compromised; discard utility gloves if they show signs of cracking, peeling, tearing, puncturing, or deterioration.

6)      Never wash or decontaminate disposable gloves for reuse.

7)      Wear appropriate face and eye protection when splashes, sprays, spatters, or droplets of blood or OPIM pose a hazard to the eye, nose, or mouth.

8)      Remove immediately or as soon as feasible any garment contaminated by blood or OPIM, in such a way as to avoid contact with the outer surface.

 

Housekeeping

 

Contaminated sharps are discarded immediately, or as soon as possible, using containers that are closable, puncture-resistant, leak proof on sides and bottoms, and labeled or color-coded appropriately.  Sharps disposal containers are available in each exam room in the Medical Department, in the storage closet in the Medical Department, and in most classrooms at the Day Care Facility.

 

Bins and pails (e.g., wash or emesis basins) are cleaned and decontaminated as soon as feasible after visible contamination.

 

Broken glassware (which may be contaminated) is picked up using mechanical means, such as a brush and dustpan.

 

All other regulated waste is placed in containers that are closable, constructed to contain all contents and prevent leakage, appropriately labeled or color-coded (see Labels), and closed prior to removal to prevent spillage or protrusion of contents during handling.

 

Refer to Fermilab Hazardous Waste Disposal Chapter (8021) for the procedures to dispose of sharps containers or other regulated waste.  It is available on the ESH web page at

 

            http://www-esh.fnal.gov/FESHM/8000/8021.htm

 

Laundry

 

Clothing of affected workers that maybe contaminated with blood or OPIM should be delivered to the Medical Department (see laundry requirements below).  All other contaminated clothing (patient/victim, children, other) will be processed on a case-by-case basis in accordance with the laundry requirements provided below or disposed of appropriately.  The laundry is picked up and cleaned by a qualified laundry service.

 

The following laundering requirements must be met.

 

1.      Handle contaminated laundry as little as possible, with minimal agitation.

2.      Place wet contaminated laundry in leak-proof, labeled, or color-coded containers before transport.

3.      Use red bags or bags with biohazard label affixed to the bag.

4.      Wear gloves, gowns, eye protection, face protection, and/or other PPE as indicated when handling and/or sorting contaminated laundry.

5.      Maintain the bag of contaminated laundry at a secure location.

6.      Arrange to have the contaminated laundry picked up by the qualified laundry service for cleaning or disposed of in accordance with chapter 8021 of this manual.

 

Labels

 

The following labeling method(s) are used at Fermilab.

 

EQUIPMENT TO BE LABELED

LABEL TYPE (size, color, etc.)

§         Bags with laboratory specimens

Biohazard label

§         Contaminated laundry

Biohazard label, red bag

§         Contaminated PPE

Biohazard label, red bag

§         Needle Containers

Biohazard label, w/ “SHARPS”

§         Small spill clean-up bag

Biohazard label, red bag

 

 Persons who are qualified BBP workers or are otherwise assigned to handle biological waste containerswill ensure that warning labels are affixed or red bags are used as required if regulated waste or contaminated equipment is brought into the facility.  Employees are to notify their supervisor and/or Senior Safety Officer (SSO) if they discover regulated waste containers, refrigerators containing blood or OPIM, contaminated equipment, etc. without proper labels.

 

 

 

HEPATITIS B VACCINATION

 

The Medical Department will provide training to affected employees on hepatitis B vaccinations, addressing the safety, benefits, efficacy, methods of administration, and availability.

 

The hepatitis B vaccination series is available at no cost after training and within 10 days of initial assignment to employees identified in the exposure determination section of this plan.  Vaccination is encouraged unless:

 

1.      Documentation exists that the employee has previously received the series,

2.      Antibody testing reveals that the employee is immune, or

3.      Medical evaluation shows that vaccination is contraindicated.

 

If an employee chooses to decline vaccination, they  must sign a declination form.  This form can be found at the end of this chapter (see Appendix A).  Employees who initially decline may request the vaccination at a later date and it will be provided at no cost.  Documentation declining vaccination is kept in the MedicalDepartment.

 

Vaccination will be provided by the Medical Department. Following hepatitis B vaccination, the health care professional's written opinion will be limited to whether the employee requires the hepatitis vaccine, and whether the vaccine was administered.

