NEW ENGLAND RESIDENTIAL SERVICES, INC.
MANUAL
FOR
BLOOD BORNE PATHOGEN
EXPOSURE CONTROL PLAN
BLOOD BORNE PATHOGENS EXPOSURE CONTROL PLAN
FACILITY NAME: NEW ENGLAND RESIDENTIAL SERVICES, Inc. / NEW ENGLAND RESIDENTIAL
SERVICES
DATE OF PREPARATION:
ORIGINAL 4/30/92 Katherine Grant LPN HSC
REVISED 1/99 Katherine Grant, LPN HSC
REVISED 2/20/99 CAROL A. CRISCI, RN CDDN
REVISED 12/12/02 DDN Consulting Services, LLC
REVISED 8/04
REVISED 1/2014
In accordance with the OSHA Blood borne Pathogens standard 29 CFR 1910.1030, the following exposure plan has been
developed:
1.
EXPOSURE DETERMINATION
OSHA requires all employers to perform an exposure determination concerning which employees may occur
occupational exposure. (Occupational exposure means reasonable 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 means (1) The following human body fluids:
semen, vaginal secretions, cerebrospinal fluid, synovial fluid, pleural fluid, pericardial fluid, peritoneal
fluid, amniotic fluid, saliva in dental procedures, any body fluid that is visibly contaminated with blood,
and all body fluids in situations where it is difficult or impossible to differentiate between body fluids;
(2) Any unfixed tissue or organ (other than intact skin) Occupational exposure is described as exposure to
bodily fluids regardless of personal protective equipment. It should be assumed that all bodily fluid is infected
even if the status of the individual is known.
Infectious materials include blood and blood byproducts, semen and vaginal secretion and if blood is visible in
feces, nasal secretions, sputum, sweat, tears, urine, emesis or saliva.
A.
The following is a list of all job classifications at our establishment in which all employees have occupational
exposure::
1.
2.
3.
4.
5.
6.
Direct Support Professionals
House Managers
Residential Directors
Program Director
Behavior Specialist
Clinical Staff
The following is a list of job classifications in which some employees at our establishment have occupational
exposure:
1. Clerical Office Worker
B.
TASKS OR PROCEDURES WHERE EXPOSURE MAY OCCUR:
1.
2.
3.
4.
Wound Care
Dental Care
Incontinent Care
Menses Care
5.
6.
7.
8.
9.
10.
During a physical restraint
During care of a client where potentially infectious material is present
CPR
First Aid
Housekeeping Task
Disposal of razors
IMPLEMENTATION SCHEDULE AND METHOLOGY– OSHA requires that a plan also include a schedule and
method of implementation for the various requirements of the standard. The following complies with this
requirement.
1.
2.
3.
2.
ENGINEERING CONTROLS
A.
All New England Residential Services facilities and programs, in addition to agency vehicles and staff vehicles
used for work purposes must have personal protective equipment for
employees at risk of exposure. Examples:
a. gowns
b. gloves
c. goggles
d. mask or face shields
e. antiseptic towelettes
f. CPR shield
g. Red Biohazard bags
B.
All facilities must have puncture resistant containers for sharps if applicable (this can include, lancets,
insulin syringes, disposable razors and razor blades). These containers shall be label or color-coded, leak
proof on sides and bottom. These containers will be disposed of when they are two-thirds filled.
C.
Hand washing facilities must be available to all employees who incur exposure to potentially infectious
material. See hand washing procedure. (Appendix)
D.
When provision of hand washing facilities is not feasible, antiseptic towelettes (Example: Purrell) should
be utilized. If used, hands shall be washed with soap and water as soon as possible.
E.
If an employee incurs exposure to his/her skin or mucus membrane, then those areas shall be washed or
flushed with water as appropriate as soon as feasible following contact.
F.
Needles, contaminated needles and other contaminated sharps will not be bent, recapped or broken. They
shall be placed in appropriated sharp containers, as stated above. The container will be taped closed when
full, double bagged and disposed of in the trash.
