AEROSOL TRANSMISSIBLE DISEASE
EXPOSURE CONTROL PLAN
FOR REFERRING – PUBLIC SAFETY
Environmental Health & Safety Department
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Rev 11/2015
SAN DIEGO STATE UNIVERSITY
ENVIRONMENTAL HEALTH & SAFETY
AEROSOL TRANSMISSIBLE DISEASE PROGRAM
EXPOSURE CONTROL PLAN FOR
REFERRING – PUBLIC SAFETY
I.
INTRODUCTION AND OVERVIEW
The California Occupational Safety and Health Administration under Title 8 of the California Code of Regulations, Section
5199: Aerosol Transmissible Disease (ATD) standard applies to employees in the healthcare setting. It would also apply to the
healthcare laboratories which handle materials that may be a source of aerosol transmissible pathogens (ATPs), emergency
responders, emergency medical transporters, and maintenance employees working in healthcare facilities. San Diego State
University’s Aerosol Transmissible Disease Exposure Control Plans can be found at the Environmental Health & Safety
website http://bfa.sdsu.edu/ehs/.
An aerosol transmissible disease/pathogen is a disease or pathogen for which droplet or airborne precautions are required. Refer
to Attachment A. for a list of aerosol transmissible pathogens.
The purpose of this standard is to limit occupational exposure to aerosol transmissible pathogens by implementing common
infection control measures in order to protect employees from those threats, and to enable the employees to continue to provide
health care and other critical services without unreasonably jeopardizing their health. The primary feature of this standard is a
written Exposure Control Plan. San Diego State University’s Aerosol Transmissible Disease Exposure Control Plans (ECP) can
be found at the Environmental Health & Safety website http://bfa.sdsu.edu/ehs/. Individual ECP’s shall develop and implement
a Department Specific ECP. The Department ECP Template can be found at http://bfa.sdsu.edu/ehs/.
II.
POLICY
San Diego State University is committed to providing a safe and healthful work environment for our entire staff. In pursuit of
this goal, the following exposure control plan (ECP) is provided to eliminate or minimize occupational exposure to aerosol
transmissible pathogens in accordance with CalOSHA standard 8 CFR 5199, "Aerosol Transmissible Diseases."
The Aerosol Transmissible Disease regulations applies to work in service categories such as police services provided during
transport or detention of persons reasonably anticipated to be cases or suspected cases of aerosol transmissible diseases,
and police services provided in conjunction with health care or public health operation.
Law enforcement is at increased risk for infection with aerosol transmissible diseases. California law currently requires police
officers to screen suspect prior to arrival into a jail and to develop procedures for management of suspects suspected of having
communicable diseases. The jails refer them immediately to a health care facility. These facilities would be defined as
referring employers under the Aerosol Transmissible Disease standards. Referring employers are required to comply with
specific program requirement as outlined below.
The ECP is a key document to assist our organization in implementing and ensuring compliance with the standard, thereby
protecting our employees. This ECP includes:

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Determination of employee exposure
Implementation of various methods of exposure control, including:
o Universal precautions
o Engineering and work practice controls
o Transfers
o Personal protective equipment
Medical Services
Post-exposure evaluation and follow-up
Recordkeeping
Procedures for evaluating circumstances surrounding exposure incidents
Incident Accident Injury Log/Sharps Injury Log
Implementation methods for these elements of the standard are discussed in the subsequent pages of this ECP.
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III. RESPONSIBILITIES
A. Environmental Health and Safety Department is responsible for:
 Establishing, implementing, and maintaining the requirements of the Aerosol Transmissible Disease Standard to
facilities, service categories, or operations on campus covered under this standard.
 Developing and implementing the elements of the SDSU Exposure Control Plan (ECP).
 Maintain, review and update the SDSU ECP at least annually and whenever necessary to include regulatory updates and
to reflect new or revised employee categories.
 Determining the level of potential exposure to aerosol transmissible pathogens for specific categories of employees.
 Providing guidance to supervisors regarding universal precautions, respiratory use, vaccinations, and Tuberculosis
screening related to aerosol transmissible pathogens.
 Ensuring that all medical actions required by the standard are performed and that appropriate employee health and
OSHA records are maintained.
 Providing training, documenting training and making the written SDSU ECP available to employees and OSHA
representatives.
 Provide or assist in coordination for emergency spill response or decontamination of isolation areas/rooms or
contaminated areas within Calpulli Center.
B. Public Safety is responsible for:
 Adopting applicable elements of the campus Exposure Control Plan to develop site-specific Exposure Control Plan
 Maintain, review and update the site specific ECP at least annually and whenever necessary to include regulatory
updates and to reflect new or revised employee categories.
 Implement elements of the site-specific Exposure Control Plan.