 

 

POST-EXPOSURE EVALUATION AND FOLLOW-UP (See Appendix B, AppendixC and Appendix D)

 

In all situations, medical evaluation within two (2) hours is crucial.

 

In the event of an EXPOSURE INCIDENT [any incident resulting in direct contact with infectious or potentially infectious material], please follow the directions as noted below.

 

  1. Notify the supervisor.
  2. Contact the Medical Department at (630) 840-3232.
  3. If the incident occurs during “off hours”, (M-F from 5PM to 7AM, Saturday, Sunday, or Holiday) the exposed employee should:
    1. Report to either Central DuPage Hospital, Copley Memorial Hospital, Delnor Community Hospital, or Provena Mercy Center with a copy of the post-exposure evaluation report (appendix B) for the physician on duty to complete.  Appendix B is the only document taken to the ER.
    2. The employee or supervisor completes item 1-24 of Appendix C.  Fermilab’s “Sharps log” consists of a file of these completed forms.
    3. The employee is to report to the Medical Department the next working day with both the original and copy of each report (Appendix B and Appendix C)
  4. In all cases Appendix B and Appendix C should be completed but this should NOT delay prompt medical evaluation.

 

Confidential medical evaluation and follow-up will be immediately available.  This evaluation will be conducted by a licensed medical professional in the Medical Department .  Following the initial provision of first aid (clean the wound, flush eyes or other mucous membrane, etc.), the following activities will be performed.

 

  1. Document the routes of exposure and how the exposure occurred.
  2. Identify and document the source individual (unless the employer can establish that identification is infeasible or prohibited by state or local law).
  3. Obtain consent and make arrangements to have the source individual tested as soon as possible to determine HIV, HCV, and HBV infectivity; document that the source individual's test results were conveyed to the employee's health care provider.
  4. If the source individual is already known to be HIV, HCV and/or HBV positive, new testing need not be performed.
  5. Assure that the exposed employee is provided with the source individual's test results and with information about applicable disclosure laws and regulations concerning the identity and infectious status of the source individual (e.g., laws protecting confidentiality).
  6. After obtaining consent, collect exposed employee's blood as soon as feasible after exposure incident, and test blood for HBV and HIV serological status
  7. If the employee does not give consent for HIV serological testing during collection of blood for baseline testing, preserve the baseline blood sample for at least 90 days; if the exposed employee elects to have the baseline sample tested during this waiting period, perform testing as soon as feasible.

 

 

ADMINISTRATION OF POST-EXPOSURE EVALUATION AND FOLLOW-UP

The Medical Department ensures that health care professional(s) responsible for employee's hepatitis B vaccination and post-exposure evaluation and follow-up are given a copy of OSHA's Bloodborne Pathogens Standard (29 CFR 1910.1030).

The Medical Department ensures that the health care professional evaluating an employee after an exposure incident receives the following:

 

  1. A description of the employee's job duties relevant to the exposure incident
  2. Route(s) of exposure
  3. Circumstances of exposure if possible, results of the source individual's blood test
  4. Relevant employee medical records, including vaccination status

 

The Medical Department provides the employee with a copy of the evaluating health care professional's written opinion within 15 days after completion of the evaluation.

PROCEDURES FOR EVALUATING THE CIRCUMSTANCES SURROUNDING AN EXPOSURE INCIDENT

The Site Occupational Medicine Director, along with the accident investigation team, will review the circumstances of all exposure incidents to determine:

 

  1. Engineering controls in use at the time
  2. Work practices followed
  3. Description of the device being used
  4. Protective equipment or clothing that was used at the time of the exposure incident (gloves, eye shields, etc.)
  5. Location of the incident (patient exam room, ambulance, emergency site, etc.)
  6. Procedure being performed when the incident occurred
  7. Employee's training

 

If it is determined that revisions need to be made, the Site Occupational Medicine Director will ensure that appropriate changes are made to this ECP. Changes may include an evaluation of safer devices, adding employees to the exposure determination list, etc.

 

EMPLOYEE TRAINING

All employees will be provided with instructions on handling blood and body fluids in New Employee Orientation.  They will be instructed to not clean up other people’s blood or body fluid.

