PART A BLOODBORNE PATHOGENS PART B BIOHAZARDOUS WASTE PLAN

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1 APPENDIX B OCCUPATIONAL SAFETY AND HEALTH PROGRAM PART A BLOODBORNE PATHOGENS PART B BIOHAZARDOUS WASTE PLAN

2 Bloodborne Pathogens Exposure Control Plan TABLE OF CONTENTS Part A Section Page I. Purpose and Scope... 1 II. Definitions. 1 III. Schedule and Methods of Implementation.. 2 IV. Employee Exposure Classification 2 V. Universal Precautions. 3 VI. Engineering and Work Practice Controls. 3 VII. Personal Protective Equipment. 5 VIII. Housekeeping.. 6 IX. Hepatitis B Vaccination... 6 X. Post-Exposure Evaluation and Follow-up 7 XI. Exposure Incident Evaluation Procedures... 8 XII. Information and Training. 9 XIII. Record Keeping 10 XIV. Regulated Waste.. 10 Attachment A: Post Exposure Protocol. 11 Attachment B: Post Exposure Checklist 13 Attachment C: Hepatitis B Vaccine Consent/Waiver Attachment D: Hepatitis B Vaccination Appeal Form.. 15 Attachment E: Medical Referral.. 16 Attachment Bloodborne Pathogen Standard. 17 Part B Section Page I. Definition of Biohazardous.. 1 II. Location.. 1 III. Segregation and Handling... 2 IV. Labeling.. 3 V. Storage and Containment 3 VI. Emergency Contingency Plan. 4 VII. Comixing. 4 VIII. Records... 4 IX. Training... 5 Attachment A: Training Attendance Records. 6 Appendix B i

3 I. PURPOSE AND SCOPE EXPOSURE CONTROL PLAN The health, safety and welfare of all employees, regardless of their tasks and responsibilities, are of fundamental concern to the Board and the District s administration. The Site Administrator/Principal must ensure that this concern is extended to students as well as visitors to each school site and at District facilities. The purpose of this Exposure Control Plan is to establish a program that will: 1). Meet the goal of providing a safe and healthy learning and/or working environment in the event of a possible Bloodborne pathogen exposure. 2). Provide an environment, which fosters safe and healthful attitudes, procedures and practices on the part of all District personnel. This program meets District requirements as established in the District Safety Program. II. DEFINITIONS Note: For any definitions not provided below, consult Chapter 1, Section 1.7, and Glossary of Terms of the District Safety Program. 1) Blood Human blood, human blood components, and products made from human blood. 2) Bloodborne Pathogens Pathogenic microorganisms that are present in human blood and can cause disease in humans. These pathogens include, but are not limited to, Hepatitis B virus (HBV) and Human Immunodeficiency Virus (HIV). 3) Contaminated The presence or the reasonably anticipated presence of blood, body fluids or other potentially infectious materials on an item or surface. 4) Contaminated Laundry Laundry that has been soiled with blood, body fluids or other potentially infectious materials. 5) Contaminated Sharps Any contaminated object that can penetrate the skin. 6) Decontaminate The use of a physical or chemical means to remove, inactivate, or destroy Bloodborne pathogens on a surface or item to the point where they are no longer capable of transmitting infectious particles and the surfaces or item in rendered safe for handling, use or disposal. 7) Engineering Controls Controls which isolate or remove Bloodborne pathogen hazards from the workplace. 8) Exposure Incident A specific eye, mouth, other mucous membrane, non-intact skin, or parenteral contact with blood or other potentially infectious materials that results from the performance of an employee s duties. 9) HBV Hepatitis B Virus 10) HBIG B Hepatitis B Immune Globulin Appendix B Part A 1

