KENYON COLLEGE
SAFETY PROCEDURES/EXPOSURE CONTROL PLAN TO ELIMINATE
OR MINIMIZE OCCUPATIONAL EXPOSURE TO BLOODBORNE PATHOGENS
HEALTH AND COUNSELING CENTER
SPARROW HOUSE
740-427-5525
DIRECTOR: Tracy W. Schermer, M.D.
Revised by Ellen McComb 3/26/01
1
KENYON COLLEGE SAFETY PROCEDURES/EXPOSURE CONTROL PLAN
TO ELIMINATE OR MINIMIZE OCCUPATIONAL EXPOSURE TO
BLOODBORNE PATHOGENS
The purpose of these procedures is intended to protect the health of Kenyon College employees from exposure to bloodborne pathogens such as the hepatitis B virus (HBV) and the human immunodeficiency virus (HIV).
Section I: Bloodborne Pathogens
Section II: Precautions Statement
Section III: Exposure Determination
A. Employees with a Definite Risk of Exposure
B. Employees with a Possible Risk of Exposure and Tasks
Section IV: Engineering and Work Practice Controls
A. Health Service
B. Custodial Personnel
C. Security Personnel
Section V: Housekeeping Methods and Schedule
A. Health Service
B. Bathrooms on College Campus
C. Any Site of an Accident
Section VI: Personal Protective Clothing and Equipment
A. When Gloves Must be Worn--
Health and counseling Center Personnel
B. When Gloves Must be Worn--
Custodial Personnel
C. When Gloves Must Be Worn--
Security Personnel
D. Other Protective Devices and When to Use
Section VII: Hepatitis B Vaccine
A. Hepatitis B Vaccination
1. Health and Counseling Center Personnel
2. Custodial Personnel
3. Security Personnel
B. Hepatitis Dosage Schedule
C. Hepatitis B Vaccine Declination
Section VIII: Post-Exposure Follow-up
A. HIV: Specific Exposure Follow-up
B. Accident Report Form
C. In Case of Emergency
SECTION IX: Employee Training Program
A. Epidemiology and Transmission of Bloodborne Pathogens
B. Hepatitis B Training Information
C. HIV Training Information
D. Employee Training Record
E. Records
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SECTION I
3
SECTION II
The laboratory specimens for which universal precautions apply are:
Any worker who has been accidentally
exposed to potentially infectious
body fluids (through accidental
needle stick or contact with mucous
membranes) will immediately contact
the Director, Health and
Counseling Center, for evaluation
and follow-up. HBV vaccination will
be offered to the employee exposed.
If the employee refuses the
vaccination, such refusal shall
be done so in writing.
Date:____________________________
______________________________________
Tracy W. Schermer, M.D.
Kenyon College
Director, Health and Counseling
Center
4
SECTION III
A. DEFINITE RISK OF EXPOSURE
HEALTH SERVICE
DATE JOB TITLE
Physician--Director, Health Center______
Physician--Orthopedic Surgeon Consultant
Physician--Other________________________
All Nurses--Registered Nurse____________
Others--(i.e., LPN, etc.)_______________
B. POSSIBLE RISK OF EXPOSURE
SECURITY
(First responders to accidents on campus)
JOB TITLE
TASKS
Emergency Response
Director of Security
to accident/injury
Assistant Director of Security " "
Security Officers
" "
C. POSSIBLE RISK OF EXPOSURE CUSTODIAL
JOB TITLE
TASKS
Cleaning dormitory
rooms/bathrooms &
Custodial staff
personnel
trash removal____
5
SECTION IV
A. ENGINEERING AND WORK PRACTICE CONTROL--HEALTH SERVICE
1. Immediately
wash hands and other skin surfaces that are
contaminated with blood and other potentially infectious
materials. Wash hands:
a. after handling and collecting lab specimens and collecting
containers (if so exposed)
b. before leaving the immediate area of work (bathroom, site of
cleaning from accident or injury) or eating or drinking
c. whenever gloves or other personal protective devices are
removed.