The employer will ensure that employees are involved in the selection of effective engineering controls to
improve employee’s acceptance of newer devices and to improve the quality of the selection process.
G.
3.
Universal Precautions:
DEFINITION: Universal precaution is treating exposure to all bodily
fluids as infectious even if the status is known to be otherwise.
Universal precautions will be followed at all work sites.
WORK AREA RESTRICTIONS
A.
C.
C.
In areas where contamination with infectious material may occur, employees are not to eat, drink, smoke,
apply cosmetics, or lip balm, or handle contact lenses.
Food and drink shall not be kept in refrigerators, freezers, shelves, cabinets, or countertops where blood or
other potentially infectious materials are present (i.e. urine specimens cannot be placed in refrigerators
utilized for food). Samples should be stored in a cooler with ice.
All procedures will be conducted in a manner, which will minimize the potential of splashing, spraying,
splattering or generating droplets of blood or other infectious material.
Procedure for handling contaminated material must be followed.
A.
Contaminated equipment shall be decontaminated as necessary, unless the decontamination is not
feasible. Review Section 5 – Housekeeping Practices
4.
B.
Proper disposal of contaminated material, examples: menses pads, diapers etc. (i.e., double bagged,
but not biohazards) Review Section 5 – Housekeeping Practices
C.
Specimens of blood are collected and removed by outside lab.
D.
Labeling or color coding is required when specimen containers leave the facility, (i.e. urine specimen cups)
PERSONAL PROTECTIVE EQUIPMENT (PPE)
All PPE shall be provided without cost to the employees. The equipment will be chosen based on the anticipated
exposure to blood or other potentially infectious material. It will only be considered appropriate if infectious
material can not pass through and reach the clothing, skin, eyes, mouth or other mucous membrane under normal
conditions of use and for the duration of time that the equipment will be worn.
Infectious contamination will be addressed as per procedure.
a.
b.
c.
c.
Disposable gloves should be worn at all times when contact with blood or other bodily fluids
fluids is anticipated, and when handling or touching contaminated items or surfaces.
(Disposable)Gloves are to be disposed of after each use. They are not to be washed or
decontaminated.
Employees hands should be washed immediately upon removal of disposable gloves.
Utility gloves may be washed or decontaminated if the glove barrier is not compromised.
They will be replaced when they are cracked, peeling, torn, punctured or deteriorating.
Gloves are to be worn for the following procedures and others as needed:
1.
2.
3.
4.
5.
6.
7.
8.
d.
e.
f.
Tooth brushing
Toileting
Wound care
Incontinence care
Vomiting/Diarrhea
Laundry
Housekeeping
Any procedure/task that present exposure to Blood or OPIM
Gowns or plastic aprons are indicated if blood splattering is likely. These situations are not
routine. An example may be, but not limited to, if a client is bleeding profusely and needs to
be restrained for emergency care.
Masks in combination with eye protection devices such as goggles or mask/shields combination
are required to be worn whenever splashes, spray splatter or droplets of blood or other infectious
material may generate contamination of the eyes, mouth or nose.
Mouth pieces, resuscitation bags or pocket masks/CPR shields for CPR usage.
All PPE will be replaced as needed to maintain their effectiveness by NEW ENGLAND
RESIDENTIAL SERVICES at no cost to the
employee.
All PPE, which is contaminated, will be removed immediately and double bagged in plastic bags.
All equipment will be removed prior to leaving the work area.
A kit containing a CPR shield, gloves and antiseptic towelettes should also be in each house and
vehicle.
5.
HOUSEKEEPING PRACTICES
A.
All facilities are to maintained on a daily cleaning schedule and on an as needed basis for immediate clean
up of infectious material. It should be cleaned up immediately or as soon as feasible with disinfectant
solution such as 1:10 dilution of bleach and water or appropriate disinfectant.
B.
All waste receptacles, pails and hampers shall be inspected and decontaminated on a weekly basis. A
separate receptacle shall be used to dispose of any contaminated articles. The receptacle shall be lined
with a plastic bag and covered. Prior to disposal, the bag should be placed in a second bag and sealed.