4 11) HIV Human Immunodeficiency Virus 12) Occupational Exposure A percutaneous injury (needle stick or cut with a sharp object), contact of mucous membranes, or contact of skin (especially if chapped, abraded or afflicted with dermatitis, or when contact is prolonged or involves an extensive area) with blood, tissues, or other potentially infectious body fluids. 13) Potentially Infectious Materials a. Human body fluids, including semen, vaginal secretions, breast milk or any other body fluid contaminated with visible blood, cerebral spinal fluid, synovial fluid, pleural fluid, peritoneal fluid, pericardial fluid, amniotic fluid, laboratory specimens that contain HIV, and all body fluids in situations where it is difficult or impossible to differentiate between body fluids; b. Any unfixed tissue or organ (other than intact skin) from a human (living or dead) 14) Personal Protective Equipment Specialized clothing or equipment worn by an employee for protection against a hazard. General work clothes and uniforms are not considered protective equipment. 15) Regulated Waste Blood, body fluids and/or tissue in any physical state; items that are contaminated with blood or other body fluids; contaminated sharps; and waste material containing or exposed to blood or other body fluids. 16) Source Individual Any person, living or dead, whose blood, fluids or tissue may be +potentially infectious. 17) Sterilize The physical or chemical procedure used to destroy all microbial life. 18) Universal Precautions An approach to infection control that suggests that all human blood, fluids and other potentially hazardous materials are to be treated as infectious. 19) Work Practice Controls Methods that reduce the likelihood of exposure to blood, body fluids or other potentially infectious materials by altering the manner in which a task is performed. III. SCHEDULE AND METHOD OF IMPLEMEMTATION All policies and procedures contained in this Exposure Control Plan were implemented on June 1, 1992 and revised January The Plan shall be reviewed and updated by the District Safety Office at least annually and whenever necessary to reflect new or modified tasks and procedures that affect occupational exposure and to reflect new or revised employee positions with occupational exposure. The Site Administrator/Principal shall ensure the provisions outlined below are strictly followed. IV. EMPLOYEE EXPOSURE CLASSIFICATION Category 1 This category includes job classifications in which District employees have occupational exposure to blood, body fluids, or potentially infectious materials. The following job types are determined to be at high risk: 1) Nurses, medical professionals, paraprofessionals, health assistants, physical/occupational therapists and assistants, health aides. 2) Principals/Assistant Principals if involved in school discipline. 3) Special education and exceptional education teachers, teacher aides, attendants if dealing with students who cannot control body fluids or cannot control their behaviors. Appendix B Part A 2

5 4) Physical education teachers, athletic coaches/trainers, locker room attendants if required to hand blood, body fluids or other potentially infectious material (e.g., providing general first aid). 5) Early childhood teachers, teacher aides (pre-kindergarten and kindergarten only) if required to handle/clean up body fluids or provide general first aid. 6) School security personnel 7) All designated First Responders at each school or support facility. Category This category includes all other School District job classifications not listed in Category one. These employees may have occupational exposure; however, these job types are determined not to be at high risk. V. UNIVERSAL PRECAUTIONS All District employees will observe universal precautions. The Site Administrator/Principal will ensure that universal precautions are followed. Engineering and Work Practice Controls will be utilized whenever there is a potential exposure to body fluids. Universal Precautions is the name that the Center for Disease Control and Prevention (CDC) uses to describe a very aggressive plan that treats all blood and body fluids as a possible source of contamination and infection. Materials that require universal precautions: Human blood and any products that include human blood or parts made from human blood Semen, vaginal secretions Cerebrospinal, synovial, pleural, pericardial, peritoneal, or amniotic fluids Saliva in dental procedures Any body fluid that is visibly contaminated with blood Any unidentifiable body fluid Workers who fall under the Universal Precautions guideline must wear gloves and other protective equipment to lower the risk of exposure to blood and body fluids. Specific precautions must be taken with dirty linen, trash and used sharp objects. If an employee is exposed to blood or body fluids, the employee has the right to request medical evaluation in regard to the need for Hepatitis B immunization and periodic Hepatitis B virus and HIV testing. VI. ENGINEERING AND WORK PRACTICE CONTROLS Engineering and work practice controls shall be used to minimize or eliminate employee exposure to blood, body fluids and other potentially infectious materials. Where occupational exposure remains after initiation of these controls, personal protective equipment shall also be required. Engineering and work practice controls shall be examined regularly to determine their effectiveness. Controls shall be amended or replaced as necessary. 1) Handling of Sharps a. Sharps shall be handled by employees using appropriate tools and hand protection b. Contaminated needles and other contaminated sharps shall not be bent, recapped or removed except as noted below. Shearing or breaking of contaminated needles is prohibited Appendix B Part A - 3