When in doubt, wash your hands!!
2. Wash
hands with an anti microbial soap, effective against HIV, for
at least ten seconds. Rinse under a stream of water. Each
custodial worker, security officer or other employee has
available to them an antimicrobial soap (VIONEX) for such
purposes.
6
Cleaning and disinfecting
work surfaces and equipment will be done at
least once per day
and after any contact with blood or other
potentially infectious
material. Use an appropriate germicide (e.g.,
ten per cent solution
of household bleach). Broken glass that may be
contaminated must
not be picked up directly with the hands but by
mechanical means (e.g.,
forceps). Specimens of blood or other
potentially infectious
materials must be placed in closable,
leak-proof containers
that are labeled or color coded (available
through the Health
Service).
A sample housekeeping
form can be found in the next section.
7
B. WORK PRACTICE CONTROLS--CUSTODIAL PERSONNEL
1. First
aid kits are in buildings
2. Safety training
programs which include use of disinfectants
and health precautions
3. Trash bags
are disposed of and replaced with new bags whenever
cans are emptied
4. Disposable
gloves are used during trash handling
5. Disposable
cardboard boxes with heavy plastic liners are used
for glass disposal in labs
6. Red plastic
boxes with tight fitting lids are used for sharps
disposal in labs
C. WORK PRACTICE CONTROLS--SECURITY PERSONNEL
1. Each
security vehicle is equipped with first aid kits
2. Safety training
programs which include use of disinfectants
and health precautions are in use
3. Gloves shall
be worn when blood or bodily fluids are involved
with the care rendered to an injured person
4. Contact with
the College Physician and/or emergency squad will
be made by security personnel when deemed necessary
D. WORK PRACTICE CONTROLS--ATHLETIC TRAINERS
1. First
aid kit and trainer's emergency bag are available at
each training room site and at major athletic events.
2. Safety training
programs which include use of disinfectants
and health precautions
3. Gloves shall
be worn when blood or bodily fluids are involved
with the care rendered to an injured athlete or student
4. Contact with
the College Physician and/or emergency squad will
be made by the trainers when deemed necessary
8
SECTION V
HOUSEKEEPING METHODS AND SCHEDULE
A. LOCATION: Health
Service Center
AREA/INSTRUMENT DISINFECTANT FREQUENCY
Waiting Room DMO Disinfectant Daily_____
Exam Rooms DMO Disinfectant Twice Daily_
Bathroom DMO Disinfectant Twice Daily_
Triage Room DMO Disinfectant Daily_____
Whirlpool Chlorozine while in use;________________
Sanizene to clean after use as used_
Therapy Room DMO Disinfectant Daily_____
Equipment in Exam Rooms DMO Disinfectant Daily_____
All Surgical Instruments Soak in Amerse 45 minutes/scrub/_____
Autoclave 265 degrees for____________
30 minutes As used____
Colposcope Clean manual adjustment with DMO______
Disinfectant; clean lens with alcohol
As used____
METHODS: A mixture of disinfectant and water is used to wash the
waiting room furniture, counter
tops, desk tops, sinks, etc._______
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B. LOCATION: Bathrooms on
College Campus
AREA/INSTRUMENT DISINFECTANT FREQUENCY
Sinks Comet, Spray 9/Spray 9/Bleach Daily______
Toilets Comet #79 Triad Bowl Cleaner (Non-Acid)_______
Daily______
Mirrors Glance Glass Cleaner Daily______
Showers Forward DC Spray 9/Bleach Daily______
Floors Forward GP/Bleach Daily______
Note: Bleach is used in cleaners used in bathrooms--10% solution
C. LOCATION: Training Room
AREA/INSTRUMENT DISINFECTANT FREQUENCY
Examining Tables 10% Bleach Solution Daily____
Ultrasound Mat Kleen Daily____
Hydrocolator Wavicide-01, Mat Kleen Daily____
Sinks
Mat Kleen or 10% Bleach Daily____
10
D. LOCATION: Any site of an accident/injury
AREA/INSTRUMENT DISINFECTANT FREQUENCY
Vomit on waiting room carpet
Emergency clean-up As needed
Blood on carpet Emergency clean-up As needed
Field House exam tables 10% Bleach Solution Daily____
Field House whirlpools Chlorozine, Mat Kleen As used__
Athletic field 10% Bleach Solution With each
Occurrence of blood exposure___
Athletic facility 10% Bleach Solution With each
(Basketball court, Tennis Court,etc) Occurrence of blood exposure
Laboratories--disposable cardboard glass waste collection boxes
are used.______________________________________________________
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SECTION VI
The College will clean, launder
and dispose of or repair and replace
personal protective equipment
at no cost to the employee.