C.
Broken glassware which may be contaminated shall not be picked up directly with the hands. It should be
picked up with brush and dust pan, tongs or forceps.
D.
Labels required by OSHA shall include the following legend:
BIOHAZARD
Regulated waste means liquid or semi-liquid blood or other potentially infectious material; contaminated
items that would release blood or other potentially infectious materials in a liquid or semi-liquid state, if
compressed. (Items that are caked with dried blood or other potentially infectious materials and are capable
of releasing these materials during handling it, contaminated sharps.) Red bags or red containers may be
substituted for labels.
6.
7.
8.
LAUNDRY PROCEDURES
A.
Laundry contaminated with blood or other potentially infectious material shall be handled as little as
possible and shall be laundered as soon as feasible.
B.
Any employee who has contact with contaminated laundry should wear protective gloves and other
appropriate personal protective equipment.
HEPATITIS B VACCINE
A.
All employees identified as having a risk of exposure will be offered the hepatitis B series at no cost.
The series will be (made available) offered within 10 days of their initial assignment to any work that
involves the potential for occupational exposure.
B.
Employees who decline the vaccination will sign a waiver ( see attached )
C.
Employees who decline the vaccine initially may request the vaccine at a later time at no cost to them.
D.
The fact sheet and waiver will be distributed and reviewed at New Employee Orientation.
POST EXPOSURE EVALUATION AND FOLLOW UP
If an employee incurs an exposure incident, it should be reported to the supervisor and the nurse. The nurse will
initiate and coordinate the record of exposure. The records will be maintained by the Human Resource Coordinator.
A.
All employees who incur an exposure will be offered post exposure evaluation and follow-up in
accordance with OSHA standards. (Refer Form Occupational Exposure Evaluation. Team Report).
According to Connecticut Public Act 89-246
1.
The employee must file a report of significant exposure within 24 hours.
2.
A test for HIV/HBV infectivity shall be drawn within 72 hours if the employee chooses. The
blood sample will be kept for 90 days per OSHA standards, in case the employee decides to
have the test. If the decision is made prior to the 90 days, the blood test is negative, and the
source person consents, the source person’s blood will be tested. If the source person refuses
to consent or disclosure, the following is needed.
B.
A statement that the person who was the source of exposure refused to consent to testing or disclosure or is
deceased.
C.
A statement of exposure evaluation from the MD, and reason for the determination that exposure has occurred.
D.
A statement that if results are knows the worker would be able to take meaningful immediate action
as defined in subsection 19A 5891J (Included in the information packet) which could not otherwise be taken.
E.
The employee will be offered post exposure prophylaxis in accordance with the current
recommendations of the U.S. Public Health Services.
F.
G.
Counseling shall be provided concerning necessary precautions to be followed.
Information will be given on what potential illness to be alert for and to report to the appropriate personnel.
The following persons have been designated to assure that the policy outlined here is effectively
carried out, as well as to maintain records related to this policy:
H.
9.
Executive Director
Program Director
Residential Directors
House Managers
Human Resource Coordinator
Nurse Consultant
BBP exposures incidents are recorded on the OSHA log as “privacy case”, (if they meet the criteria for
recording), and then recorded in the separate “sharps injury log”.
INTERACTION WITH HEALTH CARE PROFESSIONALS
A.
B.
C.
New England Residential Services will ensure that the Health Care Professionals are provided with
1.
A copy of the regulations
2.
A description of the exposed employee’s duties as they relate to the
exposure incident.
3.
Documentation of the route of exposure and the circumstances under
which the exposure occurred.
The Health Care Professional shall provide a written evaluation of:
1.
When the employee is sent to obtain the Hepatitis B series
2.
Whenever the employee is sent to a health care professional following an exposure incident
The Health Care Professional shall be instructed to limit their opinion to:
1.
If Hepatitis vaccine is indicated
2.
That the employee is informed of the results of the evaluation
3.
That the employee has been told of any medical conditions resulting from exposure
to blood or other potentially infectious material which require further treatment.
