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Topic: Bloodborne Pathogens Exposure Date Issued: 3/1/92
Control Plan - District Attorney
Section: Injury Illness Prevention Program Date Revised: 6/10/93, 10/29/93
Number: XX.17.H. 1/13/95
PURPOSE:
To establish policy and procedures to comply with state and federal regula-
tions and to eliminate or minimize employee occupational exposure to blood
and other potentially infectious materials.
LEGAL BASIS:
California Code of Regulations, Title 8, General Industry Safety Orders,
Section 5193, Bloodborne Pathogens Standard.
29 Code of Federal Regulations, 1910.1030, Occupational Exposure to Blood-
borne Pathogens.
DEFINITIONS:
"Blood" means human blood, human blood components, and products made from
human blood.
"Bloodborne Pathogens" means 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).
"Contaminated Laundry" means laundry which has been soiled with blood or
other potentially infectious materials or may contain sharps.
"Contaminated Sharps" means any contaminated object that can penetrate the
skin including, but not limited to, needles, scalpels, broken glass, broken
capillary tubes, and exposed ends of dental wires.
"Decontamination" means the use of physical or chemical means to remove,
inactivate, or destroy bloodborne pathogens on a surface or item to the
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point where they are no longer capable of transmitting infectious particles
and the surface or item is rendered safe for handling, use, or disposal.
"Engineering Controls" means controls (e.g. sharps disposal containers,
self-sheathing needles) that isolate or remove the bloodborne pathogens
hazard from the workplace.
"Exposure Incident" means a specific eye, 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.
"Handwashing Facilities" means a facility providing an adequate supply of
running potable water, soap and single use towels or hot air drying ma-
chines.
"HBV" means Hepatitis B Virus.
"HIV" means Human Immunodeficiency Virus.
"Occupational Exposure" means reasonably anticipated skin, eye, mucous
membrane, or parenteral contact with blood or other potentially infectious
materials that may result from the performance of an employee's duties.
"Other Potentially Infectious Materials" (OPIM) means:
(1) The following human body fluids: semen, vaginal secretions, cerebrospi-
nal fluid, synovial fluid, pleural fluid, peritoneal fluid, amniotic fluid,
saliva in dental procedures, any other body fluid that is visibly contami-
nated with blood such as saliva or vomitus, and all body fluids in situa-
tions where it is difficult or impossible to differentiate between body
fluids such as in emergency response;
(2) Any unfixed tissue or organ (other than intact skin) from a human (liv-
ing or dead); and
(3) HIV-containing cell or tissue cultures, organ cultures, and HIV- or
HBV-containing culture medium or other solutions; and blood, organs, or
other tissues from experimental animals infected with HIV or HBV.
"Parenteral" means piercing mucous membranes or the skin barrier through
such events as needlesticks, human bites, cuts, and abrasions.
"Personal Protective Equipment" is specialized clothing or equipment worn
or used by an employee for protection against a hazard.
"Regulated Waste" means liquid or semi-liquid blood or OPIM; contaminated
items that would release blood or OPIM in a liquid or semi-liquid state if
compressed; items that are caked with dried blood or OPIM and are capable
of releasing these materials during handling; contaminated sharps; and
pathological and microbiological wastes containing blood or OPIM. Regulat-
ed Waste includes medical waste regulated by Health and Safety Code Chapter
6.1.
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"Source Individual" means any individual, living or dead, whose blood or
other potentially infectious materials may be a source of occupational
exposure to an employee.
"Sterilize" means the use of a physical or chemical procedure to destroy
all microbial life including highly resistant bacterial endospores.
"Universal Precautions" is 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 HIV, HBV, and
other bloodborne pathogens.
"Work Practice Controls" means controls that reduce the likelihood of expo-
sure by altering the manner in which a task is performed (e.g. prohibiting
recapping of needles by a two-handed technique).