Finally, all PPE must be removed prior to leaving the work area.
There is a very limited exemption
from the use of PPE when in the
employee's professional judgment,
such use would prevent the delivery
of health care services or would
impose an increased hazard to the
employee's safety. These
are usually emergency situations. In any
case, each such exemption must
be documented and investigated to
determine whether prevention of
similar circumstances in the future is
possible.
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A. WHEN GLOVES MUST BE WORN--Health and Counseling Center Personnel
Gloves MUST be worn when:
Change gloves between patient contacts.
Under no circumstances can
latex or vinyl gloves be washed
or disinfected for reuse.
Wear gloves that fit properly and
place them to fit over the sleeve
cuff, if applicable.
Remove gloves before handling non-contaminated
items such as telephones
and when leaving the lab.
Wash hands immediately after glove removal.
A sample chart for using protective
devices follows these pages. Use
the blank spaces to include any
other PPE used in your particular
facility.
13
B. WHEN GLOVES MUST BE WORN--Custodial Personnel
Gloves MUST be worn when:
Change gloves after each specific
incident/use. Under no circumstances
can latex or vinyl gloves be washed
or disinfected for reuse.
Wear gloves that fit properly and
place them to fit over the sleeve
cuff, if applicable.
Remove gloves before handling non-contaminated items such as telephones.
Wash hands immediately after glove removal.
C. WHEN GLOVES MUST BE WORN--Security Personnel
Gloves MUST be worn when:
Change gloves after each specific
incident/use. Under no circumstances
can latex or vinyl gloves be washed
or disinfected for reuse.
14
Wear gloves that fit properly and
place them to fit over the sleeve
cuff, if applicable.
Remove gloves before handling non-contaminated items such as telephones.
Wash hands immediately after glove removal.
D. WHEN GLOVES MUST BE WORN--ATHLETIC TRAINERS
Gloves MUST be worn when:
Change gloves after each specific
incident/use. Under no circumstances
can latex or vinyl gloves be washed
or disinfected for reuse.
Wear gloves that fit properly and
place them to fit over the sleeve
cuff, if applicable.
Remove gloves before handling non-contaminated items such as telephones.
Wash hands immediately after glove
removal.
15
E. OTHER PROTECTIVE DEVICES AND WHEN TO USE
1. Health and Counseling Center Personnel
PROTECTIVE
DEVICE
WHEN TO USE
Utility
gloves Cleaning (housekeeping)--reusable until they
(Rubber)
puncture, tear or crack_____________________
Sterile
surgical
gloves
Contact with sterile areas of the body______
Masks/face
Contact with aerosols, e.g., removing blood
Shields
stoppers from tubes_________________________
2. Custodial Personnel
PROTECTIVE
DEVICE
WHEN TO USE
Utility
gloves Cleaning (housekeeping)--reusable until they
(Rubber)
puncture, tear or crack_____________________
3. Security Personnel
PROTECTIVE
DEVICE
WHEN TO USE
Utility
gloves Cleaning (housekeeping)--reusable until they
(Rubber)
puncture, tear or crack_____________________
Exam gloves Routine infection protection________________
Gowns
When protecting clothes from splashes
--remove when leaving the area when
visibly soiled with blood or other body
fluids______________________________________
4. Athletic Trainers
PROTECTIVE
DEVICE
WHEN TO USE
Utility
gloves Cleaning (housekeeping)--reusable until they
(Rubber)
puncture, tear or crack_____________________
Exam gloves Routine infection protection________________
Gowns When
protecting clothes from
splashes remove when leaving the
area when visibly soiled with blood
or other body fluids________________________
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SECTION VII
HEPATITIS B VACCINE
1. Health and Counseling Center Personnel
Employers must assure
that employees who decline the HBV vaccination
sign a statement to
that effect. The HBV declination form required
by OSHA is located
on page 19.
