EXPOSURE PROTECTION PLAN

A. BACKGROUND:

The Occupational Health and Safety Act administered under 29 CFR 653, 655, 657 amended and expanded protection of employees potentially exposed to blood borne pathogens. 29 CFR 1910.1030 is being added under authority of 29 CFR 653. The full text of the new 1910.1030 can be found in Federal Register 6 December 1991 at 64175. This section requires employers to protect potentially exposed employees from infection with pathogens that may be transmitted by contact with blood or other body secretions.

B. DEFINITIONS:

For the purpose of this policy, the following definitions shall apply unless the context clearly indicates or requires a different meaning:

"BLOOD." Human blood, blood components and products made from blood.

"BLOODBORNE PATHOGEN." Any micro- organism that can be present in human blood and can cause disease in humans. This includes but is not limited to hepatitis B (HBV) or HIV.

"CONTAMINATED." The presence or the potential presence of blood or other potentially infectious material on an item or surface.

"DECONTAMINATE." To use physical or chemical means to remove blood or other infectious material from surface or item, to render it safe for handling, use or disposal.

"ENGINEERING CONTROLS." Controls that isolate or remove blood borne pathogen hazards from the work place.

"EXPOSURE CONTROL PLAN." A written exposure control plan (ECP) designed to eliminate or minimize employee exposure. For those with an occupational exposure to bloodborne pathogens, employers are required under 29 CFR 1910.1030 to have a written exposure control plan, with annual review and updates as the law is amended.

"EXPOSURE INCIDENT." A specific eye, mouth, nasal membrane, non-intact skin or other parenteral contact with blood or other potentially infectious material in the course of employee's job.

"HBV." Hepatitis B virus.

"HIV." Human immunodeficiency virus.

"OCCUPATIONAL EXPOSURE." Reasonably anticipated skin, eye, mouth, mucous membrane or parenteral contact with blood or other potentially infectious materials that may result from the performance of an employee's job.

"OTHER POTENTIALLY INFECTIOUS MATERIAL" Bodily fluids, including semen, vaginal secretions, cerebrospinal fluid, synovial fluid, amniotic fluid, saliva in dental procedures, any body fluid that is visibly contaminated with blood, and all body fluids in situations where it is difficult or impossible to differentiate between body fluids; any unfixed tissue or organ from a human; and HIV-containing cell or tissue cultures, organ cultures, and HIV or HBV containing culture medium or other situations, and blood from experimental animals infected with HIV or HBV.

"PERSONAL PROTECTIVE EQUIPMENT." Specialized clothing or equipment worn by an employee for protection against contamination with bloodborne pathogens or other potentially infectious materials.

"REGULATED WASTE." Liquid or semi-liquid blood or other potentially infectious materials (OPIM); contaminated items that would release blood or OPIM if compressed or wet or handled (examples include but not limited to gloves, paper towels, rags, syringes, needles).

"SOURCE INDIVIDUAL." Any individual, living or dead, whose blood or other potentially infectious materials may be a source of occupational exposure to the employee.

"UNIVERSAL PRECAUTIONS." An approach to infection control whereas all human blood and certain human body fluids are treated as if known to be infectious for HIV, HBV, and other bloodborne pathogens.

"WORK PRACTICE CONTROLS." Controls that reduce the likelihood of exposure by altering the manner in which a task is performed.

C. PURPOSE:

This plan applies to all occupational exposure to blood or other potentially infectious materials. The purpose of this plan is to eliminate or minimize exposure of designated employees to bloodborne pathogens.

D. EXPOSURE DETERMINATION:

1. Employees in the following job classifications have exposure to bloodborne pathogens:

a. Police officers.

b. Volunteer fire fighters.

2. Employees in the following job classifications may have limited occupational exposure to bloodborne pathogens:

a. Maintenance workers.

