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HomeMy WebLinkAbout6.a. Exposure Control PlanCITY OF ROSEMOUNT EXECUTIVE SUMMARY FOR ACTION CITY COUNCIL MEETING DATE: AUGUST 18, 1992 AGENDA ITEM: EXPOSURE CON'T'ROL PLAN AGENDA SECTION: NEW BUSINESS PREPARED BY: SCOTT AKER, FIRE CHIEF AGENDA NITEM # 6 A ATTACHMENTS: POLICY APP OVED /BY: , u - Attached for your consideration and adoption is City Policy 2, Exposure Control Plan. This policy has been put together through the efforts of Lieutenant Dwayne Kuhns, Administrative Assistant Susan Walsh and myself. In December, 1991 OSHA issued the new bloodborne pathogens standards to protect workers from infectious diseases including but not limited to Hepatitis.B virus (HBV) and human immunodeficiency virus (HIV). The purpose of the standard is to limit occupational exposure to blood and other potentially infectious materials since any exposure could result in transmission of bloodborne pathogens (pathogenic microorganisms that are present in human blood and can cause disease in humans) which could lead to disease or death. The attached policy addresses the OSHA standards by including in the City's policy an Exposure Control Plan, Methods of Compliance, Personal Protective Equipment, Housekeeping, Hepatitis B Vaccination and Post Exposure Evaluation, Training and Record Keeping. Upon adoption of the policy by Council, training will be provided to our employees who are identified to be at risk of exposure to infectious diseases. Patrol Officer Grant Thorstad and Firefighter Joe Ger_rits have been designated to train our employees. Healtheast Divine Redeemer Hospital will train these two employees and will probably assist with the first initial training to employees this fall. Thereafter, annual review sessions will be given to the employees and all new employees will be trained. Fortunately, actual costs for implementing this policy are at a minimum. For the most part, the departments had most of these procedures in place. Divine Redeemer will provide the personal protective equipment, sharps containers, and disposal of contaminated sharps at minimum costs. The Hepatitis B the ongoing program. vaccine policy was implemented by Council in April, 1991, and cost is $200 for each new employee who consents to the vaccine RECOMMENDED ACTION: MOTION TO ADOPT CITY POLICY P-2, EXPOSURE CONTROL PLAN COUNCIL ACTION: CITY OF ROSEMOUNT POLICY TITLE• POLICY NUMBER• PROPOSED BY• DATE APPROVED BY CITY COUNCIL• EXPOSURE CONTROL PLAN P-2 ADMINISTRATION August 18, 1992 I. PURPOSE: To provide full and part-time City employees with necessary information needed to prevent the spread of infectious disease in the work place. Necessary information includes, but is not limited to, principles of infection control, the infectious disease process and the use of personal protective equipment and supplies as they relate to the prevention of occupationally acquired infectious disease. II. EXPOSURE CONTROL PLAN A) Exposure Determination 1. Employees. Employees determined to be at -risk of exposure to infectious diseases transmitted through blood and other body fluids are in the following job classifications: a) Sworn police personnel b) Police reserve officers C) Firefighters d) Custodians 2. Groups. A high risk of the transmission of infectious diseases exists when department personnel have contact with the following groups: a) Bleeding accident victims b) Alcohol abusers C) Illegal drug users d) Homosexual, bisexual, and promiscuous persons e) Hemophiliacs f) Persons with open or infected wounds g) Persons who state they have Hepatitis B or AIDS 3. Situations. Employees may encounter situations where there is a high risk of the transmission of infectious disease. They are: N a) Assisting with IV Starts/Venipuncture b) Intubation 1) endotracheal 2) esophageal 3) tracheostomy C) Suctioning d) Pt ventilation 1) mouth to mouth 2) mouth to mask 3) positive pressure device 4) bag/valve/mask e) Wound Care f) Obstetrics g) Chest Decompression h) Violent Patients i) Trauma Management j) Fracture Management k) Any time body fluids are present 1) Homes with unsanitary conditions M) Death scene, especially those situations where body fluids may be oozing from the corpse n) Combative situations, especially those situations where bleeding occurs o) Body cavity searches P) Crime scenes, specific dangers include knives, needles, and razor blades q) Extrication at auto accidents r) Cleaning and disposing of contaminated material Methods of Compliance 1) Universal Precautions Universal Precautions shall be followed by all employees at all times to prevent contact with potentially infectious materials. These shall include; blood and human body fluids, semen, vaginal secretions, cerebrospinal fluid, synovial fluid, pleural fluid, saliva, vomitus, 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. Universal precautions shall also be followed when handling, cleaning, or disposing of equipment, linen or articles contaminated by such fluids. Since any body fluid may transmit infectious diseases if it contains traces of blood, employees are directed to treat all blood and body fluids as infectious substances. 