BOOK: Operations II SECTION: Exposure Control (CAPTAIN NOTES) Page 1 of 3

Exposure Control
(Updated through 7/04)

  • The OCFD Exposure Control Plan (ECP) helps to prevent the spread of disease resulting from handling blood or other potentially infectious material.
  • The OCFD ECP was developed under OSHA Bloodborne Pathogens Standard, 29 CFR 1910.1030.
  • The OCFD EMS Officer and Safety Officer are responsible for developing and maintaining the ECP.
  • The Exposure Control Plan is current as of July 1, 2004.
  • Suggestions regarding the Plan are made by calling EMS Officer at 297-1312 or the Safety Officer at 297-3314.
  • Exposure determination is made regardless of whether PPE was worn.
  • All ranks of the Operations division have the potential for exposure during emergency responses (i.e.-EMS, rescue of persons from hostile environments, extrication).
  • All ranks of the Support Division have the potential for exposure during collateral duty function (i.e.-CPR/first aid if certified).
  • The Fire Chief and Assistant Fire Chief are considered Support Division.
  • OCFD employees will have adequate PPE on before entering an ambulance, based on risk.
  • BVM connections that come loose may spray blood, lung, and stomach contents into personnel's eyes, nose, and mouth, therefore, masks and safety glasses should be worn.
  • All blood and body fluid will be considered infectious regardless of patient status.
  • PPE bag should be taken into a scene anytime trauma bag is taken.
  • All needles/sharps should go in sharps containers immediately after puncture.
  • Tuberculocidal disinfectant solution should be used to clean all contaminated equipment and work surfaces.
  • Hands should be washed with soap and water immediately after providing care, or use of an antiseptic hand cleanser in the absence of hand washing facilities.
  • Leak-proof, labeled containers should be used for contaminated waste, laundry, or sharps.
  • Kitchen, bathrooms, and living areas are NOT to be used for decontamination.
  • OCFD employees will wear gloves and eye protection on ALL EMS calls.
  • Patient and OCFD employees must wear masks when respiratory hazards are present.
  • Hand washing facilities are located in apparatus rooms of all work sites.
  • Antiseptic (waterless) hand cleanser should be located in all trauma bags and on response vehicles.
  • Supervisors are responsible for ensuring employees' with skin or mucous membrane exposure be washed or flushed with water immediately.
  • Employees may NOT bend, recap, remove, shear, or purposely break needles or other sharps.
  • Sharps containers should be carried in trauma bag.
  • Never take a sharp from another person, hand them the container and let them put it in.
  • Sharps containers should not be allowed over 2/3 full.
  • Leak-proof containers that leak should be placed in a secondary container and labeled or color-coded to identify contents.
  • Eating, drinking, applying cosmetics, using tobacco, or handling contact lenses should NOT occur in work areas with likelihood of exposure to blood or body fluids.
  • Specimens that may puncture a primary container should also be placed in a secondary container that is puncture-resistant.
  • BSI or Specimen containers that remain in OCFD control do not have to be labeled or color-coded per OSHA regulations.
  • OCFD is responsible for all costs associated with supply, repair, replacement, and safe disposal of PPE.
  • The SENIOR Officer at each station will ensure stock of PPE is adequate and supplies nearing expiration date are used 1st.
  • All OCFD apparatus have a black canvas PPE bag with enough PPE for the whole crew.

