Destination Healthcare Staffing s Bloodborne Pathogen Exposure Control Plan & Basic Safety Guidelines (OSHA Guidelines)

Destination Healthcare Staffing s Bloodborne Pathogen Exposure Control Plan & Basic Safety Guidelines (OSHA Guidelines) Destination Healthcare Staffing will provide a written copy of our Bloodborne Pathogen Exposure Control Plan and general safety guidelines for each employee to review prior to the start of their assignment. Each facility contracted with Destination Healthcare Staffing for healthcare professionals may have specific pre-employment physical requirements. Healthcare workers working in high-risk areas may be asked for proof of immunizations or titer for a specific disease or illness. Destination Healthcare Staffing follows the CDC requirements for immunization and titers. Hepatitis B inoculation or a declination form is required on all employees. TB documentation and annual TB skin testing is also required on all employees. Your staffing coordinator will let you know exactly what is required for your specialty allied health profession and/or any given assignment. The OSHA Bloodborne Pathogen Standard applies to all employees with routine occupational exposure to blood or other potentially infectious materials. Destination Healthcare Staffing employees should receive safety and OSHA training specific to each facility during their orientation program by the contracted facility in compliance with local, state, and federal guidelines. Destination Healthcare Staffing employees on assignment at a contracted facility will be responsible for following the established safety rules and protocols. It is their responsibility to ask questions and seek answers for any safety rule or OSHA standard that is unclear and to do so prior to undertaking the task in question. Destination Healthcare Staffing employees should know and be able to carry out all facility emergency practices as outlined in their orientation to the facility/unit. Questions in regard to Destination Healthcare Staffing s Exposure Control Plan or the OSHA Bloodborne Pathogen Standard can be directed to Christopher Rock, RN, in Destination Healthcare Staffing s QI/RM Department, at (800) 453-3030, ext. 6461. He should be able to respond to any concerns or questions the employee may have in regard to OHSA s Bloodborne Pathogen Standard. At the end of this reading, a short test will be required and tested. This training will be provided and redone on an annual basis to ensure the employee receives annual re-training, as per the OSHA requirement. EXPOSURE DETERMINATION: EMPLOYEES AT RISK In compliance with OSHA s Bloodborne Pathogens Standard, 29 CRF 1910.1030, Destination Healthcare Staffing, the employer, has identified the following Destination Healthcare Staffing general STAFFING positions to be at risk for exposure to blood or other potentially infectious materials while on assignment at a host facility. AUDIOLOGIST CERTIFIED MEDICAL ASSISTANT CERTIFIED NURSING ASSISTANT CERTIFIED SURGICAL TECHNICIAN CYTOTECHNOLOGIST HISTOTECHNOLOGIST LAB PERSONNEL (LAB TECH, PHLEBOTOMIST, ETC.) LICENSED PRACTICAL NURSE MEDICAL ASSISTANT MEDICAL TECHNICIAN MENTAL HEALTH TECH NURSE PRACTITIONER PHARMACISTS PHYSICIAN ASSISTANT RADIOLOGIC SCIENCE PROFESSIONAL REGISTERED NURSE RESPIRATORY CARE (RTT, CRRT, POLYSOMNOGRAPHER, SLEEPTECH, ETC.) SURGICAL TECHNICIAN THERAPY ASSISTANT PERSONNEL (PT AND OT ASSISTANTS) THERAPY PERSONNEL (PT, SLP, OT) Page 1 of 1 Destination Healthcare Staffing 2003

COMPLIANCE METHODS UNIVERSAL PRECAUTIONS Universal precautions are the required method of control to protect employees from exposure to all human blood. The term universal precautions refers to a concept of bloodborne disease control that requires that all human blood and certain human body fluids be treated as if known to be infectious for HIV, HBV, and other bloodborne diseases. All Destination Healthcare Staffing healthcare workers should adhere to universal precautions. Universal precautions apply to all body fluids, including blood, mucous membranes, and other body fluids including semen, vaginal secretions, wound drainage, cerebrospinal fluid, etc. DO S AND DONT S OF UNIVERSAL PRECAUTIONS DO wash your hands with soap, running water, and friction prior to patient contact, immediately following patient contact, between patients, and after removing gloves. Wash hands immediately after contact with blood or any body fluids to which universal precautions apply. DO wear gloves when coming in contact with