2) Engineering and work practice controls a) Engineering and work practice controls shall be used to eliminate or minimize employee exposure. Whenever an occupational exposure risk still exists the employee must wear appropriate Personal Protective Equipment. b) Engineering controls shall be examined annually for all employees and with any changes in regulations, policy, or accepted practices, to ensure the effectiveness of the current controls. C) Any changes or additions shall be communicated to all employees within 60 days of the institution of such policies through mandatory training and inservice, at no cost to the employee. 3) Hand washing Hands and other skin surfaces must be washed thoroughly as soon as possible if contaminated with blood or other potentially infectious materials to which universal precautions apply. Hands should always be washed after gloves are removed even if the gloves appear intact. Hand washing should be completed using appropriate facilities such as utility or restroom sinks. Hands must not be washed in a sink where food preparation may occur. Hand washing should be done with warm water and soap. The application of hand creme after hands are dried is advisable. Waterless antiseptic hand cleaner shall be provided to employees when hand washing facilities are not available. Employees are advised to wash their hands at the earliest opportunity after using the waterless antiseptic hand cleaner. 4) Needles and Sharp Objects a) Employees shall take precautions to prevent injuries caused by needles, knives, broken glass, razor blades, or other sharp instruments, devices, or debris which can puncture or lacerate the skin. b) Police employees must use caution when searching prisoners for weapons or contraband or when searching small areas or crevices in containers, vehicles and buildings. C) Sharp objects that are located and are inventoried by the police department must be placed in a puncture resistant container or packaged in such a 3 manner as to render the sharp object harmless to those handling it. Evidence containers or sheathing material must be labeled with the bio- hazard warning label or color -coded or both. 5) Housekeeping a) All equipment and work areas shall be cleaned and decontaminated after contact with blood or other potentially infectious materials. b) The work area shall be cleaned with an appropriate disinfectant as soon as possible after a spill of blood or any other potentially infectious materials. C) Wastebaskets and other receptacles which have a likelihood of contamination shall be inspected and cleaned on a regularly scheduled basis. The wastebaskets must be color -coded and/or display the bio -hazard warning label. d) Wastebaskets and receptacles that are visibly contaminated shall be cleaned immediately. e) Eating, drinking, smoking, applying cosmetics or lip balm and handling contact lenses are prohibited in work areas where there is a reasonable likelihood of occupational exposure. f) Food and drink shall not be kept in refrigerators, freezers, shelves, cabinets, or on counter tops where blood or other potentially infectious materials may be present. III. PERSONAL PROTECTIVE EQUIPMENT A) Personal Employee Protective Equipment Packets will be available to all employees. These barrier garments must be used when the possibility for contamination of the employee's uniform, clothing, or person, from potentially infectious materials, blood, or body fluids exists. These packets shall include: 1) Barrier Gown 2) Head Cover 3) Shoe Covers 4) Mask 5) Eye Protection 4 Gloves must be worn as a part of this protective packet and will be available to all employees. B) The employee must use personal protective equipment except in rare and extraordinary circumstances. Such circumstances occur when in the employee's professional judgement the use of personal protective equipment would have prevented the delivery of health care or public safety services or would have posed an increased hazard to the safety of the employee or other associates. When the employee makes this judgement, the circumstances shall be reported in writing to their supervisor within 24 hours and investigated and documented in order to determine whether changes can be instituted to prevent such occurrences in the future. C) Personal Protective equipment as well as the laundering, repair, disposal, and replacement of personal protective equipment as outlined above shall be provided at no cost to the employee. D) When soiled or contaminated: 1) Personal protective equipment shall be removed prior to leaving the work place and as soon as possible when the risk of contamination has passed. 