1 TITLE: HAINES CITY POLICE DEPARTMENT GENERAL ORDER EXPOSURE CONTROL PLAN FOR BLOODBORNE/AIRBORNE PATHOGENS AND OTHER POTENTIALLY INFECTIOUS MATERIALS GENERAL ORDER: (High Risk) EFFECTIVE: August 19, 2012 AMENDED: May 13, 2014 RESCINDS: S.O.P PAGES: 10 A. PURPOSE: The purpose of this General Order is to establish certain procedures to minimize or eliminate member exposure to bloodborne/airborne pathogens and other potentially infectious materials (OPIM). B. SCOPE: This General Order shall apply to all HCPD members. C. POLICY: It shall be the policy of the HCPD to attempt to provide a safe working environment for all members. D. PROCEDURE: 1. Responsibilities: a. It shall be the responsibility of all supervisory members to ensure that members under their command are cognizant of the dangers of bloodborne/airborne pathogens and OPIM exposure. Each supervisor shall advise their members which category risk level their job falls into. b. It shall be the responsibility of the Quartermaster to maintain personal protective equipment (PPE) suitable to minimize or eliminate member exposure to bloodborne/airborne pathogens and OPIM. c. The HCPD shall offer instruction and/or information concerning the dangers of exposure to bloodborne/airborne pathogens and OPIM. It shall be the responsibility of members who may be at risk of exposure through their job classification to maintain a working knowledge of the risks involved and the preventative measures to follow. It shall be the responsibility of members to utilize PPE made available to them by the agency. d. The Community Services Division Lieutenant is responsible for the documented annual review of the Exposure Control Plan. The Community Services Division Lieutenant shall update or modify the Plan to reflect new or modified procedures or changes designed to eliminate or minimize occupational exposure. e. Human Resource is responsible for ensuring all officers, and other job classifications at foreseeable risk, receive a pre-employment examination which tests for any evidence of hepatitis or tuberculosis (TB). f. The member is responsible for obtaining the vaccination(s) at the Occupational Health Center, Inc., or other approved provider, within the prescribed time frames. 2. Exposure Determination: a. Presumptive Law (Section , F.S.), as it pertains to officers, requires a pre-employment physical examination that tests for and fails to reveal any evidence of hepatitis or TB. An officer who suffers a condition or impairment of health that is caused by hepatitis, meningococcal meningitis, or TB, that requires medical treatment, and that results in total or partial disability or death shall be presumed to have a disability suffered in the line of duty, unless the contrary is shown by competent evidence. However, in 1
2 2 G.O order to be entitled to the presumption, the officer must, by written affidavit as provided in Section 92.50, F.S., verify by written declaration that, to the best of their knowledge, there has been neither exposure nor engagement in unsafe practices outside the scope of their employment, as enumerated in Section , F.S. b. Members employed by this agency have varying risk levels of occupational exposure due to the nature of their tasks. The risk of occupational exposure occurs as a result of the nature of the work assignment. Some examples include: 1) Interaction with injured and bleeding individuals; 2) Attendance at crime scenes where blood and body fluids are present; 3) Collection of evidence at crime scenes; 4) Attendance at autopsies; and 5) Handling packaging which contains blood, urine, or body fluids (liquid or dried). c. The following job classifications in the HCPD all have occupational exposure based on foreseeable risk and shall have a pre-employment examination that tests for any evidence of hepatitis or TB: 1) All Sworn Officers; 2) Crime Scene Analysts; 3) Public Safety Aides; and 4) Custodian. d. These positions may be routinely exposed to biohazardous materials. All job classifications within the agency shall be classified by the following categories: Blood and Viral Pathogen Risk Category: 1) Minimal Risk; and 2) Foreseeable Risk. e. Other positions in the HCPD have the potential for occupational exposure, however, not on a routine basis. 3. Exposure Control Practices: a. Universal Precautions shall be used to prevent contact with potentially infectious materials. Universal Precautions means an approach to infection control. According to the concept of Universal Precautions, all human blood and certain human body fluids are treated as if known to be infectious for bloodborne/airborne pathogens and OPIM. b. The Hepatitis A (HAV) and Hepatitis B (HVB) vaccinations are voluntary and shall be provided to those experiencing occupational exposure at no cost to the member. A licensed physician or a licensed health care professional shall provide vaccines at a reasonable time and place. 1) The HAV and HVB vaccinations shall be made available for any member at risk of occupational exposure, after receipt of infectious diseases training and within ten (10) days of initial assignment,