 

All employees who have a potential occupational exposure to BBPs must receive initial training conducted by a qualified instructor selected by the division/section with the approval of the Site Occupational Medicine Director.  Refresher training is required annually.

The person conducting the training shall be knowledgeable in the subject matter covered by the elements contained in the training program as it relates to the workplace that the training will address.  Refresher training is required annually.

All employees who have occupational exposure to bloodborne pathogens receive training on the epidemiology, symptoms, and transmission of bloodborne pathogen diseases.  In addition, the training program covers, at a minimum, the following elements:

 

  1. A copy and explanation of the standard.
  2. An explanation of our ECP and how to obtain a copy.
  3. An explanation of methods to recognize tasks and other activities that may involve exposure to blood and OPIM, including what constitutes an exposure incident.
  4. An explanation of the use and limitations of engineering controls, work practices, and PPE
  5. An explanation of the types, uses, location, removal, handling, decontamination, and disposal of PPE
  6. An explanation of the basis for PPE selection
  7. Information on the hepatitis B vaccine, including information on its efficacy, safety, method of administration, the benefits of being vaccinated, and that the vaccine will be offered free of charge
  8. Information on the appropriate actions to take and persons to contact in an emergency involving blood or OPIM
  9. 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
  10. Information on the post-exposure evaluation and follow-up that the employer is required to provide for the employee following an exposure incident
  11. An explanation of the signs and labels and/or color coding required by the standard and used at this facility
  12. An opportunity for interactive questions and answers with the person conducting the training session.

 

Class schedules are available on the web at

 

http://www-esh.fnal.gov/pls/default/esh_home_page.page?this_page=100

 

RECORDKEEPING

Training Records

 

Training records are generated for each employee upon completion of training.  The training will be documented electronically in the ESH TRAIN database, located on web at http://www-esh.fnal.gov/pls/default/esh_home_page.html

 

The training records include the following:

 

  1. Dates of the training sessions
  2. Names and qualifications of persons conducting the training
  3. Names and job titles of all persons attending the training sessions

 

Original attendance sheets are kept by the trainer.  Copies are sent to the ESH section.

Employee training records are provided upon request to the employee or the employee's authorized representative within 15 working days.  Such requests should be addressed to the division/section ES&H safety organization.  Program content is available from the Medical Department.

Medical Records

Medical records are maintained for each employee with occupational exposure in accordance with applicable standards.  This includes completed copies of the appendices to this chapter.  In particular, Appendix C is considered to be the “sharps log.”

Active records are kept in the Fermilab Medical Department.

Archived records are kept at an off site storage facility for thirty years after termination of employment.

Employee medical records are provided upon request of the employee or to anyone having written consent of the employee within 15 working days.  Such requests should be sent to:

Fermilab Medical Office

P. O. Box 500 M.S. 204

Batavia, IL 60510

 

SUBCONTRACTORS

 

All subcontractors working on Fermilab Property who are exposed to bloodborne pathogens shall comply with all appropriate OSHA standards, including 29 CFR 1910.1030 and 29 CFR 1910.20.

APPENDIX A

 

 

 

HEPATITIS B VACCINE DECLINATION (MANDATORY)

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 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.

Signed: ________________________________   Witness: ______________________

Printed Name: _________________________

Date: __________________________________

 

 

 

 

 

 

APPENDIX B

 

 

Fermi National Accelerator Laboratory
Medical Office • MS204

P.O.Box 500

Batavia, IL• 60510-0500
630-840-3232        Fax: 630-840-3053

E-mail: foxen@fnal.gov

 

Date:

 

 

 

To:  Emergency physician         

 

Re:  Post exposure evaluation report for ___________________________     __________

     Fermilab Employee                           ID#

 

The above individual is being treated initially by you for possible exposure to blood borne pathogens. Our Fermilab medical office will actively monitor follow up care. Please provide us with a copy of records documenting your initial evaluation and treatment. These would include:

 

 

 

Thank you for your help in managing this case.

