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HomeMy WebLinkAboutR-1619 - Adopting an exposure control plan as required by OSHA/WISHA for Law Enforcement custody officers and other service personnel-_._--------------------- \. CITY OF MARYSVILLE EXPOSURE CONTROL PLAN AND POLICY Resolution No./t'/1 A RESOLUTION OF THE CITY OF MARYSVILLE ADOPTING AN EXPOSURE CONTROL PLAN AS REQUIRED BY OSHAjWISHA FOR LAW ENFORCEMENT, CUSTODY OFFICERS AND OTHER SERVICE PERSONNEL. ,1993 APPROVED AS TO FORM: .A~L~ City Attorney 3 CITY OF MARYSVILLE EXPOSURE CONTROL PLAN AND POLICY 1 INTRODUCTION SECTION 1. SECTION 2. SECTION 3. SECTION 4. SECTION 5. SECTION 6. SECTION 7. SECTIONS. SECTION 9. SECTION 10. SECTION 11. SECTION 12. SECTION 13. SECTION 14. SECTION 15. TABLE OF CONTENTS EXPOSURE DETERMINATION BY JOB HBV VACCINATION FOLWW-UP PROCEDURES AFTER POSSIBLE EXPOSURE TO HIV/HBV SHARPS AND DISPOSABLE ITEMS LINENS ANDLAUNDRY DISPOSABLE EQUIPMENT AND MATERIAL REUSABLE EQUIPMENT HAND WASHING PERSONAL PROTECTIVE EQUIPMENT HOUSEKEEPING General Policies Regulated Waste Other Regulated Waste DISPOSAL OF REGULATED WASTE SIGNS AND LABELING EDUCATION AND TRAINING OF EMPWYEES MEDICAL RECORDS PROCEDURES IN THE EVENT OF PERSONAL EXPOSURE APPENDICES VACCINATION DECLINATION FORM A-l EXPOSURE INCIDENT INVESTIGATION FORM A-2 POST-EXPOSURE EVALUATION AND FOLLOW-UP CHECKLIST A-3 CLEANING SCHEDULE A-4 BWODBORNE PATHOGENS TRAINING SESSION A-5 HBV POSTING NOTICE A-6 2 ~------_._-_._------------------------------- CITY OF MARYSVILLE EXPOSURE CONTROL PLAN AND POLICY It is the policy of the city of Marysville to provide a safe environment for employees which is as free as possible from infection from the Hepatitis B virus and/or HIV. As such,all employees of the City of Marysville are required to know and fol- low universal precautions as described by the Centers for Disease Control.All employees whose tasks may expose them to blood, body fluids,or other potentially infectious materials (O.P.I.M.) shall be provided with a copy of these policies or shall have access to these policies. The following policies were adopted on ,and shall be reviewed and updated at least annually.These policies shall also be reviewed and updated whenever the introduction of new or modified tasks or procedures warrant. Adopted this day of _____________________,1993 Mayor ATTEST: City Clerk APPROVED AS TO FORM: city Attorney 3 ,------------------------------------------ Exposure Determination One of the keys to implementing a successful Exposure Control Plan is to identify exposure situations employees may encounter. To facilitate this in our operations,we have prepared an expo- sure control plan for each work group per the following: Police Department: V Job classifications in which all employees have occupa- tional exposure to bloodborne pathogens. Job classifications in which some employees have occu- pational exposure to bloodborne pathogens. Tasks and procedures in which occupational exposure to bloodborne pathogens occur (these tasks and procedures are performed by employees in the job classifications listed.) Public Works: V Job classifications in which all employees have occupa- tional exposure to bloodborne pathogens. Job classifications in which some employees have occu- pational exposure to bloodborne pathogens. Tasks and procedures in which occupational exposure to bloodborne pathogens occur (these tasks and procedures are performed by employees in the job classifications listed.) Parks/Golf: V Job classifications in which all employees have occupa- tional exposure to bloodborne pathogens. Job classifications in which some employees have occu- pational exposure to bloodborne pathogens. Tasks and procedures in which occupational exposure to bloodborne pathogens occur (these tasks and procedures are performed by employees in the job classifications listed.) Executive/Finance/court/Planning/Building: V Job classifications in which all employees have occupa- tional exposure to bloodborne pathogens. Job classifications in which ~employees have occu- 4 pational exposure to bloodborne pathogens. Tasks and procedures in which occupational exposure to bloodborne pathogens occur (these tasks and procedures are performed by employees in the job classifications listed.) The initial lists were compiled on or before April 1,1993.The city's Assistant Personnel Director or Safety Officer will work with department heads and supervisors to revise and update these lists as our tasks,procedures,and classifications change. 5 1.EXPOSURE DETERMINATION BY JOB DESCRIPTION Police Department The following employees perform tasks and duties which do or may expose them to blood and/or other body fluids:(High Risk) Police Officers As police officers,your work may involve contact with another person's body fluids.Since these body fluids may be infectious,you are considered to be at risk for occupa- tional exposure to infectious disease.The environment you work in provides unpredictable risks of exposure.There- fore,you should assume that all persons whose blood and body.fluids that you come into contact with to be infec- tious. Officers shall give care and aid to those persons requ1r1ng aid regardless of the fact that the person may have an infectious/communicable disease.Officers will not refuse to aid persons solely on the information that the person may have an infectious/communicable disease. High Risk: Commissioned Police Officers Commissioned Corrections Officers Police Detectives Police Sergeants Police Lieutenants Police Chief Animal Control Officer The following Police Department employees may also be exposed through contact with employees,shared equipment or surfaces which may have become contaminated:(Low Risk) Low Risk: communications Officers Records Clerk Secretaries Receptionists Tasks or procedures performed in these offices which include a risk of exposure are: Crime scene investigations including but not necessarily limited to: 6 Accident investigations Assault investigations Burglary investigations Death investigations Sexual assault investigations Drug investigations Search warrant services Automobile and other searches All one on one contacts with citizens Evidence collection related to any of the above Whenever blood or O.P.I.M.(Other Potentially Infectious Mate- rial)is encountered during any of the above procedures,such procedure must be performed in such a manner as to prevent or minimize any splashing,spraying,or spattering of the suspect material. Tasks or procedures in the Police Department which may result in secondary exposure to support personnel through contact with potentially contaminated surfaces are: Typing Phone Handling Recordkeeping writing Surfaces Police employees are prohibited from eating and drinking,apply- ing make-up or lip balm,and handling contact lenses in the Marysville Police Department lab area,the booking area or any other prisoner holding area,in the property room or any other work area where there is a reasonable likelihood of exposure to blood or other potentially infectious material.In addition,all officers are prohibited from storing food or drink in refrigera- tors,freezers,shelves,cabinets or countertops where blood or other potentially infectious material may be or may have been present. 7 1.EXPOSURE DETERMINATION BY JOB DESCRIPTION Public Works Department The following employees perform tasks and duties which do or may expose them to blood and/or other body fluids:(High Risk) As Public Works employees,your work may involve contact with another person's body fluids.Since these body fluids may be infectious,you are considered to be at risk for occupational exposure to infectious disease.The environment you work in pro- vides unpredictable risks of exposure.Therefore,you should assume that all persons whose blood and body fluids that you come into contact with to be infectious. Employees shall give first-aid to those persons requiring aid regardless of the fact that the person may have an infec- tious/communicable disease.Employees will not refuse to aid persons solely on the information that the person may have an infectious/communicable disease. High Risk: utility Maintenance/Solid Waste Supervisor Solid Waste Collector Wastewater Treatment Plant Manager Wastewater Treatment Operator Assistant Wastewater Treatment Operator Wastewater Treatment Technician The following Public Works employees may also be exposed through contact with employees,shared equipment or surfaces which may have become contaminated:(Low Risk) Low Risk: utility Division: utility Superintendent Construction Foreman utility Maintenance/solid Waste Supervisor Equipment Operator utility Maintenance Worker Construction Service Person Bldg/Grounds Maintenance Meter Reader Repair Cross Connection Technician Public Works Receptionist Public Works Secretary utility Secretary 8 Recycling Coordinator street Division: street Superintendent Assistant Superintendent Equipment Operator Signal Technician Street Laborer Engineering: Public Works Director Public Works Engineer Construction Inspection Supervisor Engineering Technician Engineering Aide Construction Inspector Equipment Rental: Mechanic Assistant Mechanic These employees could potentially be exposed to blood and/or body fluids through mucous splash and/or by the handling of job related equipment or materials used in the performance of their duties. Tasks or procedures performed by Public Works positions which include a risk of exposure are: Treatment Plant: 1.Maintaining and cleaning bar screens. 2.Preparing samples in lab. 3.General and preventative maintenance of sewage related equipment and systems. Sanitation Division: 1.Dumping and picking up of solid waste. Street Division: 1.Cleaning up of accident scenes. 2.Discarding of dead animals. Public Works in general: 1.Interaction with the general pUblic. 