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OSHA COMPLIANCE MANUAL

 

UNIVERSITY OF MISSOURI-ST.LOUIS

SCHOOL OF OPTOMETRY

 

 

 

 

 

 

PREPARED BY

 

 

Timothy A Wingert, O.D. F.A.A.O.

W. Howard McAlister, O.D., M.P.H., F.A.A.O.

 

 

May 1, 1997

Revised February 15, 1999

Revised April 17, 2008

 

 

 

EXPOSURE CONTROL PLAN

REQUIRED BY OSHA'S BLOODBORNE PATHOGENS RULING

FOR PHYSICIANS' OFFICES

 

I. EXPOSURE DETERMINATION:

A) PROCEDURES AND TASKS WHERE EMPLOYEES COULD HAVE REASONABLY ANTICIPATED SKIN, EYE, MOUTH, MUCOUS MEMBRANE, NON-INTACT SKIN, OR PARENTERAL CONTACT WITH BLOOD OR OTHER POTENTIALLY INFECTIOUS MATERIALS (including, but not limited to):

-Vascular access procedures

-Suture removal

-Injections

-Dressing changes

-Handling contaminated sharps

-Mouth to mouth resuscitation

-Handling specimens of body fluids

-Assisting with minor procedures where sharps are involved

-Picking up trash or linens contaminated with body fluids

-Blood sugar monitoring or other fingerstick procedures

B) JOB CLASSIFICATIONS WITH POTENTIAL FOR EXPOSURE (ALL EMPLOYEES IN THESE CLASSIFICATIONS HAVE POTENTIAL FOR EXPOSURE):

-Attending Optometrist

-Attending Ophthalmologist

-Medical Assistant

C) JOB CLASSIFICATIONS WITH POTENTIAL FOR EXPOSURE (SOME EMPLOYEES IN THESE CLASSIFICATIONS HAVE POTENTIAL FOR EXPOSURE):

-Staff

 

 

III. METHODS OF IMPLEMENTATION:

A) UNIVERSAL BLOOD AND BODY FLUIDS PRECAUTIONS:

Universal precautions are observed in this office by all employees. This means that all patients' blood and other potentially infectious materials (defined below) are handled as if they are contaminated with and can transmit HIV and/or HBV. Barriers must always be used when handling blood or potentially infectious materials or if exposure may be reasonably anticipated.

Definition: Potentially infectious materials:

Semen, vaginal secretions, cerebrospinal fluid, synovial fluid, pleural fluid, pericardial fluid, peritoneal fluid, amniotic fluid, saliva in dental procedures, any body fluid visibly contaminated with blood, and all body fluids in situations where it is difficult or impossible to differentiate between body fluids.

Also, any unfixed tissue or organ (other than intact skin) from a human (living or dead).

And, HIV-containing cell or tissue cultures, organ cultures, and HIV-or HBV-containing culture medium or other solutions.

B) ENGINEERING AND WORK PRACTICE CONTROLS:

This refers to items designed to isolate or remove bloodborne pathogens from the workplace, and to practices that reduce the likelihood of exposure. If the potential for exposure remains after these controls have been instituted, personal protective equipment (special clothing or equipment worn by employees for protection against a hazard, i.e., gloves, masks, gowns, goggles, etc.) shall also be used.

It is the responsibility of the storekeeper to maintain the items used for engineering controls (i.e., point-of-use rigid sharps containers, safety needle devices, personal protective equipment, etc.) and to replace them as necessary to ensure their effectiveness. Sharps containers must be disposed of promptly when they are full, to avoid injuries associated with overfilled units.

Handwashing facilities are readily accessible to employees, and hands are washed immediately or as soon as possible after removal of gloves or other personal protective equipment (PPE).

Hands and any other skin must be washed with soap and water, and mucous membranes must be flushed with water, immediately after contact with blood or potentially infectious materials.

Contaminated needles and other sharps shall not be bent, recapped, or removed, unless no alternative is feasible. If no alternative is feasible, needle removal must be accomplished through the use of a mechanical device or a one-handed technique.

Placement of contaminated sharps:

Used sharps must be placed in closable, puncture resistant, fluorescent, orange-red containers, which are lettered in a contrasting color and bear the OSHA Biohazard symbol, immediately or as soon as possible after use. The containers must also be leakproof on the sides and bottom, and must not require employees to reach into the container by hand.