 Providing and maintaining all necessary PPE, engineering control, isolation areas, labels, and red bags as required by the
standard.
 Ensuring that adequate supplies of the aforementioned PPE are available in the appropriate sizes.
 Notify EH&S of all new employees whose job tasks require them to be part of this program.
 Assist EH&S in scheduling and notification to employees of training, respirator medical exams, vaccinations, and
Tuberculosis screenings.
C. Individual employees are responsible for:
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
Reading and being familiar with applicable elements of the Exposure Control Plan.
Complying with the procedures and work practices outlined in the Exposure Control Plan.
Complete the annual Tuberculosis screening, medical exams, N95 fit testing, and accept/decline vaccinations.
Reporting any injury or incident to their supervisor or EH&S.
Inform supervisors of opinions and recommendations to reduce exposures during work tasks.
Participate in the annual review of the site specific ECP.
Complete the annual Aerosol Transmissible Disease Program Training.
IV. EXPOSURE CONTROL PLAN COMPONENTS
The written Aerosol Transmissible Disease (ATD) Exposure Control Plan is specific to the work place and operations and
will contain the following elements:
 Determination of employee exposure
 Implementation of various methods of exposure control, including:
o Universal precautions
o Engineering and work practice controls
o Transfers
o Personal protective equipment
 Medical Services
 Post-exposure evaluation and follow-up
 Training
 Recordkeeping
 Procedures for evaluating circumstances surrounding exposure incidents
 Incident Accident Injury Log
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The ATD Plan will be reviewed at least annually by the program administrator and by employees regarding the
effectiveness of the program and their respective work areas. Document the review in writing.
Employees covered by the aerosol transmissible disease standard receive an explanation of this ECP during their initial
training session. It will also be reviewed in their annual refresher training. All employees can review this plan at any time
during their work shifts by contacting EH&S (619) 594-6778 or the employee’s Supervisor. If requested, we will provide
an employee with a copy of the ECP free of charge and within 15 days of the request.
EH&S has a site-specific ECP template to provide departments, laboratories, or shops with an easy-to-use format that may
be used as a template to develop a written exposure control plan tailored to the individual requirements of their department
in conjunction with the exposure control plan for San Diego State University. Please allow all employees access via written
or electronic copies to the department and university exposure control plan.
A. EXPOSURE DETERMINATION
Each employee must have an exposure evaluation based upon the job description and assigned tasks. The evaluation shall
be reviewed with the employee at time of hire or within 90 days of the establishment of this program. Exposure evaluation
shall be based upon employees working in healthcare facilities, service categories, or operations where patients may have
confirmed or suspected aerosol transmissible diseases/pathogens resulting in possible exposure that may result from the
performance of an employee's duties.
Employees working as sworn Police Officers and Parking Officers refer all cases confirmed or suspected of ATP’s to the
local health care facility. Public Safety can either utilize Appendix C. Non-medical Setting Screening Sample Criteria or
use criteria developed and documented within the departments ATD ECP.
B. METHODS OF COMPLIANCE
The following methods shall be instituted as means of infection control.
1.
Universal Precautions
Universal Precautions shall be utilized to prevent contact aerosol transmissible pathogens. Universal precautions
require that all human source materials are treated as if infectious. This should extend to patient care areas prior to
decontamination.
2.
Engineering and Work Practice Controls
Engineering and work practice controls shall be used to eliminate or minimize employee occupational exposure and
examined and revised on an annual basis to ensure their effectiveness. All procedures involving blood or OPIM shall
be performed in a manner as to minimize splashing, spraying and aerosolization. These controls shall include:
a. Engineering Controls
i. Law enforcement who transport a person requiring referral in a vehicle need not use respiratory protection if all
of the following conditions are met:
1.
A solid partition separates the passenger area from the area where employees are located
2.
Implement written procedures that specify the conditions of operation, including the operation of windows
and fans, that has been tested and recorded to find that there is no detectable airflow from the passenger
compartments to the employee area
3.
The airflow is tested in a representative vehicle under the specified conditions of operation and finds that
no detectable airflow from the passenger compartment to the employee area
4.
Record the results of the tests and maintains the results
5.
The person performing the test is knowledgeable about the assessment of ventilations systems
b. General Work Practices
i. The
work
practices
described
in
“Guideline
for
Isolation
Precautions”
(http://www.cdc.gov/ncidod/dhqp/gl_isolation.html), “Guidelines for Preventing the Transmission of
Mycobacterium tuberculosis in Health-Care Settings” (http://www.cdc.gov/mmwr/PDF/rr/rr5417.pdf) will be
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reviewed and followed and prevent or minimize employee exposures to airborne, droplet, and contact
transmission of ATPs.
ii. Any contact with a person as a result of performing a work task with a known or suspected ATD would require
an employee to use PPE including respiratory protection. PPE and respiratory protective equipment is available
in the squad vehicles, parking vehicles, and at the station.
iii. Spills and accidents that result in exposures of employees to potentially infectious materials shall be
immediately reported to the supervisor and EH&S.