 

Sincerely,   

 

 

 

John Foxen, MD

Director, Occupational Health

 

 

 

Appendix C

Fermilab Post Exposure Evaluation Report

(Questions 1-24 To be completed for each exposure incident)
 
                     

 

EMPLOYER INFORMATION

 

1.      Employee Name:  __________________________________________________

2.      Address:  __________________________________________________________

                        __________________________________________________________

3.      Home Telephone Number:  __________________________________________

4.      Social Security Number:  ______-_____-______     

5.      ID Number:  ____________

6.      Division/Section:  __________________________________________________

7.      Job Title:  __________________________________________________________

8.      Hire Date:  _________________________________________________________

9.      Duration of current job:  _____________________________________________

10.  Date and Time of exposure:  _________________________________________

11.  Date and time of report:  ____________________________________________

12.  Name of person reported to:  _________________________  Div/Sect: ______

13.  Location of exposure:

                Building  ___________________  Dept. _______________  Room ______

14.  Employee on duty?         YES           NO

15.  Task being performed:  ______________________________________________

16.  Precautions taken:  _________________________________________________

17.  Blood or bodily fluid involved  _______________________________________

18.  Nature of exposure:

                _____  Needlestick injury                                 _____  Non-intact skin

                _____  Other sharp instrument injury     _____  Human bite

                _____  Mucous membrane splash                     _____  Other_______________

19.  Exposure occurred during 

                _____  Needle recapping                     _____  Putting needle in box

                _____  Handling trash               _____  Medication administration

                _____  Handling linens              Other___________________________

20.  Describe exposure/injury:  __________________________________________

_____________________________________________________________________

21.  Why did exposure occur?  __________________________________________

_____________________________________________________________________

22.  How could exposure have been prevented?  ___________________________

______________________________________________________________________

SOURCE INFORMATION

 

23.  Source patient exposure known?                    YES                 NO

24.  Source patient:           Name  ____________________________________________

                                        Social Security Number  ____________________________

                                        Date of Birth  ______________________________________

                                        Address  _________________________________________

                                                         _________________________________________

                                        Phone   ___________________________________________

 

 

        

Appendix D

 

Worksheet for FNAL Medical Office Use only
 
EMPLOYEE EVALUATION

 

1.       Hepatitis B Vaccine History               YES     NO      Date  __________

                Completed 3 dose series                       YES     NO      Date  __________

                Post vaccination serology                      YES     NO      Date  __________

      Prior Hepatitis serology history                       YES     NO      Date  __________

      Prior HIV serology history                  YES     NO      Date  __________

2.      Post testing

                       

Name of test

Date Sent

Date Reported

Results

HIV serology

 

 

 

HbsAG

 

 

 

 

HEPAPTITS B VACCINATION EVALUATION

 

1.      Employee has received the Hepatitis B vaccine in the past                   YES     NO

2.      If no, does this employee desire the vaccine in the next program          YES     NO

3.      Employee is recommended to have the Hepatitis B Vaccine due

To no contraindications (pregnant, likely to become pregnant in

                the near future, nursing)                                                                                 YES               NO

4.      Treatment given  ___________________________________________________________________

5.      Employee has been counseled and informed of:

                _____  significance of exposure

                _____  risk of infection

                _____  guidelines of prevention of spread

            _____  recommendations of employee’s ability to receive

                        Hepaptis B vaccine

 

 

            _________________________________________________________

                                    FNAL Medical office MD or RN Signature and date

 

            _________________________________________________________

                                    Employee signature and date

 

6.     Healthcare professional’s written opinion on exposure provided to employee along with test results needed for further follow-up.       YES     NO

 

 

 

PHYSICIAN EVALUATION

(To be completed by Fermilab MD)

 

        SOURCE PATIENT:

1.      Source patient evaluation:

               

 

 

 

 

 

 

2.      Source patient blood tests:

                           

Name of test

Date Sent

Date Reported

Result

HIV Serology

 

 

 

HbsAG

 

 

 

Hepatitis C

 

 

 

RPR

 

 

 

Other

 

 

 

 

EXPOSED PATIENT/EMPLOYEE:

1.      This exposure is considered:

                _____  Non-infectious non-penetrating requires  no further follow-up

                _____  Potentially infectious, requires follow-up.

2.      Recommended employee and source (if source known) be drawn for HIV and Hepatitis B testing with results to be given employee by Medical Office as they are available.YES                                       NO

3.      Additional comments:

 

 

 

 

 

 

 

 

___________________________________________________

                Physician Signature and date