During use, sharps containers shall be located as close as is feasible to the point of use, or where sharps may be found. They must be kept upright during use.

When disposing of full sharps containers, they must be closed as soon as possible after removal, and if leakage is possible, placed in a closable secondary container which is constructed to contain all contents and prevent leakage during handling, storage, and transport.

Restricted Practices:

Eating, drinking, smoking, applying cosmetics or lip balm, and handling contact lenses are prohibited in work areas where there is a reasonable likelihood of exposure.

Food and drink are not kept in areas where blood or other potentially infectious materials are present.

All procedures involving blood or other potentially infectious materials must be performed in such a manner as to minimize splashing, spraying, spattering, and generation of droplets of these substances.

Mouth pipetting/suctioning of blood or other potentially infectious materials is prohibited.

Specimen Containers:

Specimens of blood and other potentially infectious materials are placed in Biohazard containers which prevent leakage and are closed before storage, transport, or shipping.

If the outside of the specimen container becomes contaminated, the container must be placed in a secondary container which prevents leakage, and fulfills the same requirements as the first container.

If the specimen could puncture the primary container, the primary container must be placed within a secondary container which is puncture-resistant, in addition to having the requirements listed above.

Contaminated Equipment:

Equipment which may become contaminated with blood or other potentially infectious materials must be examined for contamination prior to servicing or shipping and decontaminated as necessary.

If decontamination is not possible, a prominent label (fluorescent red-orange, with the Biohazard symbol) must be attached to the equipment and must state which parts of the equipment remain contaminated. All employees, the servicing representative, and/or manufacturer shall be informed of the contamination of the equipment prior to handling, servicing, or shipping.

C) PERSONAL PROTECTIVE EQUIPMENT (PPE):

When exposure may occur, gloves, gowns, lab coats, face shields or masks, eye protection, mouthpieces, resuscitation bags, pocket masks, etc., are provided to employees at no cost.

PPE is readily accessible and all employees are required to use it. Cleaning, laundering, repair, replacement, and disposal of PPE is the responsibility of the university and will be done at no cost to the employees.

PPE must not allow blood or other potentially infectious materials to pass through to or reach the employees' work clothes, street clothes, undergarments, skin, eyes, mouth, or other mucous membranes under normal conditions of use for the duration of time which it will be used.

If a garment is penetrated by blood or other potentially infectious materials, it must be removed immediately or as soon as feasible.

All PPE must be removed prior to leaving the work area, and placed in the designated area for storage, washing, decontamination, or disposal.

Gloves:

Gloves are worn for anticipated hand contact with blood, other potentially infectious materials, mucous membranes, non-intact skin, for vascular access procedures, and touching contaminated surfaces. Disposable gloves must be replaced as soon as practical when contaminated, torn, punctured, or rendered nonfunctional, and may not be washed or reused. Utility gloves may be decontaminated and reused only if their integrity is not compromised by decontamination.

Masks:

Masks with eye protection (i.e., goggles, eyeshields, etc) shall be worn whenever splashes, sprays, splatters, or droplets of blood or other potentially infectious materials may be generated.

Clinic coats:

Clinic coats are provided for situations where clothing might be splashed or soiled with blood or other potentially infectious materials. These are provided by the university.

D) HOUSEKEEPING:

The office is cleaned each evening by the maintainence staff hired by the university to perform this duty.

Any work surface or equipment contaminated with blood or other potentially infectious material is cleaned with 1:10 bleach:

-by the intern immediately or as soon as possible after contamination; or

-at the end of the workday if possible contamination has occurred.

How to clean up blood or body fluid spills:

-don gloves;

-using paper towels, blot up the majority of the fluid and dispose of towels in a red plastic biohazard bag;

-spray the contaminated area with a solution of 9 parts water/1 part bleach (must be mixed fresh daily), and allow to sit for a minute;

-wipe up the area with new paper towels, dispose of towels in the red bag, remove gloves and place in the bag;

-close the bag securely; and

-wash your hands.

Commodes are cleaned with disinfectant.

Walls are wiped down with disinfectant if visibly soiled.

Paper coverings on equipment chin rests are changed between patients and discarded as infectious waste if soiled with blood or body fluids.

