Virginia Commonwealth University Health System Medical College of Virginia Hospitals and Physicians. Infection Control Policy. II.

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1 Virginia Commonwealth University Health System Medical College of Virginia Hospitals and Physicians Infection Control Policy Subject: Policy No: Original Date: Bloodborne Pathogen Exposure Control Plan Revised Date: Reviewed Date: I. Purpose II. Table of Contents II. III. IV. Responsibility Exposure Determination and Documentation Implementation, Control and Compliance V. Hepatitis B Vaccination Program VI. VII. VIII. IX. Post Exposure Evaluation and Follow Up Education and Training Recordkeeping Appendix

2 I. Purpose The Occupational Safety and Health Administration (OSHA) issued regulations, standard 29 CFR , manufacturing the use of Universal Precautions for the prevention of bloodborne infections in health care workers (HCW). These regulations are based on the premise that any patient or person may unknowingly be infected with bloodborne pathogens including but not limited to the hepatitis B virus (HBV); human deficiency virus (HIV); hepatitis C virus (HCV); human T-lymphotrophic virus Type 1; and pathogens causing malaria, syphilis, babesiosis, brucellosis, leptospirosis, arboviral infections, relapsing fever, Creutzfeldt-Jakob disease, and viral hemorrhagic fever. The exposure control plan (ECP) is provided to eliminate or minimize occupational exposure in compliance with that standard. The Exposure Control plan includes: A. Identify employees with a potential exposure to blood or other potentially infectious materials (OPIM). B. Identify and implement methods of exposure control including: 1. Standard (universal) precautions. 2. Engineering and work practice controls. 3. Personal protective equipment. 4. Housekeeping. C. Hepatitis B vaccination program. D. Post exposure evaluation and follow up E. Education, training, and inform employees about the potential hazards. F. Procedures for evaluating an exposure. II. Responsibility A. Epidemiology 1. Maintain, review and update the ECP at least annually; revise as needed. 2. Develop and coordinate educational program. 3. Assist with compliance evaluation. 4. Serve as resource for the ECP and employee exposure. B. Employee Health 1. Administer, review and maintain records related to the HBV vaccination program. 2. Coordinate, review, and maintain documentation of all employee exposures and follow-up. C. Department managers, Medical Chiefs (Directors, Supervisors, Nurse Managers, Deans or Directors of Schools of Medicine, Nursing or other health care occupations). Review and revise the list of all job classifications in which employees have reasonably anticipated occupational exposure. 1. Revise all applicable procedures in the department to include requirements for personal protective equipment (PPE) and the management of infectious waste and soiled equipment. 2. Assure and document employee compliance and annual training (See Part VII). 3. Assure personal protective equipment and other necessary supplies are available in accessible locations. 4. Evaluate compliance issues (i.e., wearing appropriate PPE, etc).

3 5. Initiate and document disciplinary action for continued non-compliance. D. Employees All healthcare providers with the potential for exposure to blood or OPIM must comply with the recommendation in the ECP. This applies to part-time, temporary, contract, and per diem employees. III. Employee Exposure determination A. The following is a list of class titles in which employees have reasonable anticipated occupational exposure. Department managers will identify all tasks with the potential for an occupational exposure. Class Title Anesthetist Anesthetist Senior Audiologist Audiologist SR. Autopsy Technician A Autopsy Technician B Cert Nurse Practitioner A Cert Nurse Practitioner B Clergy* Clinical Nurse I Clinical Nurse II Clinical Nurse III Clinical Nurse IV Clinical Nutrition Specialist Clinical Perfusionist A Clinical Perfusionist B Clinical Social Worker Clinical Social Worker Supervisor Dental Hygienist ECMO Education Director Electrocardio Tech Electroenceph Tech Electroenceph Supv Electroenceph Tech Electroenceph Supv Electron Microscopy Tech Supv Emerg Medical Tech Emerg Medical Tech Spec Emerg Medical Tech Supv Emerg Medical Tech Supv Sr Epidemiology Manager Health Professional Students Health Education Supv (Child Life) Histotechnologist Histotechnologist Sr Histotechnologist Supv Hospital Attendant A Hospital Attendant B Hospital Attendant Spec Tasks

4 Hospital Attendant Supv A Hospital Attendant Supv C Housekeeper Housekeeper Senior Housestaff (Residents, Interns, Fellows) Human Serv Prog Coord Human Services Care Spec Sr Human Services Care Worker Infection Control Practitioner *Only those positions with reasonably anticipated occupational exposure Lab Instrument Maker Lab Instrument Supv Laboratory Manager Laboratory Aide Laboratory Specialist Laboratory Specialist Advanced Laboratory Specialist Sr. Laboratory Technician Laboratory Technician Sr. Laboratory Tech. Cytotech Manager Laundry Worker MCVH Clin OP Dir (PT) MCVH ER Attend Phys Medical Students Medical Tech Sr. Medical Tech Supv Medical Tech Mgr Medical Technologist Med Tech Cytotech Med Tech Cytotech Supv Med Tech Cytotech Supv Nuclear Medicine Tech A Nuclear Med Technologist B Nuclear Medicine Tech Mgr Nuclear Medicine Tech Supv Nurse Manager Nursing Assistant Nutrition Program Dir Nutrition Specialist A* Nutrition Specialist B* Nutritionist Occupational Therapist Occupational Therapist I Occupational Therapist II Occupatioanl Therapist II Occupational Therapist Occupational Therapist Supv Office Services Aid* Office Services Asst* Office Services Spec* Office Services Supv Sr* Operating Room Tech Patient Care Tech Pharmacist*