4.
All other findings or diagnosis shall remain confidential and should
not be included in the written report
**(Note: The written opinion to the employer is not to reference any personal medical information)
10.
TRAINING
All employees will receive annual retraining in this area. Training will be conducted by the Nurse, trained
staff, through use of a video and/or testing, as appropriate. Training Records shall be maintained for three
(3) years from the date which training occurred. The records will be maintained in the office of the Human
Resource Coordinator and will include the date of training sessions, content or summary of sessions, names
and qualifications of person conducting training and names/job title of all persons attending training sessions.
Training will consist of the following:
1.
2.
3.
4.
5.
6.
7.
8.
The OSHA standards for blood borne pathogens
Knowledge of access to the regulatory text
Epidemiology and symptomology of blood borne diseases
Mode of transmission of blood borne disease
Exposure Control plan i.e. points of the plan lines of responsibility, how the plan is
the plan is implemented and knowledge of how to access the plan.
Procedures that might cause exposure to blood or infectious material in the work site
An explanation of the use of and limitations of control methods that may prevent or reduce
exposure including universal precaution, engineering controls, work practices and personal
protective equipment
PPE availability/How to select appropriate attire and how to dispose of contaminated PPE
9.
10.
11.
11.
An explanation of the basic procedure to be followed in the event of exposure
Labeling procedure for contaminated receptacle
The Hepatitis B vaccine including efficacy, safety, and benefits of being vaccinated
RECORD KEEPING
All records (regarding Hepatitis vaccine, Post exposure incidents ) required by OSHA standards will be
maintained in (separated, locked files at ) the office of the Human Resource Coordinator.
In accordance with 29CFR1910.20.AGENCY will maintain records for 30 years for employees with
occupational exposure incidents. The record will contain:
a.
b.
c.
d.
e.
f.
g.
Name
Social Security Number
A copy of the employee Hep B vaccination status including the date of vaccine
Medical records relative to the employee’s ability to receive the vaccine
A copy of all examinations, medical testing and follow-ups
A copy of the Health Care Professional’s written opinion in cases of exposure
A copy of the information given to the Health Care Professional
New England Residential Services will ensure that these records are kept confidential and are not disclosed without
written consent from the employee except as required by law.
All records will be maintained in compliance with Connecticut State Regulation Section 19a-581590. They will be
maintained by the Human Resource Coordinator.
DATES
All provisions required by the standard will be implemented by:
1.
May 24, 1992 This exposure Control Plan
2.
June 4, 1992 Information and training record keeping
3.
July 6, 1992 Engineering and work Practice controls. PPE, Housekeeping, Hep B vaccine,
post exposure evaluation and follow-up.
OCCUPATIONAL EXPOSURE TO BLOOD BORNE PATHOGENS
PRACTICE: All significant exposure to client blood or other body fluid shall be considered serious and shall be reported.
SIGNIFICANT EXPOSURE IS DEFINED AS:
1.
A parental exposure such as a needle stick
2.
Mucous membrane exposure such as splash to the eye or mouth
3.
Cutaneous exposure involving large amounts of blood or body fluids, and prolonged contact especially when
skin is chapped, abraded or affected with dermatitis
EXAMPLES OF WHAT MAY CONSTITUE SIGNIFICANT EXPOSURE
1.
Helping an individual who has had an accident and is bleeding
2.
Helping to clean up bloody wounds
3.
Changing bed linens after an individual has hemorrhaged or experienced extensive bleeding.
4.
Changing a dressing that is covered with blood that has oozed from a wound
5.
Emptying bedpans containing bloody urine or stool with visible blood
6.
Helping a client with personal care – tooth brushing oral hygiene
7.
Assisting lab personnel to draw blood by holding an individual’s hand/arm and blood spurts
8.
ALL BODY FLUIDS, BLOOD, STOOL, URINE, SALIVA, VAGINAL SECRETIONS, WOUND
DRAINAGE, etc. ARE CONSIDERED CONTAMINATED
PROCEDURE:
1.