3.
Transfers
a.
Transfer shall occur within 5 hours of the identification of the case or suspected case, unless:
i. The encounter occurs after 3:30pm and prior to 7:00am, in which the transfer must occur no later than
11:00am
ii. The employer has contacted the local health department and determined that there is no facility that can
provide appropriate airborne infection isolation
4.
b.
Public Safety transfers some cases by direct transport to medical facilities.
c.
Public Safety can also transfer cases of ATD via medical transport.
Personal Protective Equipment (PPE)
a. Supervisors/principal investigators/professors shall assure that employees under their direction have available to
them and use appropriate PPE including, but not limited to: gloves, N95 masks and eye protection.
b. Refer to the EH&S Personal Protective Equipment Program for guidelines for using PPE and training in the use of
appropriate PPE for specific tasks or procedures.
c. PPE shall be removed immediately upon leaving the work area or if overtly contaminated and placed in
biohazardous waste for disposal. For re-usable PPE, decontaminate after use.
i. Gloves shall be worn when the employee has the potential for the hands to have direct contact human source
materials.
ii. Face shields, eye protection, respirators and masks shall be worn whenever splashes, spray, spatter, droplets or
aerosols may be generated and there is potential for eye, nose or mouth contamination.
d. Respiratory Protection
i. Respirators provided to employees must be approved by NIOSH
ii. Employees whose occupation exposure is based on entering any of the work settings or performing tasks
described in the ATD Plan shall be enrolled in the SDSU Respiratory Protection Program
iii. Respirator use shall meet SDSU Respiratory Protection Program.
iv. Respiratory Selection
1. Respirator for protection against potentially infectious aerosols should be as effective as an N95 filtering
face piece respirator, unless through a hazard assessment, a more protective respirator is necessary.
2. Full face respirator may be used unless determined that this use would interfere with the successful
performance of the required task.
v. Use the selected respirator when the employee:
1. Within 6 feet of persons who exhibit signs and symptoms of a suspected case of ATD.
C. MEDICAL SERVICES
Medical Services will be provided to employees for tuberculosis and other ATDs, and infection with ATPs through the
Medical Group or physician contracted under SDSU’s Medical Surveillance Program or SDSU’s Worker’s Compensation
Program.
1. EH&S shall advise that the employee may refuse consent to vaccination, post-exposure evaluation and follow-up at
Medical Group or physician(s) contracted under SDSU's Medical Surveillance Program or SDSU’s Worker’s
Compensation Program or another physician or other licensed health care provider.
2. Medical Services, including vaccinations, tests, examinations, evaluations, determinations, procedures, and medical
managements and follow-up shall be performed by Medical Group or physician(s) contracted under SDSU's Medical
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Surveillance Program or SDSU Worker’s Compensation Program and provided in accordance with public health
guidelines.
a.
Confidentiality of employees and patients will be maintained. Information regarding the source individual shall not
be indicated on test results and other information regarding exposure incidents.
3. Latent Tuberculosis infection (LTBI) assessment will be made available to all employees with the SDSU ATD Program.
Assessment procedures will be in accordance with applicable public health guidelines
a.
TB tests and other forms of TB assessment will be provided annually and more frequently if applicable public health
guidelines or the local health office recommends more frequent testing. Employees with baseline positive TB test
shall have an annual symptom screen.
b.
Employees who experience a TB conversion will be referred to Medical Group or physician contracted under
SDSU’s Medical Surveillance Program or SDSU’s Worker’s Compensation Program or another physician or other
licensed health care provider (PLHCP).
4. EH&S shall provide the Medical Group or PLHCP with a copy of this standard and employees TB test records. If source
has been determined, SHS shall provide any available diagnostic test results including drug susceptibility patterns relating
to the source patient if available.
5. EH&S shall request that the Medical Group or PLHCP, with the employee’s consent, perform any necessary diagnostic
test and inform the employee about appropriate treatment options.
6. EH&S shall request that the Medical Group or PLHCP determine if the employee is a TB case or suspected case, and to
do all of the following, if the employee is a case or suspected case:
a.
Inform the employee and local health officer for San Diego County
b.
Consult with local health office and inform San Diego State University of any infection control recommendations
related to the employee’s activity in the workplace
c.
Make recommendations to San Diego State University regarding precautionary removal due to suspect active
disease and provide a written opinion.
i. TB conversions shall be recorded in accordance with California Code of Regulations, Title 8, Section 14300 –
Occupational Injury or Illness Reports and Records
ii. Unless TB conversion is determined to be non-occupational, SDSU shall investigate the circumstances of the
conversion, and correct any deficiencies found during the investigation.
