Last Revised: 10/14/2003
Table of Contents
32.1 Purpose
32.2 Policy
32.3 Applicability
32.4 Authority
32.5 Definitions
32.6 Responsibilities32.6.1 Supervisors and Managers
32.6.2 Employees
32.6.3 Ames Health Unit
32.6.4 Contracting Officer's Technical Representative (COTR)32.7 New Employee Orientation
32.8 Training
32.9 Exposure Control Plan32.9.1 Exposure Determination
32.9.2 Methods of Compliance
32.9.3 Hepatitis B Vaccination, Post-Exposure Evaluation and Follow-Up
32.9.4 Communication of Hazards to Employees
32.9.5 Records32.10 Exposure Incident Evaluation and Report
32.10.1 Exposed Employee Actions in Exposure Incident Response
32.10.2 Line Management Role in Exposure Incident Response
32.10.3 Role of Ames Health Unit in Exposure Incident Response32.11 Distribution and Availability of Exposure Control Plan
32.12 Review and Update
32.13 Appendices32.13.1 Appendix A: New Employee Orientation Checklist
32.13.2 Appendix B: Request For Evaluation
32.13.3 Appendix C: Exposure Incident Checklist for Supervisors
32.13.4 Appendix D: Exposure Incident Description
32.13.5 Appendix E: Exposure Incident Evaluation
32.13.6 Appendix F: Task Controls for BBP Exposure
32.13.7 Appendix G: BBP Laboratory Inspection Checklist
32.13.8 Appendix H: Hepatitis B Vaccine Compliance Form and Fact Sheet
32.13.9 Appendix I: Consent for the HIV (HIV-1) Antibody Blood Test
32.13.10 Appendix J: Confirmation of Pre-Exposure Evaluation
32.13.11 Appendix K: Confirmation of Post-Exposure Evaluation
32.13.12 Appendix L: Occupational Exposure to Blood/Body Fluid Worksheet
32.13.13 Appendix M: Blood and Body Fluid Exposure – Medical Record
32.13.14 Appendix N: Evaluation Checklist for Bloodborne Pathogens Exposure Control (COTR)
32.13.15 Appendix O: BBP Decontamination and Spill Cleanup
32.13.16 Appendix P: Labels for Potentially Infectious Materials
32.13.17 Appendix Q: Biohazardous Waste Accumulation and Disposal Guidelines
32.13.18 Appendix R: Risk Minimization for CPR Training
32.13.19 Appendix S: Risk Minimization During CPR
This Plan states the basic policy, requirements, and procedures for compliance with Occupational Safety and Health Administration (OSHA) requirements for protection of employees from the hazards of occupational exposure to bloodborne pathogens found in 29 CFR 1910.1030.
The policy of Ames Research Center (ARC) is to provide a program that meets applicable OSHA requirements for operations at ARC. This Plan eliminates or minimizes employee exposure to bloodborne pathogens (BBP). The Bloodborne Pathogens Standard applies, by definition, to operations involving human blood or other potentially infectious materials of human origin. Universal precautions are followed as standard practice. Infection control for operations not covered by the Standard (for example, animal handling, microbiology, rest room cleaning, and sewer work) may follow these guidelines. It is NASA policy that no human immunodeficiency virus (HIV) or Hepatitis B virus (HBV) research is performed at ARC.
This manual is applicable to: (1) all Ames Employees; and (2) all persons and entities who agree in writing to comply with this manual.
29 CFR 1910.1030, Bloodborne Pathogens Standard
29 CFR 1910.1020, Access to Employee Exposure and Medical Records
For the purposes of this section, the following definitions apply:
32.6.1 Overview
The chain of responsibility for ensuring that there is a safe work environment at NASA Ames Research Center that follows required safety standards, regulations, codes, and guidelines start with the Center Director and flows downward through management and supervisors. In addition, each person who works at ARC must understand that Òa condition of employmentÓ is to observe all safety specifications applicable to the task being performed.
32.6.2 Supervisors and Managers
Supervisor and managers are responsible for understanding and implementing applicable regulations, thereby ensuring the safe conduct of operations under their control. It is the responsibility of the Branch Chief to provide resources and direction for compliance with OSHA regulations and this plan, delegating the implementation of the Bloodborne Pathogens Exposure Control Plan to supervisors as appropriate. Essential functions include:
- Identify any procedures, positions, and new or revised tasks that involve occupational exposure to bloodborne pathogens, and communicate program plans and changes relevant to that exposure to the Safety Office.
- Ensure that employees with occupational exposure receive timely orientation and training (see section 32.8) using the form and checklist provided in Appendix A section 32.13.1).
- Ensure that new employees are referred to the Ames Health Unit for Hepatitis B consultation and vaccination, using the form and checklist provided in Appendix B (see section 32.13.2).
Note: Associates and students who will perform tasks under this program should, if possible, complete medical evaluation and vaccination at their institution and provide a copy of their health care professional's written opinion (for pre-exposure evaluation) to Ames. These should be attached to the supervisor's Request for Evaluation submitted to the Ames Health Unit at the start of their employment.
- Facilitate and ensure compliance with this plan and site-specific exposure controls. Maintain documentation for specific task controls, cleaning schedules and records, inspection schedules and records, and operating procedures, as appropriate, using forms and guidelines located in the following appendices:
Section 32.13.6 - Appendix F Task Controls for BBP Exposure Section 32.13.7 - Appendix G BBP Laboratory Inspection Checklist Section 32.13.15 - Appendix O Bloodborne Pathogen Decontamination and Spill Cleanup procedure Section 32.13.16 - Appendix P Labels for Potentially Infectious Materials Section 32.13.17 - Appendix Q Biohazardous Waste Accumulation and Disposal Guidelines - Perform and coordinate required responses to exposure incidents, using forms and checklist provided in the following appendices:
- Appendix D - Exposure Incident Description
- Appendix E - Exposure Incident Evaluation
- Appendix C - Exposure Incident Checklist for Supervisors
- Identify persons who may be expected to provide first aid or Cardio Pulmonary Resuscitation (CPR) in an occupational emergency situation as designated emergency responders (for example, Disaster Assistance Response Team (DART) members). Include an appropriate job element in their performance plan, and ensure that designated responders receive regular annual and supplemental training as required (see section 32.8).
Note: There will be no undocumented or informal expectation that any employee will provide first aid and/or CPR.
32.6.3 Employees
Employees are responsible for conducting tasks and procedures in a manner that minimizes risk to self and others, in compliance with the guidelines specified in this Plan and prudent practices. The employees:
- Attend training
- Use universal precautions
- Report mishaps
- Follow engineering and work practice controls (as defined in this chapter).