2.Interaction with co-workers. 3.General maintenance and upkeep of all City equip- ment and vehicles. Employees are prohibited from cooking,eating,drinking,applying 9 make-up or lip balm,and handling contact lenses in the Marys- ville Treatment plant lab area,or any other work area where there is a reasonable likelihood of exposure to blood or other potentially infectious material.In addition,all employees are prohibited from storing food or drink in refrigerators,freezers, shelves,cabinets or countertops where blood or other potentially infectious material may be or may have been present. 10 1.EXPOSURE DETERMINATION BY JOB DESCRIPTION Parks/Golf As Park/Golf employees,your work may involve contact with another person's body fluids.Since these body fluids may be infectious,you are considered to be at risk for occupational exposure to infectious disease.The environment you work in pro- vides unpredictable risks of exposure.Therefore,you should assume that all persons whose blood and body fluids that you come into contact with to be infectious. Employees shall give care and aid to those persons requiring aid regardless of the fact that the person may have an infec- tious/communicable disease.Employees will not refuse to aid persons solely on the information that the person may have an infectious/communicable disease. High Risk Classification: Parks Foreman Parks Groundskeeper Parks Caretaker The following employees may also be exposed through contact with employees,shared equipment or surfaces which may have become contaminated:(Low Risk) Low Risk Classification: Parks and Recreation Director Golf Superintendent Assistant Golf Superintendent Golf Pro Golf Groundskeeper Seasonal Help Recreational Coordinator Parks Secretary Mechanic These employees could potentially be exposed to blood and/or body fluids through mucous splash and/or by the handling of job related equipment or materials used in the performance of their duties. Tasks or procedures performed by these positions which include a risk of exposure are: 1.Interaction with the general pUblic. 2.Interaction with co-workers. 3.Cleaning Restroom facilities. 4.Dumping solid waste. 11 5.General maintenance and upkeep of City equipment and vehicles. Employees are prohibited from eating and drinking,applying make-up or lip balm,and handling contact lenses in any work area where there is a reasonable likelihood of exposure to blood or other potentially infectious material.In addition,all employ- ees are prohibited from storing food or drink in refrigerators, freezers,shelves,cabinets or countertops where blood or other potentially infectious material may be or may have been present. 12 1. EXPOSURE DETERMINATIONBY JOB DESCRIPTION Executive/FinancefPlanningfCourt Departments The following employees perform tasks and duties which do or may expose them to blood and/or other body fluids:(High Risk) As Executive/Finance/Planning/court employees,your work may involve contact with another person's body fluids.Since these body fluids may be infectious,you are considered to be at risk for occupational exposure to infectious disease. The environment you work in provides unpredictable risks of exposure.Therefore,you should assume that all persons whose blood and body fluids that you come into contact with to be infectious. Employees shall give first aid to those persons requ~r~ng aid regardless of the fact that the person may have an infectious/communicable disease.Employees will not refuse to aid persons solely on the information that the person may have an infectious/communicable disease. Executive/Finance/Planning/court Departments: High Risk Classifications: City Hall Receptionist ** Building Official/Building Inspector **AII positions in the Finance Department assist at the front counter,therefore at times their exposure increases. The following employees may also be exposed through contact with employees,shared equipment or surfaces which may have become contaminated:(Low Risk) Executive Department: city Administrator Assistant to the Administrator Executive Secretary Assistant Personnel Director community Information Officer Systems Coordinator Municipal Court: Court Administrator Assistant Court Clerk 13 Finance Department: Finance Director Assistant Finance Director utility Billing Clerk Accounting Clerk III &II utility Billing support Clerk Planning Department: City Planner Building Permit Coordinator Planning Aide Planning Clerk Building Permit Clerk These employees could potentially be exposed to blood and/or body fluids through mucous splash and/or by the handling of job related equipment or materials used in the-performance of their duties. Tasks or procedures performed by these positions which include a risk of exposure are: In general: 1.Interaction with the general pUblic. 2.Interaction with co-workers. 3.General maintenance and upkeep of all city equip- ment and vehicles. Employees are prohibited from cooking,eating,drinking,applying make-up or lip balm,and handling contact lenses in any work area where there is a reasonable likelihood of exposure to blood or other potentially infectious material.In addition,all employ- ees are prohibited from storing food or drink in refrigerators, freezers,shelves,cabinets or countertops where blood or other potentially infectious material may be or may have been present. 14 2. HBV VACCINATION HBV vaccinations shall be offered to all employees identified as high risk free of charge by the city of Marysville.The city of Marysville will allow the use of City time and pay all fees asso- ciated with that service.The vaccination will be provided after the employee has received the training outlined in these poli- cies,but within 10 (ten)days of assignment to duties.This policy shall exempt employees who have previously received the complete vaccination series.whose antibody testing indicates they are immune.or those employees for whom the vaccine is con- traindicated.Employee vaccinations shall be documented and maintained in the employees medical record files in the City of Marysville Personnel Department as prescribed by WISHA,and shall be preserved in the city of Marysville Personnel Department for the duration of employment plus thirty (30)years. Routine booster dose(s)of the HBV vaccine shall be provided in accordance with US Public Health Service recommendations at no cost to the employees. If an employee refuses to obtain the required HBV vaccination, the employee will be required to document that refusal on the HBV Declination statement form (see Appendix A-I)which will be main- tained in the employee's medical record for the duration of employment plus thirty (30)years.If however,an employee subse- quently decides to have an HBV vaccination,it will be made available under the same terms and conditions as stated above, upon employer's receipt of a written request to the Assistant Personnel Director. 15 L-~~~~~~~~~.~_ -------------------------------------------------------- 3. FOLLOW-UP PROCEDURES AFTER POSSmLE EXPOSURETO HIVfHBV All employees are required to report any incident of exposure to blood and/or body fluids to their immediate supervisor.All exposure incidents shall be recorded on the OSHA200 form and investigated using the Exposure Incident Investigation form (see Appendix A-2)which will sUbsequently become a part of the employee's medical record.All exposures must document the routers)of exposure and the circumstances under which the expo- sure occurred. Possible exposure incidents include percutaneous needle sticks or cuts,mucous membrane exposure to blood or body fluids,or con- tact with blood or body fluids via chapped,abraded,or otherwise non-intact skin surfaces. Using the Post Exposure Evaluation and Follow-up Checklist (see Appendix A-3)the following steps will be taken:The source indi- vidual shall be notified of the exposure incident and be requested to consent to and obtain testing for HIV/HBV. A refusal of the source individual to consent for testing shall be docu- mented. The results of the source individual's test shall be made known to the exposed employee.The exposed employee shall also be reminded of the laws and regulations concerning the disclosure of the identity and infectious status of the source individual. If the source individual refuses to consent to HIV/HBV testing, or if the source individual tests positive,the exposed employee shall have a clinical evaluation which will include HIV and HBV antibody testing as soon as possible. If the exposed employee tests sero-negative,the employee shall be retested 6 weeks post-exposure and on a periodic basis there- after;12 weeks and 6 months. Follow-up procedures shall also be taken for employees exposed or potentially exposed to HBV depending on employee immunization status,antibody response,and HBV serologicstatus of source individual. If the exposed employee refuses to submit to clinical evaluation and HIV and HBV testing,such refusal will be documented and maintained in the employee's medical record (see Appendix A-I). If the employee consents to baseline blood collection,but does not consent to testing,the employee's blood sample shall be pre- served for nintey (90)days.If within nintey (90)days of expo- sure,the employee elects to have the baseline sample tested, such testing will be conducted as soon as possible. 16 Exposed employees shall have access to post-exposure prophylaxis as recommended by the US Public Health Service when medically indicated,as well as counseling. Exposed employees shall also be advised to report and seek medi- cal evaluation of any acute febrile illness within twelve (12) weeks following exposure. All tests shall be conducted by an accredited laboratory at no cost to the employee. The following information will be provided to the physician per- forming the post-exposure evaluation: A. A copy of the WISHA regulation pertaining to bloodborne pathogens. B. A description of the employee's duties. C.Documentation of the route(s)of exposure and circum- stances under which the exposure occurred. D.Results of the source individual's blood testing,if available. E.All relevant medical records of the employee,including vaccination status.