EXPOSURE DETERMINATION:
The state of California (Cal/OSHA) requires employers to perform an expo-
sure determination, the purpose of which is to identify job classifications
in which employees may incur occupational exposure to blood or other poten-
tially infectious materials (OPIM). The exposure determination must be
made without regard to the use of personal protective equipment, that is,
employees are considered to be exposed even if they wear personal protec-
tive equipment. The exposure determination is required to list all job
classifications in which employees may be expected to incur an occupational
exposure, regardless of frequency.
Cal/OSHA also requires a listing of job classifications in which some em-
ployees may have occupational exposure, and the job tasks or procedures
that would cause them to have occupational exposure.
For a listing of job classifications with occupational exposure, listed by
department, see Appendix A.
IMPLEMENTATION METHODOLOGY:
Cal/OSHA requires that the Exposure Control Plan include the methods of
implementation for the various requirements of the standard. The following
complies with this requirement:
1. Compliance methods
All County employees are required to observe universal precautions in order
to prevent contact with blood or OPIM. All blood must be treated as if it
were infectious for HBV, HIV, and other bloodborne pathogens. Where it is
difficult to differentiate between body fluid types, all body fluids shall
be considered potentially infectious materials.
Engineering and work practice controls will be utilized to eliminate or
minimize employee exposure to blood and OPIM. Where occupational exposure
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remains after institution of these controls, personal protective equipment
shall also be utilized.
Engineering controls are physical or mechanical systems provided to elimi-
nate hazards at their source, such as sharps containers or self-sheathing
needles. In this department, the following engineering controls will be
utilized:
* Proper handling and collection of evidence.
* All evidence to be properly packaged (double bagged and labeled).
* Latex gloves will be worn when there is potential for exposure.
* Bio-hazard bags for used gloves and OPIM.
* Latex gloves and bio-hazard bags are kept in first aid kits.
Engineering controls will be examined, maintained, and replaced on a regu-
lar schedule to ensure their effectiveness. Follows is the a schedule for
reviewing the effectiveness of engineering controls:
* Alan Johnson, Chief of Inspectors - Quarterly inspection and review of
engineering controls.
Work practice controls are specific procedures employees must follow on the
job to reduce their exposure to bloodborne pathogens or infectious materi-
als. Examples are hand washing, avoiding recapping of needles, and good
personal hygiene. Employees in all County departments will wash their
hands after contact with potentially infectious materials and after remov-
ing personal protective equipment. All County employees will practice good
personal hygiene. No recapping of needles is allowed in any County facili-
ty. Work practice controls that will be utilized are:
* Employees will always wear latex or other appropriate gloves when
gathering or collecting evidence. Latex gloves are to be placed in
biohazard bag taken to Emeline Clinic (1080 Emeline St.) or give to
supervisor.
* Wash hands after removing latex gloves or will use antiseptic towel-
lettes until able to wash hands.
Departments must provide handwashing facilities to employees who incur
exposure to blood or OPIM. Cal/OSHA requires that these facilities be
readily accessible after incurring exposure.
If handwashing facilities are not feasible, the department must provide an
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antiseptic cleanser in conjunction with clean cloth/paper towels or anti-
septic towellettes. If these alternatives are used, then employees must
wash their hands with soap and running water as soon as feasible.
* Antiseptic towellettes will be used to wash hands if soap and water is
not available.
* Employees shall be responsible for replenishment of towellettes after
use.
Supervisors shall ensure that after the removal of gloves or other personal
protective equipment, employees shall wash hands immediately or as soon as
feasible with soap and water.
Supervisors shall ensure that employees wash hands and any other skin with
soap and water, or flush mucous membranes with water immediately or as soon
as feasible following contact of such body areas with blood or OPIM.
2. Contaminated Needles and Sharps
Contaminated needles and other contaminated sharps shall not be recapped,
removed, bent, sheared, or purposely broken. Recapping or removal of nee-
dles is not permitted by any Santa Cruz County departments.
3. Containers for Reusable Sharps
Contaminated sharps that are reusable must be placed immediately, or as
soon as possible, after use into appropriate containers. Containers for
reusable sharps must be puncture resistant, labeled with a biohazard label,
and leak proof.
* Does not apply within the department office environment.
* Kevlar gloves to be utilized - sharps to be placed in sharps contain-
ers.
