INFECTION CONTROL - BLOODBORNE PATHOGENS

07/2012

Legislative Background

The Occupational, Safety and Health Administration (OSHA) issued the final rule on occupational exposure to bloodborne pathogens (29CFR 1910.1030) in the Federal Register on December 6, 1991 to become effective March 6, 1992. The purpose of this standard is to limit occupational exposure to blood and other potentially infectious materials since any exposure could result in transmission of bloodborne pathogens. The scope of the standard covers all employees who could “reasonably anticipate” contact with blood and other potentially infectious materials as a result of performing their job.

While school employees are at a low risk for occupational exposure, compared to health workers, the New York State Department of Labor, Public Employee Safety and Health (PESH) has included schools as public employers who need to address the bloodborne pathogen standard regulations for those employees whose job classification and tasks may place them at risk for occupational exposure.

Definitions

Bloodborne Pathogens: Microorganisms that may be present in human blood and can infect and cause disease in humans. These pathogens include, but are not limited to, human immunodeficiency virus (HIV) and hepatitis B virus (HBV).

Exposure Incident: A specific eye, mouth, other mucous membrane, non-intact skin (chapped, abraded, or affected with dermatitis), or parenteral contact with blood or other potentially infectious materials that results from the performance of an employee’s duties.

Potentially Infectious Materials: Body fluids that may or may not contain bloodborne pathogens. They include: blood, semen, vaginal secretions, breast milk, cerebrospinal fluid, synovial fluid, pleural fluid, peritoneal fluid, pericardial fluid, amniotic fluid, saliva, and any other body fluid in which blood is visibly present. Body fluids include drainage from cuts, scabs, and skin lesions. No distinction is made between body fluids from persons with a known disease and those from persons with undiagnosed illness or without symptoms. Body fluids of all persons should be considered potentially infectious.

Universal Precautions: Part of a broader program of infection control. “Universal Precautions”, as developed by the Centers for Disease Control, assumes that all blood and certain body fluids are potentially infectious for human immunodeficiency virus (HIV), hepatitis B virus (HBV) and other bloodborne pathogens. Therefore, the intent of Universal Precautions is to prevent parenteral, mucous membrane and non-intact skin exposure to bloodborne pathogens.

Training

The School Nurse should provide an annual training on infection control of bloodborne pathogens for the staff in the buildings to which s/he is assigned.

Training should include the following:

  • A definition of bloodborne pathogens
  • A definition of potentially infectious materials
  • A demonstration of “Universal Precautions” and protective equipment
  • An explanation of proper hand washing techniques
  • A review of standard procedures for handling an exposure to blood and/or body fluids
  • A distribution of protective equipment to all staff

Protective Equipment Kits

Protective equipment kits must be provided for any employee who may be faced with a situation that would involve handling or cleaning-up of minor blood/body fluid spills. Kits should be kept in classrooms and carried with teachers when they move with students to another location (recess, field trips, etc.).

The following materials are to be included in the protective equipment kit:

  • One large zip lock bag to hold smaller items
  • Disposable latex or vinyl gloves - 2 pair
  • Small plastic bags - 4
  • Individual Antimicrobial Towelettes - 4
  • Individual Alcohol Swab - 8
  • Gauze pads - 16 (8 - 2x2, 6 - 4x4)
  • Band Aids - 12
  • Instructions for use

The following “Instructions for Use” (H.E. 333) should be included in all kits:

INSTRUCTIONS FOR USE

1. Wear disposable gloves before handling blood/body fluids.

2. Provide first aid treatment.

3. After giving first aid, all disposable items contaminated with small amounts of blood should be placed in a plastic bag, that is tied shut and put in a wastebasket.

4. Any clothing contaminated with blood/body fluid should be placed in a plastic bag and sent home or to the hospital with the injured person.

5. Any blood/body fluid spilled on surfaces should be cleaned up with soap and water. The surfaces should be disinfected with household bleach (1:10 part water) or rubbing alcohol.