2) It shall be placed in a clear plastic linen bag and sealed by tying shut. 3) It will then be disposed of in the appropriate manner. E) If a garment has been penetrated by potentially infectious materials: 1) It shall be removed as soon as possible and replaced if the potential for continued exposure continues to exist. 2) If the skin beneath such a garment has been contaminated it shall be immediately washed with a disinfectant wash solution. Such incidents will then be documented in writing to the supervisor as in IIIb above. 3) Disposal shall be handled as in IIId above. 5 F) Gloves 1) Gloves will be worn by all employees when it can be reasonably anticipated that they may have hand contact with blood, other potentially infectious materials, mucous membranes, and non -intact skin, and when handling or touching contaminated articles or surfaces. 2) Disposable (single use) gloves such as surgical gloves or exam gloves will be replaced as soon as possible when they become contaminated, and as soon as feasible when they become torn, punctured, or when their ability to act as a barrier becomes compromised. 3) Disposable (single use) gloves will not be washed or decontaminated for reuse. 4) Gloves will be available at -all times. 5) Heavy duty protective gloves will be available at all times. a) These gloves must be worn when there is a significant risk of the normal weight glove not being strong enough to provide adequate barrier protection. b) This may be due to the nature of the patient's injuries or the environment the employee is in. C) Heavy duty gloves will be single use only and will not be washed or reused. G) Masks and Eye Protection Masks and eye protection shall be worn at all times when there is reasonably anticipated eye, nose, or mouth contamination from splashes, spray, splatter, or droplets of blood or other potentially infectious materials. H) Contaminated Uniforms or Clothing If the employee's uniform or personal clothing becomes contaminated with blood or other potentially infected materials, it shall be removed as soon as possible. The area underneath should be thoroughly washed with soap and water. Sets of alternative temporary clothing will be available on each vehicle in appropriate sizes for temporary use until such time as clean clothing can be obtained. It is suggested that 0 each uniformed employee bring one complete uniform to work with them to facilitate replacement when necessary. IV. HOUSEKEEPING A) Cleaning 1) All reusable equipment shall be cleaned and then decontaminated using a disinfecting solution as soon as possible after becoming contaminated with blood or other potentially infectious materials, and before reuse with another patient. 2) Contaminated work surfaces will be disinfected using a disinfecting solution as soon as possible after the completion of the procedure. 3) Broken glassware or other broken or sharp objects which have a potential for puncturing or cutting of the skin which may be contaminated may not be picked up directly with the hands. It must be cleaned up using mechanical means, such as a dust pan and brush or other such devices. 4) Single use patient care items shall not be cleaned or reused and will be replaced as soon as possible if they become contar-Anated. 5) Garbage receptacles in the vehicles will be cleaned with a disinfecting solution whenever they become contaminated. They shall also be inspected to insure that they have not been visibly contaminated, and cleaned with a disinfecting solution when contaminated. B) Sharps 1) Contaminated sharps will be promptly disposed of after use, in the supplied, leak resistant, labeled and closable containers provided as soon as possible after use without recapping. They Shall Not be bent, sheared, replaced in the sheath or guard, or removed from the syringe after use. 2 ) Sharps containers will be replaced before the door on the top of the container contacts any of the contents of the container. This will ensure that the containers do not become overfull. 3) Sharps containers shall be placed in vehicles such that they will remain upright throughout use and easily 7 accessible to employees. 4) Sharps containers will be disposed of before full by: a) Closing lid of container securely. b) Placing in closed red marked bags. If the outside of this bag should become contaminated it shall be in a double red, marked bagged to insure that the contents may not spill, leak or protrude during storage, transport, or shipping. C) Delivered to DRMH Hospital. d) Not be emptied for reuse at any time. 5) Reusable sharps such as bandage scissors that have been contaminated, shall be placed in the provided container for cleaning and decontamination as soon as possible. These sharps shall then be removed by dumping out into a sink for cleaning. They may not be removed by reaching into the container. They will then be cleaned and disinfected using a disinfecting solution. C) Laundry 1) Contaminated laundry, such as blankets and towels, shall be handled as little as possible. Contaminated laundry shall be placed in bags or containers bearing the bio- hazard label or color coded to alert others of the potential danger. 