32.6.4 Ames Health Unit
The Health Unit, as the government's delegated representative, performs some responsibilities of the employer, as defined in 29 CFR 1910.1030, as follows:
- Provides medical consultation, Hepatitis B vaccine, and vaccination series to NASA employees who anticipate occupational exposure upon receiving a Request for Evaluation from their supervisor and exposure incident follow-up as recommended by the Ames physician.
- Maintains ARC medical records as specified in 29 CFR 1910.1030, and provides copies of records (see section 32.9.5.1) using forms provided in the appendices.
- Provides HBV vaccination booster dose(s) to any government employee employed at ARC in a position with occupational exposure when any booster dose is recommended by the U.S. Public Health Service at a future date.
- Provides emergency care to any person who experiences exposure while providing emergency aid as a Good Samaritan act at ARC, and, with consent, transfers relevant medical records to the health care provider designated by the exposed person.
32.6.5 Contracting Officer's Technical Representative (COTR)
Contractors shall identify positions or operations that are subject to Bloodborne Pathogens regulations. The safety plan provided to ARC for such contracts must contain a Bloodborne Pathogens Exposure Control Plan that complies with the provisions of this program. The COTR is responsible for ensuring that safety, health, and environmental compliance for BBP is maintained during contract operations. Contractors who perform tasks with occupational exposure shall be covered by their employer's Bloodborne Pathogens Protection Program with exposure controls that comply, at a minimum, with the provisions of this Plan. Specific COTR functions for tasks subject to the Bloodborne Pathogens standard include:
- Ensure that the onsite manager is knowledgeable regarding OSHA Bloodborne Pathogens regulations, and provides resources and direction for compliance with all requirements.
- Verify contractor's written Exposure Control Plan and procedures to comply with all elements of the standards.
- Review and evaluate performance of the contractor's Exposure Control Plan using the form Appendix N (see section 32.13.14).
32.6.6 Overview
The Safety, Health, and Medical Services Division has the following responsibilities:
As soon as a new employee is hired for tasks with occupational exposure, the supervisor must enroll the employee in Bloodborne Pathogens basic training and schedules Hepatitis B vaccination consultation at the Occupational Ames Health Unit (by submittal of the form in Appendix B, section 32.13.2). Within ten working days of the initial assignment, the Hepatitis B vaccination is made available to the employee after BBP training. General and task-specific safety training is also scheduled or provided by the supervisor. A New Employee Orientation Checklist for supervisors is provided in Appendix A (section 32.13.1).
Employees with occupational exposure shall participate in a training program that is provided during working hours and at no cost. The training program is given as followings:
- Within ten (10) days of initial assignment.
- At least annually (after initial training).
- When new or modified tasks or procedures affect occupational exposure.
Training is made available to government employees by the Safety Health, and Medical Services Division (Code QH). Bloodborne Pathogens Training (BBPT) provides instruction in the elements specified in 29 CFR 1910.1030, which include:
- An accessible copy of the regulatory text of the Bloodborne Pathogens Standard and an explanation of its contents.
- A general explanation of the epidemiology and symptoms of bloodborne diseases.
- An explanation of the modes of transmission of bloodborne pathogens.
- An explanation of the employer's exposure control plan and the means by which the employee can obtain a copy of the written plan.
- An explanation of the appropriate methods for recognizing tasks and other activities that may involve exposure to blood and other potentially infectious materials.
- An explanation of the use and limitations of methods that will prevent or reduce exposure including appropriate engineering controls, work practices, and Personal Protective Equipment (PPE).
- Information on the types, proper use, location, removal, handling, decontamination and disposal of Personal Protective Equipment (PPE).
- An explanation of the basis for selection of Personal Protective Equipment (PPE).
- Information on the Hepatitis B vaccine, including information on its efficacy, safety, method of administration, the benefits of being vaccinated, and that the vaccine and vaccination is offered free of charge.
- Information on the appropriate actions to take and persons to contact in an emergency that involves blood or other potentially infectious materials.
- An explanation of the procedure to follow if an exposure incident occurs, including the method of reporting the incident and the medical follow-up that will be made available.
- Information on the postexposure evaluation and follow-up that the employer is required to provide for the employee following an exposure incident.
- An explanation of the required signs and labels and/or color-coding.
- An opportunity for interactive questions and answers with the person conducting the training session.
Additionally, persons who are designated as emergency care providers will be trained in the proper use of resuscitator and emergency ventilation devices such as masks, mouthpieces, resuscitation bags, shields/overlay barriers. Emergency care providers will also be instructed in the provisions for limited permitted exemptions from the use of PPE in certain emergency situations (see CPL 2-2.44C M.4.c.).
32.9.1 Exposure Determination
32.9.1.1 Civil Service Job Classifications with Possible Bloodborne Pathogen Exposure
There are no civil service job classifications at ARC with all persons having reasonably anticipated exposure to bloodborne pathogens.
Civil service job classifications in which some ARC personnel may have reasonably anticipated exposure include:
Occupation Code Position Title 80 Physical Security Specialist 80 Security Officer 80 Security Specialist 401 AST, Neurobiological Studies 404 Biological Laboratory Technician 413 Physiologist 499 Student Trainee, Biological Science 601 Human Research Manager 602 Medical Officer 690 Industrial Hygienist 1301 AST, Life Support Studies Personnel in these classifications shall be identified as having reasonably anticipated exposure when their position includes the following tasks:
Tasks with bloodborne pathogen exposure
- Emergency response
- Patient/subject care
- Phlebotomy and blood specimen handling
- Research with blood or other potentially infectious materials (as defined in section 32.5, number 24)
- Research with human tissue cell cultures.
32.9.1.2 ARC Positions and Tasks with Bloodborne Pathogens Exposure
All persons whose position description includes the following job classifications have reasonably anticipated exposure. These are typically contractor positions. Positions with bloodborne pathogen exposure:
- Physician
- Nurse
- Phlebotomist
- Security officer
- Law enforcement officer
- Security shift supervisor
- Designated emergency
Some persons whose position description includes the following job classifications have reasonably anticipated exposure, when assigned listed tasks.