(see Appendix A-3) The Marysville Personnel Department will obtain a written report and opinion from the physician performing the post-exposure eval- uation which shall be limited to: A.Whether an HBV vaccination is indicated,and if the employee has received such vaccination. B.That the employee has been informed of the results of the evaluation. C.That the employee has been told about any medical conditions resulting from exposure to blood or other infectious mate- rial which warrant further evaluation or treatment. In the event of employee exposure to blood or body fluids via percutaneous needle stick,cuts,or mucous membrane exposure, necessary medical treatment shall be administered as appropriate for the type of injury. 17 4.SHARPS AND DISPOSABLE ITEMS Police Department The following sharp instruments or disposable sharps are fre- quently encountered and or collected as evidence by members of the Marysville Police Department: A.Hypodermic needles B.Syringes c.Knives D.Razor blades E.Blood stained broken glass or tool marked metal F.And as many other sharp instruments as one can imagine. Subsequent to recovery or use,potentially contaminated sharp instruments and/or disposable sharps shall be disposed of in the following manner: A.All such sharp items shall be placed in a leakproof, rigid,puncture-resistant,break-resistant container which is conspicuously labeled and which is located in the Marysville Police Department lab room or the Marysville Police Department property room. B.All evidence will be processed and or packaged only in the Marysville Police Department lab area.This will avoid contamination of other work areas and also put the officer in close contact with the necessary evidence containers and bags used in said process. c.The person recovering/receiving sharp instrument or item shall be responsible for its proper disposal as soon as fea- sible.In no instance will any officer leave any such sharp instrument at any work station or in any vehicle beyond the end of the employee's shift. D.Needles shall not be recapped,purposely bent or broken,or removed from disposable syringes.(If recapping or removal is necessary,it must be accomplished by using a mechanical device or a one-handed "scoop"technique). E.Scalpel blades shall be removed from the handle using clamped forceps and placed in the appropriate sharps container by the person using that item. F.Knives and other sharps necessary for evidence will at all times remain in an approved,properly labeled sharps container. G.Appropriate protective gloves will be worn at all times when handling any sharps or knives possibly contaminated by 18 H. blood or OPIM. At no time will any retrieve any item. with tongs,pliers, officer reach into a sharps container to All such removal will be accomplished or other mechanical tool. 19 4.SHARPS AND DISPOSABLE ITEMS Public Works The following sharp instruments or disposable sharps are fre- quently encountered by employees in the Public Works Department: 1.Hypodermic needles 2.Syringes 3.Knives 4.Razor Blades 5.Blood stained broken glass 6.Brooms used in street sweeping 7.Medical waste 8.Any and all sewage related materials Subsequent to recovery or use,potentially contaminated sharp instruments and/or disposable sharps shall be disposed of in the following manner: A.All such sharp items shall be placed in a leakproof, rigid,puncture-resistant,break-resistant container which is conspicuously labeled and which is located in all vehicles,first aid station,and at the front desk of the Lloyd Taubeneck building. B. The person recovering/receiving sharp a instrument or item shall be responsible for its proper disposal as soon as feasible.In no instance will any employee leave any such sharp instrument at any work station or in any vehicle beyond the end of the employee's shift without noti- fying his/her supervisor. C.Needles shall not be recapped,purposely bent or broken,or removed from disposable syringes.(If recapping or removal is necessary,it must be accomplished by using a mechanical device or a one-handed "scoop"technique). D.Scalpel blades shall be removed from the handle using clamped forceps and placed in the appropriate sharps container by the person using that item. E.Knives and other sharps necessary for evidence will at all times remain in an approved,properly labeled sharps container. F.Appropriate protective gloves will be worn at all times when handling any sharps or knives possibly contaminated by blood or OPIM. G.At no time will any employee reach into a sharps container to retrieve any item.All such removal will be accomplished 20 with tongs,pliers,or other mechanical tool. 21 4.SHARPS AND DISPOSABLE ITEMS Park/Golf Department The following sharp instruments or disposable sharps are fre- quently encountered by employees of the Park/Golf Department: 1.Hypodermic needles 2.Syringes 3.Knives 4.Razor Blades 5.Blood stained broken glass SUbsequent to recovery or use,potentially contaminated sharp instruments and/or disposable sharps shall be disposed of in the following manner: A.All such sharp items shall be placed in a leakproof, rigid,puncture-resistant,break-resistant container which is conspicuously labeled and which is located in all vehicles,riding mowers,off-road vehicles,the front desk at the Park Office,Caretakers home,Pro Shop,and Golf Maintenance Shop. B.The person recovering/receiving sharp a instrument or item shall be responsible for its proper disposal as soon as feasible.In no instance will any employee leave any such sharp instrument at any work station or in any vehicle beyond the end of the employee's shift without noti- fying his/her supervisor. C.Needles shall not be recapped,purposely bent or broken,or removed from disposable syringes.(If recapping or removal is necessary,it must be accomplished by using a mechanical device or a one-handed "scoop"technique). D.Scalpel blades shall be removed from the handle using clamped forceps and placed in the appropriate sharps container by the person using that item. E.Knives and other sharps necessary for evidence will at all times remain in an approved,properly labeled sharps container. F.Appropriate protective gloves will be worn at all times when handling any sharps or knives possibly contaminated by blood or OPIM. G.At no time will any employee reach into a sharps container to retrieve any item.All such removal will be accomplished with tongs,pliers,or other mechanical tool. 22 4.SHARPS AND DISPOSABLE ITEMS Executive/Finance/Planning/Court Departments SUbsequent to recovery or use,potentially contaminated sharp instruments and/or disposable sharps shall be disposed of in the following manner: A.All such sharp items shall be placed in a leakproof, rigid,puncture-resistant,break-resistant container which is conspicuously labeled and which is located in the janitor's closet. B.The person recovering/receiving sharp a instrument or item shall be responsible for its proper disposal as soon as feasible.In no instance will any employee leave any such sharp instrument at any work station or in any vehicle beyond the end of the employee's shift without noti- fying his/her supervisor. C.Needles shall not be recapped,purposely bent or broken,or removed from disposable syringes.(If recapping or removal is necessary,it must be accomplished by using a mechanical device or a one-handed "scoop"technique). D.Scalpel blades shall be removed from the handle using clamped forceps and placed in the appropriate sharps container by the person using that item. E.Knives and other sharps necessary for evidence will at all times remain in an approved,properly labeled sharps container. F.Appropriate protective gloves will be worn at all times when handling any sharps or knives possibly contaminated by blood or OPIM. G.At no time will any employee reach into a sharps container to retrieve any item.All such removal will be accomplished with tongs,pliers,or other mechanical tool. 23 5. LINENSAND LAUNDRY Police Department All employees who handle or have contact with contaminated linen shall wear gloves. The following linen items are used/worn in this office and may be exposed to blood or body fluids in the performance of duties by officers: A.Uniform shirts,pants,coats,ties,hats,jumpsuits B.Ballistic vests C.Clothing other than uniforms Employees whose clothing or equipment becomes contaminated during the course of duties should remove the clothing or equipment at the earliest possible convenience. contaminated linen shall be handled as little as possible with a minimum of agitation.contaminated linen shall be bagged at the location where it is recovered/received and shall not be sorted or rinsed on location.For officer convenience,such receptacles will be located adjacent to showers in locker rooms. Contaminated linen shall be placed in a red,leakproof bag which shall be marked "Bio-Hazard"to indicate the potential infectious status of its contents.Should outside contamination of the bag occur,double bagging shall be required. The Marysville Police Department shall be responsible for trans- port.laundering,and disinfection of linen items. 