blood, body fluids containing visible blood, and other body fluids to which universal precautions apply. DO wear gloves when handling contaminated articles: lab specimens, dressings, linen, etc. DO protect yourself from potentially infected materials by wearing gloves if you have any minor cuts, scratches, or dermatitis of the hands. DO wear masks, gowns, and/or goggles in addition to gloves, to protect yourself during procedures that may involve splashing of blood and/or contaminated body fluids. DO prevent injuries from needles, scalpels, and other sharp instruments. DON T recap used needles. DON T bend or brake used needles. DO place used disposable syringes, needles, and sharp items into a puncture-resistant container. DON T disregard an accidental needle stick or other exposure such as a splash to the eyes or mouth. DO cleanse the site thoroughly with soap and water, contact the appropriate in-site personnel, and notify Destination Healthcare Staffing. DO clean all blood and body fluids spills promptly. Use detergent and water followed by a disinfecting solution. DO dispose of articles (used gloves, dressing, bandages, etc.) contaminated with blood or body fluids into a plastic red bag. Double bag if highly saturated. DO treat all linen and clothing soiled with blood or body fluids (to which universal precautions apply) as infectious. Employ universal precautions when handling contaminated linen and clothing. CONTAMINATED EQUIPMENT Contaminated equipment that is reusable should be cleaned of visible organic material, placed in a puncture resistant container, and returned to central hospital supply or to some other designated place for decontamination and reprocessing. Instruments and other reusable equipment used in the performance of an invasive procedure should be disinfected and sterilized using the following recommendations. Equipment and devices that enter the patient s vascular system or other normally sterile areas of the body should be decontaminated and sterilized prior to use on each patient. Equipment devices that touch intact mucous membranes but do not penetrate the patient s body surfaces should be decontaminated and sterilized prior to use on each patient. Contaminated work surfaces should be decontaminated with an appropriate disinfectant after completion of procedures immediately or as soon as feasible 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. REGULATED WASTE DISPOSAL Host facilities, following federal guidelines, will have procedures for compliance outlined in their employee exposure plan. Specimens of blood or other potentially infectious materials should be placed in containers that prevent leakage during collection, handling, processing, storage, transport, or shipping. All containers need to be labeled with the international biological hazard symbol and the wording Biohazard. The biohazard labels should be fluorescent orange or orange-red with the lettering in contrasting colors. The labels must be affixed to the containers by string, wire, adhesive, or any method that prevents the label s loss or unintentional Page 2 of 2 Destination Healthcare Staffing 2003

removal. Red bags or red containers may be used in place of labels. If universal precautions are utilized in the handling of all specimens, the labeling or color coding system is not necessary, provided the containers are recognizable as containing specimens. A secondary container is needed if outside contamination of the primary container occurs. If specimens will puncture the primary container, they need to be placed within a secondary container, which is puncture resistant. ENGINEERING AND WORK PRACTICE CONTROLS Destination Healthcare Staffing employees are required to dress safely and sensibly in appropriate hospital unit attire to decrease the risk of accident or injury. All unsafe equipment should be reported immediately to the supervisor and steps taken to prevent accidental injury. Unsafe working conditions, an unsafe environment, or unsafe practices should be reported to the facility supervisor and to Destination Healthcare Staffing. Destination Healthcare Staffing employees are responsible for maintaining a safe work area. HEPATITIS B VACCINE It is the intent of this policy to prevent the spread of Hepatitis B to employees of Destination Healthcare Staffing. All currently employed Destination Healthcare Staffing personnel having occupational exposure to blood and potentially infectious materials have the right to receive the Hepatitis B vaccination series. Each