6 1. Contaminated needles and other contaminated sharps shall not be bent, recapped, or removed unless the employee can demonstrate that no alternative is feasible. 2. Such bending, recapping, or needle removal must be accomplished through the use of a mechanical device or a one-handed technique. c. Immediately or as soon as possible after use, all sharps shall be placed in appropriate containers and disposed of according to regulatory waste procedures. These containers shall be: 1. Puncture resistant; 2. Labeled or color-coded in accordance with OSHA standards; and 3. Leak-proof on the sides and bottom. 2) Personal Hygiene a. Hand washing facilities shall be readily accessible b. Employees shall wash their hands with soap and running water immediately or as soon as feasible, after removal of gloves or other personal protective equipment c. Employee shall wash their hands and any other exposed skin with soap and running water immediately, or as soon as feasible, following contact of body areas infected with body fluids or other potentially infectious materials d. Employees shall rinse or flush mucous membranes with water immediately, or as soon as feasible, following contact of such areas with body fluids or other potentially infectious materials. e. When the use of hand washing facilities is not feasible, employees shall use alcohol hand sanitizer. Thereafter, employees shall wash their hands with soap and running water as soon as feasible f. Eating, drinking, smoking, applying cosmetics or lip balm, and handling contact lenses are prohibited in work areas where there is likelihood of an occupational exposure g. All clean up procedures involving blood, body fluids or other potentially infectious materials shall be performed in such a manner as to minimize splashing, spraying, spattering and generation of droplets from the substances h. Food and drink shall not be kept in refrigerators, freezers, shelves, cabinets, or countertops where blood or potentially infectious materials are present 3) Infectious Materials Handling a. Any potentially infectious material shall only be placed in designated containers that prevent leakage during collection, handling, processing, storage, transport and shipping. Such containers shall be properly closed, sealed, and labeled. b. Containers for storage, transport or shipping of any potentially infectious materials shall be: 1. Appropriately labeled or color-coded as described in Section IX of this Plan; and 2. Closed prior to being stored, transported or shipped. c. If outside contamination of the primary container occurs, it shall be placed within a second regulation leak proof container, appropriate labeled and properly closed 4) Equipment Handling Equipment that may become contaminated with blood, body fluids or other potential infectious materials shall be examined prior to use and shall be decontaminated as necessary. Appendix B Part A 4

7 5) Cleaning and Disinfecting All spills and contamination must be immediately contained and cleaned by staff trained and equipped to work with potentially infectious materials. a. All surfaces exposed to blood, body fluids or other potentially infectious materials shall be wiped clean and appropriately disinfected using approved disinfectant or other EPA registered disinfectant b. Cleanup kits shall be used to clean items or equipment and surfaces that are exposed to blood, body fluids or other potentially infectious materials c. Surfaces exposed to blood, body fluids or other potentially infectious materials should be cleaned and disinfected by employees appropriately trained to use cleanup kits and disinfectants VII. PERSONAL PROTECTIVE EQUIPMENT (PPE) Personal protective equipment is special clothing or equipment worn for protection against Bloodborne pathogens and other hazards. This may include the following: Latex gloves Gowns Aprons Face shields Masks Eye Protection Laboratory coats CPR micro shields Resuscitation bags 1) The District Safety Office must approve all Personal Protective Equipment. The School District provides approved and appropriate Personal Protective Equipment at no cost to the employees. 2) Personal Protective Equipment shall be considered appropriate only if it does not permit blood, body fluids or other potentially infectious materials to pass through or reach the wearer s work clothes, street clothes, undergarments, skin eyes, mouth, or other mucous membranes under normal conditions of use and for the duration of time which the protective equipment will be used. 3) Employees shall use appropriate Personal Protective Equipment whenever there is a potential for occupational exposure. a. An employee may temporarily and briefly decline the use of Personal Protective Equipment only under rare and extraordinary circumstances when, in the employee s professional judgment, its use will prevent the delivery of first aid or public safety services, or will pose an increased hazard to oneself or co-worker b. When an employee makes such a judgment, the circumstances shall be investigated and documented by the District Safety Office in order to determine whether changes should be instituted to prevent such occurrences in the future 4) If a garment is pretreated by blood, body fluids or other potentially infectious materials, the garment shall be removed immediately or as soon as feasible. Appendix B Part A 5