6. After providing first aid and/or cleaning up a blood/body fluid spill, remove the latex gloves, turning them inside out during removal. Place the soiled gloves in a plastic bag with other contaminated items. Tie the bag and dispose of the contaminated material in a wastebasket.

7. Wash hands thoroughly with soap and water.

NOTE: Larger blood/body fluid spills should be referred to the appropriate custodial staff for cleaning and disinfecting.

In cases of severe injury with excessive bleeding, blood/body fluid soaked disposable materials must be placed in a “red” container marked “Biomedical Waste”.

If your skin, eyes, or mucus membranes have come in direct contact with blood or body fluids from another individual or from a contaminated surface, wash the exposed area with soap and water immediately and report the exposure incident to the School Nurse.

Handling A Blood and Body Fluid Exposure

Whenever possible in an emergency situation, responding staff should always direct or assist an individual involved with a blood/body fluid incident to care for him/herself with minimal contact to the staff member. However, when the injured party is unable to care for him/herself, the responding staff should always use universal precautions and implement an appropriate barrier between him/herself and the individual in need of assistance.

The following procedures must be followed when there is an incident of exposure to blood or body fluids:

  • Latex or vinyl gloves must be worn when responding to a blood/body fluid exposure and when cleaning exposed surfaces.
  • When the skin is intact, the exposed individual must wash the exposed area and hands with soap and water or alcohol towelettes.
  • If the exposed area has open lesions, wounds, or skin that is not intact, the area must be scrubbed with soap and running water. A skin disinfectant (i.e. 70% alcohol, Betadine, Hibiclens) should be applied after washing.
  • If the individual gets blood in the eyes or mouth, flood the exposed area with running water at room temperature for 2-3 minutes. Use an eye wash station, if one is available. If blood is in the mouth, rinse with water for 2-3 minutes and spit out into a sink.
  • Personal clothing soaked with blood/body fluids of another person should be removed, placed in a plastic bag using gloves, and taken home for laundering. The skin in contact with the contaminated garment should be washed as indicated above. No one should continue his or her daily activities wearing blood-contaminated clothing.
  • Once the exposed area is cleansed and disinfected, latex or vinyl gloves should be turned inside out when removed to avoid contact with the skin. The soiled gloves and materials should be discarded in a sealable plastic bag. Hands should be thoroughly washed with soap and running water.

Cleaning Blood and Body Fluid Spills

The following procedures are to be followed when disinfecting and cleaning blood/body fluids from hard, washable surfaces.

  • Wear latexor vinyl gloves and other appropriate barriers throughout the cleaning and disinfecting process.
  • Use paper towels or tissues to wipe up small soiled areas. After the spill is removed, use clean paper towels and soap and water to thoroughly clean the area.
  • For larger spills, apply a sanitary absorbent agent. Once absorbed, vacuum or sweep up the material and discard it in a sealable plastic bag. (Contact the Custodian.)
  • Once cleaned, contaminated surfaces should be disinfected with an EPA-approved disinfectant according to the manufacturer’s instructions. (Contact the Custodian.)
  • Once the contaminated surface is cleansed and disinfected, latex orvinylgloves should be turned inside out when removed to avoid contact with the skin. The soiled gloves and cleaning materials should be discarded in a sealable plastic bag. Hands should be thoroughly washed with soap and running water.

Disposal of Bio-Medical Waste

Unregulated medical waste is material that has come in contact with body fluids but can be normally disposed of in a sanitary sewer system and/or by a local waste hauler. Examples of unregulated medical waste are disposable towels; gowns and paper sheeting; bloodstained bandages, gauze, and cotton; cotton swabs; and tongue depressors.