PPE Kit Supplies
Engines, RL's, and HM5 / Tankers, TP's, and BP's
5 / BSI kits / 3 / BSI kits
5 / Disposable Respiratory Masks / 3 / Disposable Respiratory Masks
5 pairs / Safety Glasses / 3 pairs / Safety Glasses
5 / CPR Pocket Masks / 3 / CPR Pocket Masks
5 pairs / Latex Gloves / 3 pairs / Latex Gloves
2 / Red Biohazard Bags / 2 / Red Biohazard Bags
1 / Bio-Cleanup Kit / 1 / Bio-Cleanup Kit
  • If a N95 or 9970 respirator will not fit personnel, they will be issued a 6000 Series, non-disposable, respirator.
  • Heavy-duty utility gloves will be worn for cleaning, disinfecting, or decontamination of equipment.
  • Non-latex gloves, glove liners, powderless gloves, or similar alternatives are available to those employees with allergies to latex, etc.
  • Utility gloves may be decontaminated for re-use if integrity of glove has not been compromised.
  • Gloves will be worn on ALL EMS calls and all employees will carry an extra pair.
  • Change gloves between patients in multiple-casualty situations, when possible.
  • Disposable gloves will be worn under firefighting gloves during rescue operations involving exposure to blood or infectious materials.
  • Facial protection should be used where splash contact is possible.
  • Workers should wear air-purifying respirators if airborne transmissible disease is suspected. Patients should wear oxygen mask as a minimum.
  • Face shields on structural helmets do NOT meet OSHA requirements for exposure control facial protection.
  • Gowns or structural firefighting gear may be used for splash protection, based on situation.
  • If it is wet, treat it as infectious.
  • Disinfectant solutions (tuberculocidal) will be mixed within 24 hours of use.
  • Durable equipment (backboards, splints, safety glasses, etc.) will be washed with hot, soapy water, rinsed with water, disinfected with tuberculocidal solution per manufacturer, and allowed to dry.
  • Chlorine bleach should not be used on structural firefighting gear (impairs fire-retardant properties).
  • If work clothes are contaminated, clothes should be replaced with clean clothes after showering.
  • Contaminated work clothes will be washed in hot, soapy water and rinsed with clean water or district washer/extractor.
  • Washer/extractor machines are located at Fire Stations 4, 7, 14, 18, 25, and 34.
  • Contaminated, damaged equipment will be cleaned/disinfected before sending out for repairs.
  • Regulated waste will be placed in leak-proof containers that are closeable and color-coded or labeled.
  • Reusable sharps should not be removed by hand from sharps containers.
  • Reusable bins and containers that store biohazard waste will be inspected, cleaned, and disinfected weekly or immediately if contamination is present.
  • Contaminated work surfaces will be disinfected at the scene or immediately when returning to the station.
  • The Company Officer will ensure biohazard bags that are 2/3 full will be placed in a red biohazard bag, tied closed, and taken to Station # 7 for storage in the designated locker (also logged in biohazard log book).
  • Station #7 will contact the EMS Officer when waste pickup is necessary.
  • The current waste management company will make every effort to pick up waste from Station #7 within 1 week of notification.
  • The 3 types of biohazard waste containers in use by OCFD include:1 gallon red plastic sharps boxes with clear plastic lid, 1 quart red plastic sharps boxes with clear plastic lid (carried in trauma bag), and biohazard plastic bags (for non-sharps).
  • Biohazard waster containers should be ordered on the monthly EMS supply order form.
  • Items used that are not contaminated should be put in regular trash.
  • Biohazard disinfecting sinks should be disinfected before and after disinfecting equipment.
  • For significant amounts of blood/body fluids (greater than contents of 1 biohazard bag), contact the OCFD HazMat Team.
  • Contaminated emesis containers should be placed in red plastic bags and sealed.
  • Post exposure procedures (anti-viral medication) must be started within 2 hours of HIV exposure.
  • Occupational risk exposures include completing OSDH Form 207, Official Injury Report, Supervisor's Investigation Report, Physicians Authorization Form, Run Report, and Exposure Information Sheet.
  • Exposures should be reported on Official Injury Report, but not on fire incident reporting.
  • Exposure may include: break in skin caused by contaminated object, needle stick, blood/fluid in eyes, nose, mouth, skin (cuts, abrasions, sores, rashes), by inhalation of infectious material, or any other exposure employee feels is significant.
  • Immediately after exposure, affected area must be washed with soap and water or saline for eyes, supervisor will contact EMS QA Officer, once at station the supervisor notifies District Officer who will ensure necessary injury forms are completed.
  • Employee and supervisor with assistance of EMS QA Officer will complete OSDH Risk Exposure form, enter exposure with timeline on Item 11, EMS QA Officer or Exposure Control Officer complete Lines 14-19, hospital completes Lines 17, 18, & 19, and ensure Official Injury Report, Supervisor's Accident Investigation Report, Physician Authorization (if treated), and Run report
  • QA officer will complete the Exposure Information Worksheet.
  • To determine exposures, QA Officer can contact OSDH Epidemiologist.
  • If employee requests hospital evaluation after QA Officer counsels them, the QA Officer will get the patient's name and location.
  • QA Officer will take or meet employee at BaptistHospital to determine exposure as defined by Centers for Disease Control.
  • If a risk exposure DOES occur, the QA officer will take Form 207 and OSHA envelope to source patient's health care facility, meet with Exposure Control Practitioner or ER Supervising Nurse to sign Form 207 in lower right corner, remove YELLOW copy and leave GREEN copy with facility, and return to BaptistHospital until employee is released.
  • Exposure Control Officer contacts employee after an exposure to provide counseling and ensure follow-up procedures are started.
  • If a risk exposure DOES NOT occur, EMS QA Officer will provide counseling, ensure Form 207, Injury Report, and Supervisor's Report are forwarded to Exposure Control Officer (through Battalion Chief of Operations) who will then contact employee for further counseling and file employee's medical documents.
  • All Oklahoma medical facilities have to report patients with reportable acute diseases to OSDH, Acute Disease Division, who in turn contact City/County Health Department (OCCHD).
  • OSDH and OCCHD have 24/7 on-call personnel.
  • CountyHealth is responsible for follow-up with contacts with reported patients.
  • If Acute Disease patient is transported to the hospital, OCCHD contacts transport agency and OCFD by calling OCFD Dispatch non-emergency (297-3439) and ask for Exposure Control Officer (ECO).
  • ECO determines if OCFD/OCPD responded to reported acute disease patients, assist with follow-up if an exposure occurred, and report to OCCHD if contact was made.
  • OCFD offers annual TB testing to all personnel.
  • If annual TB test is positive, CompChoice will schedule your appointment with the McBride Clinic for chest x-ray.
  • Positive TB tests are NOT taken to BaptistHospital and a 207 Form is NOT required.