- Technician (laboratory science)
- Plumber: clean sewer (when expected to contain sharps and/or contaminated material)
Examples of jobs at NASA Ames Research Center that deal with Bloodborne Pathogens include:
Position Tasks with bloodborne pathogen exposure Research scientist Handle human tissue products, e.g., human cell culture, standard for blood analyzer, and human serum albumin. Research associate Payload scientist Experiment support scientist The following job classifications have specific prohibited activities:
Position Prohibited activities, listed for contingency operations only Custodian/janitor Pick up waste containing sharps Clean undisinfected area following injury or illness Clean Occupational Health Unit contaminated area Clean clinical research laboratory contaminated area Clean and/or autoclave contaminated labware
- Hazardous waste technician: handle improperly packaged biohazardous waste
- Incinerator operator: handle improperly packaged biohazardous waste
32.9.2 Methods of Compliance
This section contains mandatory compliance methods specified in 29 CFR 1910.1030. Managers or supervisors must develop site-specific guidelines for conducting tasks with BBP exposure. A worksheet is provided in Appendix F (section 32.13.6) for documentation of the controls and PPE provided for tasks with anticipated exposure. The worksheet is attached to the local (e.g., organization, site, or project) safety plan, with any standard operating procedures (SOPs) and other appropriate supplemental documentation.32.9.2.1 Universal Precautions
Universal Precautions are adopted as the primary rule to prevent exposure to potentially infectious materials. Under circumstances in which differentiation between body fluid types is difficult or impossible to determine, all body fluids will be considered potentially infectious materials. Universal Precautions, which supplement biohazard control measures at worksites with occupational exposure, are standard practice for all procedures in emergency or outpatient settings where there are traumatic injuries.
32.9.2.2 Engineering and Work Practice controls
General controls specified by the Bloodborne Pathogens Standard are as follows:
- Personnel shall wash hands with running water and soap:
- Before leaving the work area.
- After removal of gloves or other PPE.
- After contact with blood or other potentially infectious materials (wash all affected skin and flush affected mucous membranes). If there are no handwashing facilities, antiseptic towelettes or antiseptic hand cleanser and clean towels shall be provided. Personnel will wash with running water and soap as soon as feasible.
- 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.
- Food and drink will not be kept in refrigerators, freezers, shelves, cabinets, or on countertops where blood or other potentially infectious materials may be or may have been used or stored.
- Specimens of blood or other potentially infectious materials will be placed in containers that prevent leakage during collection, handling, processing, storage, transport, or shipping.
- All containers will be identified by the Biohazard symbol and legend (predominantly fluorescent orange or orange-red with lettering and symbols in a contrasting color) and a label identifying the date, contents, and responsible person. Containers must be
- Easily accessible
- Maintained upright throughout use
- Replaced routinely
- Not overfilled
- Closed immediately prior to removal or replacement
- Placed in a secondary container if leakage is possible
- Biohazard warning labels will be affixed to refrigerators and freezers that contain blood or other potentially infectious materials (an example is provided in Appendix P, section 32.13.16).
- All procedures that involve blood or other potentially infectious materials will be performed in a manner that minimizes splashing, spraying, spattering, and generating droplets of these substances. If possible, blood samples will be capped during centrifugation. Operations that generate aerosols will be conducted within an exhaust or biohazard containment hood or glove box.
- Pipettes, suction tubes, or other equipment may not be placed in the mouth while in an area where blood or other potentially infectious materials are present.
- Devices that offer an alternative to needles (stopcocks, needle-protected systems, or needleless systems) or self-sheathing needles will be used whenever possible.
- When it is not possible to use self-sheathing needle syringes and the employee must recap, some type of device that protects the hand or allows a safe one-handed recapping method must be used. A proper, one-handed scoop method is a work practice that may also be used in these circumstances. A written justification for recapping shall be included in the worksite exposure control plan.
- Shearing or breaking of contaminated needles is prohibited. Contaminated needles and other contaminated sharps will not be bent, recapped, or removed by hand as general practice. In circumstances where these actions are necessary, a written justification is included in the worksite exposure control plan. Such actions may be accomplished only through the use of a mechanical device or a one-handed technique.
- Contaminated disposable sharps are placed in red Sharps Boxes (immediately or as soon as possible after use). Disposable sharps containers will be:
- Closable
- Puncture resistant
- Leakproof on the sides and bottom
- Labeled or color-coded in accordance with this standard (an example is provided in Appendix P, section 32.13.16)
- Easily accessible
- Located as close as is feasible to area of use
- Maintained
- Replaced routinely and not allowed to overfill
- Closed immediately prior to removal or replacement
- If leakage is possible, placed in secondary container that is closable, labeled, and can contain all contents and prevent leakage.
- Not opened, emptied, or cleaned manually or in any other manner that would expose employees to the risk of percutaneous injury.
- Contaminated reusable sharps will be promptly placed in appropriate containers until properly reprocessed. These sharps will not be stored or processed in a manner that requires employees to reach by hand into the containers where these sharps have been placed. These containers must meet the same requirements as containers for disposable sharps with the exception that they are not required to be closable and may be reused.
Note: All disposed sharps are defined as medical waste, except for certain exempted veterinary items. However, all needles and sharps must be disposed of in "Sharps Boxes."
- Requirements for disposal of medical waste with bloodborne pathogens are provided (See Appendix Q, section 32.13.17), and also in the Ames Environmental Management Handbook.
- Protective coverings are used wherever possible. These include, for example, plastic equipment covers and disposable, absorbent, plastic-backed work surface covers. If this option is chosen, the covering must be removed and replaced at stated minimum intervals. For example, as soon as is feasible following overt contamination or at the end of a shift if the cover becomes contaminated during the shift.
- Equipment that may become contaminated with blood or other potentially infectious materials is examined prior to servicing or shipping and shall be decontaminated as necessary, unless the supervisor demonstrates to the Safety Division that decontamination of such equipment or portions of such equipment is not possible. A readily observable label stating which portions remain contaminated is attached to the equipment. The supervisor ensures that this information is conveyed to all affected employees, the service representative, and/or the manufacturer, as appropriate, prior to handling, servicing, or shipping, so that appropriate precautions are taken.
- Health care workers who have exudative lesions or weeping dermatitis must refrain from all direct patient care and from handling patient-care equipment until the condition resolves.
- CPR training is provided at Ames to designated emergency responders as well as to volunteers who request training in order to respond as "Good Samaritans" in an emergency at home or elsewhere. Recommendations for minimizing risk during CPR training are contained in a Sample Exposure Control Plan distributed by the American College of Occupational and Environmental Medicine (Appendix R, section 32.13.18). These recommendations are standard practice for CPR training provided or sponsored by ARC. A discussion of risk minimization during actual CPR is also provided in Appendix R, section 32.13.19.