24 5.LINENS AND LAUNDRY Public W orks/park/Golf Department All employees who handle or have contact with contaminated linen shall wear gloves. The following linen items are used/worn in this department and may be exposed to blood or body fluids in the performance of duties by the employees: A.Uniform shirts,pants,coats,hats,coveralls,jumpsuits. B.Clothing other than uniforms Employees whose clothing or equipment become contaminated during the course of duties should remove the clothing or equipment at the earliest possible convenience. contaminated linen shall be handled as little as possible with a minimum of agitation.contaminated linen shall be bagged at the location where it is recovered/received and shall not be sorted or rinsed on location. For Public Works employees'convenience,such receptacles will be located in locker rooms,changing areas,next to soiled laundry pick-up. For Parks Department employees'convenience,receptacles will be located next to normal laundry drop off bins on the caretaker's porch. For Golf Department employees'convenience,receptacles will be located under the stairs at the maintenance shop next to normal laundry drop off bins. Contaminated linen shall be placed in a red,leakproof bag which shall be marked "Bio-Hazard"to indicate the potential infectious status of its contents.Should outside contamination of the bag occur,double bagging shall be required. The City's contracted laundry service shall be responsible for transport,laundering,and disinfection of linen items. 25 5. LINENSAND LAUNDRY ExecutivefFinance,Planning/Building,Court All employees who handle or have contact with contaminated linen shall wear gloves. Contaminated linen shall be placed in a red,leakproof bag which shall be marked "Bio-Hazard"to indicate the potential infectious status of its contents.Should outside contamination of the bag occur,double bagging shall be required. The city's contracted laundry service shall be responsible for transport,laundering,and disinfection of linen items. 26 6.DISPOSABLE EQUIPMENT AND MATERIAL Disposable gloves and other disposable personal protective equip- ment found in Infection Control Kits,(located in all city vehi- cles,including patrol vehicles,the Police lab,Marysville Treatment Lab,in the jail booking area,and in all reception areas.)do come in contact with blood or body fluids and could potentially expose employees to HIV/HBV. The above referenced non-sharp disposable equipment and/or mate- rial shall be segregated and disposed of in a leak proof plastic bag.Said bags will be located in: Police - The Police lab,all police vehicles,in the jail booking area; Public Works -Wastewater treatment plant lab,First Aid medical station in shop,all vehicles,Lloyd Taubeneck building employee restooms and locker rooms. Parks - Golf - Court - In the workshop next to the sink. In trucks. Under the steps in the maintenance shop. In trucks. In the jail booking area. Planning - Finance/ Executive -At City Hall in the Janitor's closet Transport and disposal of the above referenced items shall be carried out as outlined in the housekeeping section of these pol- icies and procedures. 27 7.REUSABLE EQUIPMENT Police Department The following reusable equipment is used in this office and does come in direct contact with blood or other body fluids and could potentially expose officers to HIVjHBV: A.Handcuffs B.Leg irons C.Night sticks or extension batons D.Flashlights E.Patrol vehicles and associated equipment F.Lab aprons Reusable equipment shall be scrubbed to remove all debris from surfaces immediately following contamination by the person using said equipment. All said equipment will be sterilized using cold sterile solu- tions prepared to appropriate dilution as recommended for control of HBV. Contaminated clothing item(s)will be handled as defined in sec- tion 5 of this policy. 28 7.REUSABLE EQUIPMENT Public Works Department The following reusable equipment is used in the Public Works Department and does come in direct contact with blood or other body fluids and could potentially expose employees to RIVjRBV: ·A.Solid Waste vehicles and associated equipment. B.All hand and power tools used in maintenance of all jobs as assigned daily;in the maintenance of all equipment and vehicles;and during all construction projects. c.Wastewater treatment plant equipment such as forceps, gloves,lab glassware,sponges and any other associated items. Reusable equipment shall be scrubbed to remove all debris from surfaces immediately following contamination by the person using said equipment. All said equipment will be sterilized using cold sterile solu- tions prepared to appropriate dilution as recommended for control of RBV. contaminated item(s)will be handled as defined in section 5 of this policy. 29 7.REUSABLE EQUIPMENT Park Department The following reusable equipment is used in the Park/Golf Depart- ment and does come in direct contact with blood or other body fluids and could potentially expose employees to HIV/HBV: A.Reusable Gloves~ B.All hand and power tools used in maintenance of all jobs as assigned daily;in the maintenance of all equipment and vehicles;and during construction projects. Reusable equipment shall be scrubbed to remove all debris from surfaces immediately following contamination by the person using said equipment. All said equipment will be sterilized using cold sterile solu- tions prepared to appropriate dilution as recommended for control of HBV. contaminated item(s)will be handled as defined in section 5 of this policy. 30 -----------------_.._.- 8;HAND WASHING All employees having direct contact with blood or O.P.I.M.shall wash hands using warm water and soap before,when anticipated, but always after contact with blood or O.P.I.M.If such facili- ties are unavailable,alcohol foams or antiseptic towelettes may be used.(Found in infection control kits.) Employees shall immediately remove and dispose of gloves in appropriate segregated waste receptacles located in the: Police - Public Works - Parks - Golf - court - Planning - Executive/ Finance - Police lab and/or jail booking area. Wastewater Treatment plant lab,First Aid Medical station in shop,all vehicles,Taube- neck Building employee restrooms and locker rooms. In the workshop next to the sink. Under the steps in the maintenance shop.In trucks. Employee restroom. Employee restroom. The waste receptacle in the janitor's closet. Where exposure may occur in order to prevent contamination from spreading to other work areas. Employees shall immediately and thoroughly wash hands and other exposed skin surfaces after removal of gloves using warm water and soap.The city of Marysville encourages all employees to reg- ularly wash their hands as a means of controlling the spread of infectious diseases. These procedures shall also be followed after removal of other personal protective equipment following accidental exposure to blood or body fluids. Reusable personal protective equipment as listed above in section 7 shall be rinsed and sterilized per the recommendations set forth by the manufacturer. 31 L .. 9;PERSONAL PROTECTIVE EQUIPMENT Police Department The Marysville Police Department shall provide and maintain,in a sanitary and reliable condition,necessary personal protective equipment which is relevant to the procedures and job functions of the various Marysville Police Department officers.Officers are required to use appropriate protective equipment for the task they are performing,except in those extraordinary circumstances when such use would,in the officer's professional jUdgement, prevent the service from being provided.In such cases the inci- dent shall be investigated and documented in order to determine if changes can be instituted to prevent such occurrences. The use of gloves is indicated and must be worn: A.For all emergency response care which involves potential exposure to blood or body fluids,particularly if the officer has cuts,abraded skin,chapped hands, dermatitis,hang nails,or other non-intact skin. B.During all decontamination procedures involving clean up of blood or body fluids. C.During the collection and processing of all potentially contaminated evidentiary items both at the crime scene and in the Marysville Police Department lab area. D. When scrubbing equipment contaminated with blood or body fluids prior to sterilization. Gloves shall be of appropriate quality and material and shall comply with the standards of safety for the procedure performed. The Marysville Police Department shall supply a sufficient quan- tity of gloves of appropriate size for each officer.Hypo-aller- genic gloves,glove liners,powderless gloves or similar alterna- tives will be made available to those officers who are allergic to the gloves normally provided.Gloves shall be single-use and shall be disposed of immediately following each contaminant con- tact or procedure. Masks and eye protectors are to be available and are required to be used when contamination of mucosal membranes (eye,nose,or mouth)with body fluids is likely to occur. Resuscitation equipment is provided to minimize the need for mouth-to-mouth resuscitation and shall be easily accessible in the event resuscitation is necessary.Mouth suctioning of blood or other potentially infectious material is prohibited. All contaminated personal protective equipment must be removed 32 from vehicles or work stations,cleaned or disposed of in the appropriate area or container prior to leaving the work area. New or cleaned personal protective equipment will also be installed to replace contaminated equipment.This will be the responsibility of the officer who used the equipment.Failure to replace/restock used materials will make the officer(s)sUbject to disciplinary action. 