8 5) All Personal Protective Equipment must be removed before leaving the work area. Upon removal, Personal Protective equipment shall be placed in appropriately designated area or container for storage, washing, decontamination, or disposal. 6) All Personal Protective Equipment shall be cleaned, laundered and disposed of by the School District according to established procedures approved by the District Safety Office. 7) Gloves shall be worn when it can be reasonably anticipated that there will be contact with blood, body fluids or other potentially infectious materials, and when handling or touching contaminated items or surfaces. a. Disposable (single use) gloves shall be replaced as soon as practical when contaminated, torn, punctured, or when their ability to function as a barrier is compromised b. Disposable (single use) gloves shall not be washed or decontaminated for reuse under any circumstances c. Utility gloves may be decontaminated for reuse if their integrity is not compromised, according to established procedures approved by the District Safety Office d. Utility gloves must be discarded if cracked, peeling, torn, punctured, or otherwise exhibits signs of deterioration, or when their ability to function as a barrier is compromised 8) Masks shall be worn alone or in combination with eye protection devices whenever splashes, spray, spatter or droplets of blood and/or body fluids or other potentially infectious materials may be generated, and when eye, nose or mouth contamination can be reasonably anticipated. 9) Appropriate protective clothing includes gowns, aprons, lab coats, or similar outer garments that are worn in occupational exposure situations. The type and characteristics of such protective clothing must be appropriate to the task and degree of exposure anticipated. 10) Shoe covers shall be worn in instances when gross contamination can reasonably be anticipated. VIII. HOUSEKEEPING 1) Work sites shall be maintained in a clean and sanitary condition. 2) All equipment, environmental areas, and working surfaces shall be cleaned and decontaminated by trained staff after contact with blood, body fluids, or other potentially infectious materials. All contaminated surfaces shall be decontaminated with an appropriate disinfectant. 3) Broken glassware that may be contaminated shall not be picked up directly with the hands. It shall be cleaned up using appropriate hand protection and tools. IX. HEPATITIS B VACCINATION 1) Pre-exposure Vaccination School District employees whose job classifications are outlined in Category 1 will be offered the vaccine. The vaccine will be offered within ten (10) working days of the initial job assignment, unless the employee has previously had the vaccine or wishes to submit results of antibody testing verifying sufficient immunity Employees who agree to receive the Hepatitis B Vaccine will sign a Hepatitis B Vaccine consent form (Attachment C). Employees who decline the vaccine will be requested to sign a waiver (Attachment C). Such employees may change their mind at any future time and request immunization, which will be given at no cost to the employee. Any employee in Category 2 may appeal for immunization due to unique circumstances of their individual job duties by completing the Hepatitis B Vaccination Appeal form (Attachment D). The School District will assure that if appropriate the vaccine is offered. Appendix B Part A - 6

9 2) Post-exposure Vaccination For employees in Category 2, who are potentially exposed because of their duty to provide general first aid, the vaccine will be offered if the employee has an exposure incident as defined in this plan. Employees having an exposure incident who decline the Hepatitis B Vaccine will sign a waiver. Employees who initially decline the vaccine but who later wish to have it will receive the vaccine at no cost. X. POST-EXPOSURE EVALUATION AND FOLLOW-UP All exposure incidents must be reported immediately to the Site Administrator/Principal. All employees who incur an exposure incident will be offered post-exposure evaluation and follow-up in accordance with OSHA (29 CFR ), Bloodborne Pathogen Standard. This will include, at minimum, the following items: 1) A confidential medical evaluation and follow-up shall be conducted by the assigned healthcare professional and shall include the following elements: a. Documentation of the route(s) of exposure; b. Circumstances under which the exposure incident occurred; and c. Any significant factors known regarding the source individual, which may be pertinent to treatment. This may include collection and testing of the source individual s blood for HBV and HIC status upon consent 2) Collection and testing of an exposed employee s blood for HBV and HIV status. a. The employee will be offered the option of blood collection for HIV and HBV serological testing b. If the employee consents to baseline blood collection, but does not at that time consent to HIV testing, the sample shall be preserved for at least 90 days, during which time HIC testing will be done at the employee s election c. The employee will be offered post-exposure treatment in accordance with the current recommendations of the U.S. Public Health Service (Refer to SDHC Post Exposure Protocol: Attachment A) d. The healthcare professional will counsel the employee concerning precautions to take during the period after the exposure incident. Counseling will include information on what potential symptoms or illnesses that may ensue as a result of the incident or treatment that should be reported to the healthcare professional e. The Site Administrator/Principal has been designated to assure that the policy outlined herein is effectively implemented f. The post exposure procedure outlined below shall be posted in all school clinics and potential exposure areas POST EXPOSURE PROCEDURE a. Administer first-aid Care of infected site: 1. Wash contaminated skin with soap & water 2. Flush mucous membranes with water 3. Irrigate eyes with sterile saline Appendix B Part A 7