3 3 G.O including transfers, unless medically contraindicated or the member has previously received the series of preventive immunizations. 2) Members declining to participate shall sign an acknowledgement of their declination. 3) If a member declined the original offer of vaccination(s), they shall receive the vaccination(s) if they decide to accept them at a later date. 4) If, at a later date, the U.S. Public Health Service or attending physician recommends a booster shot, that shall be offered by the HCPD. 5) The Hepatitis A and/or B Vaccination Election (HCPD Form 233) shall be used to document the members who receive the vaccination, as well as those who decline the vaccination. This form shall be maintained in the member s confidential file within Human Resources. 6) Those members at risk who separate employment are requested to be tested for TB and hepatitis before their exit to ensure they have not had occupational exposure. c. Exposure is minimized by use of the following engineering controls: 1) Biohazard boxes shall be used for all potentially infectious waste. 2) Biohazard sharps containers shall be used for potentially contaminated sharps. 3) Transport containers shall be used to transport or mail evidence. 4) Hand washing facilities are readily accessible; otherwise an appropriate antiseptic alternative is available. d. Exposure reduction is achieved through the following work practice controls: 1) Skin should be washed with soap and water as soon as feasible after removal of personal protective equipment or following contact with potentially infectious materials. 2) Extreme care shall be taken with syringes or other sharps. All syringes are assumed to be contaminated with HBV and Human Immunodeficiency Virus (HIV). Syringes are to be handled only when necessary; no recapping or needle bending shall be done unless using a mechanical device. Member safety is of paramount importance when handling sharps. Syringes should be placed in the provided safe syringe containers or, if discarded, placed in the appropriate sharps containers. (Refer to the Evidence Submission Manual) 3) There shall be no eating, drinking, applying cosmetics, or handling contact lenses in areas where there is the potential for occupational exposure. 4) No food or drink shall be stored in refrigerators, freezers, or other surfaces where potentially infectious materials are present. 5) Infectious materials are to be contained in leak-proof packaging. Bloodstained clothing, bedding, etc., should be air-dried before being stored in biohazard bags. 6) If outside biohazard containers or other packaging is contaminated, it must be placed in a secondary package which meets the regulations. 7) The container for storage, transport, or shipping shall be labeled with the biohazard symbol. The label shall be orange or orange-red with lettering or symbols in a contrasting color.
4 G.O ) Appropriate biohazard labels shall be affixed to biohazard waste containers, refrigerators, freezers, and other containers used to hold biohazardous materials. 9) Members shall be provided with appropriate protective equipment to prevent potentially infectious materials from reaching their person or their clothing. This equipment shall be accessible and maintained to provide the necessary effectiveness. 4. Personal Protective Equipment (PPE): a. When there is occupational exposure, appropriate PPE shall be used by members, unless the agency shows that a member temporarily and briefly declined to use PPE under limited extenuating circumstances. When the member makes this judgment, the circumstances shall be investigated and documented in order to determine whether changes can be instituted to prevent such occurrences in the future. b. PPE is considered "appropriate" only if it does not permit blood or OPIM to pass through or reach a member'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 is used. c. Accessibility: PPE shall be: 1) Provided, repaired, replaced, cleaned, laundered, and disposed of at no cost to the member; and 2) Placed in areas accessible to any member required to use them. d. Contamination: 1) Contaminated PPE shall be: a) Removed immediately, if the garment is penetrated by blood or OPIM; b) Removed immediately at the completion of the task; and c) Placed in a water-soluble biohazard bag for holding contaminated garments (e.g., uniforms, personal clothing) to be laundered or, if not to be reused, disposed of in biohazardous waste receptacles. Water-soluble biohazard bags shall be made available for issue to all members by the Quartermaster. 2) No contaminated garments are to be taken home by a member for laundering. Garments that have been placed in a water-soluble biohazard bag shall be taken to the Quartermaster. The Quartermaster shall contact a designated cleaner for pick-up and laundering. 3) If available, a replacement garment(s) shall be issued to the member. e. Gloves: 1) Gloves shall be worn when it can be reasonably anticipated that a member may have hand-contact with blood or OPIM or when handling or touching contaminated items or surfaces. Disposable (singleuse) gloves such as surgical or examination gloves shall be replaced as soon as practical when contaminated, or as soon as feasible if they are torn, punctured, or when their ability to function as a barrier is compromised. Disposable (single-use) gloves shall not be washed or decontaminated for reuse. 4