Positive TB Reporting
OKC Injury Report / Supervisor's Investigation Report
  • Date/time of positive reading
  • How it occurred (if unknown enter "Potentially exposed to airborne pathogen"
  • Severity of injury (circle "being treated")
/
  • Date of positive reading
  • What happened (positive TB test)
  • Why (unknown until further testing)
  • What should be done (N/A)
  • What's been done (assisted with further testing)

Complete Physician's Authorization Form
Contact Exposure Control Officer (QA or EMS Officer) for further steps
  • Individuals with a positive TB test will complete a Health Screen questionnaire annually.
  • Potential TB exposures will follow Critical Post Exposure procedures and will not go to BaptistHospital.
  • The QA Officer will take 207 Form to source patient's hospital with a potential TB exposure.
  • Employee is contacted by CompChoice to schedule TB testing following a potential TB exposure (may take up to 2 weeks).
  • Positive TB readings during any portion of TB testing will result in a chest x-ray and referral to the employees resident county health department.
  • Hepatitis B vaccinations, which are made under the supervision of a licensed physician or licensed health care professional, are offered to all OCFD employees.
  • Refusal of Hepatitis B vaccination must be accompanied by OSHA waiver indicating refusal.
  • Annual training in exposure control will be through train-the-trainer programs for each district and shift.
  • The training work section will provide 2 exposure control trainers to train support personnel.
  • Exposure control training includes: Bloodborne pathogen epidemiology, symptoms of exposure, tasks to limit exposure, reporting of exposures, and vaccination programs.
  • The Safety Work Section maintains exposure control training records for 3 years from the date of training.
  • Exposure and medical records are maintained for at least the duration of employment PLUS 30 years.
  • Employee exposure and medical records are made available to OSHA and NIOSH upon request.

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