E. TASKS PERFORMED THAT MAY LEAD TO BLOODBORNE PATHOGEN EXPOSURE:

1. Handling persons who have cuts or other sources of bleeding.

2. Being injured in any way by another person in line of duty.

3. Contamination of eye, mouth, nose, or open skin.

4. Contamination of any organ in (C) while cleaning blood or body fluids.

5. Improper handling of used gloves, soiled clothing, contaminated items (towels, weapons, clothing, glasses, etc.).

6. Care of person involved in an accident.

7. Performing CPR or attempting to control bleeding.

F. PRECAUTIONS OBSERVED TO ELIMINATE OR MINIMIZE EXPOSURE:

1. Hand washing facilities shall be maintained in all facilities with potable running water, soap, and single-use paper towels or hot air hand dryers.

2. Situations that prevent hand washing in a facility will be handled by having in the vehicle a hand washing solution such as a water solution mixed to 10% bleach strength or bottle isopropyl alcohol, or pre-packed hand wipes with benzalkonium chloride and disposable one-use paper towel. When an exposed personnel uses this method of hand washing, they shall, as soon as practical, go to a facility and wash their hands with soap and water.

3. Employees shall wash their hands after removal of protective gloves, contamination by a potential infectious material and after removal of protective clothing.

4. Employees shall wash their hands or other body parts and flush all mucous membranes with copious amounts of water immediately or as soon as feasible after contact with blood or other infectious material.

5. Contaminated paper towels, gloves or other materials used to clean or disinfect hands while in vehicles shall be packed in plastic bag and securely closed. This plastic bag contains regulated hazardous waste. It shall be stored in the trunk of the vehicle and as soon as feasible taken to the facility (police department or fire department) for disposal into a biohazard red plastic liner, closed trash container.

6. Specimens of blood or other bodily fluids, materials or tissue shall be placed in a container that prevents leakage during collection, handling, processing, storage, transport or shipping.

7. Such materials noted in (F) shall be labeled and color coded in red prior to being transported, mailed, shipped or stored.

8. Equipment which may be contaminated with blood or other infectious material shall be inspected prior to servicing or reuse. It shall be decontaminated prior to continued use, shipping, storage or transportation.

9. Decontamination of equipment and items may be accomplished with a solution of 10% bleach or hot soap and water or undiluted rubbing alcohol, while wearing protective equipment.

10. Personal protective equipment shall be provided to all employees with a potential for exposure to blood and other infectious materials. It shall include the following:

(a) Gloves made of non-permeable latex of sufficient strength that they do not tear or puncture for the duration of time that the protective equipment is in use. Vinyl gloves are not suitable in most instances, as they tear and puncture easily.

(b) Gloves shall be single use; they shall not be reused or washed.

(c) Utility gloves may be washed and reused if the integrity of the rubber is not disrupted (such as heavy rubber gloves used in the cleaning and washing of contaminated cruisers).

(d) Eye protection in the form of goggles or glasses with solid side shields shall be made available to all designated personnel for protection from situations where there may be droplet spray of blood or other infectious materials.

(e) Shoe covers or boots will be provided and worn in situations where gross contamination can be reasonably expected.

(f) If a garment (uniform or over gown) is penetrated by blood or other infectious material, it will be removed immediately or as soon as possible. Cleaning of garment shall be provided by employer at no cost. Garment will be placed in biohazard bag and transported to appropriate laundry or cleaning facility.

11. Worksite shall be maintained in clean sanitary manner. Regulated hazardous waste, such as used gloves or contaminated towels, will be disposed of in a red biohazard bag. Contaminated work surfaces shall be washed down with 10% bleach or alcohol as soon as possible after contamination with blood or other infectious material.

12. Regulated waste containers shall be closeable, lined with a red biohazard leak-proof sealable bag. This biohazard bag shall be closed prior to removal from the work site and disposed of in accordance with applicable regulations of the United States and Commonwealth of Kentucky.

13. Employees having contact with contaminated wastes, contaminated laundry or contaminated vehicles or equipment shall wear protective gloves and, if appropriate, eye protection and surgical face masks (example: in washing down a blood-contaminated vehicle, the person working or hosing down the vehicle should wear gloves, goggles and mask).