5 5 G.O ) Utility gloves may be decontaminated for reuse if the integrity of the glove is not compromised. Utility gloves 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. f. Face Protection - Masks, Eye Protection and Face Shields: Masks, in combination with eye protection devices such as goggles or glasses with solid side shields, or chin-length face shields, shall be worn whenever splashes, sprays, spatters, or droplets of blood or OPIM may be generated and eye, nose, or mouth contamination can be reasonably anticipated. g. Disposable Coveralls, Aprons, and Other Protective Body Clothing: Appropriate protective clothing such as, but not limited to, disposable coveralls, aprons (used exclusively in, and removed as exiting exposure areas), or other similar garments shall be worn in occupational exposure situations. The type and characteristics depend upon the task and degree of exposure anticipated. Surgical caps and/or hoods and shoe covers shall be worn in instances when gross contamination can reasonably be anticipated. 5. Personal Protection Levels: a. Some routine tasks or procedures subject the member to greater degrees of exposure than others. The greater the degree of exposure, the greater the level of PPE required for safe work performance. Levels of personal protection can be characterized by the materials required for use during the specific task or procedure. 1) Level 0: a) Task - Administrative functions; contact with sealed intact evidence. b) Protection - None. 2) Level I: a) Task - Crime scenes with little or no bodily fluids. b) Protection - Double gloves, disposable gowns or coveralls. 3) Level II: a) Task - Crime scenes where bodily fluids must be collected. b) Protection - Double gloves, disposable gowns or coveralls, face protection. 4) Level III: a) Task - Rendering first aid with excessive blood loss; interaction with injured and bleeding individuals; cleaning of biological spills; present at autopsies and crime scenes. b) Protection - Double gloves, disposable coveralls, disposable face shields, and shoe covers, at minimum. b. All members performing tasks at Levels I, II, or III shall have access to a biohazard waste disposal container. 6. Exposure Incidents: a. Post-exposure and follow-up evaluations for those members who experience incidents or exposures to human blood or other potentially hazardous body fluids:
6 G.O ) A member has the right to a confidential medical evaluation and follow-up attention. 2) When possible, the member shall take the source person to the nearest emergency room at the time of exposure. The member shall attempt to obtain consent from the source person before proceeding to the hospital for both the member and the source person to receive testing. The consent will allow the member to obtain the source person's test results. 3) With the member's consent, the health care professional shall provide a post-exposure evaluation, which consists of drawing blood from the member for a baseline test. If the member gives consent for the blood to be drawn, but not tested, the blood shall be preserved for a minimum of ninety (90) days. The member can authorize the blood to be tested at any time within the ninety (90)-day period. a) Should the source person decline authorization to be tested, the Community Services Division Lieutenant shall be contacted immediately to obtain a court order requiring the source person to be tested for all bloodborne pathogens. The court order shall require medical personnel who perform such testing to provide the test results of the source person. b) The City Attorney shall prepare the court order. The Community Services Division Lieutenant shall present the City of Haines City Accident Statement, the Exposure Report (HCPD Form 236), the Petition for Screening for Communicable Diseases (HCPD Form 234), and all reports pertaining to the exposure to the City of Haines City Attorney for the completion of the court order, pursuant to Section , F.S. b. Any exposure incident shall be immediately reported by the member's immediate supervisor to the current Workers' Compensation carrier. The member's immediate supervisor shall make arrangements for the delivery of the completed City of Haines City Accident Statement, a copy of any written reports, and a completed Exposure Report to the Community Services Division Lieutenant. 1) Upon receipt of the report of the exposure from the member's immediate supervisor, the Community Services Division Lieutenant shall perform the following tasks: a) Obtain all associated reports and documents from the member's immediate supervisor. b) Ensure copies of all exposure records and medical documentation are delivered to Human Resources for inclusion in the member's confidential file, as required by the State of Florida General Records Schedule, and in accordance with Health Insurance Portability and Accountability Act (HIPAA) compliance guidelines. 2) The Community Services Division Lieutenant shall deliver the City of Haines City Accident Statement and all associated original reports and documents to Human Resources, within twenty-four (24) hours or the next regular business day. a) Failure to comply with this requirement could result in the agency being monetarily fined by the Division of Workers' Compensation, loss of benefits for the affected member, and disciplinary action. 3) Subsequently, the exposed individual and their supervisors shall evaluate the situation and provide suggested preventative measures and corrective actions. These suggested actions shall be forwarded to the Captain. 7. Decontamination Procedures: a. If blood or OPIM are spilled, the area shall be cleaned and sanitized before it can be utilized. 1) PPE shall be worn during cleanup. 6