Immediately after exposure by needle stick or cut, wash site well with soap and water.
After splash to mucous membranes, rinse thoroughly with water
2.
Complete incident report form NOTE: if an employee, all documentation will go into his/her file.
3.
Exposures must be reported to the Director or House Manager assigned to the site at which the
exposure occurred immediately. This person shall initiate the Occupational Exposure Evaluation
4.
5.
6.
Team Report.
Refer employee to the nearest designated Occupational Health Center. The employee must receive
treatment and evaluation within 24 hours.
All known exposures shall be investigated by the Safety Committee to establish the conditions
surrounding the exposure and to improve training, work practices, or protective equipment to
prevent a recurrence.
The consulting nurse in each house will routinely check all incident reports and forward any with
suspected occupational exposure incidences to designated OSHA representative who will in turn
notify the employee as soon as possible in order to review the report and the following:
A.
B.
C.
D.
7.
Was there a significant exposure to Blood Borne pathogens? (the nurse will review
the incident report and decide)
If yes, was procedure followed? (New England Residential Services post-exposure incident report)
Check with employee as to Hepatitis B status
Follow procedure for HIV significant exposure check list if applicable
Exposure reports for Blood Borne Pathogens shall be kept confidential to protect the privacy of the
injured. Only these persons with a need to know will be permitted access to such incident reports.
Completed exposure report forms shall be maintained separately from the employee personnel records, reports of significant
exposure will be maintained for the duration of employment up to 30 years.
CLEANING UP SPILLS AND DECONTAMINATION OF BLOOD OR BODY FLUIDS
PRACTICE: It is the practice of NEW ENGLAND RESIDENTIAL SERVICES that all spills or splashes of blood or other body
fluids be cleaned up and the spill or splash area decontaminated as soon as possible. This is to minimize the danger of environmental
contamination and the possible spread of blood borne infections to employees and residents. This is to also prevent exposure to the
AIDS, HIV and Hepatitis B viruses or other blood borne infections through contact with blood or body fluids.
EQUIPMENT AND SUPPLIES NEEDED
1.
Non sterile gloves (exam or heavy duty)
2.
Spray bottle of disinfectant (1 part bleach to 10 parts water)(Appropriated disinfectant)
3.
Cloth or paper towel
4.
Double plastic bag
5.
Mask, goggles and impervious isolation gown (as appropriate to the situation)
6.
Forceps, tongs or brush and dustpan (as applicable if picking up Broken glass)
7.
Other items as appropriate or as may be needed
PROCEDURE:
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
Assemble necessary equipment and supplies
Put on non-sterile exam gloves or heavy duty gloves
Use forceps, tongs or brush and dustpan to pick up broken glass
Wipe up the spill or splash with a cloth or a paper towel
Discard the saturated paper towel into the plastic bag
Spray the spill or splash with the disinfectant solution until the contaminated area is wet.
Wipe up the disinfectant solution with a paper towel. Repeat as necessary until the spill or
splashes are dry.
Discard the contaminated cleaning paper towel into the plastic bag
Spray disinfectant solution onto the discarded paper towel inside the plastic bag
Remove gloves and place them into the plastic bag
Tie the bag. If the outside of the plastic bag becomes contaminated with blood, place the contaminated bag into
a clean plastic bag
Place the plastic bag into a second plastic bag and dispose of in the trash
WASH HANDS
NOTE: On a small spill area and skin surface, a 70% isopropyl alcohol pledge may be used to
disinfect the area
NOTE: Surfaces and equipment contaminated with spills or splashes of blood or body fluids must
be cleaned up as soon as practical.
SEPARATING AND STORAGE OF MEDICAL WASTES
In the event of a large amount of contaminated waste, bodily fluids containing infectious material or blood soaked bandage material,
a red bio-hazard bag will be used for cleanup. It will be stored in a separate location from other trash and disposed of by a licensed
facility according to state regulations.
PRACTICE: Medical wastes stored for treatment, disposal, or pickup shall be protected in accordance with established policies
and procedures. Medical waste will be separated from general waste in accordance with current federal and state guidelines.