32.9.2.3 Personal Protective Equipment (PPE)
Personal Protective Equipment (PPE) is selected for each task with occupational exposure. PPE provides an effective barrier to the passage of potentially infectious materials to or through the employees' clothing or prevents contact with skin, eyes, mouth, or other mucous membranes, for the duration of use. Selection of PPE is performance based. A supply of the designated PPE (in the appropriate size, where applicable, for each involved employee) is maintained in each workplace where potentially infectious materials may be present. Any employee who declines to use the provided PPE for any reason shall confer with the supervisor and/or the Safety Office in order to determine alternative protection. Appropriate PPE is available from Ames Stores Stock.
Note: N-Dex ª nitrile gloves are hypoallergenic. These "blue" gloves or cotton gloves are recommended as liners for persons who are sensitive to latex rubber gloves.
- Gloves must be worn when it is reasonably anticipated that the employee may have hand contact with blood, other potentially infectious materials, mucous membranes, or non-intact skin. Gloves must also be worn when performing vascular access procedures, and when handling or touching contaminated items or surfaces.
Note: Handwashing is required after glove removal because neither vinyl nor latex procedure gloves are completely impermeable.
Disposable (single use) gloves such as surgical or examination gloves are replaced as soon as possible when contaminated or as soon as feasible if they are torn, punctured, or when their ability to function as a barrier is compromised. Disposable gloves will not be washed or decontaminated for reuse.
Utility gloves may be decontaminated for reuse if the integrity of the glove is not compromised. However, they must be discarded if they are cracked, peeling, torn, punctured, or exhibit other signs of deterioration or when their ability to function as a barrier is compromised.
- Masks, in combination with eye protection devices, such as goggles or glasses with solid side shields or chin-length face shields, will be worn whenever splashes, spray, spatter, or droplets of blood or other potentially infectious materials may be generated and eye, nose, or mouth contamination can be anticipated.
- Appropriate protective clothing such as, but not limited to, gowns, aprons, lab coats, clinic jackets, or similar outer garments must be worn in occupational exposure situations. The type and characteristics depend upon the task and degree of exposure anticipated.
- All PPE will be removed prior to leaving the work area.
- When PPE is removed it will be placed in an appropriately designated area or biohazard container for storage, washing, decontamination, or disposal.
- Soiled laundry will be handled, stored, and processed in a manner that prevents the spread of infection and assures the maintenance of clean linen. Soiled laundry shall be stored and handled separately from clean linen. Personnel handling soiled laundry will use gloves and wash hands after handling. Carts used to transport soiled laundry shall be so labeled, cleaned daily, and not used for clean linen. Contaminated laundry will not be sorted or rinsed, and will be contained with a minimum of agitation in closed, labeled containers or red bags at the location where it was used. Wet items will be double bagged.
- Resuscitator devices shall be readily available and accessible to persons designated as emergency care providers (e.g., security guard, DART member). These shall include emergency ventilation devices such as masks, mouthpieces, resuscitation bags, and shields/overlay barriers.
32.9.2.4 Housekeeping
Supervisors shall ensure that the worksite is maintained in a clean and sanitary condition. The supervisor establishes and posts an appropriate written schedule for cleaning of equipment and environmental and working surfaces. The method of decontamination is specified based on the location within the facility, the tasks and procedures being performed in the area, the type of surface to be cleaned, and the type of soil present. A sample BBP Laboratory Inspection Supplemental Checklist (Appendix G, section 32.13.7) may be used as a supplement to the general laboratory inspection checklist.
Note: The Center for Disease Control (CDC) states that HBV can survive for at least one week in dried blood on environmental surfaces or contaminated needles and instruments.
A supply of disinfectant shall be maintained available in all work sites where potentially infectious materials are present. A 1:10 dilution of household chlorine bleach (5 percent sodium hypochlorite) is recommended. Bleach solutions must contain, at a minimum, one-fourth cup household bleach per gallon of water. Environmental Protection Agency (EPA) registered "hospital disinfectant" chemical germicides that have a label claim for tuberculocidal activity (for example, Cidex, Isolyser) are acceptable alternatives when used following manufacturer's instructions for rinsing or immersion with minimum of three minutes duration. Equipment should be pre-cleaned of any visible material before germicidal chemical is applied.A recommended procedure is provided in Appendix O (section 32.13.15).
- Contaminated work surfaces will be decontaminated with an appropriate EPA-approved disinfectant after completion of procedures; immediately or as soon as possible when surfaces are overtly contaminated or after any spill of blood or other potentially infectious materials; and at the end of the work shift if the surface may have become contaminated since the last cleaning.
- Protective coverings, such as plastic wrap, aluminum foil, or imperviously backed absorbent paper used to cover equipment and environmental surfaces, are removed and replaced as soon as possible when they become overtly contaminated or at the end of the work shift if they are contaminated during the shift.
- All bins, pails, cans, and similar receptacles intended for reuse that may become contaminated with blood or other potentially infectious materials are inspected and decontaminated on a regularly scheduled basis, and cleaned and decontaminated immediately or as soon as possible when overtly contaminated.
- Broken glassware that may be contaminated will not be picked up directly with the hands. It is cleaned up using mechanical means, such as a brush and dustpan, tongs, or forceps.
- Laboratory spills are cleaned up by the staff, following the decontamination guidelines provided in Appendix O, section 32.13.15. In the event of an unusual or particularly large spill, involved personnel may contact the Safety Division for assistance.
- In the event of a spill of infectious material in a public access area (e.g., hallway, elevator), involved personnel will keep all persons away from the spill area and call the Dispatch Office at 4-5416.
- Disinfection of spills that involve blood or OPIM is the responsibility of the involved staff or emergency responders. The disinfection process must be completed before the custodial staff is contacted for cleanup. The custodial staff will not clean up spills prior to their disinfection.
- Contaminated laundry is:
- Neither sorted nor rinsed
- Placed in a bag or container at the location where used
- Placed in red bags or bags with biohazard label
- Contained in a manner to prevent leakage
32.9.3 Hepatitis B Vaccination, Post-Exposure Evaluation and Follow-Up
The Ames Health Unit is the provider of required medical services to Government employees who have experienced occupational exposure, with off-hours emergency care provided by 911 call responders.
Note: Law prohibits NASA from requiring the employee to obtain services under their personal health insurance.
An employee who is not covered by this plan but who experiences an exposure incident at ARC that is unrelated to the performance of their occupational tasks will be provided with emergency care (not follow-up) at the Ames Health Unit.32.9.3.1 Pre-exposure Evaluation and Vaccination
Upon receipt of a Request for Evaluation (Appendix B, section 32.13.2) from the employee's supervisor, the Ames Health Unit schedules an appointment for the employee. With adequate advance notification, the Ames Health Unit makes Hepatitis B vaccination available to the employee within ten working days of initial assignment, unless the employee has previously received the complete Hepatitis B three-vaccination series, or antibody testing reveals that the employee is immune, or the vaccine is contraindicated for medical reasons. The Ames Health Unit notifies the employee of the scheduled appointment date, and, following the evaluation, forwards a copy of the Health Care Professional's Written Opinion for pre-exposure evaluation to the employee's supervisor. The supervisor should modify the employee's assignment if necessary to preclude exposure prior to the evaluation.