E) INFECTIOUS WASTE:

The following items are considered to be infectious waste:

-sharps (needles, skin staples, broken glass, razors, scalpels, etc.);

-lab specimens (of any body fluid or tissue) if discarded;

-glass tubes or other glass;

-discarded vaccines or other biological agents;

-blood, blood products, body fluids; and

-any equipment or objects contaminated with blood or body fluids that are to be disposed

Infectious Waste containers are not reusable, are constructed of heavy duty biohazard bags, and are disposed of by the University. These containers are closed prior to pickup, designed to prevent leakage of fluids during handling, storage, transport, and shipping, and have the biohazard symbol prominently displayed on the outside. If the outside of the bag becomes contaminated, it is placed in a secondary container which fulfills the same requirements.

Broken glass is not picked up with the hands, but must be cleaned up using mechanical means (i.e., a brush and dustpan, forceps, etc.).

Blood or blood products may be carefully poured down a drain connected to a sanitary sewer.

F) LAUNDRY:

Contaminated laundry is handled as little as possible and with minimum agitation. It is placed in bags in the rooms where it was used and is not sorted or rinsed on the premises. Linen items used in this office are laundered by a laundry service contracted by the university. The person responsible for washing contaminated linen is included in this exposure control plan. For reasonably anticipated exposures, employees are instructed to wear personal protective clothing.

HEPATITIS B VACCINATION AND POST-EXPOSURE FOLLOWUP:

A) All employees with potential for occupational exposure are offered the Hepatitis B vaccine series at no cost to the employee. All employees who suffer exposure to blood or other potentially infectious materials are given free post-exposure evaluation and follow-up as soon as possible (within two working days) by the physician on duty. All post-exposure lab tests are done by an accredited lab.

B) Hepatitis B vaccine is offered to all employees with potential for exposure within 10 days of initial employment, after they receive training. Exceptions would be if the employee has previously received the complete series of vaccinations for Hepatitis B, has antibody testing that proves immunity to Hepatitis B, or the vaccine is contraindicated for medical reasons.

If employees initially decline the vaccine but decide to take it at a later date, they shall be vaccinated then at no cost to the employee. If U.S.P.H. recommends routine boosters in the future, they will be provided free to employees.

C) POST-EXPOSURE EVALUATION AND FOLLOWUP:

After an employee reports an exposure a physician will provide confidential medical evaluation and followup, including:

-documentation of the route of exposure and circumstances under which the exposure occurred; and

-identification and documentation of the source patient.

The source patient's blood shall be tested for HBsAg and HIV as soon as possible, unless the source patient is known to be HB or HIV positive. Consent must be obtained for HIV testing. (See "Recommendations for Obtaining Consent for HIV Testing" and "Informed Consent for Testing for HIV Antibody and for Limited Release of Test Results" forms, attached.)

The results of the source patient's tests will be made available to the exposed employee, and the employee will be informed of applicable laws and regulations concerning disclosure of the identification and status of the source patient. Confidentiality of all results is mandatory.

The exposed employee's blood will be tested as soon as possible after exposure occurs and consent for testing is obtained. If the employee consents to baseline blood collection but does not give consent at that time for HIV testing, the sample shall be preserved for at least 90 days. If the employee elects to have the baseline sample tested within 90 days of exposure, it will be done as soon as possible after consent.

D) POST-EXPOSURE PROPHYLAXIS:

Recommendations for post-exposure prophylaxis:

See "Hepatitis B Prophylaxis Following Percutaneous or Permucosal Exposure", attached.

E) INFORMATION PROVIDED TO THE HEALTHCARE PROFESSIONAL:

Anyone administering the Hepatitis B vaccination to healthcare workers or evaluating an employee after an exposure incident shall be given a copy of the Bloodborne Pathogens regulations. The person evaluating an exposure incident will also be provided:

-a description of the exposed employee's duties as they relate to the exposure incident;

-documentation of the route(s) of exposure and circumstances under which exposure occurred;

-results of the source patient's blood testing; and

-all medical records relevant to the appropriate treatment of the employee; including vaccination status, which are the employer's responsibility to maintain.

F) HEALTHCARE PROFESSIONAL'S WRITTEN OPINION:

The physician who evaluates the exposed employee will render his/her opinion regarding:

-the employee's need for Hepatitis B vaccination (i.e., whether HB vaccination is indicated for the employee, and if the employee has received such vaccination); and

-any medical conditions resulting from exposure to blood or other potentially infectious materials which require further evaluation or treatment.

A copy of this written opinion which indicates that the employee has been informed of these will be given to the employee, and a copy kept in the employee's file in the office.