7. Laboratory tests shall be conducted by an accredited laboratory
8. Sharp Rees Stealy Occupational medicine, Biosafety Officer, SDSU Environmental Health and Safety will collaborate to
provide recommended vaccinations, screenings and follow-up. Employees can accept or decline vaccinations. For
vaccinations that are unable to be provided due to a lack of availability of a recommended vaccine, the licensed health
care provider for occupational medicine will provide a statement regarding availability and anticipated wait time to
procure said vaccinations.
9. The following vaccine schedule will be applied to referring employees:.
Vaccine
Seasonal Influenza
Schedule
One dose annually
10. Vaccination will be made available to all employees who have occupational exposure after the employee has received
training on this standard and within 10 working days of initial assignment unless:
a.
Employee has previously received the recommended vaccinations and is not due to receive another vaccination dose
b.
The Medical Group or PLHCP has determined that the employee is immune in accordance with applicable public
health guidelines
c.
The vaccine is contraindicated for medical reasons.
11. Additional vaccine doses shall be made available within 120 days of the issuance of any new public health guidelines
recommending the additional dose.
12. Prescreening serology program shall not be implemented as a prerequisite for receiving a vaccine, unless applicable
public health guidelines recommend this prescreening prior to administration of the vaccine.
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13. Employees who decline to accept a recommended and offered vaccination must sign Vaccination Declination Statement
and submit to supervisor.
14. Any employee, who originally declines a vaccination by completing Vaccination Declination Statement, can decide to
accept the vaccination at a later date via written request to EH&S. The vaccination will be provided within 10 working
days of receiving the written request from the employee.
15. The Medical Group or PLHCP administering a vaccination or determining immunity must provide the following
information to SDSU
a.
Employee name, birth date and Red ID.
b.
Date of vaccine dose or determination of immunity.
c.
Whether the employee is immune to the disease, and whether there are any specific restrictions on the employee’s
exposure or ability to receive the vaccine.
d.
Whether an additional vaccination dose is required, and if so, the date the additional vaccination dose should be
provided
16. EXCEPTION: Where these procedures cannot be implemented because of the lack of availability of vaccine, SDSU shall
document efforts made to obtain the vaccine in a timely manner and inform employees of the status of the vaccine
availability, including when the vaccine is likely to become available. Availability of the vaccine will be reviewed at least
every 60 calendar days and employees will be informed when the vaccine becomes available.
D. POST-EXPOSURE EVALUATION AND FOLLOW-UP
Exposure Incidents
1. Medical Group or PLHCP who determines that a person is a reportable aerosol transmissible disease case or suspected
case shall report the case to the local health officer
2. SDSU shall determine whether the employee of any other employer may have had contact with the case or suspected case
and notify the other employer within 72 hours of reporting to the local health officer.
a. These employees may include paramedics, emergency medical technicians, and emergency responders.
3. Once aware of an employee having been exposed to a Reportable Aerosol Transmissible Disease, SDSU will do the
following:
a. Determine which employees had significant exposures within 72 hours of initial notification
b. Within 96 hours or a timeframe that is reasonable for specific disease, notify employees who had significant exposure
of the date, time and nature of the exposure.
c. Send employee with significant exposure for a post-exposure medical evaluation with the Medical Group or physician
contracted under SDSU’s Medical Surveillance Program or SDSU’s Worker’s Compensation Program.
d. Obtain recommendation from the Medical Group regarding precautionary removal and a written opinion.
e. Determine if employees of any other employers may have been exposed and notify the employer within 72 hours.
4. Information provided to the Medical Group, Physician or Other Licensed Health Care Professional
5. Medical Group contracted under SDSU’s Medical Surveillance Program and SDSU’s Worker’s Compensation Program
or Other Licensed Health Care Professionals will be provided a copy of the Aerosol Transmissible Disease Standard and
applicable public health guidelines.
6. After an exposure incident, provide the evaluating medical group the following:
a. Incident/Accident Report Form available on the EH&S website
i. Include employee duties as related to exposure
ii. Include circumstance which the exposure incident occurred
b. Any available diagnostic test results, including drug susceptibility pattern or other information related to the source of
exposure that could assist in the medical management of the employee
c. SDSU Medical Records for the employee that is relevant to the management of the employee, including tuberculin
skin test results and other relevant test for ATP infections, vaccination status, and determinations of immunity.
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7. Precautionary removal recommendation from the evaluation physician or other licensed health care professional
8. Request written opinion regarding precautionary removal as prevention for the spread of the disease agent
9. If removal is recommended, removal shall be maintained until the employee is determined noninfectious and shall in no
way effect employee rights, benefits, or job status.