Note: NASA shall not make participation in a prescreening program a prerequisite for receiving Hepatitis B vaccination. Participation in a baseline serum storage program is strictly voluntary.
An employee who declines to accept Hepatitis B vaccination shall be required to sign a declination statement (Appendix H, section 32.13.8) as a condition of employment in a position with bloodborne pathogen exposure. Hepatitis B vaccination will be provided to any employee who has previously declined to accept it but decides to accept vaccination while still employed and performing tasks with occupational exposure at ARC.
The Ames Health Unit shall also provide any booster dose(s) recommended by the U.S. Public Health Service at a future date.
32.9.3.2 Postexposure Evaluation and Follow-up
Following a report of an exposure incident, the Ames Health Unit provides a confidential medical evaluation and follow-up to the exposed employee, in accordance with Center for Disease Control guidelines. This follow-up includes obtaining blood specimens from the employee and from the source individual, where feasible, when consent is obtained, and the maintenance of required medical records. Exposure follow-up checklists for exposed and source individuals are provided in Appendix L, section 32.13.12.
Medical counseling is provided by Ames Health Unit health care professionals. Confidential psychological counseling is available to Government employees, at no cost, through the Employee Assistance Program. Information about this counseling program is available from the Safety Division.
32.9.4 Communication of Hazards to Employees
Warning labels will be affixed to containers of regulated waste, refrigerators, and freezers that contain blood or other potentially infectious material. Warning labels are also affixed to other containers used to store, transport, or ship blood or other potentially infectious materials. Individual containers that are placed in a labeled container during storage, transport, shipment, or disposal do not require warning labels. However, any such container that has the potential to become separated from its labeled outer container shall be labeled.Labels will be either an integral part of the container, or will be affixed as close as possible to the container by string, wire, adhesive, or other method that prevents the loss or unintentional removal of the label.
Labels required by the Bloodborne Pathogens standard shall be predominantly fluorescent orange or orange-red with lettering and symbols in a contrasting color, except for labels on red bags or red containers, which do not need to be color-coded. Labels include the biohazard symbol with either BIOHAZARD or, in the case of regulated waste, BIOHAZARDOUS WASTE.
Guidelines for labels required for materials and waste at ARC are provided in Appendix P, section 32.13.16 and also in the Ames Environmental Management Handbook.
32.9.5 Records
32.9.5.1 Medical Records
Medical records will be retained by the Ames Health Unit for each NASA employee with occupational exposure. Records will be retained for 30 years post employment. HIV test requests are maintained as separate coded records.
Medical records are confidential and will not be disclosed or reported without the employee's express written consent to any person within or outside the workplace, except as may be required by law. These records are provided for examination and copying to the subject employee upon request. Any records generated for a non-NASA employee will be released to a health care provider designated by the employee.
Note: In the event of any bloodborne pathogen exposure incident, the Office of the Chief Counsel shall be called for consultation and advice regarding content, disclosure, and release of medical records.
32.9.5.2 Training Records
Training records will be retained by the Safety, Health and Medical Services Division (Code QH) for each employee with occupational exposure. Records shall be retained for a minimum of three years from the date on which the training occurred. The records will be available upon request to the employee and his/her supervisor, and to employee representatives, ARC management, and regulatory agencies. Training records will include, at a minimum:
- Dates of training sessions
- Contents or summary of training sessions
- Names and qualifications of trainers
- Names and job titles of all persons who attended the training sessions
The first priorities in response to any mishap that involves personnel are to obtain emergency assistance, if needed, and to prevent further injury or damage. Actions to be taken by the exposed employee, the cognizant supervisor, and Ames Health Unit are described below.Any incident with possible bloodborne pathogen exposure must be reported to the ARC supervisor, who must ensure that response actions are performed.
32.10.1 Exposed Employee Actions in Exposure Incident Response
In the event of any known or suspected occupational exposure to blood or potentially infectious materials, the exposed employee must report promptly to the Ames Health Unit for medical aid and consultation. After hours, the employee will call 911 (or the Ames Dispatch Office) for assistance in reporting to a local hospital emergency room. The employee or involved coworker must promptly report the mishap to his/her supervisor. The scene may be preserved, if appropriate, for accident investigation, while preventing subsequent exposure risk.It is the employee's responsibility to coordinate scheduling of appointments for treatment, testing, evaluation, discussion, and counseling with his/her supervisor, and to request transportation (to be provided by ARC) if needed.
32.10.2 Line Management Role in Exposure Incident Response
The cognizant supervisor is responsible for ensuring that the exposed employee receives all appropriate medical care, for investigating and reporting the incident, and for immediate and ultimate corrective actions. If any unaltered source material remains (for example, blood in a test tube), the supervisor should seal, label, and deliver it to the Ames Health Unit for possible testing. If the source individual is known or can be identified, it is appropriate for the supervisor to suggest that the individual report to the Ames Health Unit for consultation, without discussion of blood testing. These proceedings should be documented; however, the source individual may not be named in the record without written consent. It is the supervisorÕs responsibility to enable the employee to schedule and attend convenient appointments for consultation, treatment, and counseling.If the Ames Health Unit does not provide exposure incident services, the supervisor will coordinate arrangements for care and for transfer of documentation to the health care provider, as well as ensure that medical records are transferred from the health care professional to the Ames Occupational Health Unit for the employee's file.
An Exposure Incident Action Checklist for Supervisors is provided in Appendix C, section 32.13.3, to facilitate documentation of required actions.
Supervisors should refer to APR 1700.1 Chapter 4, Mishap Reporting and Investigating, for general mishap procedures. After telephonic notification to the Safety Division, the formal mishap report will be made using NASA Form 1627. The initial report must be forwarded to the Safety Division within 24 hours of the incident.
The Bloodborne Pathogens Standards specify information that must be included in the mishap description. The Exposure Incident Description form is provided in Appendix D, section 32.13.4, to facilitate inclusion of all required information in the report. The exposed employee's supervisor shall provide this information (as completely as possible) to the Ames Health Unit (or other health care provider) when the employee is treated and evaluated. It may be appropriate to provide a more complete incident description in the final report. However, confidential information, including medical diagnosis and test results, may not be revealed. Supervisors are advised to consult with the Office of the Chief Counsel before submission of the final mishap report.