employee will be asked to complete a Consent/Refusal form, which will become part of the employee s personnel file. A record of the inoculation series or refusal of such will be kept thereon and will become part of the employee s personnel file. Any employee requesting Hepatitis B vaccination will receive compensation for the inoculation series only after completion of all three injections. The employee will be required to provide receipts in order to be reimbursed for the cost of the vaccination. ABOUT THE DISEASE Hepatitis B is a systemic viral infectious disease affecting the liver. An estimated 300,000 people in the United States are infected each year. The incubation period for Hepatitis B is relatively long; symptoms can be mild and completely without outward symptoms, or it can be severe, prolonged, and possibly fatal. Most infected individuals have no symptoms until years later, but can continue to transmit the infection to others as carriers. Transmission of the disease occurs primarily through contact with blood and body fluids. Hepatitis B can also be passed from a mother who has the virus to her unborn child. As an employee working in a hospital or other health care facility, you are five to ten times greater at risk than the general population due to your frequent direct and indirect contact with blood and other bodily fluids such as urine, bile, tears, saliva, wound drainage, vaginal secretion, and blood. Possible routes of exposure to blood and body fluids include accidental puncture wounds or cuts, and splashes to the eye or mouth. ABOUT THE VACCINE A vaccine is available for protection against the Hepatitis B virus and consists of biochemically and biophysically inactivated human Hepatitis B surface antigen particles. The vaccine for Hepatitis B will not prevent other forms of Hepatitis, such as Hepatitis A or Hepatitis C. Full immunization requires a three-stage process, consisting of an intramuscular dose of the vaccine initially, then a second and third dose given one and six months later. The vaccine provides immunity in more than 95% of its recipients. The vaccine has not been proven to be totally effective for all persons receiving the vaccine, with a non-effectiveness rate of approximately 5%. Testing for immunity at least 2 months post-vaccination is the only way to confirm immunity. If immunity has not developed after the three standard doses, a booster dose should be given. SIDE EFFECTS AND PRECAUTIONS The incidence of side effects from the vaccine is low, but includes soreness and redness at the injection site, low grade fever, headache, nausea, fatigue, vertigo, rash, and joint pain. The most common form of the vaccine can cause adverse reactions in certain individuals who have yeast sensitivities. Any adverse reaction to the vaccine must be reported and the employee should seek follow-up medical care. As with any vaccine or medical treatment, more serious side effects may be a possibility, but have not been reported and are not expected. The Following groups of people should not receive the vaccine: persons with bleeding disorders, persons with severe heart or lung disease, persons with active infection or febrile illness, persons receiving immunosuppressive therapy, pregnant or nursing women (unless approved in writing by personal physician), and persons with hypersensitivity to yeast or any vaccine component. Page 3 of 3 Destination Healthcare Staffing 2003

POST-EXPOSURE FOLLOW-UP The first step following any exposure incident is to thoroughly cleanse the area with soap and water. All Destination Healthcare Staffing employees receiving an occupational exposure (e.g., needle stick, etc.) should report the exposure to the appropriate facility supervisor or on-site personnel so that he/she can follow facility s protocols governing bloodborne pathogen exposure follow-up. All exposure incidents should also be reported to Destination Healthcare Staffing as soon as possible, either through your staffing coordinator. The employee will then receive instruction on how to follow-up with Destination Healthcare Staffing s HR department in Salt Lake City to officially report the exposure injury to us and to receive information in regard to Worker s Compensation, as necessary. Following reporting of an exposure incident to the facility and Destination Healthcare Staffing, the exposed employee shall obtain a confidential medical evaluation and follow-up by their personal physician. Destination Healthcare Staffing will maintain all records