8453.01 - CONTROL OF BLOOD-BORNE PATHOGENS

Parma City Schools

Administrative Guidelines

8453.01 - CONTROL OF BLOOD-BORNE PATHOGENS
Purpose

This written plan has been developed to reduce, remove, or control employee exposure to the Hepatitis B virus (HBV), Human Immunodeficiency Virus (HIV) and other bloodborne pathogens as defined in OSHA standard 29 C.F.R. 1910.1030. Additionally, it meets the compliance standards of Ohio House Bill (H.B.) 308, Public Employees Risk, and Reduction Act.

The Standards

A copy of the referenced OSHA standard 29 C.F.R. 1910.1030 is included in this plan's appendixes (Appendix A). Additional information on this standard may be obtained from the Superintendent.

Location of Written Exposure Control Plan

This District's Exposure Control Plan will be kept on file in the principal's office and a copy in the school's clinic. A copy will also be filed in the Nursing and Community Health Services Division, Cuyahoga County Board of Health, Cleveland, Ohio. A copy of this written plan and its appendixes is available to any employee upon request.

Definitions per OSHA Standard 29 C.F.R. 1910.1030

	A.	Bloodborne Pathogens: Pathogenic microorganisms that are present in human blood and can cause disease in human beings. It includes but is not limited to hepatitis B virus (HBV) and human immunodeficiency virus (HIV).

	B.	Exposure Incident: A specific eye, mouth, other mucus membrane, nonintact skin or parenteral contact with blood or other potentially infectious materials that occurs during the performance of an employee's duties.

	C.	Occupational Exposure: Reasonably anticipated skin, eye, mucus membrane or parenteral contact with blood or other potentially infectious materials that may occur during the performance of an employee's duties.


D.	Other Potentially Infectious Materials

	The following human body fluids:

	1.	semen

	2.	vaginal secretions/discharge

	3.	synovial (joint) fluid

	4.	pleural (lung) fluid

	5.	amniotic (uterine) fluid

	6.	breast milk

	7.	any body fluid that is visibly contaminated with blood

	8.	all body fluids in situations where it is difficult or impossible to tell the difference between body fluids

E.	Parenteral: Piercing mucus membranes or skin through needle sticks, human bites, cuts, and abrasions.

Exposure Determination

The Superintendent has determined that employees in the following job classifications have some occupational risk to an exposure of bloodborne pathogens. This determination was made after reviewing the employees' tasks and duties.

Job Classification	Tasks and Duties Determining
	Occupational Exposure

Designated secretarial/	Administers first aid to
clerical personnel and	students with injuries where
elementary noon monitors who	there is a potential risk
regularly administer first aid	for contact with blood or
	other potentially infectious
	materials.


Job Classification	Tasks and Duties Determining
	Occupational Exposure

Athletic coaches,	Responds to accidents or
Physical Education	injuries to students where
Teachers and Student	there is a risk for contact
Trainers	with blood or other
	potentially infectious
	materials.

Personnel in selected	Exposed to blood and other
Special Education	potentially infectious
programs: Multihandicapped,	material while performing
Orthopedically Impaired,	their duties.
Severe Behavior Handicapped
and Developmentally Disabled --
Intensified Instruction

Vocational Education	Attends to students in
Teachers Trade and	response to an accident
Industrial Programs	where there is a risk for
	contact with blood or other
	potentially infectious
	materials.

Pre-school, Day Care	Exposed to blood and other
and Extended Day	potentially infectious
Care Personnel	materials while performing
	their duties.

Custodians and Cleaners	Exposed to blood and other
	potentially infectious waste
	while cleaning facility
	which includes restrooms and
	emptying waste containers.

Transportation Personnel:	Exposed to blood and other
Vehicle Operators and	potentially infectious
Bus Aides	materials while performing
	their duties.