33 9.PERSONAL PROTECTIVE EQUIPMENT Public Works Department, Park/Golf,ExecutivefFinance,Court, Planning The City of Marysville shall provide and maintain,in a sanitary and reliable condition,necessary personal protective equipment which is relevant to the procedures and job functions of the var- ious employees.Employees are required to use appropriate pro- tective equipment for the task they are performing,except in those extraordinary circumstances when such use would,in the employee's professional judgment,prevent the service from being provided.In such cases the incident shall be investigated and documented in order to determine if changes can be instituted to prevent such occurrences. The use of gloves is indicated and must be worn: A.For all emergency response care which involves potential exposure to blood or body fluids,partiCUlarly if the employee has cuts,abraded skin,chapped hands, dermatitis,or other non-intact skin. B.During all decontamination procedures involving clean up of blood or body fluids. c.When scrubbing equipment contaminated with blood or body fluids prior to sterilization. Gloves shall be of appropriate quality and material and shall comply with the standards of safety for the procedure performed. The city of Marysville shall supply a sufficient quantity of gloves of appropriate size for each employee.Hypo-allergenic gloves,glove liners.powderless gloves or similar alternatives will be made available to those employees who are allergic to the gloves normally provided.Gloves shall be single-use and shall be disposed of immediately following each contaminant contact or procedure. Masks and eye protectors are to be available and are required to be used when contamination of mucosal membranes (eye,nose,or mouth)with body fluids is likely to occur. Resuscitation equipment is provided to minimize the need for mouth-to-mouth resuscitation and shall be easily accessible in the event resuscitation is necessary.Mouth suctioning of blood or other potentially infectious material is prohibited. All contaminated personal protective equipment must be removed from vehicles or work stations,cleaned or disposed of in the appropriate area or container prior to leaving the work area. New or cleaned personal protective equipment will also be installed to replace contaminated equipment.This will be the 34 responsibility of the employee who used the equipment.Failure to replace/restock used materials will make the employee (s)subject to disciplinary action. 35 10.HOUSEKEEPING General Policies: A cleaning schedule for equipment/or areas will be established and maintained.The following guidelines will be followed until such time as procedures or policies require an appropriate update.(see Appendix A-4) All equipment and work surfaces shall be cleaned as soon as prac- tical after any contamination by blood or other potentially infectious material.In no circumstances will this be left for other officers/employees to do.It is the responsibility of the officer/employee who contaminated the area. Protective coverings used-to cover equipment are to be removed, cleaned or replaced as soon as feasible after being contaminated. All bins,cans,or other receptacles which will be reused and which may be contaminated are to be emptied,cleaned and decon- taminated at the end of each work shift. Broken glass which may be contaminated is not to be picked up by hand,but cleaned up or picked up by using a broom and dust pan, tongs,or forceps. Reusable sharps are,after use,to be placed in the appropriate labeled container.Officers/Employees shall not reach into such containers with their hands;but must place and retrieve used, and presumably contaminated,sharps with tongs or forceps. Regulated waste (disposable sharps) Contaminated sharps shall be discarded immediately after they are located or used,or as soon as feasible,in appropriate contain- ers.This presumes that there is no compelling need to retain the item for evidentiary purposes.Appropriate containers whether for disposal or evidence are described as follows: A.Closable B.Puncture resistant C.Leak-proof on sides and bottoms D.Appropriately labeled (see labeling section) E.Maintained upright F.Emptied or replaced daily or whenever 2/3 full,except evidence containers When moving containers containing contaminated sharps,care should be taken to assure the container is closed to prevent spillage or protrusion of contents. 36 In the event of leakage or protrusion,the container is to be placed in a secondary container which must also be closable, puncture resistant,and leak-proof. other Regulated Waste other regulated waste includes liquid or semi-liquid blood or other infectious materials;contaminated items that would release blood or other potentially infectious materials in a liq- uid or semi-liquid state if compressed;items that are caked with dried blood or other potentially infectious materials and are capable of releasing these materials during handling;contami- nated sharps;and pathological and microbiological wastes con- taining blood or other potentially infectious materials. Such regulated waste must be placed in the appropriate,labeled containers.containers must meet the following specifications: A.Closable B.Able to prevent leakage during handling,storage,or transport C.Appropriately labeled Containers must be closed prior to removal to prevent leaks.If outside contamination of a container occurs,the container is to be placed in a secondary container which is also closable,able to prevent leakage,and appropriately labeled. 37 -------------------------------------- 11.DISPOSAL OF REGULATED WASTE At the end of each day,regulated waste shall be removed from vehicles and other work areas and placed in an appropriate waste receptacle lined with a red,leak-proof plastic bag,and stored in the appropriate location for pick-up and disposal by an out- side contractor retained by the City of Marysville or Snohomish County Health District.such independent contractors will be responsible for the training of their employees regarding the identification,segregation,and disposal of infectious waste. 38 12.SIGNS AND LABELING Warning labels shall be affixed to all containers of regulated waste,laundry,sharps containers,disposable personal protection equipment,refrigerators,or freezers containing blood or other potentially infectious material,and containers used to store or transport blood or potentially infectious materials. warning labels will include the following symbol and will be flo- rescent orange or orange-red,or predominantly so,with lettering and symbol in a contrasting color. (see CH 296-62 WAC Part J,page 17 attached as Appendix A-7) warning labels will be affixed to containers by string,wire or adhesive in order to prevent their unintentional removal. Note:Red containers may be substituted for labels. Red bags will be used for contaminated laundry and non-sharp reg- ulated waste. 39 13.EDUCATION AND TRAINING OF EMPLOYEES All employees whose job functions involve the risk of exposure to blood or body fluids shall receive appropriate education and training prior to the commencement of their duties and annually thereafter.Such education and training shall,at a minimum, include: A. A copy of the regulation and an explanation of its contents. B. A general explanation of the epidemiology and symptoms of bloodborne diseases. c.An explanation of the modes of transmission of bloodborne pathogens. D. An explanation of each department's exposure control plan and means by which the employee can obtain a copy of the written plan. E. An explanation of the appropriate methods for recogn~z~ng tasks and other activities that may involve exposure to blood or other potentially infectious materials. F.An explanation of the use and limitations of methods that will prevent or reduce exposure,including work practices and personal protective equipment. G.Information on the types,proper use,location, removal,handling,decontamination and disposal of personal protective equipment. H.An explanation of the basis for selecting personal protec- tive equipment. I.Information on the Hepatitis B vaccine including information on its efficacy,safety,method of admin- istration,benefits of being vaccinated,and that the vaccine will be offered free of charge. J.Information on the appropriate actions to take and persons to contact in an emergency involving blood or other poten- tially infectious materials. K. An explanation of the procedures to follow if an expo- sure incident occurs,including the method of report- ing the incident and the medical follow-up that will be made available. L.Information on the post-exposure evaluation and follow-up that the employer is required to provide. 40 M.An explanation of the signs and labels and/or color- coding used by the employer. N. An opportunity for interactive questions and answers with the persons conducting the training sessions. Additional training will be provided when new tasks or procedures involving potential exposure are instituted. Records of training sessions will be maintained for three (3) years.Such records will include: A.The date of training. B. A summary of the content of training. c.The names and qualifications of person(s)conducting the training session. D.The names and job titles of all persons attending the training session. (Bloodborne Pathogens Training Sessions form,Appendix A-5) Training records will be made available to employers,their rep- resentatives,and appropriate government representatives. 