10 b. Refer to the Post Exposure Protocol Checklist (SB 70311) c. Complete Florida Department of Labor notice of Injury form (DWC-1) d. Complete the Workers Compensation Medical Referral form (SB 70303). Send to medical provider in sealed envelope with employee e. Complete the Post Exposure Medical Information form (SB 70310), Information is confidential and should be sent with employee in a sealed envelope to the medical provider f. Call medical provider to authorize medical care g. Employee is to report to Lakeside Occupational Medical Center ( ) for medical evaluation as soon as possible. For evenings, nights, weekends and holidays, call Lakeside ( ) and the medical provider on-call will return the call and advice accordingly h. Review the exposure incident and institute any engineering controls to avoid future exposures. i. Notify District Safety Office of incident. 3) Interaction with Healthcare Professionals a. A written opinion shall be obtained from the healthcare professional that evaluated employees of the District as a result of an exposure incident. Written opinions will be obtained in the following instances: 1. When the employee is sent to obtain the Hepatitis B Vaccine; and 2. Whenever the employee is sent to a healthcare professional following an exposure incident. b. Healthcare professionals shall be instructed to limit their opinions to: 1. Whether the Hepatitis B Vaccine is indicated for an employee and if the employee has previously received the vaccine. 2. That the employee has been informed of the results of the evaluation within 15 days of completion of the medical evaluation. 3. That the employee has been told about any medical conditions resulting from exposure to blood, body fluids or other potentially infectious materials which h require further evaluation or treatment. 4. All other findings or diagnoses shall remain confidential and shall not be included in the written report. 4) Accurate medical records shall be established and maintained for each employee with occupational exposure (see Section XIII Record Keeping). XI. EXPOSURE INCEDENT EVALUATION PROCEDURES 1) Whenever an exposure incident occurs, the circumstances surrounding the exposure incident shall be evaluated by the Principal/Site Administrator. The District Safety Office shall conduct a follow-up evaluation based on the following: a. Engineering controls in place and utilized at the time of the exposure incident; b. Work practice controls in place and followed at the time of the exposure incident; c. Personal protective equipment and clothing available and utilized at the time of the exposure incident, and d. Policy/control deficiencies, if any Appendix B Part A - 8

11 2) The goal of this evaluation is to identify and correct problems in order to prevent recurrence of similar incidents. XII. INFORMATION AND TRAINING (SEE A TRAINING IN BIOMEDICAL WASTE PLAN PART B ) Information and training material appropriate in content and vocabulary to education level, literacy and language of employees shall be provided. 1) All employees shall participate in a training program that will be provided: a. At the time of initial assignment to tasks involving occupational exposure and annually thereafter b. When tasks or procedures are added or modified that may affect the employees occupational exposure 2) Training shall include: a. Access to a copy of the OSHA Standard (29 CFR ) and an explanation of the contents; b. A general explanation of the epidemiology and symptoms of Bloodborne diseases; c. An explanation of the modes of transmission of Bloodborne pathogens; d. An explanation of the Exposure Control Plan and access to it; e. An explanation of the appropriate methods for recognizing tasks and other activities that may involve exposure to bloods or other potentially infectious materials; f. 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; g. Information on the types, proper uses, removal, location, handling, decontamination and disposal of personal protective equipment and clean up kits; h. An explanation of the basis for selection of Personal Protective Equipment; i. Information on the Hepatitis B Vaccination program; j. Information on appropriate actions to take in the event of an exposure incident; k. An explanation of proper signs, labels and color-coding required on infectious materials and; l. An opportunity for interactive questions and answers with the person conducting the training. The trainer must be knowledgeable in the subject matter and workplace addressed in training m. Records of each training session shall be kept, including: 1. Dates of the training session; 2. The content or a summary of training; 3. Names and qualifications of person(s) conducting the training; and 4. Names and job titles of all persons attending training n. Training records shall be maintained in the District Safety Office for a period of three (3) years from the date of training Appendix B Part A - 9

12 XIII. RECORD KEEPING 1) Medical records following the occurrence of an exposure incident shall be established and maintained for each employee cared for under this exposure protocol. a. All records required by the standard will be maintained by the District or by the assigned healthcare provider. The District will have access to all medical records regarding vaccinations and exposures from the healthcare provider b. These medical records shall include: Employee s name and social security number A copy of employee s Hepatitis B Vaccination record A copy of medical examinations, testing, and follow-up procedures A copy of the healthcare professional s written report/opinion A copy of the information provided to the evaluating healthcare professional c. Employee medical records shall be kept confidential. Information contained therein shall not be disclosed without the employee s written consent d. Employee medical records shall be maintained for the duration of employment plus thirty-(30) years. 2) Documentation of employee s failure to use Personal Protective Equipment Refer to Section VII, Item C. 3) All medical and training records shall be made available to the Assistant Secretary of Labor for Occupational Safety & Health and the Director of the National Institute for Occupational Safety & Health, U.S. Department of Health and Human Resources or their representative(s) upon request. 4) Employee medical and training records shall be provided upon request to the employee or anyone having his/her written consent. XIV. REGULATED WASTE Chapter 64E-16, Florida Administrative code requires that a site-specific written plan be established to ensure proper identification, packaging, removal and disposal of hazardous biomedical waste substances. The following (Part B) section of this appendix includes a plan, that when each site completes the information will be a site-specific disposal plan. Each site Administrator/Principal shall ensure (part B) and reviewed and updated annually at the beginning of each school year. Appendix B Part A 10