All other findings and results will be kept confidential and shall not be included in the written report.

G) MEDICAL RECORDKEEPING:

Exposure Records:

The employers shall establish and maintain confidential records on each employee with occupational exposure which shall not be disclosed or reported without the employee's express written consent to any person outside the workplace except as required by law, and shall include:

-the employee's name and social security number;

-a copy of the employee's Hepatitis B vaccination status with dates of vaccinations and any medical records relevant to the employee's ability to receive vaccinations;

-a copy of all results of examinations, medical testing, and follow-up procedures;

-the employer's copy of the examining physician's written opinion (see above); and

-a copy of the Blood/Body Fluid Exposure Report Form (attached).

These records must be kept for at least the duration of employment plus 30 years.

 

Training Records:

The requirements for these records are fulfilled by the Training Outline and inservice rosters, and must be kept for 3 years from the date on which the training occurred.

See the OSHA Bloodborne Pathogens regulation for specifics regarding who shall have access to all records.

H) COMMUNICATION OF HAZARDS TO EMPLOYEES:

Biohazard warning labels shall be affixed to containers of regulated waste, refrigerators and freezers containing blood or other potentially infectious materials, and other containers used to store, transport, or ship blood or other potentially infectious materials.

Labels must be affixed as close as feasible to the containers by a method that prevents their loss or unintentional removal.

Red bags or containers may be substituted for labels.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

ATTACHMENTS

GUIDELINES FOR HIV CONSENT AND COUNSELING

ANTIBODY TEST RESULTS AND WHAT THEY MEAN

HEPATITIS B PROPHYLAXIS FOLLOWING PERCUTANEOUS OR PERMUCOSAL EXPOSURE

VACCINE TABLE: HEPATITIS B PROPHYLAXIS

HEPATITIS B VACCINE INFORMATION

BLOOD/BODY FLUID EXPOSURE REPORT FORM

WHAT YOU SHOULD KNOW AFTER AN EXPOSURE TO BLOOD OR OTHER BODY FLUIDS

PREVENTION OF TRANSMISSION OF BLOODBORNE PATHOGENS (AIDS AND HEPATITIS B)

OUTLINE OF TRAINING INFORMATION FOR EMPLOYEES ON PREVENTION OF TRANSMISSION OF BLOODBORNE PATHOGENS

(AIDS AND HEPATITIS B)

RECOMMENDATIONS FOR OBTAINING CONSENT FOR HIV TESTING

 

 

GUIDELINES FOR HIV CONSENT AND COUNSELING

I. Consent.

A. For HIV testing, separate consent is deemed necessary, the following recommendations should be observed.

1. Responsibility for obtaining consent rests with the patient's physician.

a. Responsibility for obtaining consent rests with the patient's attending physician. In case of a needlestick or mucous membrane splash, the qualified charge nurse may, after receiving a telephone physician order, counsel the patient and obtain written consent.

2. Consent from unconscious/incompetent patients.

a. If the patient is unconscious, incompetent, or otherwise incapable of giving consent, written consent must be obtained from the patient's next of kin, except in emergencies.

3. Phone consent.

a. Telephone consent may be obtained from the next of kin if there are two (2) witnesses.

II. Counseling.

A. Before obtaining consent:

1. Give the patient a consent packet with:

a. A copy of the booklet, "What You Should Know About AIDS."

b. Consent Form -- to be read and discussed with the patient; answer all questions and request feedback from the patient.

c. Telephone number for additional information (AIDS Hotline 1-800-342-AIDS).

2. Complete the consent form in its entirety.

 

B. After the test results are received:

1. Results are to be released to patients and employees by physicians or to employees by the Infection Control Coordinator only. No positive Elisa results should be shared with patient until confirmed by Western blot.

a. If results are positive: give the patient the information in the red packet containing:

1. AIDS Hotline (1-800-342-AIDS).

2. "CDC Recommendations (Instructions to the person who has a positive antibody test)," see attached.

3. "Antibody Test Results and What They Mean (A Positive Result)," see attached.

4. The patient should be advised to have a complete physical and TB Skin Test immediately, and be counseled on proper nutrition and a healthy lifestyle.

b. If the results are negative: give the patient the information in the green packet containing:

1. "Antibody Test Results and What They Mean (A Negative Result), see attached."