10. Written opinion from the physician or other licensed health care professional
11. Provide employee a copy of the written opinion of the evaluation physician or other licensed health care professional
within 15 days of evaluation
12. TB conversions, Reportable Aerosol Transmissible Diseases, Aerosol Transmissible Pathogen exposure incident written
opinions shall be limited to the following information:
a. Employee’s TB test status or applicable RATD test status
b. Employee infectivity status
c. Statement that employee is informed of the results of the medical evaluation and has been offered applicable
vaccinations, prophylaxis or treatment
d. Statement that employee is informed of any medical conditions resulting from exposure to TB, RATD or ATP that
require further evaluation or treatment and employee has been informed of treatment options
e. Recommendations for precautionary removal from regular assignment
E. TRAINING
The training program shall be provided at the time of initial assignment to tasks where occupational exposure may take
place and at least annually thereafter. Additional training shall be provided when there are changes in the workplace or
when there are changes on procedures that could affect worker exposure to ATPs. The training shall include:
1. General explanation of the ATD standard, ATDs including the signs and symptoms that referral
2. SDSU Aerosol Transmissible Disease Prevention Program and Public Safety Exposure Control Plan
3. Proper methods for recognizing tasks and other activities that may expose employees to aerosol transmissible pathogens
4. Proper use of personal protective equipment and its use, location, removal procedure, cleaning, decontamination and
disposal
5. Fit test and training for proper use of respirator
6. TB surveillance procedures
7. Medical services procedure including methods of reporting exposure incidents, and the employee
8. Vaccines that are available to employees covered under this standard, including the seasonal influenza vaccine.
a.
Vaccine information shall include
i. Efficacy
ii. Safety
iii. Method of Administrations
iv. Benefits of being vaccinated
v. Vaccine and vaccination will be offered free of charge
9. Employee access to the employer’s written procedures and participation in review of the effectiveness of the procedures
10. Interactive questions and answers with a knowledgeable person. Training not given in person shall provide interactive
questions to be answered within 24 hours by a knowledgeable person
F. RECORDKEEPING
1.
Medical Records
a.
Employee exposure record will be maintained within Human Resources as well as the administering PLHCP and will
not be combined with any non-medical records. The records will include:
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i. Employee name and identifier
ii. Vaccination status for all vaccines covered under this standard including vaccine records provided by employee
and any signed declination forms
iii. Written opinions provided by PLHCP and the results of all TB assessments
iv. Incident/Accident Report Form and information from PLHCP regarding exposure incidents
b.
All medical records will be:
i. Kept confidential
ii. Not disclosed or reported without employee’s express written consent to any person within or outside the
workplace except as permitted or as require by law. Records that do not contain individually identifiable medical
information, or from which individually identifiable medical information has been removed may be shared
without written consent.
iii. Medical record will be maintained for the duration of employment plus 30 years.
2.
Training Records
a.
Training records will include the following information
i. Date of training
ii. Contents or summary of training
iii. Name and qualifications of person conducting training
iv. Name and job titles of persons attending training
b.
3.
Training records will be maintained for three years from date of training
Records of implementation of ATD plan
a.
Annual review of ATD plan shall include names of persons conducting review, date of review, name and work areas
of employees involved, and a summary of the conclusions. Records will be retained for three years.
b.
Exposure incidents shall be retained and made available as employee exposure records, and shall include:
i. Date of exposure incident
ii. Name of all exposed
iii. Disease or pathogen exposed to
iv. Name and job title of person performing the evaluation
v. Identity of local health officer and/or PLHCP consulted
vi. Date of evaluation
vii. Date of contact and contact information for any other employee who either notified the employer or was notified
by the employer regarding potential employee exposure
c.
Records of unavailability of Vaccines
i. Records shall include name of person who determine vaccine was not available, name and affiliation of the
person providing the vaccine availability information, and date of the contact. Record shall be retained for three
years.
d.
Records of unavailability of Airborne Infection Isolation rooms or areas shall include the name of person who
determined that an AII room or are was not available, the name and affiliation of the person contacted for transfer
possibilities, fate of contact, the name and contact information for local health officer providing assistance, times and
dates of these contact. Records shall not contain patient’s individually identifiable medical information, and shall be
retained for three years.
e.
Records of decisions not to transfer a patient to another facility for AII medical reasons shall be documented in the
patient’s chart, and a summary shall be provided to the plan administrator providing only the name of the physician
determining that the patient was not able to be transferred, the date and time of the initial decision and the date, time
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and identity of the person who performed each daily review. Records shall not contain a patient’s individually
identifiable medical information and shall be retained for three years
4.
f.
Records of inspection testing and maintenance of non-disposable engineering controls including ventilation and
other air handling systems, air filtration systems, containment equipment, biological safety cabinets and waste
treatment systems shall be maintained for a minimum of five years and shall include the name and affiliation of the
person performing the test, inspection or maintenance, the date and any significant findings and actions that were
taken.
g.