13 POST EXPOSURE PROTOCOL ATTACHMENT A SCHOOL DISTRICT OF HILSSBOROUGH COUNTY Transmission of Bloodborne pathogens occur most frequently with needle sticks and blood splashed to the mucosa. The risk of infection, however, is estimated to be 0.02%. Every effort to minimize the risk of exposure through education efforts, engineering controls and the development of procedures to minimize blood and body fluid contact should be encouraged. Universal precautions must be applied in all activities to avoid contact with potentially infected human fluids. The assigned Medical Provider will keep a copy of School District s Exposure Control Plan in the medical facility. Treatment of all School District employees will be provided according to the Post Exposure Protocol. Any deviation from this plan by the medical provider must be reported to the District Safety Office. The medical provider will advise the District of the need to test the source, if possible, for HIV antibody and Hepatitis. It is the District s responsibility to notify the parent/guardian of the request for testing. Preferably, a medical provider, assigned by the District at no cost to the source, will conduct testing of the source. If the parent/guardian chooses, testing may be conducted by the student s private medical provider and results will be forwarded to the medical provider assigned by the District. If source testing is not possible, treatment is determined by the District s assigned medical provider on a case-by-case basis, based on the patient s history of the source and risk potential of the sources. Incidents involving skin scratches, human bites, etc. Must be evaluated in regard to blood and body fluid exposure with an actual or potentially infected source. An exposure must meet the criteria of a blood or mucous membrane exposure with infected or potentially infected blood or body fluid. Post Exposure Protocol (PEP) should be initiated within 1-2 hours post- exposure; however the interval after which there are no benefits from PEP medical treatment for humans is undefined. Initiating medical treatment after a longer period may be considered for highest risk cases. PEP medical treatment should be administered for a 4-week period, if tolerated. If the source HIC status in unknown, initiation of PEP medical treatment should be decided on a case-by-case basis based on the extent of the exposure and likelihood of HIV infection. Employees treated with PEP medical treatment shall be monitored on a regulated basis and receive follow-up counseling regarding test results. Employees should also be counseled in regard to the possibility of secondary transmission to sexual partners. Employees should be advised to practice safe sex until the series of follow-up tests are completed. Hepatitis B exposure will be evaluated. A Hepatitis B titer will be drawn on all employees who have previously received the Hepatitis B Vaccine. The need for Hepatitis B booster will be determined based on titer results. Appendix B Part A 11

14 The Hepatitis B vaccine will be offered to employees known to be at risk because of the exposure. The assigned medical provider on a case-by-case basis will determine treatment with HBIG and/or Hepatitis B Vaccine. It is the responsibility of the School District employee to: Comply with all recommended medical care Attend all scheduled medical appointments Report any possible adverse effects of treatment Report any symptoms of illness as indicated in the medical counseling It is the responsibility of the assigned Medical Provider to provide the employees with a copy of the post-exposure treatment and follow-up plan. Appendix B Part A - 12

15 ATTACHMENT B SCHOOL DISTRICT OF HILLSBOROUGH COUNTY POST EXSPOSURE PROTOCOL CHECKLIST For all injuries with possible exposure to contaminated body fluids Principal/Site Administrator Incidents that result in a possible Bloodborne pathogen must receive a medical evaluation immediately. The following steps must be taken in order to assure appropriated medical evaluation and treatment. Assigned Medical Provider CHECKLIST Administer first-aid 24-hour availability Lakeside Occupational Medical Centers, PA th Street Temple Terrace, FL Phone: (813) Fax: (813) Secondary phone number (727) Complete Florida Department of Labor notice of Injury form (DWC-1) Complete the Workers Compensation Medical Referral form (SB 70303). Send to medical provider in sealed envelope with employee. Call medical provider to authorize medical care. Employee is to report to Lakeside Occupational Medical Center (phone: ) for medical evaluation as soon as possible. For evenings, nights, weekends and holidays call Lakeside and the medical provider on-call will return the call and advise accordingly. Review the exposure incident and institute any engineering controls to avoid future exposures. Notify the District Safety Office of incident. Phone FOR QUESTIONS: District Safety Office (813) Appendix B Part A