4. Work Area Restrictions
In work areas where there is a reasonable likelihood of exposure to blood
or OPIM, employees may not eat, drink, apply cosmetics or lip balm, smoke,
or handle contact lenses.
Food and beverages are not to be kept in refrigerators, freezers, shelves,
cabinets, or on counter or bench tops where blood or OPIM are present.
All procedures involving blood or OPIM will be performed in a manner which
will minimize splashing, spraying, spattering, and generation of droplets
of these substances. Mouth pipetting/suctioning of blood or OPIM is pro-
hibited.
5. Specimens
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Specimens of blood or OPIM will be placed in a container which prevents
leakage during the collection, handling, processing, storage, transport, or
shipping of the specimens.
The container used for this purpose will be properly labeled or color-coded
and closed prior to storage, transport, or shipping. The standard provides
for an exemption for specimens from the labeling/color coding requirement
if a facility utilizes universal precautions in the handling of all speci-
mens and the containers are recognizable as containing specimens. This
exemption applies only while the specimens remain in the facility.
All specimens which could puncture a primary container will be placed with-
in a secondary container which is puncture resistant. If outside contamina-
tion of the primary container occurs, the primary container shall be placed
within a secondary container. Secondary containers shall meet all the
requirements for primary containers.
6. Contaminated Equipment
Department Heads or their designees are responsible for ensuring that
equipment which has become contaminated with blood or OPIM is examined
prior to servicing or shipping and is decontaminated as necessary, unless
the decontamination of the equipment is not feasible.
7. Personal Protective Equipment (PPE)
PPE Provision
Department Heads are responsible for ensuring that the following provisions
are met:
All PPE used in each department will be provided without cost to employees.
PPE will be chosen based on the anticipated exposure to blood or OPIM. The
protective equipment will be considered appropriate only if it does not
permit blood or OPIM to pass through or reach the employees' clothing,
skin, eyes, mouth, or other mucous membranes under the normal conditions of
use and for the duration of time for which the protective equipment will be
used. PPE provided in this department is:
* Latex gloves, bio-hazard bags and sharps containers are provided to
all designated staff and eye protection when appropriate.
* Alan Johnson, Chief of Investigations is in charge of this operation.
PPE Use
Department Heads and their designees shall ensure that all employees use
appropriate PPE unless a supervisor shows that an employee temporarily and
briefly declined to use PPE, when, under rare and extraordinary circum-
stance, it was the employee's professional judgement that in that specific
instance its use would have prevented the delivery of healthcare or posed
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an increased hazard to the safety of the worker or co-worker. When the
employee or supervisor makes this judgement, the circumstances must be
investigated and documented in order to determine whether changes could be
instituted to prevent such occurrences in the future.
PPE Accessibility
Department Heads and their designees shall ensure that appropriate PPE in
the appropriate sizes is readily accessible at the work site or is issued
without cost to employees. Hypoallergenic gloves, glove liners, powderless
gloves, or other similar alternatives shall be readily accessible to those
employees who are allergic to the gloves normally provided.
PPE Cleaning, Laundering and Disposal
All PPE will be cleaned, laundered and/or disposed of by the department at
no cost to the employees. All necessary repairs and replacements will be
made by the department at no cost to employees.
All garments which are penetrated by blood shall be removed immediately or
as soon as feasible. All PPE will be removed prior to leaving the work
area.
When PPE is removed, it shall be placed in an appropriate designated area
or container for storage, washing, decontamination or disposal.
Gloves
Gloves shall be worn where it is reasonably anticipated that employees will
have hand contact with blood, non-intact skin, mucous membranes, or OPIM,
when performing vascular access procedures, and when handling or touching
contaminated items or surfaces.
Disposable gloves are not to be washed or decontaminated for re-use and are
to be replaced when they become contaminated, if they are torn or punc-
tured, or when their ability to function as a barrier is compromised.
Eye and Face Protection
Masks in combination with eye protection devices, such as goggles or glass-
es with solid side shield, or chin length face shields, are required to be
worn whenever splashes, spray spatter, or droplets of blood or OPIM may be