2. Custodial Personnel
If custodial employees
are exposed to blood or other bodily fluids
that place them at
risk of infection, they shall follow the
"Post-Exposure" protocol
(Section VIII).
3. Security Personnel
Since security is often
the first responder to the scene of an
accident and/or injury,
they must initiate emergency care. All
precautions to prevent
unnecessary exposure must be taken to prevent
contact with bodily
fluids. Post-Exposure Follow-Up (Section VIII)
will be followed if
exposure occurs.
4. Athletic Trainers
Since the athletic
trainers are often the first to respond to an
athletic injury, they
must initiate emergency care. Further, the
athletic trainers
may become exposed while treating an
athlete/non-athlete
with an open or draining wound. All precautions
to prevent unnecessary
exposure must be taken to prevent contact with
bodily fluids.
Post-Exposure Follow-Up (Section VIII) will be
followed if exposure
occurs (refer to News: United States Department
of Labor Occupational
Safety and Health Administration, USDL 92-436,
1/6/92, First Aid
Providers May Receive Hepatitis B Vaccine Upon
Exposure).
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HEPATITIS B VACCINATION
DATES DOSAGES ADMINISTERED
NAME DOSE 1 DOSE 2 DOSE 3
1.___________ _________________ ___________________________________________________
2.________________________________________________________________________________
3.________________________________________________________________________________
4.________________________________________________________________________________
5.________________________________________________________________________________
6.________________________________________________________________________________
7.________________________________________________________________________________
8.________________________________________________________________________________
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HEPATITIS B VACCINE DECLINATION
(MANDATORY)
I understand that due to my occupational exposure to blood or other
potentially infectious materials, I may be at risk of acquiring hepatitis B
virus (HBV) infection. I have been given the opportunity to be vaccinated
with hepatitis B vaccine, at no charge to myself; however, I decline
hepatitis B vaccination at this time. I understand that by declining this
vaccine, I continue to be at risk of acquiring hepatitis B, a serious
disease. If in the future I continue to have occupational exposure to
blood or other potentially infectious matertials and I want to be
vaccinated with hepatitis B vaccine, I can receive the vaccination series
at no charge to me.
Date:
Employee: _______________________________
(Please Print)
Employee Signature: _____________________________________
Employer
Signature: _____________________________________
19
SECTION VIII
In spite of our best efforts to
the contrary, accidents DO happen.
All workers must know how to respond
quickly and correctly to
accidental injuries. If
you have cut or contaminated your skin, first
perform routine first aid:
wash with soap and water; and, if
appropriate, bandage the site.
Wash contaminated mucosal and
conjunctival sites with large
quantities of water.
Report all accidents as
soon as possible to your supervisor or the
College Physician and fill out
an accident report form.
The OSHA Standard as well as the
Health and Counseling Center requires
medical evaluation and follow-up
for all employees who have had an
exposure incident (cut, needle
stick, spray, etc.)
Post-Exposure follow-up consists of:
20
The Health and Counseling Center
will provide employees who have had
an exposure incident with specific
information, including:
If a skin
puncture was due to a needle stick or an employee is
exposed
to body fluids by percutaneous, permucosal or non-intact
skin routes,
the following actions will be undertaken by the
College
Physician:
1.