16 APPENDIX B PART B HILLSBOROUGH COUNTY PUBLIC SCHOOLS BIOHAZARDOUS WASTE PLAN School Date I. Definition of Biohazardous Waste Any solid or liquid waste which may present a threat of infection to humans including non-liquid tissue, body parts, blood, blood products, body fluids from humans and other primates, laboratory and veterinary wastes which contain human disease causing agents, and discarded sharps. The following area also included: a. Used, absorbent materials saturated with blood, blood products, body fluids or and secretions contaminated with visible blood and absorbent materials saturated with blood or blood products which have dried. b. Non-absorbent, disposable devices that have been contaminated with blood, body fluids or secretions or excretions visibly contaminated with blood, but have not been treated by an approved method. *Body Fluids Those fluids which have the potential to harbor pathogens, such as the human immunodeficiency virus and Hepatitis B Virus and include blood, blood products, lymph, semen, vaginal secretions, cerebrospinal, synovial, pleura, peritoneal, pericardial, and amniotic fluids. Also any unidentifiable fluids and anybody excretions visibly contaminated with blood. II. Location: a. The following specific items generated in this facility based on the definition of Biohazard waste for absorbent materials are: b. The following specific items generated in this facility based on the definition of Biohazard waste for non-absorbent materials are: Appendix B Part B - 1

17 Sharps: Objects capable of puncturing, lacerating, or otherwise penetrating the skin. c. The following specific objects generated in this facility based on the definition of Biohazardous waste for sharps are: III. Segregation and Handling Biohazardous wasted shall be identified and segregated from other solid waste at the point of origin and placed into the proper disposal container. Point of Origin is defined as the room or areas where Biohazardous waste is generated. All sharps shall be discarded at the point of origin into a harms container that is rigid, leak and puncture resistant and clearly labeled with the phrase and international incidental metals as described in section 64E (2) (b)1.b., F.A.C. The sharps containers shall be ordered from the District Central Warehouse at no cost to the school. Sharps containers must be sealed when full. A sharps container is considered full when materials placed into it reach the designated fill like or when additional materials cannot be placed in the container without cramming or when no additional materials are to be placed in the container. The full sharps container shall be placed in the Bio-Med Waste Box for disposal. a. The sharps containers in this facility are located: All non-sharps Biohazardous shall be packaged and sealed at the point of origin in impermeable, red plastic bags, or sharps containers at the discretion of the generator. The international biological hazard symbol shall be at least inches in diameter on bags 19 x 14 or larger, and at least one inch in diameter on bags smaller than 19 x F.A.C. Red bags will be provided by the Bio-Med waste contractor. b. The red bags in this facility are located: c. Any employee handling or transferring Biohazardous wasted shall wear minimal protective clothing including a minimum of gloves. The personal protective clothing provide in this facility is: Appendix B Part B 2

18 IV. Labeling Biohazardous waste bags and sharps containers shall be labeled with the generators name and address if treatment and disposal is off site. The waste transport company is to apply proper labeling sealing for all waste removed from sites. The person or persons responsible for proper labeling procedure are: MEDICAL ENVIRONMENTAL SERVICES, INC. V. Storage and Containment Storage of Biohazardous waste of the generating facility shall not exceed 28 days. The 28 day period shall commence when the first non-sharps items of Biohazardous waste is placed into a red bag or sharps container, or when a sharp container indoor storage areas shall have restricted access and be designed in the operating plan. They shall be located away from pedestrian traffic, be vermin and insect free, and maintained in a sanitary condition. Packages of Biohazardous wasted shall remain sealed until treatment, except when compacted in accordance with the requirements of this chapter as stated in 64E (2). Ruptured or leaking packages of Biohazardous wasted shall be placed into larger packaging without disturbing the original seal. All packages containing Biohazardous waste shall be visibly identifiable with the international biological symbol and one of the following phrases: BIOHAZARDOUS WASTE BIOHAZARDOUS INFECTIOUS WASTE INFECTIOUS SUBSTANCE The symbol shall be red, orange, or black and the background color shall contrast with that symbol or comply with the requirements cited in subpart Z of 29 CFR subparagraph (g)(1)(C), Occupational Exposure to Bloodborne Pathogen Standard. a. The indoor Biohazardous waste storage area in this facility is located: b. Outdoor storage areas, must be approved by the District Safety Office, including containers and trailers shall, in addition to the above criteria, be conspicuously marked with the international biological symbol as described in paragraph 64D (2)(a), F.A.C., and shall be secured against vandalism and unauthorized entry. The international biological symbol on the outdoor storage area shall be a minimum of six inches in diameter. Appendix B Part B 3