The final NASA Mishap Report (NASA 1627) will contain an evaluation of policies, engineering controls, and work practices in place, and failures of control at the time of the incident, including discussion of the effectiveness of protective equipment and clothing used. It must also contain documentation of actions taken and a schedule (with dates) for actions planned to prevent recurrence. Appendix E, section 32.13.5, is provided for this purpose.
32.10.3 Role of Ames Health Unit in Exposure Incident Response
Some responsibilities of the employer are delegated to the Ames Health Unit, acting as provider of emergency and follow-up health care, and as the maintainer of ARCÕs medical records. The Ames Health Unit, as the GovernmentÕs representative, shall, with consent, provide relevant records to the health care provider for any exposed individual, subject to consultation and advice by Office of the Chief Counsel regarding legal restrictions.When a Government employee presents for treatment and evaluation of possible bloodborne pathogens exposure, the Ames Health Unit shall determine if exposure has occurred and initiate appropriate actions. These may include evaluation, consultation, testing, and prophylaxis, if indicated, for the exposure and any reported illnesses, and shall provide a health care professionalÕs written opinion to the exposed employee within 15 days of evaluation. The written opinion will meet all of the requirements as listed in 29 CFR 1910.1030 (sec. (E) (5). All other findings or diagnosis shall remain confidential and shall not be included in the written report.
An exposed employee will be informed of the results of the source material or, with consent, the results of the source individual's testing for Hepatitis B Virus and Human Immunodeficiency Virus, and told about any medical conditions resulting from the exposure that may require further evaluation or treatment, while still maintaining confidentiality as required by law. California Health and Safety Code Sec. 199.21 specifically prohibits the disclosure of results of an HIV test in a manner that identifies or provides identifying characteristics of the person to whom the test results apply, except pursuant to written authorization, or when another statute expressly provides an exemption. Civil penalties can be assessed against violators of this statute. Such test results can be revealed, however, with the express, written consent of the source individual.
Checklists and forms used by the Ames Health Unit are provided in the appendices.
The Ames Health Unit provides emergency services, including offer of HBV vaccination, to any person who experiences an exposure incident at ARC in performance of duties or as a provider of emergency first aid, whether as collateral duty or as a good samaritan.
This chapter, which contains the ARC Bloodborne Pathogens Exposure Control Plan, will be provided to each employee with occupational exposure at the time of initial Bloodborne Pathogens Standard training, and copies shall be made available to each employee at annual refresher training.
This chapter shall be updated by attachments issued as Interim Policy Statements whenever new or substantially modified tasks are provided to the Health, Safety, and Medical Services Division or when new or modified applicable regulations become effective.The chapter shall be reviewed periodically by the Safety, Health, and Medical Services Division with revision and update if needed. Revisions will incorporate new or changed requirements mandated by legislation, exposure control plan updates for new or substantially modified positions, tasks and procedures that affect occupational exposure, and preventive measures initiated in response to exposure incidents that occurred since the previous update.
TO: Ames Health Unit DATE: FROM: NAME (Supervisor): Org: Mail Stop: Phone: Employee Name: Mail Stop: Phone: Bloodborne Pathogens Assignment Start Date: The above named employee has been assigned tasks with bloodborne pathogens exposure. Please establish a medical record for this employee, and make Hepatitis B vaccination available to him/her unless he/she has previously received the complete Hepatitis B vaccination series, antibody testing has revealed that the employee is immune, or the vaccine is contraindicated for medical reasons.
Participation in a prescreening program is not a prerequisite for receiving Hepatitis B vaccination.
An employee who declines to accept Hepatitis B vaccination shall sign the declination statement (DQH-BBP4) to be retained in his/her medical record.
If the employee initially declines Hepatitis B vaccination but at a later date, while still covered by the Standard, decides to accept the vaccination, please provide it for him/her.
If a routine booster dose(s) of Hepatitis B vaccine is recommended by the U.S. Public Health Service at a future date, please provide such booster dose(s) to the employee.
Employee Name:__________ Date Of Incident:_____ Date/Initial:______ 1. Secure area, obtain aid if needed 2. Ensure that either employee goes to Occupational Health Unit or other health care professional is made available to employee 3. Identify witnesses and involved personnel 4. Identify source of exposure (individual or material) 5. Send source individual or material to Occupational Health Unit or other health care provider for testing; if consent cannot be obtained, send documentation to Occupational Health Unit 6. Determine circumstances, record on Exposure Incident Description (32.13.4) 7. Take Exposure Incident Description (32.13.4) to Occupational Health Unit
If employee goes to other health care professional, ensure that Exposure Incident Description (32.13.4) and other mandatory information is provided to the health-care professional (32.13.12)8. Notify the Safety Office of exposure incident 9. Supervise cleanup and area follow-up, if any 10. Submit NASA 1627 Mishap Report (initial) to DQH within 24 hours 11. Investigate causes, schedule appropriate actions; record on Exposure Incident Evaluation (32.13.5) 12. Ensure that the employee receives a copy of the health care professional's written opinion (within 15 days of evaluation) 13. Contact Ames Legal Office; schedule consultation with employee and other involved persons regarding confidentiality of source name and test results. 14. If the employee does not use the Health Unit as health care provider, ensure that the employee receives the results of tests on source blood and that copies of test results are forwarded to the Health Unit. 15. Ensure that the employee is enabled to receive all recommended testing, prophylaxis, and treatment, at no cost and at a convenient time and place. 16. Ensure that a consultation appointment is made with a health care professional, for the employee, at no cost to the employee and at a convenient time and place, to discuss medical status, including any reported illnesses and recommended treatment. 17. Ensure that the employee is enabled to receive counseling, at no cost and at a convenient time, and place. 18. Submit NASA 1627 Mishap Report (final) to DQH with Exposure Incident Description (32.13.4) and Exposure Incident Evaluation (32.13.5) attached within two weeks.