Identify the source patient and notify him/her of the incident.
Obtain voluntary consent, if possible, to obtain a blood
specimen and test for HIV antibodies.
2.
The exposed worker should donate a blood specimen to be tested
for HIV antibodies. If this test is negative, the worker
should be tested at six weeks, twelve weeks and six months
after exposure. Furthermore, it is recommended that workers
who are seronegative at six months be tested for HIV antibodies
at nine, twelve and 24 months post-exposure.
3.
The exposed worker should be counseled to follow the
recommendations of the CDC and Surgeon General regarding
preventing AIDS transmission:
do not donate blood or plasma
inform sex partners of potential exposure to infection
avoid pregnancy during the follow-up period
inform physicians, dentists and other health care providers
of potential exposure so that they may take appropriate
precautions
clean and disinfect surfaces on which blood or body fluids
have spilled
do not share razors, toothbrushes, etc.
In areas
where AIDS is more prevalent, prophylactic doses of
Zidovudine
(AZT) may be considered after occupational exposure.
Treatment,
if elected, ideally begins within an hour after exposure.
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KENYON COLLEGE
HEALTH AND COUNSELING CENTER
ACCIDENT REPORT FORM
TYPE OF ACCIDENT/
DATE/INITIALS
EMPLOYEE INJURED
ROUTE OF EXPOSURE
________________________
_____________ __________________
________________________
________________________
________________________
Social Security #_______________
________________________
________________________
________________________
Date of Hepatitis Vaccine ______
________________________
______________________________
(or attached Declination Form)
________________________
SEROLOGICAL TESTS PERFORMED (HIV, HBV):
Date Test Result ______________________
Date Test Result ______________________
Comments ___________________________________________________
___________________________________________________________________________
POST-EXPOSURE PROPHYLAXIS ADMINISTERED:
Date ___________
By _____________________________________
SOURCE PATIENT'S NAME ______________________________________________
PHONE NUMBER __________________
HIV TEST RESULT HBV TEST RESULT____________
NOTE:
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EMERGENCY INFORMATION
Employee Date ________
In case
of an emergency or accident in which I am unable to
contact
my family or friends, the following person should be
notified:
Name __________________________________________________________
Relationship __________________________________________________
Address _______________________________________________________
Phone ( )___________________________________________________
In the
event the above named individual cannot be reached,
please
contact one of the following people in the order
indicated:
1. Name ____________________________________
Relationship ____________________________
Address _________________________________
___________________________________________________
Phone ( )_____________________________
2. Name ____________________________________
Relationship ____________________________
Address _________________________________
___________________________________________________
Phone ( )_____________________________
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SECTION IX
Training
will include but is not limited to:
These
requirements are all located within this Safety Procedures/
Exposure
Control Plan. The College Physician and/or head nurse
will be
available to answer any questions an employee may have.
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A. EPIDEMIOLOGY AND TRANSMISSION OF BLOODBORNE PATHOGENS
Hepatitis B virus (HBV) has long
been recognized as a pathogen capable
of causing serious illness and
death. Because the virus is transmitted
through blood and certain body
fluids, persons who come in contact with
blood and other potentially infectious
materials as the result of
carrying out their duties are
at increased risk of contracting HBV.
The human immunodeficiency virus
(HIV), the virus that causes AIDS, has
only been recognized in the last
decade. Because the transmission of
HIV is considerably less efficient
than HBV, the risk of HIV
infection to employees who must
handle blood and other potentially
infectious materials is less than
for HBV infection (i.e., HIV results
in fewer seroconversions following
exposure incidents). The
consequences of HIV infection
are grave, however, because HIV
causes the fatal disease AIDS.
B. HEPATITIS B TRAINING INFORMATION
Hepatitis B virus (HBV) infection
is the major infectious bloodborne
occupational hazard to health
care workers. Death may result from
acute and chronic hepatitis.