Methods of Compliance

A.	Standard (Universal) Precautions will be observed in this school as a means to prevent employees from contact with blood and other potentially infectious materials. All blood or other potentially infectious materials will be considered infectious regardless of the perceived status of the source individual.

B.	Engineering/Work Practice Controls

	Engineering and work practice controls are implemented to eliminate or reduce the exposure risk to the school's employees. Engineering controls isolate or remove the hazard or isolate the employee from an exposure. Work practice controls alter the manner in which a job is performed. If the possibility of exposure still remains after these controls have been implemented, appropriate personal protective equipment (PPE) will be used.

	Specific engineering/work practice controls for the District include:

	1.	Hand Washing and other General Hygiene Measures

		a.	Hand washing is a primary infection control measure which protects both the employee and student. Appropriate hand washing must be diligently practiced. When other skin areas or mucous membranes come in contact with blood or other potentially infectious materials, the skin must be washed with liquid soap and water. Mucous membranes must be flushed with copious amounts of water. All employees must wash their hands immediately after removing latex gloves.

		b.	Note for employees who are not in close proximity to running water (i.e., bus drivers): May use disposable benzalkonium chloride towelettes until access to running water is available.

		c.	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 to blood or other potentially infectious materials.


	d.	Food and drink will not be kept in refrigerators, freezers, shelves, cabinets, or on counter tops where blood or other potentially infectious materials are present. Note: Breast milk may not be stored in a refrigerator where there is food and drinks. The GRADS Program has a separate refrigerator for breast milk storage.

	e.	Employees should not put their hands or arms into any waste containers or bags.

2.	Sharps Management

	a.	Contaminated needles or other contaminated sharps will not be bent, recapped, or removed. Shearing or breaking contaminated needles is prohibited. Broken glass contaminated with blood will be placed in a sharps container.

	b.	Sharps containers must be able to close, be puncture resistant, labeled or color-coded, leak proof on sides and bottom and maintained upright throughout its use. Containers are to be easily accessible to personnel and located as close as feasible to the immediate areas where sharps are used or found. NOTE: Sharps containers will be located in a locked cabinet in the clinic.

	c.	Do not over fill the sharps containers. Containers that are two-thirds (2/3) full will be promptly disposed. Local hospitals may be contacted as a possible resource for disposing of full sharps containers.

3.	Housekeeping

	a.	The workplace will be maintained in a clean and sanitary condition. Every employee is responsible for keeping work areas clean.


b.	When a blood spill occurs, special materials will be used. These materials are located in the school's clinic and with the custodians. Note: Commercially prepared kits may be found on each of the school buses. The materials include the following:

	1)	disinfectant cleaner

	2)	absorbent material

	3)	disposable gloves

	4)	spatula/scraper

	5)	plastic disposable bag

c.	All equipment and work surfaces in contact with blood or other potentially infectious material will be cleaned according to the kit's or the following instructions:

	1)	Spills are cleaned with a 5.25% bleach solution (one (1) cup bleach to nine (9) cups of water) (hypochlorite) or a solution containing one-forth (1/4) cup bleach to two and a half (2 1/2) cups of water. This solution is changed daily. Wear eye protection if solution is placed in a spray container so eye contact can be avoided.

	2)	Most spill materials may be disposed in a regular plastic bag. A hazardous material bag (red bag) is used if there is a copious amount (dripping) of blood or other potentially infectious material.

	3)	All mops, bins, pails, cans, and similar containers intended for re-use in the workplace which have a reasonable likelihood for becoming contaminated with blood or other potentially infectious materials will be decontaminated with a hypochlorite (bleach) solution. Soak cleaning tools in the hypochlorite solution for twenty (20) minutes.


			4)	Broken glass must never be picked up with one's hands. Broken glass is cleaned by using a brush and dust pan, or tongs.