Under New York State law, some medical wastes have become regulated and therefore require special handling for their disposal. Regulated medical wastes applicable to schools are materials that belong in the following categories:

1. Items that are saturated and/or dripping with human blood or have been caked with dried human blood

2. Sharps, needles, syringes, or used blades

3. Any additional waste material that has come in contact with infectious material that the school believes may pose a risk

Procedures for Handling the Disposal of Regulated Bio-medical Waste

Blood: Accidents involving large bleeding wounds necessitate a referral to the emergency room. All materials saturated with blood/body fluids should be sealed in a plastic bag and sent with the patient to the emergency room for proper disposal.

Sharps: Individuals who require injectable medication or the use of sharps for any medical treatment must provide an approved, puncture-proof sharps container. It is the responsibility of the individual (if an adult employee) or the parent/guardian of a student to remove and dispose of the container.

Exceptions: Each Health Office is equipped with a red container suitable for containing REGULATED bio-medical waste. This container and the “red bags” within the container are to be used ONLY for items that are saturated with large amounts of human blood or have been caked with large amounts of dried human blood and ONLY when the above procedures can not be followed. If bio-medical waste is placed in the red containers or if an individual does not remove a sharps container as described in the above procedures, the School Nurse must notify the Director of the Bureau of Health and Physical Education to arrange for proper disposal of the materials.

Reporting Incidents of Blood and Body Fluid Exposure

Universal Precautions must be enforced throughout the School District and all staff informed and trained to utilize appropriate barriers to prevent the exposure of skin or mucous membranes to blood or other body fluids. The School Nurse should be consulted if an individual comes in contact with the blood or body fluids of another person.

Post Exposure Evaluation

An exposure must be immediately reported to the administrator or supervisor in the building. The exposed individual and, when identification is possible, the source individual must be referred to the School Nurse for post exposure evaluation.

Assessment of Risk

When notified of an exposure, the School Nurse must examine and/or interview any individual who comes in contact with the blood or body fluid of another person. In determining the risk for potential exposure to blood-borne pathogens the following must be considered:

  • The degree of contact with mucous membranes
  • The presence of breaks in the skin contacted
  • The length of the contact
  • The nature of the contact (i.e. bite, puncture, spill)
  • The volume of the contact

When the School Nurse determines that there is a risk of potential exposure to blood-borne pathogens, s/he must provide counseling regarding the following:

  • The HBV antibody or previous vaccination status for HBV
  • The need for HBV/HIV antibody testing
  • Medical follow-up and notification of a health care provider of the exposure
  • The need for post exposure vaccination (HBV)
  • Issues of confidentiality

If the exposed individual is a District employee, s/he should be advised that medical care, blood sampling, and vaccination against Hepatitis B would be provided by the District at no cost to the individual. In addition, the School Nurse/ must complete exposure forms as directed below.

Potential Exposure Forms - District EmployeeProcedures

The School Nurse must complete the “Blood and Body Fluids Incident of Exposure Form” (H.E. 320) with the exposed individual as soon as possible.

The “Documentation and Identification of Source Individual” form (H.E. 322) must be completed by the School Nurse and forwarded to the health care provider of the source of the exposure.

If s/he is a District employee, within one month of the exposure, the individual exposed should complete the “Blood and Body Fluids Exposure Follow-Up Form” (H.E. 321) with the School Nurse.

At the time the “Follow-Up Form” is completed, the exposed employee should sign the “Declination Statements” on the back of the form if s/he has refused medical treatment or Hepatitis B vaccination.

Once completed, the “Incident Form”, “Follow-Up Form”, and the “Declination Statements” should be forwarded to the building administrator. A copy should be maintained in the health office.

If the School Nurse is not available in the building at the time of the exposure incident, the administrator or supervisor must advise the exposed individual to seek immediate treatment at the emergency room or with their health care provider.

Potential Exposure Forms - Student Procedures

When notified of an exposure, the School Nurse must complete the “Blood and Body Fluids Incident Form” with the exposed student as soon as possible.

The “Documentation and Identification of Source Individual” form must be completed by the School Nurse and forwarded to the health care provider of the source of the exposure.

A “Student Incident Report” must be completed by the School Nurse.

One copy of each completed form should be filed in the student’s health folder.

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