41 14.MEDICAL RECORDS A medical record for each employee whose duties include potential occupational exposure will be maintained by the City of Marys- ville.These records will include: A.The name and social security number of the employee. B. A copy of the employee's HBV vaccination status including the dates of vaccination and any medical records regarding the employee's ability to receive the vaccination. C. A copy of all opinions,examinations,testing,and follow-up involving post-exposure incidents. D. A copy of any information provided to any other health care professional regarding possible exposure. Such records will be kept confidential and will not be disclosed to any person,except as required by law,without the express written consent of the employee.Such records will be maintained for thirty (30)years beyond the duration of the employment. In the event the city of Marysville ceases to do business and there is no successor employer to transfer the records to,the city of Marysville will notify the Department of Labor and Indus- tries at least three (3)months prior to the disposal,and will transfer them to the Department if requested to do so. 42 15.PROCEDURES IN THE EVENT OF PERSONAL EXPOSURE All employees are required to use the following procedures in the event of exposure to possibly infectious blood or bodyfluids: A.Needle Stick/Cut:Milk the exposure to express blood and clean the wound vigorously with soap and water for at least 10-15 seconds using friction. B.Mucosal Splash:For a mucosal splash to eyes,nose,or mouth,flush or rinse with saline or water.For a mucosal splash to the skin or contamination of open wound,wash with soap and water.Shower and change clothes if necessary. C.Blood Splash/contact:For blood splash to mucosal tissues follow mucosal splash guideline above.For blood splash or contact to chapped,abraded,cut or broken skin,wash with soap and water and again remove contaminated clothing as soon as possible. D.For any other contact with blood or body fluids to skin surfaces,wash with soap and water immediately or antisep- tic wipes when wash facilities are not available.Remove contaminated clothing,shower and if continued contamina- tion is anticipated,put on appropriate personal protective equipment. E.Reporting:Report all needle sticks,mucosal splashes, and contamination of open wounds with blood and/or body fluids to your immediate senior supervisor. 43 - ----------------------------------~ Appendix A-l CONFIDENTIAL VACCINATION DECLINATION FORM DATE:_ EMPLOYEE NAME:_ EMPLOYEE SOCIAL SECURITY NUMBER _ I understand that dueto my occupational exposure to blood or other p'oten- tial infectious materials I may be at risk of acquiring Hepatitis Bvirus (HBY) infection.I have been given the opportunity to be vaccmated with Hepatitis B vaccine at no charge to myself.However\I declinethe Hepatitis B vacci- nation atthis time.I understand that by declining this vaccine,I continue to be at riskof acquiring Hep.atitis B,a serious disease.If, inthe future,I con- tinueto have occupalional exposure to blood or other potentially infectious materials and Iwantto be vaccinated with hepatitis B vaccine,can receive the vaccination series at no charge to me. Employee Signature Supervisor Department Head city Administrator Date Date Date Date Return Original to Personnel Department CorEmployee's permanent medical record file. 44 Appendix A-2 EXPOSURE INCIDENT INVESTIGATION FORM Date of Incident: Location: Department: Job Title of Employee Involved: Time of Incident: potentially Infectious Materials Involved: Type:Source: circumstances:(Work being performed,etc.): How Incident was caused (accident,equipment malfunction,etc.): Personal Protective Equipment being used: Actions taken (decontamination,clen-up,reporting,etc): Recommendations for avoiding repetition: cc:Department Head Safety Committee Chainnan Personnel Department (Original) 45 Appendix A-3 CONFIDENTIAL POST -EXPOSURE EVALUATION AND FOLLOW-UP CHECKLIST The following steps mustbe taken,and information transmitted,inthe case of an employee's exposure to Bloodborne Pathogens: ACTIVITY COMPLETION DATE ) Source individual Employee furnished with documentation regarding exposure incident. Source individual identified. (_-;:::--_,......."...-:-;--...,--_--J Source individual's blood tested and results given to exposed employee. Exposed employee's blood collected and tested Appointment arranged for employee with healthcare professional. () Professional's Name Documentation forwarded to healthcare professional. Bloodborne Pathogens Standard. Employee's job description. Description of Exposure Incident, including routes of exposure. Result of source individual's blood testing. Employee's medical records. Original to Personnel Department Cor employee's permanent medical record file. 46 SCHEDULED EQUIPMENT/AREA CLEANING CLEANERS AND SPECIAL (DAYITIME)DISINFECTANTS USED INSTRUCTIONS AppendixA-5 BLOODBORNE PATHOGENS TRAINING SESSION DATEOF SESSION:_ SESSION SUMMARY (ATTACHED) INSTRUCTOR (S)QUALIFICATIONS EMPLOYEE Return completed form to Personnel Department. JOB TITLE 47 MAKE SURE YOU HAVE RECEIVED YOUR HEPATITIS B VACCINATION The vaccination is given at the following times: LOCATION:_ To sign up call or talk to your supervisor The vaccination is free of cherqe to all employees. Appendix A-7 Part J Biological Agents WAC 296-62-080 296-62-08001 296-62-08050 Biologicalagents. Bloodborne Pathogens Appendix A-Hepititis B Vaccine Declination (Mandatory) 1 1 21 WAC 296-62-080,Biological agents. (1)Definition.Biological agents are organisms or their by-products. (2) .Protection from exposure.Workmen shall be protected from exposure to hazardous concentrations of biological agents which may arise from processing, handling or using materials or waste.IOnic,73-3, §296-<12-Q80,filed snm,Order 7Cl-8,§296-<12-Q80,filed ttnne,effective 911nO;Rule 8.010,effective 811/63.1 WAC 296-62-08001,Bloodbome Pathogens. (1) Scope and Application.This section applies to all occupational exposure to blood or otber potentially infectious materials as defined by subsection (2) of this section. (2)Definitions.For purposes of this section, the following shall apply: "Blood" means human blood, human blood components,and products made from human blood. "Bloodbome 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 (HBY) and human immunodeficiency virus (HIY). "Clinical Laboratory"means a workplace where diagnostic or other screening procedures are performed on blood or other potentially infectious materials. "Contaminated" means the presence or the reasonably anticipated presence of blood or other potentially infectious materials on an item or surface. "Contaminated Laundry"means laundry which has been soiled with blood or other potentially infectious materials or may contain contaminated sharps. 'Contaminated Sharps'means any contaminated object thatcan 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 bloodbome pathogens 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. Part J.Page 1 (4/92 Issue) Chapler 296-62 WAC BiologM:al Ageats WAC 296-62-08001 (Cont.) "Director"means the Director of the Washinglon State Department of Labor and Industries;the state designee for the Washington State Plan. "Engineering Controls"means controls (e.g.,sharps disposal containers,self-sheathing needles)tbat isolate or remove Che bloodborne pathogens hazard from tbe workplace. "Exposure Incident" means a specific eye, mouth,other mucous membrane,non-intact skin,or parenteral contact with blood or other potentially infectious materials tbat 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 machines. ,"Licensed Healthcare Professional"is a person wbose legally permitted scope of practice allows him or .her to independently perform the activities required by subsection (6)Hepatitis B Vaccination and Post-exposure Evaluation and Follow-up, "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 perfonnance of an employee's duties. "Other Potentially Infectious Materials"means: (a) The following human body tluids:semen,vaginal secretions,cerebrospinal tluid,synovial fluid, pleural fluid,pericardial tluid,peritoneal tluid,amniotic fluid, saliva in dental procedures,any body tluid that is visibly contaminated witb blood, and all body tluids in situations wbere it is difficult or impossible to differentiate between body tluids; (b)Any unfixed tissue or organ (other tban intact skin) from a buman (living or dead); and (c)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 sucb events as needlesticks, human bites, cuts, and abrasions. "Personal Protective Equipment"is specialized clothing or equipment worn by an employee for protection against a hazard. General work clothes (e.g.,uniforms,pants,shirts or blouses) not intended to function as protection against a hazard are not considered to be personal protective equipment. "Production Facility"means a facility engaged in industrial-scale,large-volume or high concentration production of HlV or HBV. "Regulated Waste" means liquid or semi-liquid blood or other potentially infectious materials;contaminated items that would release blood or other potentially infectious materials in a liquid or semi-liquid stale if compressed;items that are caked with dried blood or other potentially infectious materials and are capable of releasing these materials during handling;contaminated sharps; and pathological and microbiological wastes containing blood or other potentially infectious materials. Part J.Page 2 (4/92 Issue) Chapter 296-61 WAC BiologM:a1 Agee ts WAC 296-620.08001 (ConL) "Research Laboratory" means a laboratory producing or using research-laboratory-scale amounts of HIV or HBV. Research laboratories may produce high concentrations of HIV or HBV but not in the volume found in production facilities. "Source Individual" means any individual,living or dead, whose blood or other potentially infectious materials may be a source of occupational exposure to the employee.Examples include,but are Dotlimited to, 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; human remains; and individuals who donate or sell blood or blood components. "Sterilize" means the use of a physical or chemical procedure to destroy all microbial life including highly resistant bacterial endospores. "Universal Precautions"are 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 bloodbome pathogens. "Work Practice Controls"means controls that reduce the likelihood of exposure by altering the manner in which a task is performed (e.g.,prohibiting recapping of needles by a two-handed technique). (3)Exposure control (a)Exposure Control