2. AIDS Hotline (1-800-342-AIDS).

 

A POSITIVE RESULT

 

IF YOU TEST POSITIVE, IT DOES MEAN:

1. You have been infected with the AIDS virus, and your body has produced antibodies.

2. Your blood sample has been tested more than once and the tests show that it has antibodies to the AIDS virus.

3. Researchers have shown that most people with AIDS antibodies have active virus in their bodies. Assume you are contagious and that you can pass the virus on to others.

 

A POSITIVE RESULT DOES NOT MEAN:

1. That you are immune to AIDS.

2. That you necessarily have AIDS or AIDS-related condition (ARC). But you can reduce your chances of getting AIDS by avoiding further contact with the virus and living a healthy lifestyle.

 

THEREFORE, A POSITIVE RESULT MEANS THAT YOU SHOULD:

1. Protect yourself from any further infection.

2. Protect others from the virus by following AIDS precautions in sex, drug use, and general hygiene.

3. See a physician for a complete evaluation and advice on health maintenance.

4. Avoid drugs and heavy alcohol use, eat well, get plenty of rest, and avoid stress.

5. Do not donate blood, plasma, sperm, body organs, or other tissue.

 

DEFINITIONS:

1. Antibody - a substance the body makes when it is infected.

2. Immunity - resistance to infection.

3. Virus - an agent which can cause infection.

4. HIV - Human Immunodeficiency Virus - the virus which causes AIDS.

 

CDC RECOMMENDATIONS

Instructions to the person who has a

POSITIVE ANTIBODY TEST

 

A PERSON WHO HAS A POSITIVE ANTIBODY TEST SHOULD BE PROVIDED THE FOLLOWING INFORMATION AND ADVICE:

1. The prognosis for an individual infected with HIV over the long term is not known. However, data available from studies conducted among homosexual men indicate that most people will remain infected.

2. Although asymptomatic, infected people may transmit HIV to others. Regular medical evaluation and follow-up is advised, especially for those who develop signs or symptoms suggestive of AIDS.

3. Do not donate blood, plasma, body organs, other tissue, or sperm.

4. There is a risk of infecting others by sexual intercourse, sharing needles, and possibly via saliva through oral-genital contact or intimate kissing. Whether condoms are effective in preventing infection is not known, but consistent use may reduce transmission.

5. Do not share toothbrushes, razors, or other implements that could become contaminated with blood.

6. Women with positive antibody tests, or women whose sexual partners are seropositive, are themselves at increased risk of acquiring AIDS. If they become pregnant, their offspring are also at increased risk. HIV may be transmitted to infants in breast milk.

7. After accidents resulting in bleeding, contaminated surfaces should be cleaned with household bleach (sodium hypochlorite) freshly diluted 1:10 in water.

8. Devices that have punctured the skin, such as hypodermic and acupuncture needles, should be steam sterilized by autoclave before being reused or safely discarded. Whenever possible, disposable needles and equipment should be used.

9. When seeking medical or dental care, inform caregivers of your positive antibody status so that precautions can be taken to prevent transmission.

10. Blood-collecting centers should offer the antibody test to contacts of antibody rejected blood donors (e.g., sexual partners, people with whom needles have been shared, infants born to positive mothers).

 

 

A NEGATIVE RESULT

 

IF YOU TEST NEGATIVE, IT DOES MEAN:

1. No antibodies to the AIDS virus have been found in your blood at the time of the test.

 

THREE POSSIBLE EXPLANATIONS FOR A NEGATIVE TEST RESULT:

1. You have not been infected with the AIDS virus.

2. You have had contact with the virus, but have not become infected and therefore have not produced antibodies. However, repeated exposure to the AIDS virus will increase your chances of becoming infected.

3. You have been infected with the virus, but have not yet produced antibodies. Research indicates that most people will produce antibodies within two to eight weeks after infection. Some people will not produce antibodies for at least six months. A very small number of people never will produce antibodies.