PROCEDURE:
1.
Medical waste in Red Biohazard bags may not be discarded with general trash
2.
Should general trash be placed in containers with medical waste, the trash will be handled
as regulated medical waste
3.
Medical waste generated will be separated (to the extent practical) (e.g. blood soaked bandages,
tubing, gauze pads, and swabs)
4.
It shall be the responsibility of all employees to discard waste into appropriate receptacles
5.
Medical waste must be discarded into designated containers (e.g. red bag or container marked with
“BIOHAZARD“symbol)
6.
Should medical wastes storage containers become full, the facility coordinator will notify the
administrator to arrange for pick up.
7.
It is the responsibility of the agency to monitor the medical waste storage to ensure that medical
wastes are treated, disposed of, or picked up by the authorized vendor on a timely basis.
BIOHAZARD LABELING
PRACTICE: It is the practice of NEW ENGLAND RESIDENTIAL SERVICES that (regulated waste) material contaminated
with blood, body fluids, or other potentially infections material must be identified by a ‘BIOHAZARD’ label when red bagging is
not used.
PROCEDURE:
1.
When red bagging is not used all waste containing blood, body fluids or other potentially infectious
materials must be identified by a BIOHAZARD label.
2.
Biohazard labels shall be used as a means to prevent accidental injury or illness to employees who
are exposed to hazardous or potentially hazardous conditions, equipment, or operations which are
out of the ordinary, unexpected, or not readily apparent.
Note: When red bagging or red containers are not used, labels shall be used.
3.
Warning labels will be affixed to containers of regulated waste, refrigerators containing blood or
other potentially infectious material, and other containers used to store, transport or ship blood or other
potentially infections materials.
4.
Bags or other receptacles containing articles contaminated with potentially infections material (such as dressing
to a wound which are soaked, dripping saturated, dried or caked), including contaminated disposable items,
shall be labeled or otherwise identified. The labels shall have the single word BIOHAZARD or the biological
hazard symbol.
Note: If the outside of the bag is contaminated with body fluids, a second outer bag shall be used.
5.
If tags are not used, red bagging or red containers shall be used as a means of identification of
contaminated materials.
HEPATITIS B FACT SHEET
1.
The disease: Hepatitis is an inflammation of the liver. It can be caused by a virus, bacteria, chemical agents or poisons.
There are several type of infectious hepatitis (A, B, non-A and non-B), which are caused by a virus. The institutionalized mentally
retarded population was once identified as a high risk group. Screening and vaccinations were done in the 1980’s. At the time of
screening some people were identified as carriers of the disease. The mentally retarded population is at no more of a risk of
contracting the disease but due to institutionalization were more apt to be exposed to the disease. people with mental retardation
living in the community are at no higher risk than the general population.
Hepatitis B strikes about 200,000 persons each year in the U.S.A. It is usually spread by contact with infected blood, or blood
products. It is spread by sharing IV drug needles, sexual relations, transfusions, contaminated needles which might be used in ear
piercing or tattooing. It is spread by person to person, or by person to environment to person such as someone cleaning up blood
from the environment. It is not spread through casual contact, or by the air. The occupational risk of contracting hepatitis B from
an infected person lies primarily from the contact with blood or blood products, although safety procedures have been established
for use when working with any body fluids such as blood, urine, feces, semen, or saliva.
2.
The vaccine: NEW ENGLAND RESIDENTIAL SERVICES will pay for the series of three injections.
A.
Hepatitis B vaccine is manufactured from yeast and not blood plasma. You would receive three injections:
one initial, one in a month and one six months from the initial injection. The injections are given in the upper
arm in the deltoid muscle. The vaccine when introduced into the body stimulates the body to produce
antibodies to protect you from contracting the disease. The vaccine produces protective immunity in about
90% of healthy persons.
B.
Testing for immunity after the vaccination is recommended and is paid for by NEW ENGLAND RESIDENTIAL
SERVICES.
C.