Plan. (i) Each employer having aa employee(s) with occupational exposure as defined by subsection (2)of this section shall establish a written Exposure Control Plan designed to eliminate.minimize employee exposure. ~ (ii)The Exposure Control Plan shall contain at least the following elements: (A)The exposure determination required by subdivision (3)(b), (B)The schedule and method of implementation for subsections (4),Methods of Compliance,(5), HIV and HBV Research Laboratories and Production Facilities,(6), Hepatitis B Vaccination and Post-Exposure Evaluation and Follow-up,(7), Communication of Hazards to Employees,and (8), Recordkeeping,of this standard, and, (C)The procedure for 'the .evaluation of circumstances surrounding exposure incidents as required by subdivision/item (6)(c)(i)of this section. (iii) Each employer shall ensure that a copy of the Exposure Control Plan is accessible to employees in accordance with WAC 296~2-o5209. (iv) The Exposure Control Plan shall be reviewed and updated at least annually,and whenever necessary to reflect Dew or modified tasks and procedures which affect occupational exposure,and to reflectnew or revised employee positions with occupational exposure. (v)The Exposure Control Plan shall be made available to tbe Director upon request for examination and copying. Part J,Page 3 (4/92 Issue) CbaplO'296-02 WAC Biological Agents WAC 296-62·08001 (Cont.) (b) Exposure determination. (i) Each employer who has an employee(s) with occupational 'exposure as defined by subsection (2)of this section shall prepare an exposure determination.This exposure determination shall contain the following: (A) A list of all job classifications in whicb all employees in those job classifications have occupational exposure; (B) A list of job classifications 10 which some employees have occupational exposure,and, (C)A list of all tasks and procedures or groups of closely related tasks and procedures in which occupational exposure occurs,and that are performed by employees in job classifications listed in accordance with the provisions of sub-division/item (3)(b)(i)(B) of this section. (ii) This exposure determination shall be made without regard to the use of personal protective equipment.' (4) Methods of compliance. (a) General. Universal precautions shall be observed to prevent contact with blood or other potentially infectious materials. Under circumstances in which differentiation between body fluid types is difficult or impossible, all body fluids shall be considered potentially infectious materials. (b) Engineering and work practice controls. (i) Engineering and work practice controls shall be used to eliminate or minimize employee exposure. Where occupational exposure remains after institution of these controls, personal protective equipment shall also be used. (ii)Engineering controls shall be examined and maintained or replaced on a regular schedule to ensure their effectiveness. (iii) Employers shall providehandwashing facilities which are readily accessible toemployees. (iv) When provision of handwashing facilities is not feasible, the employer shall provide either an'appropriate antiseptichand cleanser in conjunction with clean cloth/paper towels or antiseptic towelettes, When antiseptic hand cleansers or towelettes are used, hands shall be washed with soap and running wateras SOon as feasible. (v) Employers shall ensure that employees wash their hands immediately or as soon as feasible after removal of gloves or other personal protective equipment. (vi) Employers 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 other potentially infectious materials. (vii) Contaminated needles and other contaminated sharps shall not be bent, recapped, or removed except as noted in sub-division/items (4)(b)(vii)(A)and (4)(b)(vii)(B) below. Shearing or breaking of contaminated needles is prohibited. Part Jf Page 4 (4/92 Issue) Chapl.r 296-62 WAC Bwlop AJtots WAC 296-62-08001 (Cant.) (A)Contaminated needles and other contaminated sharps shall not be recapped or removed unless the employer can demonstrate that no alternative is feasible or that such action is required by a specific medical procedure. (B)Such recapping or needle removal must be accomplished through the use of a mechanical device or a nne-handed technique. (viii)Immediately or as SOOn as possible after use,contaminated reusable sharps shall be placed in appropriate containers until properly reprocessed.These containers shall be: (A)Puncture resistant; (B)Labeled or color-coded in accordance with this standard; (C)Leakproof on the sides and bottom;and (D)In accordance with the requirements set forth in sub-division/item (4)(d)(ii)(E) for reusable sharps. (ix)Eating,drinking,smoking,applying cosmetics or lip balm,and handling contact lenses are prohibited in work areas where there is a reasonable likelihood of occupational exposure. (x)Food and drink shall not be kept in refrigerators,freezers,shelves,cabinets or on countertops or benchtops where blood or other potentially Infectious materials are present. (xi) All procedures involving blood or other potentially infectious materials shall be performed in such a manner as to minimize splashing,spraying,spattering,and generation of droplets of these substances. (xii)Mouth pipelling/suctioning of blood or other potentially infectious materials is prohibited. (xiii)Specimens of blood or other potentially infectious materials shall be placed in a container which prevents leakage during collection,handling,processing,storage,transport,or shipping. I L (A) (B) (C) The container for storage,transport,or shipping shall be labeled or color-coded according to sulKlivision/item (7)(a)(i)and closed prior to being stored, transported,or shipped. When a facility utilizes Universal Precautions in the handling'of all specimens, the labeling/color-coding of specimens is not necessary provided containers are recognizable as containing specimens.This exemption only applies while such specimens/containers remain within the facility.Labeling or color-coding in accordance with sub-division/item (7)(a)(i) is required when such specimens/containers leave the facility. If outside contamination of the primary container occurs,the primary container shall be placed within a second container which prevents leakage during handling,processing,storage,transport,or shipping and is labeled or color-coded according to the requirements of this standard. If the specimen could puncture the primary container,the primary container shall be placed within a secondary container which is puncture-resistant in addition to the above characteristics. Part J,Page 5 (4/92Issuo) Cbopltr 1%-61 WAC Bi.ological Ageats WAC 296·62-08001 (Cont.) (xiv)Equipment which may become contaminated with blood or other potentially infectious materials shall be examined prior to servicing or shipping and shall be decontaminated as necessary,unless the employer can demonstrate that decontamination of such equipment or portions of such equipment is not feasible. (A) A readily observable label in accordance with sub-division/item(7)(a)(i)(H)shall be attached to the equipment stating which portions remain contaminated. (B)The employer shall ensure that this information is conveyed to all affected employees,the servicing representative,and/or the manufacturer,as appropriate, prior to handling,servicing,or shipping so that appropriate precautions will be taken. (c)Personal protective equipment. (i)Provision.When there is occupational exposure,the employer shall provide,at no cost to the employee,appropriate personal protective equipment such as, hut not limited to, gloves,gowns,laboratory coats,face shields or masks and eye protection,and mouthpieces,resuscitation bags,pocket masks,or other ventilation devices.Personal protective equipment will be considered "appropriate"only if it does not permit blood or other potentially infectious materials to pass through to or reach the employee'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 will be used.. (ii) Use.The employer shall ensure that the employee uses appropriate personal protective equipment unless the employer shows that the employee temporarily and briefly declined to use personal protective equipment when,under rare and extraordinary circumstances, it was the employee's professional judgment that in the specific instance its use would have prevented the delivery of health care or public safety services or would have posed an increased hazard to the safety of the worker or co-worker.When the employee makes this judgement,the circumstances shall be investigated and documented in order to determine whether changes can be instituted to prevent such occurrences in the future. (iii)Accessibility.The employer shall ensure that appropriate personal protective equipment in the appropriate sizes is readily accessible at the worksite or is issued 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. (iv)Cleaning,Laundering,and Disposal.The employer shall clean,launder,and dispose of personal protective equipment required by subsections (4) and (5)of this section,at no cost to the employee. (v)Repair and Replacement.The employer shall repair or replace personal protective equipment as needed to maintain its effectiveness,at no cost to the employee. (vi) If a garment(s)is penetrated by blood or other potentially infectious materials,the garment(s)shall be removed immediately or as soon as feasible. (vii) All personal protective equipment shall be removed prior to leaving the work area. Part J,Page 6 (4/92 Issue) Chapter 2%-62 WAC Biological Ageuts WAC 296-62-68001 (ConI.) (viii) When personal protective equipment is removed it shall he placed in an appropriately designated area or container for storage, washing,decontamination or disposal. (ix) Gloves. Gloves shall he worn when it can he