 

IF YOU TEST NEGATIVE, IT DOES NOT MEAN:

1. That you have nothing to worry about. The AIDS epidemic has not yet peaked.

2. That you are immune to the virus.

3. That you have not been infected with the virus. You may have been infected and not yet produced antibodies.

 

 

HEPATITIS B PROPHYLAXIS

FOLLOWING PERCUTANEOUS OR PERMUCOSAL EXPOSURE

EXPOSED PERSON

SOURCE:

HBSAG-POSITIVE

SOURCE:

HBSAG-NEGATIVE

SOURCE:

NOT TESTED OR UNKNOWN

Unvaccinated

TREATMENT:

HBIGx1 (1) and initiate HB vaccine (2)

TREATMENT:

Initiate HB vaccine (2)

TREATMENT:

Initiate HB vaccine (2)

Previously vaccinated:

--known responder

 

 

 

 

 

--known nonresponder

TREATMENT:

 

Test exposed for anti-HBs:

--If adequate, no treatment (3)

--If in-adequate, HB vaccine booster dose

HBIGx2 or HBIGx1 and one dose HB vaccine

TREATMENT:

 

No treatment

 

 

 

 

 

 

No treatment

TREATMENT:

 

No treatment

 

 

 

 

 

 

If known high-risk source, may treat as if source were HBsAg-positive

Response unknown

TREATMENT:

Test exposed for anti-HBs:

--If inadequate, HBIGx1 plus HB vaccine booster dose

--If adequate, no treatment (3)

TREATMENT:

No treatment

TREATMENT:

Test exposed for anti-HBs:

--If inadequate, HB vaccine booster dose

--If adequate, no treatment (3)

 

(1) HBIG dose 0.06 ml/kg IM.

(2) HB vaccine dose: see following table on Vaccine.

(3) Adequate anti-HBs: greater than or equal to 10 SRU.

VACCINE TABLE

HEPATITIS B PROPHYLAXIS

GROUP

HEPTAVAX-B

(1-2)

RECOMBIVAX HB

(1)

ENGERIX-B

(1-3)

Children and adolescents

11-19 years

20 ug--1.0 ml

5 ug--0.5 ml

20 ug--1.0 ml

Adults

over 19 years

20 ug--1.0 ml

10 ug--1.0 ml

20 ug--1.0 ml

Dialysis patients and other immunocompromised patients

40 ug--2.0 ml

(4)

40 ug--1.0 ml

(5)

40 ug--2.0 ml

(6)

 

(1) Usual schedule: three doses at 0, 1, and 6 months.

(2) Available only for hemodialysis or other immunocompromised patients and for persons with known allergy to yeast.

(3) Alternate schedule: four doses at 0, 1, 2, and 12 months.

(4) Two 1.0 ml doses given at different sites.

(5) Special formulation for dialysis patients.

(6) Four-dose schedule recommended at 0, 1, 2, and 6 months.

 

 

HEPATITIS B VACCINE INFORMATION

(Factors significant to the administration

of the Hepatitis B Vaccine)

HEPTAVAX-B is a non-infectious formalin inactivated sub-unit viral vaccine derived from surface antigen (HBsAg or Australia antigen of Hepatitis B virus).

RECOMBIVAX-HB is a non-infectious sub-unit viral vaccine derived from Hepatitis B surface antigen (HBsAg) produced in yeast cells.

ENGERIX-B is a non-infectious synthetic vaccine derived from HBsAg produced in yeast cells.

1. The three vaccine profiles are similar. More data is available on Heptavax-B because of its longer time in research and its use around the world, and should be available for those allergic to yeast.

2. The drug is recommended for intramuscular injection. The preferred site in adults is the deltoid muscle. Injections given into the buttocks have demonstrated lower conversion rates--primarily because sometimes the drug has been given into fatty tissue.

3. The pharmaceutical firm recommends the consistent use of either Heptavax or Recombivax-HB in the vaccination series given to an individual. However, if an individual has completed the series with one vaccine, the other may be used as a booster. Engerix may be used to complete a series begun with Recombivax.

4. The employee who is pregnant should receive the vaccine only if clearly needed. Refer to a private physician.

5. Persons on immunosuppressive therapy may require more than the usual vaccine series of three doses.

6. The immunization regimen consists of three doses of vaccine as follows:

a. 1st dose - elected date.

b. 2nd dose - 1 month later.

c. 3rd dose - 6 months after the 1st dose.

7. An accelerated dosing schedule for post-exposure prophylaxis with Engerix may be used. This would be:

a. 1st dose - elected date.

b. 2nd dose - 1 month later.

c. 3rd dose - 2 months after the 1st dose.

d. 4th dose - 12 months after the 1st dose.