C.	Personal Protective Equipment (PPE)

	1.	When there is a risk for occupational exposure, this school's staff will be provided with appropriate personal protective equipment. The following employees are required to use the supplied equipment listed below. PPE's must be worn in the following situations:

		a.	Personnel designated to administer first aid

			Latex gloves when tending to an injury where blood or other potentially infectious material is present.

		b.	Athletic Coaches and Physical Education Teachers

			Latex gloves when tending to an injury where blood or other potentially infectious material is present.

		c.	Special Education Personnel

			Latex gloves when cleaning up any body fluids or tending to an injury where blood or other potentially infectious material is present.

		d.	Vocational Education Teachers

			Latex gloves when tending to an injury where blood or other potentially infectious material is present.

		e.	Preschool, Day Care and Extended Day Care Personnel

			Latex gloves when changing diapers and when tending to an injury where blood or other potentially infectious material is present.

		f.	Custodial and Cleaning Staff

			Latex gloves and all disposable protective equipment found in special spill kits when cleaning up blood or other body fluids.


		g.	Transportation Personnel

			Latex gloves and all disposable protective equipment found in special spill kits when cleaning up blood or other body fluids.

	2.	In addition, any employee administering first aid must use disposable latex gloves which are kept in the school's clinic.

	3.	If cardiopulmonary resuscitation (CPR) is implemented, a disposable face shield or a one (1) way valve mask should be used for artificial respirations. The disposable face shields or one (1) way masks may be found in the school's clinic. Additionally, school nurses, bus drivers and athletic coaches will be issued disposable face shields.

	4.	Any work garments soaked or permeated by blood or other potentially infectious material will be removed immediately or as soon as possible. The school system will arrange for appropriate laundering. See the Custodial Supervisor for further instructions.

	5.	All PPE shall be removed prior to leaving the site where it was used. Noncontaminated equipment will be returned to its designated storage area, while contaminated equipment will be either disposed or cleaned and decontaminated.

	6.	Disposable gloves are NOT to be washed or decontaminated for re-use. All contaminated gloves are discarded after use. Hands must be washed immediately after gloves are removed.

D.	Hepatitis B Immunization

	1.	All employees identified by job classification as having a risk of occupational exposure shall be offered the Hepatitis B immunization at no cost to the employee once training is completed.


	2.	This immunization will be offered within ten (10) working days after the employee has received the requisite training in compliance with 1910.1030. Employees, who have already been immunized or have a medical condition which contraindicates the administration of the immunization, will not be immunized. Employees who have already been immunized will provide documentation of that immunization. Employees may voluntarily decline the immunization for any reason.

	3.	Employees who are offered the HBV immunization shall sign the Acceptance/Declination Form (See Appendix B). Employees who initially decline the immunization may have the immunization provided at a later date at the employer's expense. The Acceptance/Declination form will be kept in the employee's personnel record.

	4.	The Human Resources Department or designee will make arrangements for the immunizations as well as maintain the HBV immunization and bloodborne pathogen education records and waivers on all of the school's employees.

Post-Exposure Evaluation and Follow-Up

An exposure incident is a specific eye, mouth, other mucous membrane, nonintact skin, or parenteral contact with blood or other potentially infectious materials that result from the performance of an employee's duties. To qualify the incident as an exposure, the principal will use Appendix C - Evaluation for Post-Exposure Incident. This form is filed in the employee's personnel record regardless of whether there was an exposure or not.


B.	When an employee experiences an exposure incident, it is reported immediately to the principal and the Human Resources Department. If the principal qualifies the incident as an exposure, the employee will be given a consent form (See Appendix D) for post-exposure evaluation. If the source of the exposure is known, the source or source's parents will be contacted by the principal. The principal will request permission for the source to be tested. Appendix E is used. Additionally, the principal will follow up on the source testing and request the results of the source evaluation. A release will be obtained from the source so that the source's test results may be given to the employee. All employees who are exposed will be offered confidential post-exposure evaluation and follow up at the employer's expense. The evaluation consists of:

	1.	Completion of an incident report that documents the route of exposure and circumstances under which the exposure occurred.