How long does protection from Hepatitis B Vaccine Last? Studies indicate that immunological memory remains intact
for at least 20 years among healthy vaccinated individuals who initiated Hepatitis B vaccination >6 months of age. The
vaccine confers long-term protection against clinical illness and chronic Hepatitis B virus infection. Cellular immunity
appears to persist even though antibody levels might become low or decline below detectable levels.
3.
Side effects: The most common side effect observed following vaccination has been soreness at the site of injection, including
redness, swelling and warmth. Also observed has been occasional fatigue, malaise, low grade fever, chills, irritability, nausea,
headache, or dizziness. Anaphylactic reaction has never been documented but is possible as it is a parenteral injection.
4.
Post Exposure: If you’ve been immunized and you are exposed, you probably will not need further treatment unless your antibody
level is low. Then you will need further treatment. You will need to be tested and a booster dose will be given. Report any
exposure incident to your supervisor immediately. A post exposure evaluation will be done.
Know that there are at least five types of viral hepatitis
Five types of viral hepatitis have been identified (see table below)
They have similar clinical features, but vary significantly in modes of transmission, prevalence
and outcome.
DIFFERENT TYPES OF HEPATITS
Types of
Hepatitis
Mode of
Transmission
Incubation Period
Serological
Tests
A
Fecal/Oral
15 to 50 days
Available
Complications
Fulminant hepatitis relapse
Fulminant hepatitis
Chronic liver disease
Cirrhosis
Primary hepatocellular carcinoma
B
Parenteral/
Sexual/Perinatal
40 to 180 days
Available
C
Parenteral
35 to 75 days
Available
Chronic liver disease
Cirrhosis
Primary hepatocellular carcinoma
D
Parenteral/
Sexual/Perinatal
21 to 49 days
Available
Chronic liver disease
Fulminant hepatitis
E
Fecal/Oral
28 to 42 days
Not Widely
Available
High mortality in pregnant women
Fetal demise
HANDWASHING - Appendix I
CLEANLINESS IS THE BEST PROTECTION FROM DISEASE.
EFFECTIVE PROTECTION KNOWN.
HANDWASHING IS THE MOST
WHEN TO WASH HANDS:
PERSONNEL MUST WASH HANDS
1)
Before assisting with personal care of individuals
2)
Before and after contact with the face and mouth of individuals
3)
After personal use of the toilet
4)
After blowing or wiping the nose
5)
Before eating, smoking or drinking
6)
On completion of duty
7)
Before preparing food, unloading the dishwasher, and setting the table
8)
After doing the laundry
9)
When coming on duty
10)
Whenever hands are soiled
PROCEDURE FOR EMPLOYEE SIGNIFICANT EXPOSURE INCIDENTS
(CHECK EACH ITEM THEN PROCEED)
QUESTIONS
Date
Yes
No
Did the Did the employee feel he/she was put at significant risk for contracting blood borne diseases?
1.
Was the House Manager, Director or Human Resource Coordinator notified?
2.
Was the NEW ENGLAND RESIDENTIAL SERVICES employee injury report completed?
3.
Did the Employee Health representative meet with the employee w/i 48 hours?
A. Was the employee willing to have baseline blood drawn w/I 72 H?
B. Did the E.H. rep advise the employee regarding requirements if
the employee is requesting that the source individual be tested?
C. Did the E.H. rep. assist the employee in arranging for baseline test and was
the appointment made?
D. Did the E.H. rep. initiate the process of informed consent between the
physician, individual and guardian, if applicable?
4.
Have the employee test results been obtained? Are results negative?
5.
Has informed consent been obtained?
In the above situation all criteria have been met to have the source individual tested for HIV status. The individual will be
tested and the results will be shared with the employee, ensuring confidentiality as outlined by law. The physician will share
results with the individual and/or guardian.
6.
B
Safety Committee or designee convenes the exposure evaluation team.
Committee determine if significant exposure has occurred
Committee determines of all steps of the procedure as outlined in the law have
been followed of the law.