7 G.O ) Removal of blood spills or OPIM: a) Small spills: Paper towels or powders/granules designed for that purpose shall be used to cover or pick up vomit or other body liquid spills. All materials shall be placed in a red biohazard bag for disposal. b) Large spills: Appropriate TB effective disinfectant shall be added to the spill area and allowed ten (10) minutes of contact time before the aforementioned powder or granule absorption process is begun. All materials shall be placed in a red biohazard bag for disposal. 3) Disinfecting after removal: a) Small spills: The spill area shall be sprayed with a TB effective disinfectant spray and allowed ten (10) minutes of contact time. The surface area shall then be allowed to air dry. b) Large spills: The spill area shall be mopped with an appropriate TB effective disinfectant and allowed ten (10) minutes of contact time. Any remaining spill shall be removed with a mop and bucket. The leftover disinfectant mixture shall be discarded. The surface shall then be allowed to air dry. The mop heads shall be laundered using appropriate settings to sanitize them, or if warranted, the mop heads shall be disposed of in a red biohazard bag. b. All PPE that was worn shall be disposed of in a red biohazard bag. Members that were involved in a cleanup shall utilize proper hand washing techniques. c. The work environment shall be maintained in a clean and sanitary condition. 8. Training: a. The Patrol Division Lieutenant shall be responsible for maintaining a current Lesson Plan on file regarding the Exposure Control Plan for Bloodborne/Airborne Pathogens and OPIM. b. Members shall receive training with regard to this standard at the time of initial assignment and on an annual basis thereafter. Additional training shall be required when members' tasks are updated or changed to a different level of occupational exposure. c. Records of the training shall be maintained for three (3) years and shall include contents or summary of the training session, names and qualifications of persons conducting the training, and names and job titles of all members attending. d. The training program shall provide members with the following: 1) A general explanation of the epidemiology and symptoms of bloodborne diseases; 2) An explanation of the modes of transmission of bloodborne pathogens and OPIM; 3) Information about HVB and the HVB vaccination program; 4) Information concerning the use of methods to prevent or reduce exposure, including appropriate engineering controls, work practices, and PPE; 5) A review of this General Order; 6) Information concerning how to identify situations and activities which could provide exposure to blood or OPIM; 7
8 G.O ) Information concerning exposure control procedures and familiarization with the agency s biohazardous waste disposal procedures; 8) An explanation of the proper procedures to follow if an exposure occurs, including post exposure follow-up; 9) Recognizing the international bio-hazardous waste symbol; 10) Access to a copy of Occupational Safety and Health Administration (OSHA) regulations; and 11) An opportunity to have questions answered. 9. OSHA Bloodborne Pathogen Regulations: A copy of sub-part Z of title 29 of the Code of Federal Regulations part Bloodborne Pathogens can also be found at: or in hard copy format in the HCPD Library. E. GLOSSARY: ACCIDENT - Any unplanned action or event which results in injury to an individual, or damage to equipment or an instrument. BIOHAZARD - Any biological agent or substance present or arising from the work environment which presents or may present a hazard to the health and/or well-being of the worker and/or the community, if biological in source, and capable of producing harmful effects on other biological organisms. "BIOHAZARD"- LABELED - Affixed with a label containing the word "Biohazard," the symbol for biohazard and bearing fluorescent orange or orange-red or predominantly so, with lettering or symbols in a contrasting color. BIOHAZARD WASTE - Any solid waste or liquid waste which may present a threat of infection to humans. Biohazard waste may be divided into two (2) types: Infectious Waste and Hazardous Infectious Waste. BIOHAZARDOUS WASTE BOX - A "Biohazard"-labeled cardboard box lined with a properly labeled red bag. These containers are provided by the biohazard waste disposal contractor. The contractor must meet all existing state and federal regulations regarding the