Infected health care workers can
spread the infection to family
members or rarely, to their patients.
The use of hepatitis B vaccine,
engineering and work practice controls
and personal protective equipment
prevents almost all of these
occupational hepatitis B infections.
HBV attacks and replicates in liver
cells. Infection with HBV in a
susceptible person can produce
two types of outcomes: self limited
acute hepatitis B and chronic
HBV infection. The most frequent
response seen in healthy adults
is development of self limited acute
hepatitis and the production of
an antibody against HbsAg. The
production of this antibody coincides
with the destruction of liver
cells and elimination of the virus
from the body.
Unfortunately, the destruction
of liver cells in an attempt to rid the
body of this infection often leads
to clinically apparent acute
hepatitis B. About one-third
of infected individuals have no symptoms
when infected with the virus,
one-third have a relatively mild
clinical course of a flu-like
illness which is usually not diagnosed
as hepatitis and one-third have
a more severe clinical course with
jaundice (yellowing of the eyes
and skin), dark urine, extreme fatigue,
anorexia, nausea, abdominal pain
and sometimes joint pain, rash and
fever. These symptoms require
hospitalization in about 20% of
jaundiced cases and often cause
several weeks to months of work loss
even in those cases that do not
require hospitalization. Fulminant
hepatitis, which is about 85%
fatal with even the most advanced medical
care, develops in about one to
two per cent of reported acute
hepatitis B cases, and an estimated
on per 1000 HBV infections.
The second type of response, development
of chronic HBV infection,
has more severe long-term consequences.
About six percent to ten
percent of newly infected adults
cannot clear the virus from their
liver cells and become chronic
HBV carriers. These individuals
continue to produce HbsAg for
many years, usually for life. HBV
carriers are at high risk of developing
chronic persistent hepatitis,
chronic active hepatitis, cirrhosis
of the liver and primary liver
cancer. About 25% develop
chronic active hepatitis. The latter is a
progressive, debilitating disease
that often leads to cirrhosis of the
liver after five to ten years.
Chronic HBV infection has been
estimated to cause ten percent
of the 25,000 - 30,000 deaths that occur
due to cirrhosis in the USA each
year.
Seven to 30 percent of susceptible
health care workers sustaining
needle sticks from HbsAg-positive
patients can be expected to become
infected if they did not receive
post-exposure prophylaxis.
25
C. HIV TRAINING INFORMATION
HIV is a member of a group of viruses
known as human retroviruses.
HIV gradually depletes the number
of cells which are essential for
immune function, rendering the
infected individual increasingly
susceptible to opportunistic infections
and clinical disorders.
These conditions can be aggressive,
rapidly progressive, difficult
to treat and less responsive to
traditional modes of treatment.
They usually lead to the death
of the HIV infected patient.
Infection with HIV may be identified
through testing the blood for
the presence of HIV antibodies.
Although the antibodies do not
appear to defend or protect the
host against HIV, they serve as
markers of viral infection.
Most people infected with HIV have
detectable antibodies within six
months of infection, with the
majority generating detectable
antibodies between six and twelve weeks
after exposure.
The enzyme linked immunosorbent
assay (ELISA or EIA) technique used
to detect HIV antibodies is sensitive,
economical and easy to perform
However, this test can produce
a false positive result. Therefore,
current recommendations include
repeating the ELISA results. A
positive ELISA test and a positive
Western blot result indicate the
presence of HIV antibodies and
HIV infection.
26
D. EMPLOYEE TRAINING RECORD
I have read and understood the
safety procedures outlined in the
manual. I have been given
the opportunity to ask questions to clarify
portions of this manual.
I will to the best of my abilities, make
every attempt to practice these
safety policies in order to reduce
health risks to myself, my coworkers
and our patients.
TRAINER _________________________________________________
DATE TITLE/TRAINING DESCRIPTION EMPLOYEE SIGNATURE
27
E. RECORDS
28