	2.	Identification and documentation of the source individual, unless the employer can establish that identification is not feasible or prohibited by law (i.e. a minor).

	3.	Offering the employee blood testing for HBV and HIV serological status within ninety (90) days of the incident.

	4.	Post-exposure prophylaxis, when medically indicated.

	5.	Counseling concerning precautions to take during the period after the exposure incident. The employee will be given information on potential illnesses and symptoms to be aware of.

	6.	Evaluation of reported illnesses.

C.	The Human Resources Department will ensure that the health care professional responsible for the employee's HBV vaccination is provided the following:

	1.	A copy of the OSHA standard (Appendix A)

	2.	A description of the exposed employee's duties as they relate to the exposure incident.

	3.	Documentation of the route of exposure and circumstances under which the exposure occurred - use Appendix F.


	4.	Results of source individual's blood testing, if available.

	5.	All medical records relevant to the appropriate treatment of the employee including vaccination status which is the employer's responsibility to maintain.

D.	If the employee is medically evaluated and tested, the employee will provide the Human Resources Department with a copy of the evaluating health care professional's written opinion within fifteen (15) days of the completion of the evaluation. The written opinion for post-exposure evaluation and follow-up is limited to the following information:

	1.	that the employee has been informed of the results of the evaluation

	2.	that the employee has been told about any medical conditions resulting from exposure to bloodborne pathogens which require further evaluation or treatment.

	3.	all other findings or diagnoses shall remain confidential and will not be included in the written report.

Communications of Hazards to Employees

Employees will be informed of hazards through a system of BIOHAZARD CONTAINERS, RED BAGS AND LABELS.

Warning labels will be affixed to containers of regulated wastes, 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. Contaminated equipment will also be labeled in this manner.

Labels are fluorescent red with lettering or symbols in a contrasting color. The label is either an integral part of the container or affixed as close as possible to the container which will prevent loss or unintentional label removal. The label shall have the biohazard symbol and the text "BIOHAZARD."

Employee Training

All employees will participate in a training program on bloodborne pathogens upon initial assignment and annually which includes the following:

	A.	explanation of OSHA and H.B. 308 standard

	B.	epidemiology and symptomatology of bloodborne diseases

	C.	modes of transmission of bloodborne pathogen

	D.	explanation of the school's Exposure Control Plan

	E.	job classifications that may have some occupational exposure to blood and other potentially infectious materials

	F.	engineering and work practices utilized by the school

	G.	Personal Protective Equipment and cleanup equipment available, when it is used, how it is properly used, and where it is located

	H.	information about the Hepatitis B vaccine

	I.	who to contact in an emergency involving blood or other potentially infectious materials - Immediate reporting will be stressed.

	J.	Post-exposure evaluation and follow-up

	K.	communication of hazards to employees

	L.	opportunity for "questions and answers"

Recordkeeping

A medical record will be established and maintained for each employee who experience an occupational exposure to bloodborne pathogens. The record will be maintained for the duration of employment plus thirty (30) years. The school is responsible for maintaining employee exposure medical records.

The medical record will contain the following information:

	A.	employee's name and social security number

	B.	employee's HBV vaccination status to include vaccination dates or any medical records relative to the employee's ability to receive the HBV vaccine

	C.	a copy of examination results, medical testing, and any follow-up procedures

	D.	the employer's copy of the health care professional's written opinion

	E.	a copy of the information provided to the health care professional when employee initially evaluated

The medical records must be kept confidential. No medical information may be disclosed or reported without the employee's express written consent to any person within or outside the workplace.

Documentation of training will be maintained in the Business Office for three (3) years from the date of each training.

The training documentation will include:

	A.	date(s) of training sessions

	B.	outline of information provided

	C.	names and qualifications of persons conducting the training

	D.	signatures and job titles of the employees attending the training

Annual Review

This Exposure Control Plan shall be reviewed and updated at least annually and whenever necessary to reflect new requirements, tasks, etc.