5 Pharmacist Senior* Pharmacy Assistant A* Pharmacy Assistant B* Pharmacy Assist Director* Pharmacy Supervisor Physical/Occupational Ther Aide Physical Therapist Assist I Physical Therapist Assist II Physical Therapists Assist Recruit Physical Therapist III *Only those positions with reasonably anticipated occupational exposure. Physical Therapist Instit Physical Therapist Supv Physical Therapy Asst Dir Physical Therapy Recruit Physical Therapy Spec Practical Nurse A Practical Nurse B Psychologist Psychologist Senior Radiation Therapy Tech Sr. Radiation Therapy Tech Supv Radiologic Dosimestrist Radiologic Specialist Radiologic Sr Tech Radiologic Maint Eng* Radiologic Maint Eng Mgr* Recreation Therapist Recreation Therapist Sr. Registered Nurse Research Specialist Respiratory Therapy Asst Resp Therapy Asst Dir Respiratory Therapy A Respiratory Therapist B Respiratory Therapist Supv RN Advanced Practitioner RN Clint A RN Clin B RN Hourly RN Liaison RN Recruit Security Manager Security Officer Security Office Supv* Social Worker Speech Pathologist Speech Pathologist Sr Speech Pathologist Supv Sterile Supply Lead Worker Sterile Supply Supervisor Sterile Supply Supervisor Sr Sterile Supply Worker Sterile Supply Worker Sr

6 Transplant Coordinator Ultrasound Tech A Ultrasound Tech B Ultrasound Tech Supv Staff Physicians *Only those positions reasonably anticipated occupational exposure. IV. Implementation, Control and Compliance A. Standard Precautions (identified by OSHA as universal precautions). 1. All employees will apply standard precautions for all patient care. See isolation guidelines pages 3-5. a. Handwashing (pg. 3) b. Personal protective equipment (PPE) (pg. 3) c. Patient care equipment (pg. 3-4) d. Environmental control (pg. 4) 1. Linen (pg. 4) 2. Handling specimens (pg. 4-5) 3. Patient placement (pg. 5) 4. Occupational health and bloodborne pathogens (pg. 5) B. Exposure Control Plan 1. The ECP applies to all employees 2. The ECP is introduced to the employee during hospital orientation. 3. The ECP will be reviewed during annual training. 4. The ECP will be maintained in the Infection Control manual. 5. Epidemiology will inform employees with any significant ECP revisions. C. Engineering controls and work practices 1. Implemented to eliminate or minimize employee exposure to blood or OPIM. 2. Defined in the Isolation Policy (pg. 3-8). These include the terms, Engineering Controls, Sharps with Engineered Sharps Injury Protection, and Needleless Systems as defined by the Needlestick Safety and Prevention Act approved October Compliance will be monitored by Epidemiology and as outlined in II. A. C. of this ECP. 4. Annual review will identify needed revisions. V. Hepatitis B vaccination program All guidelines and requirements can be found in the Preventive Medicine policy. VI. Post-Exposure evaluation and follow-up All guidelines and requirements can be found in the Preventive Medicine policy. These include additional requirements in compliance with the The Needlestick Safety and Prevention Act, approved October VIII. Employee training

7 A. All employees with anticipated exposure to bloodborne pathogens must participate in training on epidemiology, symptoms, and transmission of bloodborne pathogen diseases during new employee orientation followed by annual update. B. The training must include: 1. An accessible copy of the OSHA Bloodborne Pathogen Standard (CFR ). 2. Identify where our ECP is found. 3. A general explanation of the epidemiology, symptoms, and method of transmission of bloodborne disease. 4. An explanation of the appropriate use of methods for recognizing procedures and other activities that may involve exposure to blood and OPIM. 5. Definition of a significant exposure. 6. An explanation of the use and limitations of practices that will prevent or reduce exposure including basis for selection, appropriate use of personal protective equipment (PPE) and other work practices. 7 Information on the types, proper use, location, removal, handling, decontamination and/or disposal of PPE. 8. Information on the Hepatitis B vaccine including efficacy, safety, method of administration, benefits, and that the vaccine is offered free of charge. 9. Information on the appropriate actions to take and persons to contact in an emergency involving blood or OPIM. 10. 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. 11. Proper disposal of infectious (regulated medical) waste. 12. An opportunity for interactive questions and answers with the person conducting the training session. C. Training records must include the following: 1. The dates of the training session. 2. The contents or an outline of the training sessions. 3. The names of persons conducting the training. 4. The names of all persons attending the training session. 5. These records are to be maintained for five years in Human Resources. VII. Record Keeping A. Medical records are maintained for each employee with occupational exposure in accordance with 29 CFR , Access to Employee Exposure and Medical Records. B. Employee medical records are provided upon request of the employee or to anyone having written consent of the employee within 15 working days submitted to the Employee Health Services department. C. An exposure incident is evaluated to determine if the case meets OSHA s Recordkeeping Requirements (29 CFR 1904).

8 D. Includes requirements for sharps injury log in compliance with the The Needlestick Safety and Prevention Act, approved October 2000 and defined in the Prevention Medicine Policy. Chair, Infection Control Committee Hospital Epidemiologist Date Date

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