Records of the respiratory protection program shall be maintained in accordance with the SDSU Respiratory
Protection Program for Student Health Services
Availability
5.
a.
Records, other than employee medical records, shall be made available upon request to the Chief and NIOSH and
the local health officer for examination and copying.
b.
Training records, exposure control plan and records of implementation of the ATD exposure control plan, other than
medical records containing individually identifiable medical information, shall be made available as employee
exposure records to employees and employee representatives
c.
Employee medical records shall be provided upon request to the subject employee, anyone having written consent of
the subject employee, the local health officer, and the Chief and NIOSH for examination and copying
Transfer of Records
a.
Employer shall comply with the requirements involving transfer of employee medical and exposure records
b.
If employer ceases to do business and there is no successor employer, the employer shall notify the Chief and
NIOSH at least three months prior to the disposal of the records and shall transmit them to NIOSH if required within
that three-month period.
G. EXPOSURE INCIDENT/ACCIDENT REPORT
The University shall establish and maintain an Incident/Accident Report, which is a record of each exposure incident
involving contact with a confirmed or suspect patient with an aerosol transmissible pathogen. The Incident/Accident
Report is in addition to the Supervisor Injury Report or Worker’s Compensations claims and shall be maintained for 30
years from the last day of employment. The information recorded shall include the following:
1.
Date and time of the exposure incident.
2.
Description of the exposure incident including:
a. Job classification of the exposed employee.
b. Work area where exposure occurred.
c. Work procedure at the time of incident.
d. How the incident occurred.
e. Body part involved in the incident.
Each exposure incident shall be reviewed and investigated by EH&S and the department to determine if any changes or
modifications to a work task would reduce the likelihood of the injury occurring in the future.
V.
ATTACHMENTS
Appendix A Aerosol Transmissible Pathogens
Appendix B. Respiratory Hygiene/Cough Etiquette
Appendix C. Non-medical Setting Screening Sample Criteria
Appendix D.1. ATD Vaccination for Referring
Appendix D.2. ATD Vaccination for Non-Healthcare Employees
Appendix D.3. ATD Vaccination for Referring Employees
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Appendix A
Aerosol Transmissible Pathogens
i. Diseases/Pathogen Requiring Airborne Infection Isolation
1.
Aerosolizable spore-containing powder or other substances that is capable of causing serious human disease, e.g.
Anthraz/Bacillus anthracis
2.
Avian Influenza/Avian Influenza A viruses (strains capable of causing serious diseases in humans)
3.
Varicella disease (chickenpox, shingles)/Varicella zoster and Herpes zoster viruses, disseminated disease in any patient.
Localized disease in immunocompromised patient until disseminated infection ruled out.
4.
Measles (rubeola)/Measles virus
5.
Monkeypox/Monkeypox virus
6.
Novel or unknown pathogens
7.
Severe acute respiratory syndrome (SARS)
8.
Smallpox (variola)/Variola virus
9.
Tuberculosis (TB)/Mycobacterium tuberculosis – Extrapulmonary, draining lesion; Pulmonary or laryngeal disease,
confirmed; Pulmonary or laryngeal disease, suspected
10. Any other disease for which public health guidelines recommend airborne infection isolation
ii. Diseases/Pathogens Requiring Droplet Precautions
1.
Diptheria pharyngeal
2.
Epiglottitis, due to Haemophilus influenza type B
3.
Haemophilus influenza Serotype B (HiB) disease/Haemophilus influenza Serotype B – Infants and children
4.
Influenza, human (typical seasonal variations)/Influenza viruses
5.
Meningitis
6.
Haemophilus influenza, type B known or suspected
7.
Neisseria meningitides (meningococcal) known or suspected
8.
Meningococcal disease sepsis, pneumonia
9.
Mumps (infectious parotitis)/Mumps virus
10. Mycoplasmal pneumonia
11. Parvovirus B19 infection (erythema infectiosum)
12. Pertussis (whooping cough)
13. Pharyngitis in infants and young children/Adenovirus, Orthomyxoviridae, Epstein-Barr virus, Herpes simplex virus,
Pneumonia
14. Adenovirus
15. Haemophilus influenza Serotype B, infants and children
16. Meningococcal
17. Mycoplasma, primary atypical
18. Streptococcus Group A
19. Pneumonic plague/Yersinia pestis
20. Rubella virus infection (German measles)/Rubella virus
21. Severe acute respiratory syndrome (SARS)
22. Streptococcal disease (group A streptococcus)
23. Skin, wound or burn, Major
24. Pharyngitis in infants and young children
25. Pneumonia
26. Scarlet fever in infants and young children
27. Serious invasive disease
28. Viral hemorrhagic fevers due to Lassa, Ebola, Marburg, Crimean-Congo fever virus (airborne infection isolation and
respirator use may be required for aerosol-generating procedures)
29. Any other disease for which public health guidelines recommend droplet precautions
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Appendix B.