2) The laundry service receiving the laundry must be advised of the contents. V. HEPATITIS B VACCINATION AND POST EXPOSURE EVALUATION A) Hepatitis B vaccination shall be made available to all employees, who may have an occupational exposure, after training and within 10 days of their initial assignment to work. 1. This vaccination shall be provided at no cost to the employee. 2. Shall be made available at a reasonable time and place. 3. Shall be provided by a licensed physician or under a physician's direction according to U.S. Public Health Guidelines. 4. Prescreening is not required for HBv. 5. Hepatitis B vaccination may be refused by the employee. a) If an employee does not wish to be vaccinated they must sign a refusal statement. b) If they later decide at any time that they wish to 0 be vaccinated, the vaccination will be provided within 10 days, at no cost to them. B) Post Exposure Procedures, Evaluation and Followup 1) If an employee receives a significant exposure: a) They shall immediately or as soon as possible wash the exposed area using soap and water. b) They will then notify their supervisor as soon as possible that they have had an exposure. The supervisor shall be responsible for completion of the supervisor's First Report of Injury form. The employee will, as soon as possible, complete the employee's First Report of Injury form. C) They will go to the nearest or most appropriate facility to be evaluated. If at a hospital, that hospital should be notified to insure that the patient will be tested as soon as possible. d) Document the route of exposure and the incident in which they were exposed so that it may be evaluated to determine if work practices should be changed to prevent exposures in the future. This report should then be turned in to their supervisor prior to the end of their shift, or within 24 hours. e) The employee should be tested as soon as possible to determine their initial status. f) The exposed employee's blood shall be collected as soon as feasible and tested after consent is obtained. If the employee consents to base line blood collection but does not give consent for HIV testing, the sample shall be preserved for at least 90 days. If, within 90 days of the exposure incident, the employee elects to have the base line sample tested, such testing shall be done as soon as feasible. g) All employee health records pertaining to the exposure and medical findings and diagnoses will be kept confidential. h) Records pertaining to the exposure will be kept for the duration of the employees employment plus 30 years. 2) Request shall be made to the receiving facility of the source individual to test for HBV/HIV. a) The results of these tests shall be made available to the employee as well as the laws concerning disclosure identity. b) If the Source refuses to be tested, the employee should proceed to be evaluated as above in 1). 6 3) Within 15 days the employee shall be provided with the written professional opinion of the evaluating physician. Recommendations for treatment and inoculation will be followed at the employer's expense. VI. INFORMATION AND TRAINING A) Labels and Signs 1) All containers or sharps or contaminated articles shall be identified with the Bio -hazard label. 2) All linen in clear plastic bags shall be considered as contaminated and shall be handled with universal precautions. 3) All red plastic bags shall be considered to contain contaminated articles and shall be handled with universal precautions and disposed of properly. B) Training The City of Rosemount shall provide training regarding the spread of infectious disease to all personnel with the potential for occupation exposure. Training will be provided at the time of initial assignment to tasks where occupational exposure may take place. Annual refresher courses must be provided. Additional training shall be provided as technology and medical research dictate. VII. RECORD KEEPING A) Accurate records shall be kept for each employee with occupational exposure. B) These records shall include: 1) Name and Social Security Number. 2) HIB vaccination status and medical record relating to receiving vaccine. 3) Results of exams, medical testing, and follow-up procedures, and record of event of exposure. 4) Employer's copy of professional written opinion. 5) A copy of information provided to the professional. C) Confidentiality 1) All employee medical records will be kept confidential. 2) No records may be released without the employee's written consent. D) Records will be kept for a period of 30 years beyond the employee's duration of employment. 10 E) Training Records 1) Shall include: a) Date of Training b) Contents of training C) Names and qualifications of trainers d) Names and job titles of all persons attending training 2) Training records shall be kept for 3 years from the date of training. 11