handling and disposal of biohazardous waste. BLOODBORNE PATHOGENS - A virus that is 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) in all of its forms. BODY FLUIDS - Those fluids of biological origin which have the potential to harbor pathogens. CONTAMINATED - Any item which may contain a hazardous material or substance. Items which have had direct contact with body fluids, body parts and/or hazardous chemicals. CONTAMINATED LAUNDRY - Laundry which has been soiled with blood or OPIM. DECONTAMINATION - The use of physical or chemical means to remove, inactivate, or destroy bloodborne pathogens and OPIM on a surface or item to the point where they are no longer capable of transmitting infectious particles and the surface or item is rendered safe for handling, use, or disposal. DISINFECTION - A process that destroys or irreversibly inactivates infectious microorganisms. DOCUMENTATION - A written record or report. 8
9 9 G.O ENGINEERING CONTROLS - Controls (e.g., sharps disposal containers, hoods) that isolate or remove bloodborne pathogen hazards from the workplace. EXPOSURE AREAS - Rooms in which occupational exposure to bloodborne pathogens is a part of routine duties. EXPOSURE INCIDENT - A specific eye, mouth, other mucous membrane, non-intact skin, or parenteral contact with blood or OPIM that results from the performance of a member's duties. EXPOSURE OR EXPOSED - Any situation in which a member may inhale, absorb through the skin or eyes, accidentally ingest, or otherwise come into contact with a hazardous substance. FORESEEABLE RISK - The probability of occupational exposure that may place a member at risk of infection that is incurred when a member is performing the basic duties associated with their employment. HAZARDOUS INFECTIOUS WASTE - All infectious waste that is potentially harmful if released into the environment without first being sterilized such as scalpel blades, needles, syringes, glass tubes, pipettes. INCIDENT - The occurrence of a safety hazard. INFECTIOUS WASTE - All materials that may be suspected of harboring pathogenic organisms, e.g., disposable gloves and glassware, blood tubes, sweeping papers, packaging which has been saturated with a body fluid, containers used for transportation of body parts, body fluids, and human remains. LIMITED EXTENUATING CIRCUMSTANCES - An unexpected attack by a bleeding suspect at a scene or a sudden unexpected change in the source individual s status. NEXT REGULAR BUSINESS DAY - Monday through Friday from 8:00 a.m. - 5:00 p.m., with the exception of city-appointed holidays that occur on these days. OCCUPATIONAL EXPOSURE - Reasonably anticipated skin, eye, mucous membrane, or parenteral contact with blood or OPIM that may result from the performance of a member's duties. OTHER POTENTIALLY INFECTIOUS MATERIALS (OPIM) - Any human body fluid, tissue, or organ other than intact skin. Any biologic agent or other disease causing agent which upon exposure, ingestion, inhalation, or assimilation into any person, will or may reasonably be anticipated to cause disease or death. PARENTERAL - Piercing mucous membranes of the skin barrier through such events as needle sticks, human bites, cuts, abrasions, etc. PROPHYLAXIS - Protective treatment for or prevention of disease. SHARPS - Any devices with physical characteristics capable of puncturing, lacerating, or otherwise penetrating the skin, e.g., knives, syringes. SHARPS CONTAINER - A closable puncture-resistant container, which is leak-proof on the sides and bottom. The container must also be "Biohazard"-labeled and be designed primarily for the containment of sharps. This precludes the use of milk jugs, coffee cans, or other types of unapproved containers. This container is used to hold used contaminated sharps until disposal of the filled container. No reusable containers are used for this purpose. SOURCE PERSON - Any person, living or dead, whose blood or OPIM may be a source of occupational exposure to a member. Examples include, but are not limited to: human remains, hospital and clinic patients, clients in institutions for the developmentally disabled, trauma victims, clients of drug and alcohol treatment facilities, residents of hospices and nursing homes, and individuals who donate or sell blood or blood components. STERILIZATIONS - A process which destroys all micro-organisms.
10 G.O TRANSPORT CONTAINER - A closable, puncture-resistant container which is leakproof. The container must also be "Biohazard"-labeled. This container is used to transport or mail evidence and may consist of a plastic bag-lined cardboard box. UNIVERSAL PRECAUTIONS - An approach to infection control. According to the concept of Universal Precautions, all human blood and certain human body fluids are treated as if known to be infectious for bloodborne pathogens and OPIM. WORK AREA - An area where biohazardous materials are produced, examined, or utilized. WORK PRACTICE CONTROLS - Practices that reduce the likelihood of exposure by altering the manner in which a task is performed. F. ACCREDITATION STANDARDS: CALEA (none) DRAFTED:428/042114//Filed:100.3 AMENDED: May 13, 2014 APPROVED: RICHARD H. SLOAN HAINES CITY POLICE DEPARTMENT 10