regarding an exposure incident. HAZARD COMMUNICATION STANDARD About 32 million workers are potentially exposed to one or more chemical hazards. Chemical exposure may cause or contribute to many serious health effects such as heart ailments, kidney and lung damage, sterility, cancer, burns, and rashes. Some chemicals may also be safety hazards and have the potential to cause fires and explosions and other serious accidents. In 1983, the Occupational Safety and Health Administration (OSHA) issued a rule called Hazard Communication that applies to employers in the manufacturing sector of industry. The scope of the rule was expanded in 1987 to include employers in the non-manufacturing sector of industry. (Federal Register 52 (163): 31886, August 24, 1987.) The basic goal of the standard is to ensure that employers and employees know about chemical hazards and how to protect themselves. This knowledge, in turn, should help to reduce the incidence of chemical source illnesses and injuries. IT IS THE LAW TO KNOW AND UNDERSTAND THE POTENTIAL DANGERS OF HANDLING CHEMICALS. The healthcare facility you are working in should provide information on: All hazardous chemicals you may come in contact with in the work environment. Where to locate the Material Safety Data Sheets (MSDS) on hazardous chemicals. System of labeling used in the healthcare facility to identify hazardous chemicals. Updates and training on hazardous chemicals. Information on protective measures for use with hazardous chemicals. Written employee exposure plan and emergency measures. PROTECT YOURSELF BY: Check with your supervisor if you are not familiar with a chemical or a procedure utilizing the chemical. Always read the label. Ask for the MSDS on any chemical you have questions about. Be familiar with the emergency steps for exposure. Wear protective clothing, masks, gloves, radiation detector badges. Wash your hands before and after procedures. Follow guidelines for removing protective clothing. Take note of all posted warnings or instructions. Transport hazardous materials safely. Follow precaution when working around radiation; take care to avoid unnecessary exposure. Only work in well-ventilated areas when using or mixing chemicals. Always use and follow universal precautions. FIRE AND ELECTRICAL SAFETY Fire prevention is YOUR responsibility, as well as every other employee! Common causes of fire are careless smoking, pressurized oxygen, flammable liquids and gases, and electrical equipment. Follow and enforce all hospital smoking regulations to patients, employees, volunteers, delivery personnel, non-facility workers and hospital visitors. Follow label direction when using and storing flammable liquids and gases. Never smoke around oxygen. Store cylinders in appropriate areas. Electricity can start a fire, shock, burn or kill. Remember, electricity passes from the power source to the equipment through a conductor, the conductor is the electrical cord. If the electrical cord is damaged, the power source will look for other elements to carry the electricity to the equipment. Page 4 of 4 Destination Healthcare Staffing 2003

Skin, body fluids, metal, YOU, may become the conductor if there is a fault in the cord. Always inspect safety equipment prior to use. *Never use a cord that is frayed, split or has bare wire exposed. Cords that feel warm to touch should not be used. REPORT faulty equipment conditions to your supervisor immediately. Be especially careful of equipment a patient may bring from home, if allowed. Remove the cord from the wall socket by grasping the plug. NEVER YANK ON THE CORD! Plugs should fit firmly into the outlet, never bend the prongs. Avoid using extension cords if possible. Before using one, be sure its use does not exceed its specified amperage load (consult the appropriate facility technical personnel for approval). Never piggyback extension cords and do not plug more than one extension cord into an outlet. Report any minor shocks or tingling sensation to your supervisor immediately and do not use the equipment. Keep the work area dry around electrical equipment. Dry your hands prior to touching electrical equipment. Do not touch patients and electrical equipment at the same time. Remember, patients have wet dressing, pads and catheters that may make them sensitive to electric shock. All staff should know the location of the fire alarms in their work area, and should be trained to operate them in the dark. All staff should know the location of portable fire extinguishers