Respiratory Hygiene/Cough Etiquette
To prevent the transmission of all respiratory infections in healthcare settings, including influenza, the following infection control
measures should be implemented at the first point of contact with a potentially infected person. They should be incorporated into
infection control practices as one component of Standard Precautions.
1. Visual Alerts
Post visual alerts (in appropriate languages) at the entrance to outpatient facilities (e.g., emergency departments, physician offices,
outpatient clinics) instructing patients and persons who accompany them (e.g., family, friends) to inform healthcare personnel of
symptoms of a respiratory infection when they first register for care and to practice Respiratory Hygiene/Cough Etiquette.

Notice to Patients to Report Flu Symptoms
Emphasizes covering coughs and sneezes and the cleaning of hands
 Cover Your Cough
Tips to prevent the spread of germs from coughing
 Information about Personal Protective Equipment
Demonstrates the sequences for donning and removing personal protective equipment
2. Respiratory Hygiene/C ough Etiquette
The following measures to contain respiratory secretions are recommended for all individuals with signs and symptoms of a
respiratory infection.



Cover or sneezing;
Use in the nearest waste receptacle after use;
Perform hand hygiene (e.g., hand washing with non-antimicrobial soap and water, alcohol-based hand rub, or antiseptic
handwash) after having contact with respiratory secretions and contaminated objects/materials.
Healthcare facilities should ensure the availability of materials for adhering to Respiratory Hygiene/Cough Etiquette in waiting areas
for patients and visitors.


Provide tissues and no-touch receptacles for used tissue disposal.
Provide conveniently located dispensers of alcohol-based hand rub; where sinks are available, ensure that supplies for hand
washing (i.e., soap, disposable towels) are consistently available.
3. Masking and Separation of Persons with Respiratory Symptoms
During periods of increased respiratory infection activity in the community (e.g., when there is increased absenteeism in schools and
work settings and increased medical office visits by persons complaining of respiratory illness), offer masks to persons who are
coughing. Either procedure masks (i.e., with ear loops) or surgical masks (i.e., with ties) may be used to contain respiratory secretions
(respirators such as N-95 or above are not necessary for this purpose). When space and chair availability permit, encourage coughing
persons to sit at least three feet away from others in common waiting areas. Some facilities may find it logistically easier to institute
this recommendation year-round.
4. Droplet Precautions
Advise healthcare personnel to observe Droplet Precautions (i.e., wearing a surgical or procedure mask for close contact), in addition
to Standard Precautions, when examining a patient with symptoms of a respiratory infection, particularly if fever is present. These
precautions should be maintained until it is determined that the cause of symptoms is not an infectious agent that requires Droplet
Precautions http://www.cdc.gov/ncidod/dhqp/ppe.html.
NOTE: These recommendations are based on the Draft Guideline for Isolation Precautions: Preventing Transmission of Infectious
Agents in Healthcare Settings. Recommendations of the Healthcare Infection Control Practices Advisory Committee (HICPAC),
CDC.
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Appendix C.
Non-medical Setting Screening Sample Criteria
This appendix contains criteria to be used by non-medical employees for screening purposes in settings where no health care providers
are available. Coordination with local health departments, including TB control programs, may be necessary for the success of this
referral policy. Employees must maintain clients’ privacy during the screening procedures. Speak to patient in a private area.
1.
For screening a cough client with potential TB
a. If he/she has had a cough for more than three weeks.
Yes
No
b. If, in addition to cough, he/she has had one or more of the following clinical symptoms of TB disease:
Unexplained weight loss (>5lbs)
Night Sweats
Fever
Chronic Fatigue/Malaise
Coughing up blood
A person who has had a cough for more than three weeks and who has one of the other symptoms in 1.b. must be referred to
a health care provider for further evaluation, unless that person is already under treatment.
2.
Screening for other vaccine preventable aerosol transmissible diseases
(pertussis, measles, mumps, rubella, chicken pox)
a. If he/she has any of the following symptoms:
i. Severe coughing spasms, especially if persistent; coughing fits may interfere with eating, drinking and
breathing
Yes
No
ii. Fever, headache, muscle aches, tiredness, poor appetite followed by painful, swollen salivary glands, one
side or both sides of face under jaw
Yes
No
iii. Fever, chills, cough, runny nose, watery eyes associated with onset of an unexplained rash (diffuse rash or
blister-type skin rash)
Yes
No
iv. Fever, headache, stiff neck, possibly mental status changes
Yes
No
A person who answers yes to any of the symptoms in 2.a. must be referred to a health care provider for further evaluation,
unless that person is already under treatment.