8. Precautions for practices for prevention of needlesticks or other exposures should not be relaxed.

9. For additional information see manufacturers' recommendations.

 

 

BLOOD/BODY FLUID EXPOSURE REPORT FORM

This form is to be completed by the employee reporting an incident or exposure involving blood or other potentially infectious materials, including, but not limited to:

1. All accidental needle punctures, unless the needle is clean

2. Cuts or scratches involving equipment soiled with a patient's blood or other potentially infectious materials

3. Splashes of blood or other potentially infectious materials into the eyes, onto mucous membranes, or onto freshly broken skin areas (less than 24 hours old)

4. Skin broken from a human bite

EMPLOYEE NAME

DATE & TIME OF INCIDENT LOCATION OF INCIDENT

EMPLOYEE'S SS# EMPLOYEE'S PHONE #

DESCRIBE WHAT HAPPENED, CAUSING THE INCIDENT: ________________________

COULD THIS HAVE BEEN PREVENTED? IF SO, HOW?

WERE UNIVERSAL PRECAUTIONS BEING OBSERVED AT THE TIME OF THE INCIDENT?

NAME OF PATIENT WHOSE BLOOD OR SECRETIONS ARE INVOLVED

RECORD # ROOM #

DATE ATTENDING OPTOMETRIST

DIAGNOSIS OF PATIENT

DATE THIS FORM WAS COMPLETED

EMPLOYEE'S SIGNATURE

DATE OF SOURCE PATIENT'S HIV AND/OR HBsAg TESTING

RESULTS-HIV HBsAg

DATE OF EXPOSED EMPLOYEE'S HB VACCINATIONS

EXPOSED EMPLOYEE'S ANTI-HBS STATUS (IF KNOWN)

It is my opinion that this exposed employee does does not require HB vaccination at this time, for the following reason(s)

Signature of physician evaluating this incident ____________ _________

Date_______________________

WHAT YOU SHOULD KNOW

AFTER AN EXPOSURE TO

BLOOD OR OTHER BODY FLUIDS

1. It is best to be cautious. Assume that you have been infected with HIV and act accordingly, until lab tests prove otherwise.

2. IF YOU KNOW WHO THE SOURCE PATIENT IS, GET THEM TESTED FOR HIV AND HEPATITIS AS SOON AS POSSIBLE!! This is important. If the patient goes home before having his blood drawn once, you will have to have your blood drawn four times, over a period of 6 months, and for that length of time, you will not know whether you have been infected.

3. If the source patient is HIV positive, your chances of becoming infected from this exposure are less than 1%. From a Hepatitis B positive source, the chances are 25-30%.

4. If you should develop a fever 12 weeks after the exposure, it could be related to the incident, and you should inform your doctor.

5. Inform your physician of any behavioral risk factors (i.e., IV drug use, homosexuality, multiple sex partners) that could cause you to already have a positive HIV test. THIS INFORMATION IS PRIVILEGED AND CONFIDENTIAL.

6. Until all tests return negative, do not donate blood, plasma, body organs, or other tissue.

7. Let your physician, dentist and any other health professional that may be placed at risk know that you may have been exposed to HIV/Hepatitis B, so they may do their best to avoid transmission while caring for you.

8. There is a risk of infecting others by sexual intercourse, sharing needles, and oral-genital contact. Latex condoms are recommended for preventing transmission.

9. NEVER share toothbrushes, razors, or other implements that could become contaminated with blood.

10. HIV-positive women and women with HIV-positive sex partners are at risk of acquiring AIDS. If they become pregnant, their offspring are also at increased risk. Breast milk may transmit the virus to an infant.

11. After accidents resulting in bleeding, contaminated surfaces should be cleaned up with a freshly mixed solution of 1 part household bleach to 9 parts water.

12. Devices that have punctured skin, such as hypodermic, acupuncture, and tattoo needles, should be steam sterilized by autoclave before reuse or safely discarded. Whenever possible, disposable needles and equipment should be used.

PREVENTION OF TRANSMISSION OF BLOODBORNE PATHOGENS

(AIDS AND HEPATITIS B)

 

1) Symptoms of AIDS are related to lack of immunity. Generally, people with AIDS are more susceptible to infections and certain types of cancer. It is important to realize that there are no symptoms of HIV! You can have the AIDS virus in your blood for up to eleven years or more, and never know it.

This is the reason that UNIVERSAL BLOOD AND BODY FLUIDS PRECAUTIONS are mandated by law. Because you don't know who is infected with HIV, you have to assume that everyone can be HIV-positive, and protect yourself accordingly.