In the above situation all criteria have been met to have the individual tested without informed consent. The individual will
be tested and the results will be shared with the employee, ensuring confidentiality as outlined by law. The physician will
share results with the individual and/ or guardian.
Signature:
Date completed
CONSENT FOR HIV TEST
I have been informed that my blood will be tested in order to detect whether or not I have antibodies and or antigens in my
blood to the Human Immunodeficiency Virus (HIV). I understand that the test is performed by withdrawing blood and using
a substance to test the blood.
I have been informed that the test is new and its accuracy and reliability are still uncertain and that the test results, may in some
cases indicate that a person has antibodies and or antigens to the virus when the person does not (false positive), or that it may
fail to detect that a person has antibodies to the virus when the person has the antibodies (false negative) I understand that in
order to diagnose AIDS, other means must be used in conjunction with this blood test.
I have been informed that if I have any questions in regards to the nature of the blood test, its expected benefits, the risks and
alternative tests. I may ask those questions before I decide to consent to the blood test.
I understand the results are confidential and will only be released to those health care practitioners directly responsible for my
care and treatment and to no others, as required by law. I further understand that no additional release of the results will be
made without my written authorization.
By my signature below I acknowledge that I have been given all the information I desire concerning the blood test and the
release of the results and have had all my questions answered. Further, I acknowledge that I have given consent for the
performance of a blood test to detect antibodies to the Human Immunodeficiency Virus.
Signed:
If signed by other than the patient indicate relationship
Date:
Witness: ___________________________________
INFORMED CONSENT TO AIDS-VIRUS (HIV) ANTIBODY TEST
I have read all of this form or it has been read to me and I have discussed it with my doctor or test counselor. I have been told
about the nature of HIV, AIDS and HIV-related illness and have been told about how the virus may be passed from one person
to another.
I agree to take the HIV antibody test.
_____________________________________
Name of the person to be tested
_________________
Date of Birth
_____________________________________
Signature of the person to be tested
Or person authorized to consent for person
_________________
Date
If someone other than the person to be tested has signed, state the name and address of the person signing and the relationship
to the person to be tested. If necessary explain why the person to be tested did not sign.
I have provided to the person who signed this form an explanation of the nature of the disease HIV, AIDS, and HIV related
illness, information about behaviors known to pose risk for transmission of HIV infection and have discussed and answered
any questions about the information covered in the form.
_____________________________________
Name of the physician or test counselor
_____________________________________
Signature of physician or test counselor
OCCUPATIONAL EXPOSURE EVALUATION TEAM REPORT
Name of Employee:
Date Reported ______________
Name of source individual:
Significant exposure: Yes _________
NO _________
Date of exposure ____________
Accident and incident report attached: Yes _________ No __________
Explanation of incident:
Plan of Correction
Follow up:
_____________________________________
Signature of Employee
___________________________
Date
_____________________________________
Signature of Supervisor
___________________________
Date
_____________________________________
Signature of Human Resource Coordinator
____________________________
Date
Cc: File: Human resources
WAIVER TO AIDS-VIRUS (HIV) ANTIBODY TESTING
I have read all of this form or it has been read to me and I’ve discussed it with my doctor or test counselor. I have been told
about the nature of HIV and HIV related illness and have been told about how the virus may be passed from one person to
another.
I refuse to take the HIV antibody test
________________________________________
Name of person refusing the test
_______________________
Date of birth
________________________________________
Signature of the person refusing test
_______________________
Date
If someone other than the person to be tested has signed, state the name and address of the person signing and the relationship
to the person to be tested. If necessary explain why the person to be tested did not sign.
I have provided to the person who signed this form an explanation of the nature of the disease HIV, AIDS, and HIV related
illness. Information about behaviors know to pose risk for transmission of HIV infection and have discussed and answered
any questions about the information covered in the form.
_____________________________________
Name of the physician or test counselor
_____________________________________
Signature of physician or test counselor
OSHA Annual Sign Off by Administration
I have reviewed the Control plan and it is current and up to date with practice.
NAME
SIGNATURE
DATE