in their work areas and know how and when to use them. If a fire breaks out, stay calm to set an example for patients. Report the fire, following the facility s procedures and policies. Move patients who are in immediate danger away from smoke or flames. DEFIBRILLATOR GUIDELINES (for those employees where this applies) Make sure the patient s chest is dry to ensure proper condition. Make sure you are standing on a dry surface and you are not touching any metal or the patient s body surface. Paddles should be dry prior to applying the gel. Shut off oxygen prior to defibrillation to prevent electrical sparks or explosion. ERGONOMICS Destination Healthcare Staffing employees are responsible for demonstrating proper body mechanics for lifting and transfer of patients and equipment within their duties. Musculoskeletal disorders (MSD) can result from using improper body mechanics when moving or assisting a patient or when handling heavy equipment. Symptoms are physical indications that an employee may be developing an MSD. Symptoms vary in severity, depending on the amount of exposure to MSD hazards. Examples of MSD symptoms include numbness, burning, pain, tingling, cramping, and stiffness. OSHA has a proposed standard (not finalized yet) that requires MSD be reported to the employer. If you sustain any type of MSD, this should be reported to Destination Healthcare Staffing through your staffing coordinator. If an injury is sustained, the employee will then receive instruction on how to follow-up with Destination Healthcare Staffing s HR department. If an injury is sustained, the employee will be referred to a health care practitioner (HCP). The HCP should inform the employee about other physical activities that could aggravate the MSD during the recovery period. When the employee returns to works, he/she should then be careful in using proper mechanics when lifting patients or equipment so that they do not re-aggravate the injury. Page 5 of 5 Destination Healthcare Staffing 2003

DESTINATION HEALTHCARE STAFFING ALLIED HEALTH PROFESSIONAL BLOODBORNE PATHOGEN STANDARD POST-TEST Name: Title: Date: Score Please complete this test and return it to Destination Healthcare Staffing. Check the correct answer. 1. Hepatitis B is spread by sexual contact, sharing of needles, through infected blood and blood products, and from an infected female to her unborn child. TRUE FALSE 2. Healthcare workers are currently at risk for exposure to: A. Hepatitis B virus B. HIV C. Both A and B 3. Universal precautions apply to: A. Blood B. Body fluids with visible blood C. Mucous membranes D. Other body fluids including semen, vaginal secretions, cerebrospinal fluid, etc. E. All of the above 4. Hand washing should be done: A. Prior to patient contact B. After removing gloves C. Immediately following patient contact and between patients D. All of the above 5. To protect against needle stick injury: A. Recap used needle; dispose immediately into a puncture-resistant container B. Do not recap used needle; dispose immediately into a puncture-resistant container Page 6 of 6 Destination Healthcare Staffing 2003

6. If a needle stick or other exposure injury occurs to you, the healthcare worker should: A. Cleanse the site thoroughly with soap and water B. Notify the appropriate facility supervisor or personnel C. Notify Destination Healthcare Staffing D. All of the above 7. Gloves need not be changed before caring for the next patient. TRUE FALSE 8. Hepatitis B vaccination provides guaranteed immunity to the Hepatitis B virus. TRUE FALSE 9. The OSHA Bloodborne Pathogen Standard applies to: A. All routine employees with occupational exposure to blood or other infectious materials B. MDs and nurses only 10. Universal precautions do not apply to soiled clothing or linen. TRUE FALSE Page 7 of 7 Destination Healthcare Staffing 2003

DESTINATION HEALTHCARE STAFFING ALLIED HEALTH PROFESSIONAL CONFIRMATION OF OSHA TRAINING I hereby certify that I have received and reviewed a copy of Destination Healthcare Staffing s OSHA Bloodborne Pathogen Exposure Control Plan, and Destination Healthcare Staffing has provided me written instruction and training in regard to the OSHA standard. NAME: TITLE: SIGNATURE: DATE: Additionally, I certify that (if applicable) I have received OSHA Bloodborne Pathogen training previously, as follows: Date of Instruction: / / Location: Instructor: *Please sign and return this form to your Destination Healthcare Staffing representative Page 8 of 8 Destination Healthcare Staffing 2003