14. All protective equipment, laundry of contaminated blood-penetrated uniforms, cleaning of equipment and repair of protective equipment shall be provided to the employee at no cost.

15. Protective equipment shall be readily accessible and issued to employees in sufficient quantities to ensure availability. Employees needing specialized gloves for proven allergy to latex or glove powders will be provided with hypoallergenic gloves or glove liners.

16. All spills of blood or blood-contaminated fluids should be promptly cleaner, using an EPA approved germicide or a 1:100 solution of household bleach in the following manner while wearing gloves. Visible material should be removed with disposable towels or other appropriate means that will ensure against direct contact with blood. If splashing is anticipated, protective eyewear should be worn along with an impervious gown or apron which provides an effective barrier to splashes. The area should then be decontaminated with an appropriate germicide.

G. VACCINATION:

Hepatitis B vaccination will be made available to all employees with exposure levels as defined in D. 1. and 2. at no cost to the employees.

1. Vaccination will consist of three separate injections of hepatitis B vaccine into the deltoid arm muscle. The vaccination shall occur on day 0, day 30 and at 6 months. A posttest will be done after the vaccine series has been completed to determine if antibodies have developed, and a booster shot will be given if necessary following the post test.

2. Employees will not be required to accept vaccination; however, employees who decline the vaccination must sign a waiver (Attachment 1).

3. Employees who decline vaccination and subsequently decide to be vaccinated will receive the vaccine at no cost to the employee, provided occupational exposure still exists.

4. Employees who have been previously vaccinated and show immunity through blood antibody testing will not be re-immunized.

5. Newly employed personnel in classes with exposure levels as defined in D. 1. and 2. shall be offered vaccination as soon as practical following employment.

H. :

If an employee has a specific job related incident that results in Exposure Incident, as defined in definitions B., a confidential medical evaluation and follow-up will be provided by the department.

1. Employee must report exposure incident to employer immediately.

2. Documentation of route of exposure and circumstances of exposure must be written.

3. Report of source individual identification shall be included in the report unless not feasible or prohibited by state or local law.

4. Source individual's blood may be drawn under protective precautions, with written permission of source individual, in order to test for HBV and HIV. If consent is not obtained, then employer shall establish that legally required consent cannot be obtained. If source individual refuses blood test for HBV and HIV, blood cannot be drawn without permission of the courts under Kentucky law.

5. If source individual is already known to be infected with HBV or HIV, testing of source individual for known infection need not be repeated.

6. Exposed employees' blood shall be collected as soon as feasible after written consent for testing is obtained.

7. If exposed employee consents to HBV testing but refuses HIV testing, their serum for HIV testing shall be frozen for 90 days. If within 90 days the employee decides to allow HIV testing baseline, it shall be provided as soon as possible at no cost to the employee.

8. All testing shall be done by a reputable certified laboratory and paid for by the department.

9. Employee blood testing shall be accomplished as follows after written permission to test:

(a) Baseline blood test for HBV surface antibody (to determine immunity) and HBV and HIV test base line. If HIV baseline is negative, then exposed employee will be retested for HIV in 6 weeks, 12 weeks, 6 months, 12 months, and 24 months post exposure.

(b) If an employee with exposure has not been immunized or not completed all immunizations, they will be given with their permission HBV immeglobulin injections, HBV vaccination #1 ABD gamma globulin injection. All testing and injections and follow-up care will be paid for by the department.

I. INFORMATION AND TRAINING:

1. All employees with occupational exposure shall participate in a training program on precautions and prevention of HBV and HIV, at no cost to the employee and during working hours.

2. Training will be provided for newly employed personnel in classes with exposure levels as defined in D. 1. and 2. as soon as practical following the beginning of employment.

3. Training shall be repeated annually.

J. MEDICAL RECORDS:

1. Employer will maintain medical records of all vaccinations, post exposure evaluations and health care related to exposure in accordance with 29 CFR 1910.20.

2. Employee training records shall be maintained in accordance with 29 CFR 1910.20.