3.
Any client who exhibits any of the above described findings and reports contact with individuals known to have any of these
transmissible illnesses in the past 2-4 weeks should be promptly evaluated by a health care provider.
4.
Health officials may issue alerts for community outbreaks of other diseases. They will provide screening criteria, and people
must be referred to medical providers as recommended by the health officer.
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Appendix D.1.
ATD Vaccination for Health Care Workers
SAN DIEGO STATE UNIVERISTY
AEROSOL TRANSMISSIBLE DISEASE PROGRAM
Name:
Red ID #:
Birthdate:
Recommended Aerosol Transmissible Disease Vaccination for Health Care Workers
Vaccine
Schedule
Had vaccine
or know self
to be immune
(Date)
Seasonal Influenza
One Dose Annually
Measles, Mumps,
Rubella
Two Doses
Tetanus, Diptheria,
and Acellular
Pertussis
One dose, booster as
recommended
Varicella-zoster
Two Doses
Screening
Test Type
Tuberculosis
Screening
Decline to be
vaccinated
(sign attached
waiver)
Would like to
be
vaccinated?
Date
Neg PPD within last year
Hx of Positive PPD with Neg CXR
Neg Annual Symptom Review
I have completed the above section to the best of my knowledge. I am aware that the County of San Diego Department
of Public Health has issues an order that all health care personnel are required to either receive the annual Influenza
Vaccination, or, upon declination of the vaccine, must wear an N95 mask when working within 6 feet of patients during
the flu season. If I choose to decline any of the available vaccination provided by my employers, as indicated in my
attached declination form, I can at any time change my mind and request the vaccination from my employer.
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Signature
Date
Appendix D.2.
ATD Vaccination for Non-Healthcare Employees
SAN DIEGO STATE UNIVERISTY
AEROSOL TRANSMISSIBLE DISEASE PROGRAM – Non-Healthcare
Print Name:
Dept:
Red ID Number:
Birthdate:
Recommended Aerosol Transmissible Disease Vaccination for Non-Healthcare Employees
You must complete this form to receive credit for your SDSU Aerosol Transmissible Disease training.
Check the box to request the vaccination or decline the vaccination. The vaccination is free of charge.
☐REQUEST SEASONAL INFLUENZA VACCINATION
I would like to receive the seasonal Influenza vaccination.
☐DECLINATION OF SEASONAL INFLUENZA VACCINATION
I understand that due to my occupational exposure to aerosol transmissible diseases, I may be at risk of
acquiring infection with Influenza virus. I have been given the opportunity to be vaccinated against this
disease or pathogen at no charge to me. However, I decline this vaccination at this time. I understand that
by declining this vaccine, I continue to be at risk. If in the future I continue to have occupational exposure
to aerosol transmissible diseases and want to be vaccinated, I can receive the vaccination at no charge to
me by notifying my supervisor and contacting SDSU Environmental Health & Safety (619) 594-6778.
All employees covered under the SDSU ATD Program will be enrolled in the annual Tuberculosis Screening. The
screening involves the Quantiferon Gold TB Blood Test and analysis conducted at Sharp Rees Stealy La Mesa
Occupational Medicine Department. This is free of charge to employees.
Signature:
Date:
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Appendix D.3.
ATD Vaccination for Referring Employees
SAN DIEGO STATE UNIVERISTY
AEROSOL TRANSMISSIBLE DISEASE PROGRAM - REFERRING
Print Name:
Dept:
Red ID Number:
Birthdate:
Recommended Aerosol Transmissible Disease Vaccination for Referring Employees
You must complete this form to receive credit for your SDSU Aerosol Transmissible Disease training.
Check the box to request the vaccination or decline the vaccination. The vaccination is free of charge.
☐REQUEST SEASONAL INFLUENZA VACCINATION
I would like to receive the seasonal Influenza vaccination.
☐DECLINATION OF SEASONAL INFLUENZA VACCINATION
I understand that due to my occupational exposure to aerosol transmissible diseases, I may be at risk of
acquiring infection with Influenza virus. I have been given the opportunity to be vaccinated against this
disease or pathogen at no charge to me. However, I decline this vaccination at this time. I understand that
by declining this vaccine, I continue to be at risk. If in the future I continue to have occupational exposure
to aerosol transmissible diseases and want to be vaccinated, I can receive the vaccination at no charge to
me by notifying my supervisor and contacting SDSU Environmental Health & Safety (619) 594-6778.
All employees covered under the SDSU ATD Program as Referring will be enrolled in the annual Tuberculosis Screening.
The screening involves the Quantiferon Gold TB Blood Test and analysis conducted at Sharp Rees Stealy La Mesa
Occupational Medicine Department. This is free of charge to employees.
Signature:
Date:
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