 

2) Symptoms of Hepatitis B include jaundice, nausea, joint pain, malaise, and anorexia.

 

3) Modes of transmission of HIV and HBV-

a) Parenteral (through-the-skin):

-stick from a contaminated needle

-transfusion of contaminated blood

-splash of contaminated blood or body fluids into your eyes, nose, or mouth

-touching contaminated blood or body fluids with your non-intact skin or mucous membranes

b) Perinatal:

-from a mother to a fetus in utero

-from a mother to an infant in breast milk

c) Sexual:

-from an infected partner through unprotected sex

4) Activities that may cause exposure to HIV/HBV:

-recapping needles

-overfilling needle containers

-not wearing gloves to handle blood or body fluids

-CPR without a pocket mask

-YOU think of some!

5) Personal Protective equipment available:

-gloves

-gowns

-masks

-goggles

YOU are responsible for anticipating exposures! Think of what you will be doing, and dress for the occasion!

6) Ways to prevent exposure:

-do not recap needles

-observe Universal Precautions

-do not overfill needle containers

-do not pass sharp instruments by hand

-wear gloves to touch a patient's nonintact skin or mucous membranes, or to clean up blood or body fluids

-wear an impervious gown if you anticipate a splash or spray of blood

7) HBV vaccine:

safety - side effects: nausea, sore arm, fatigue

effectiveness - 90-96% of people vaccinated develop protective titer levels

benefits - HB can kill you or cause chronic disease, with all the symptoms listed above

8) What to do after an exposure: Report it, and be tested

9) Explanation of signs, labels, and color coding

 

 

OUTLINE OF TRAINING INFORMATION FOR EMPLOYEES

ON PREVENTION OF TRANSMISSION OF BLOODBORNE PATHOGENS

(AIDS AND HEPATITIS B)

WHEN: New employees are trained prior to employment, or at least within 10 days of beginning work. All employees will be trained annually thereafter.

WHO: All employees with potential for exposure to blood or other potentially infectious materials as listed in office Exposure Control Plan.

1) Frequency of occurrence of HIV and HBV

Symptoms of HIV

Symptoms of HBV

2) Modes of transmission of HIV and HBV

3) Office program to prevent bloodborne diseases

4) Activities that may cause exposure to HIV/HBV

5) Personal Protective equipment available, and how to find, use, decontaminate, and dispose of it

6) Ways to prevent exposure

7) HBV vaccine: safety effectiveness benefits

8) What to do after an exposure

9) Explanation of signs, labels, and color coding

 

I have received and understand the above information:

Signature Date

 

RECOMMENDATIONS FOR OBTAINING CONSENT

FOR HIV TESTING

RESPONSIBILITY:

It is primarily the responsibility of the office physicians to obtain consent for HIV testing from patients. Pre- and Post-test counseling must be given to all patients. If the office nurse has been trained in pre and post test counseling, she may also perform the counseling and obtain consent, if so instructed by a physician.

WHEN TO OBTAIN CONSENT:

A) As soon as possible after an occupational exposure of any office staff member to any patients' blood or other potentially infectious materials

B) Upon a patient's request

C) For diagnostic purposes

COUNSELING:

1) Give the patient a consent packet containing:

-A copy of the booklet "What You Should Know About AIDS"

-The AIDS "Hotline" telephone number; 1-800-342-AIDS

-A consent form for HIV Antibody Testing

2) Read and discuss with the patient all aspects of the consent form. Allow the patient to ask questions. Answer them honestly and request feedback from the patient.

3) Complete the consent form entirely, and have the patient sign and date the form.

4) When test results are received:

REMEMBER: DO NOT GIVE OUT POSITIVE OR INDETERMINATE EIA RESULTS!

IF EIA RESULTS ARE POSITIVE, YOU MUST WAIT FOR WESTERN BLOT CONFIRMATION TO RELEASE RESULTS TO THE PATIENT!

If EIA results are negative-

-tell the patient that his results are negative

-give the patient a copy of "Antibody Test Results and What they Mean"(A negative result) and answer any questions

If EIA and Western Blot are positive-

-tell the patient that his results and a confirmatory test are positive

-give the patient a copy of "Antibody Test Results and What they Mean"(A positive result)

-give the patient a copy of CDC recommendations for persons with positive HIV antibody tests

-instruct the patient that he should have a TB skin test immediately, and a complete medical examination

-discuss good nutrition, adequate rest, and good hygiene etc. with the patient