19 c. Biohazardous waste shall be treated by steam, incineration, or an alternative process approved by the department. The District has contracted with offsite transportation and Incineration Company registered with the Florida Department of Environmental Regulation The name of Biohazardous waste transport company serving this facility is: Permafix (813) VI. Emergency Contingency Plan, Decontaminating Procedures All surfaces contaminated with spilled or leaked Biohazardous waste shall be decontaminated as part of the cleaning process. Decontamination is the process of removing pathogenic microorganisms from objects or surfaces, thereby rendering them safe for handling. Biohazardous waste may be disposed into a sanitary sewer system, an onsite sewage treatment and disposal system, or other system to approve such wastes by the Department of Environmental Protection or the department, if it is in a liquid or semi-solid form and aerosol formation is minimal. The disinfectant or disinfectants utilized in this facility are listed below: VII. Comixing Hazardous materials shall not be put into the bio-waste container at any time. Biohazardous waste mixed with hazardous wasted, as defined in Chapter , F.A.C., Hazardous Waste, shall be managed has hazardous waste. Biohazardous waste mixed with radioactive waste shall be managed in a manner that does not violate the provisions of Chapter 10D-91. The Biohazardous waste shall be managed in accordance with provisions of Chapter 64E-116, F.A.C., after the radioactive component has decayed in storage as provided for in Chapter 10D- 91, F.A.C. or is otherwise not regulated under Chapter 10D-91, F.A.C. Any other solid waste or liquid, which is neither hazardous nor radioactive in character, combined with untreated Biohazardous waste shall be managed as untreated Biohazardous waste. VIII. Records The school/site shall keep a copy of each pick up manifest with plan. All Biohazardous waste management records shall be maintained for 3 years and shall be available for review by the department. All Biohazardous waste records including manifests, invoices, and certificates of destruction are located at: THE DISTRICT SAFETY OFFICE Appendix B Part B 4

20 IX. Training Each facility or their designee shall train new personnel who handle Biohazardous waste as part of their work responsibilities. This training shall be provided prior to commencement of duties related to Biohazardous waste handling. Refresher training shall be completed annually by all personnel who handle Biohazardous wasted. Training shall detail compliance with the facility s operating plan and Chapter 64E-16, F.A.C., shall be maintained as part of the operating plan. Plans shall be updated when regulations, facility policies, or procedures change. See attached training attendance records Appendix B Part B- 5

21 HILLSBOROUGH COUNTY PUBLIC SCHOOLS DISTRICT SAFETY OFFICE 4224 W. Crest Avenue Tampa, Florida In-service Education Biohazardous Waste Training Attendance Subject: State of Florida Department of Health, Chapter 64E-16, Florida Administration Code, Onsite Biohazardous Waste Standards: Segregation, Labeling, packaging, transporting, storing, treating, decontamination of Biohazardous waste spills, and emergency contingency plan. Instructor: Date of Training: Print Name: Signature Appendix B Part B - 6

22 EMPLOYEE EXPOSURE CLASSIFICATION CATEGORY 1 For Hepatitis B Vaccine This category includes job classifications in which District employees have occupational exposure to blood, body fluids or potentially infectious material. The following job types are determined to be at high risk: A. Nurses, Medical Professionals/Paraprofessionals. Health Assistants, Physical/Occupational Therapists and Assistants. B. Principals/Assistant Principals-if involved in school discipline. C. Special Education and Exceptional Education Teachers, Teacher Aides, Attendants if dealing with students who cannot control body fluids or cannot control their behaviors. D. Physical Education Teachers, Athletic Coaches/Trainers, Locker Room Attendants-if required to handle blood, body fluids or other potentially infectious material (e.g., providing general first aid). E. Early Childhood Teachers, Teacher Aides (Pre-Kindergarten and Kindergarten only) if required to handle/clean up body fluids or provide general first aid. F. School Security Personnel. G. All designated First Responders at each school or support facility. Taken from: School District of Hillsborough County Safety Health and Environmental Program Manual

23 SCHOOL DISTRICT OF HILLSBOROUGH COUNTY HEPATITIS B VACCINE CONSENT/WAIVER FORM EMPLOYEE (Fill out one section only) EMPLOYEE # CONSENT: I have reviewed the Category 1 job classifications and my job falls into that category. My job is: I have reviewed the online Bloodborne Pathogen safety video and I am requesting the Hepatitis B vaccine series of 3 injections. Signature: Work Location: Date: Site # Waiver: Declining Vaccination Series I understand that my job falls into Category 1 and 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 the Hepatitis B vaccines at no charge to me. However, I decline Hepatitis B vaccinations at this time. If in the future I continue to have occupational exposure to blood or other potentially infectious materials and I want to be vaccinated with the Hepatitis B vaccines I can receive the vaccination series at no charge to me. Signature Date I have completed the Hepatitis B vaccination series. Dates Completed #1 #2 #3

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