Attach to Initial NASA Mishap Report (NASA 1627)Employee Name: Date of Incident: Time of Incident Location of Incident Job Classification Description of employee's duties during the exposure incident Potentially infectious material (PIM) involved: Type Source (name if available) Route of Exposure _____ Needlestick _____ Piercing of skin with contaminated sharp _____ Splashing/spraying of blood or other PIM _____ Other (describe) Circumstances under which the exposure occurred How the incident was caused (accident, equipment malfunction, etc.) Personal Protective Equipment (PPE) being used Actions taken (first aid, decontamination, cleanup) _____________________________________________________________ Supervisor (Printed Name) (Signature) Date
Attach to Final NASA Mishap Report (NASA 1627) Employee Name: Date of Incident Time of Incident Location of Incident Job Classification Engineering controls and work practices in place Failures of control at time of exposure incident Actions to prevent recurrence (include date completed or scheduled) ______________________________________________________________ Supervisor (Printed Name) (Signature) Date
Organization: Job Classification: Task Description:
| Type of BBP exposure risk: | |
| Direct contact with blood | |
| Direct contact with other fluid (specify) | |
| Needle stick | |
| Other sharps hazard (specify) | |
| Other hazards associated with task: |
Engineering and Work Practice Controls Ventilation Housekeeping _ General exhaust _ Cleaning schedule _ Local exhaust hood _ Cleaning/Decontamination methods (specify) _ Tissue culture _ Front exhaust to room _ Biohazard containment SUPPLEMENTAL RULES AND PROCEDURES (specify) Personal Protective Equipment (Specify by name, size, and part number) Eye/Face _ Safety glasses _ Goggles _ Face shield Hand _ Gloves, disposable _ Gloves, reusable _ Other Inhalation _ Surgical mask (nuisance protection only) Note: respirators are not authorized for BBP protection and may not be used in BBP worksites except by special arrangement with Code QH. Clothing _ Coat/smock _ Coverall _ Apron _ Gauntlets _ Boots _ Surgical cap _ Other (specify) Comments Completed By: ____________________________________________________ Printed Name Signature Date
EMPLOYEE SUPERVISOR Name: Name SS# Org: Mail Stop: Phone: Phone: CONSENT FORM
I have read the information sheet about Hepatitis B and the Hepatitis B vaccine. I have had the opportunity to ask questions and understand the benefits and the risks of the Hepatitis B vaccination.I understand that I must have three doses of vaccine to confer immunity. However, as with all medical treatment, there is no guarantee that I will become immune or that I will not experience an adverse side effect from the vaccine. I request that it be given to me.
____________________________________________________________ Printed Name Signature DateVACCINATED/IMMUNE
___I have received the Hepatitis B vaccine. What year? ___Positive blood titer. Date: Vaccine contraindicated for medical reasons._____________________________________________________________ Printed Name Signature Date
DECLINATION
I understand that because of 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 materials and I want to be vaccinated with Hepatitis B vaccine, I can receive the vaccination series at no charge to me._____________________________________________________________ Printed Name Signature Date Date HEPATITIS B VACCINE Product Name Date Dose Site Lot# Signature 1. 2. 3.OCCUPATIONAL EXPOSURE TO HEPATITIS B VIRUS (HBV)
Employee Fact Sheet
HEPATITIS B: Hepatitis B is a viral infection of the liver caused by Hepatitis B virus (HBV). Each year approximately 300,000 new infections are reported to the Center for Disease Control. Most people who become infected with Hepatitis B recover completely, but 5 to 10 percent will become chronic carriers of the virus. Although many chronic carriers do not have symptoms of the disease, they are capable of transmitting the virus to other persons, primarily through blood exposures or sexual contact. Each year 4000 to 5000 persons die from Hepatitis B induced liver disease, cirrhosis, or liver cancer. (Two hundred of these die shortly after initial infection from fulminant HBV).
OCCUPATIONAL EXPOSURE: Health care workers with direct patient contact, laboratory workers and researchers, and other employees with blood or body fluid contact are at increased risk for acquiring the Hepatitis B virus. An unvaccinated individual who receives an accidental blood or body fluid exposure from an infected source has a 40 percent chance of becoming infected with Hepatitis B.
VACCINATION: Becoming infected with Hepatitis B is preventable. The Hepatitis B vaccine, a synthetic vaccine made from a yeast base, is currently being offered to Government employees at risk at no cost to the employee. Full immunization requires completion of a series of three vaccinations given over a six-month period. Eighty to 90 percent of healthy people who receive the vaccine develop antibodies that protect them from getting Hepatitis B. There is no evidence that the vaccine has ever caused Hepatitis B. At this time, no one knows how long the immunity produced by the vaccine will last, and the need for additional vaccinations has not been determined. Health care workers who are immunocompromised or on dialysis might require increased doses of the vaccine in order to convert to positive antibodies. The incidence of side effects is very low. A few persons experience tenderness and redness at the injection site. A low-grade fever may occur. Rash, nausea, joint pain, and mild fatigue have also been reported.
TREATMENT OF EXPOSURE: If the individual has received the Hepatitis B vaccine and has documented antibodies to HBV, no further treatment is necessary at the time of exposure. However, someone who is not protected by the vaccine and does not have antibodies to HBV needs to receive Hepatitis B Immunoglobulin (HBIG) as soon as possible after the exposure. These persons are also encouraged to receive the Hepatitis B vaccine at this time.
If you have any questions about Hepatitis B vaccine, call the Ames Health Unit at 4-5287.
I have been informed that my blood will be tested in order to detect whether or not I have antibodies in my blood to the HIV (HIV-1) virus, the causative agent of Acquired Immune Deficiency Syndrome (AIDS). I understand that the test is performed by withdrawing blood and using a substance to test the blood.
I have been informed that the test results may, in some cases, indicate that a person has antibodies to the virus when the person does not (false positive) or fail to detect that a person has antibodies to the virus when the person has the virus (false negative). I have also been informed that currently this is the blood test that may be used to identify the infection with the HIV-1 virus, and that in order to diagnose AIDS; other means must be used in conjunction with the blood test.
I have been informed that if I have any questions regarding the nature of the blood test, its expected benefits, its risks, and alternative tests, I may ask those questions before I decide to consent to the blood test.
I understand that the results of this blood test will be released only to those health care practitioners directly responsible for my care and treatment. I further understand that no additional release of the results will be made without my written authorization.
By my signature below, I acknowledge that I have been given all the information I desire concerning the blood test and release of results and have had all my questions answered. Further, I acknowledge that I have given consent for the performance of a blood test to detect antibodies to the HIV (HIV-1) virus.
_____________________________________________________________ Witness Printed Name Signature Date _____________________________________________________________ Printed Name Signature Date
Health Care Professional's Written OpinionTo:
Mail Stop:
This letter is to confirm that you have been informed of the results of the evaluation requested by your supervisor because your job has tasks with possible exposure to bloodborne pathogens.
Current guidelines indicate that the Hepatitis B vaccine be given in order to confer immunity before exposure. In your situation:
___Hepatitis B vaccination series or booster is recommended for you and you initiated the vaccination.
___You have previously been vaccinated and have evidence of immunity.
___Hepatitis B vaccination is recommended and you declined vaccination or have not returned to the Ames Occupational Health Unit.
___OtherIn addition, health care professionals have evaluated your ability to use personal protective equipment and have determined that:
___You are not restricted in the use of personal protective equipment.
___You are subject to the following restrictions in the use of personal protective equipment:If you need additional information regarding your medical evaluation or have questions, please contact the Ames Health Unit at 4-5287.
_____________________________________________________________ Printed Name Signature Date
Copy to requesting supervisor:
Name: _______________________________ Mail Stop:_____________
Health Care Professional's Written OpinionTo:
Mail Stop:
This letter is to confirm that you have been informed of the results of the evaluation following your recently reported exposure to blood or bodily fluids.
Current guidelines indicate that the Hepatitis B vaccine be given after exposure.
In your situation:
___Hepatitis B vaccination series or booster is indicated for you and you initiated the vaccination.
___You have previously been vaccinated and have evidence of immunity.
___Hepatitis B vaccination is recommended and you declined vaccination or have not returned to the Ames Health Unit.
___OtherThis letter also confirms that you have received information regarding any medical conditions resulting from exposure to blood that would require further evaluation and treatment and to report these to the Ames Health Unit. Instructions have been given regarding follow-up blood testing.
If you need additional information regarding your exposure evaluation or have questions, please contact us at the Ames Health Unit at 4-5287.
_____________________________________________________________ Printed Name Signature Date
Employee Name: Date Of Incident: Org. Code: Time: Phone: Location: ___Exposed employee examined at Ames Health Unit
___Exposed employee blood collected (baseline)
___Hepatitis B status known/ordered
___HIV status known/ordered
___Appointment made for results
___Tetanus/Diphtheria last received on
___Letter to employee regarding Hepatitis B status
___Follow-up HBV/HIV blood tests performed:6 weeks
3 months
6 months
1 year
___Exposed employee examined and treated outside Ames
Name and address of health care professional:_______________________________________________________
___Documentation forwarded to health care professional
___Copy of OSHA Bloodborne Pathogens Standard
___Description of Incident (section 32.13.4)
___Source individual's blood test results (with consent)
___Exposed individual's relevant medical records
Attempt to identify source individual documented___Source identified, consent obtained
___Source identified, consent not obtained
___HBsAG drawn and ordered
___HIV drawn and ordered
___Risk factors identified
Comments:
(Source: Draft NIH Exposure Control Plan)All work surfaces and equipment that come into contact with blood, body fluids, and any infectious agent or materials must be disinfected daily, upon completion of work, with an appropriate disinfectant. Additionally, work surfaces and equipment must be disinfected after any overt spill. Work surfaces should be covered with plastic-backed absorbent toweling to facilitate cleanup and reduce production of aerosols that may result from a spill. Spills within work areas are to be cleaned up by laboratory or research personnel. Housekeeping staff is not authorized to clean up spills of potentially infectious material. Spills of potentially infectious material are to be cleaned up using the following method:
- Notify persons in the immediate area that a spill has occurred.
- Wearing the appropriate protective equipment (impervious gloves, lab coat, etc.), cover the spill with disposable toweling or other absorbent material.
- Carefully pour a freshly prepared 1-in-10 dilution of household bleach (or other suitable disinfectant prepared to manufacturer's specifications) around the edges of the spill, and work to the center.
- Allow a 20-minute contact time.
- Using paper toweling, wipe up the spill, working from the edges of the spill to the center.
- Be careful to avoid cuts with broken glass. Any broken glass should be carefully discarded into an approved sharps container using tongs, brush and pan, or other indirect means of handling.
- Clean the spill area again with fresh disinfectant.
- Place all used materials (not containing sharps) into a red biohazard bag and tie shut. Place the bag into a second red bag. Before the second bag is closed, all personal protective equipment should be removed and placed into the bag. Label (date and generator name, at a minimum) and request pickup for disposal.
For large spills (over one-half cup), mop using a 1:10 bleach solution (or EPA disinfectant). After cleaning, the mixture in the bucket should be flushed down the toilet.
NOTE: Any contaminated PPE must be bagged for disposal or commercial laundry, and shall not be sorted or rinsed at the location of use. Contaminated PPE may not be taken home by an employee for cleaning.
Waste generated from operations with occupational exposure is medical waste when it contains or is visibly contaminated with human blood, fluid, or tissue, or when it contains or is contaminated with pathogenic or infectious microorganisms. Discarded sharps are treated as medical waste, regardless of contamination (except veterinary used sharps). The definition of Medical Waste applies to disposal procedures.
The Bloodborne Pathogens definition of Regulated Waste for purposes of personnel protection differs in that it is a performance-type standard, which bases the distinction between regulated and unregulated waste on the potential to release PIM during handling. Materials that are visibly contaminated with small amounts of blood or OPIM not subject to release as liquid or flakes may not be Regulated Waste but are still medical waste.
Medical waste (solid or liquid) may not be treated (except as inherent in procedures) unless authorized by Environmental Services Division. Authorized procedures are:
Sterilized (autoclaved) waste shall be disposed as ordinary waste, unless it is hazardous chemical waste. Biohazard labels shall be removed or defaced, and red bags placed within opaque bags in order to eliminate any identification of the waste as biohazardous.
Source: American College of Occupational and Environmental MedicineSample Exposure Control Plan
Source: American College of Occupational and Environmental MedicineSample Exposure Control Plan
No transmission of Hepatitis B virus infection during mouth-to-mouth resuscitation has been documented. However, because of the theoretical risk of salivary transmission of HIVB during mouth-to-mouth resuscitation, special attention should be given to the use of disposable airway equipment or resuscitation bags and the wearing of gloves when in contact with blood or other body fluids. Resuscitation equipment and devices known or suspected to be contaminated with blood or other body fluids should be used once and disposed of or be thoroughly cleaned and disinfected after each use.
Clear plastic facemasks with one-way valves are available for use during mouth-to-mask ventilation. These masks provide diversion of the victim's exhaled gas away from the rescuer and may be used by health-care providers and public safety personnel properly trained in their use during two-person rescue, in place of mouth-to-mouth ventilation. The need for and effectiveness of this adjunct in preventing transmission of an infectious disease during mouth-to-mouth ventilation are unknown. If this type of device is to be used as reassurance to the rescuer that a potential risk might be minimized, the rescuer must be adequately trained in its use, especially with respect to making an adequate seal on the face and maintaining a patent airway. Such a device requires two hands to secure a proper face seal and to maintain an open airway. As an additional precaution, the rescuer may elect to wear latex gloves because saliva or blood on the victim's mouth or face may be transferred to the rescuer's hands.