reasonably anticipated that the employee may have hand contact with blood, other potentially infectious materials,mucous membranes,and non-intact skin; when performing vascular access procedures except as specified in sub-division/item (4)(c)(ix)(D); and when handling or touching contaminated items or surfaces. (A) Disposable (single use) gloves such as surgical or examination gloves, shall he replaced as soon as practical when contaminated or as soon as feasible if they are tom,punctured,or when their ability to function as a barrier is compromised. (B)Disposable (single use) gloves shall not he washed or decontaminated for re-use: (C)Utility gloves may he decontaminated for re-use if the integrity of the glove is not compromised. However, they must he discarded if they are cracked, peeling,tom,punctured, or exhibit other signs of deterioration or when their ability to function as a barrier is compromised. (D)If an employer in a voluoteer blood donation center judges that routine gloving for all phlebotomies is Dot necessary then the employer shall: (I)Periodically reevaluate this policy; (II) Make gloves available to all employees who wish 10 use them for phlebotomy; (lll)Not discourage the use of gloves for phlebotomy;and (IV) Require that gloves he used for phlebotomy in the following circumstances:. (sa) When the employee has cuts,scratches,or other breaks in his or her skin; (bb) When the employee judges that hand contamination with blood may occur, for example, when performing phlebotomy on an uncooperative source individual;and (cc) When the employee is receiving training in phlebotomy. (x) 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 he worn whenever splashes, spray, spatter, or droplets of blood or other potentially infectious materials may be generated and eye,nose, or mouth contamination can be reasonably anticipated. (xi)Gowns,Aprons, and Other Protective Body Clothing.Appropriate protective clothing such as, but not limited to,gowns,aprons, lab coats,clinic jackets,or similar outer garments shall be worn in occupational exposure situations.The type and characteristics will depend upon the task and degree of exposure anticipated. Part J,Page 1 (4/92 Issue) Chapter 2%-62 WAC B;oloP<aJ AI"'" WAC 296-62.()8001 (Cont.) (xii) Surgical caps or hoods and/or shoe covers or boots shall be worn io instances when gross contamination can reasonably be anticipated (e.g.,autopsies,orthopaedic surgery.) (d) Housekeeping. (i) General.Employers shall ensure that the worksite is maintained in a clean and sanitary condition,The employer sball detennine and implement an appropriate written scbedule for cleaning and method of decontamination based upon the location within the facility, type of surface to be cleaned, type of soil present, and tasks or procedures being performed in the area. (ii) All equipment and environmental and working surfaces shall be cleaned and decontaminated after contact with blood or other potentially infectious materials. (A) Contaminated work surfaces sball 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. (B)Protective coverings, such as plastic wrap,aluminum foil, or imperviously-backed absorbentpaper used to cover equipment and environmental surfaces,shall be removed and replaced as soon as feasible when they become overtly contaminated or at the end of the workshift if they may have become contaminated during the shift. (C) All bins, pails, cans, and similar receptacles intended for reuse whicb have a reasonable likelihood for becoming contaminated with blood or other potentially infectious materials shall be inspected and decontaminated on a regularly scheduled basis and cleaned and decontaminated immediately or as soon as feasible upon visible contamination. (D) Broken glassware which may be contaminated shall not be picked up directly with the hands.It shall be cleaned up using mechanical means, sucb as a brush and dust pan, tongs, or forceps. (E) Reusable sbarps that are contaminated with blood or other potentially infectious materials sball not be stored or processed in a manner thai requires employees 10 reacb by band into the containers where these sharps have been placed. (iii) Regulated Waste. (A) Contaminated Sharps Discarding and Containment. (I)Contaminated sbarps shall be discarded immediately or as soon as feasible in containers that are: (aa) Closable; (bb) Puncture resistant; Part J,Page 8 (4192 Issue) WAC 296-62-08001 (Cont.) Chapt..-296-62 WAC BioI""w:a1 Agee" (cc)Leakproof on sides and bottom: and (dd) Labeled or color-coded in accordance with sub-division/item (7)(a)(i) of this section. (II) During use, containers for contaminated sharps shall be: (aa) Easily accessible to personnel and located as close as is feasibleto the immediatearea where sharps are used or can be reasonably anticipated to be found (e.g.,laundries); (bb) Maintained upright throughout use; and (cc) Replaced routinely and not be allowed to overfiII. (III) When moving containers of contaminated sharps from the area of use, the containers shall be: (aa) Closed immediatelyprior to removal or replacement to prevent spillage or protrusion of contents during handling, storage, transport, or shipping; (bb) Placed in a secondary container if leakage is possible. The second container shall be: (AA) Closable; (BB) Constructed to contain all contents and prevent leakage during handling,storage,transport,or sbipping; and (cq Labeled or color-coded according to paragrapb (g)(I)(i)of this standard. (IV).Reusable containers shall not be opened, emptied,or cleaned manually or in any other manner which would expose employees to the risk of percutaneous injury. (B) Other Regulated Waste Containment. (1) Regulated waste sball be placed in containers which are: (aa) Closable; (bb) Constructed to contain all contents and prevent leakage of fluids during handling, storage,transport or shipping; (cc) Labeled or color-eoded in accordance with sub-division/item (7)(a)(i) this standard; and (dd) Closed prior to removal to prevent spillage or protrusion of contents during handling, storage,transport,or shipping. Part Jt Page 9 (4/92 Issue) Cbapt...296-62 WAC BioIog;w Ai ..... WAC 296-62-08001 (Cont.) (Il)If outside contamination of the regulated waste container occurs,it shall be placed in a second container. The second container shall be: (aa)Closable; (bb) Constructed to contain all contents and prevent leakage of fluids during handling,storage,transport or shipping; (cc) Labeled or color-coded in accordance with sub-division/item (7)(a)(i) of this section; and (dd) Closed prior to removal to prevent spillage or protrusion of contents during handling,storage,transport,or shipping. (C)Disposal of all regulated wasteshall be in accordance with applicable regulations of the United States, States and Territories,and political subdivisions of States and Territories. (iv)Laundry. (A) Contaminated laundry shall be handled as little as possible with a minimum of agitation. (I) Contaminated laundry shall be bagged or containerized at the location where it was used and shall not be sorted or rinsed in the location of use. (Il) Contaminated laundry shall be placed and transported in bags or containers labeled or color-coded in accordance with sub-division/item (7){a)(i)of this section. When a facility utilizes Universal Precautions in the'handling of all soiled laundry',alternative labeling or color-coding is sufficient if it permits all employees to recognize the containers as requiring compliance with Universal Precautions. (III)Whenever contaminated laundry is wet and presents a reasonable likelihood of soak-through of or leakage from the bag or container,the laundry shall be placed and transported in bags or containers which prevent soak-through and/or leakage of fluids to the exterior. (B) .The employer shall ensure that employees who have contact with contaminated laundry wear protective gloves and other appropriate personal protective equipment. (C)When a facility ships contaminated laundry off-site to a second facility which does not utilize Universal Precautions in the handling of all laundry, the facility generating the contaminated laundry must place such laundry in bags or containers which are labeled or color-eoded in accordance with sub-division/item (7)(a)(i). (5)mv and HBV Research Laboratories and Production Facilities. (a)This subsection applies to research laboratories and production facilities engaged in the culture, production,concentration,experimentation,and manipulation of HIV and HBV. Itdoes not apply to clinical or diagnostic laboratories engaged solely in the analysis of blood,tissues, or organs. These requirements apply in addition to the other requirements of the standard. Part J,Page 10 (4/92 Issue) Chapter 296-62 WAC Biological Agents WAC 296-62-08001 (Cont.) (b) Research laboratories and production facilities shall meet the following criteria: (i) Standard microbiological practices. All regulated waste shall either be incinerated or decontaminated by a method such as autoclaving known to effectively destroy bloodbome pathogens. (ii) Special practices. (A) (B) (C) (D) (E) (F) (G) (H) (1) Laboratory doors shall be kept closed when work involving HIV or HBV is in progress. Contaminated materials that are to be decontaminated at a site away from the work area shall be placed in a durable,leakproof,labeled or color-eoded container that is closed before being removed from the work area. Access to the work area shall be limited to authorized persons.Written policies and procedures shall be established whereby only persons who have been advised of the potential biohazard, who meet any specific entry requirements, and who comply witb all entry and exit procedures shall be allowed to enter the work areas and animal rooms. When other potentially infectious materials or infected animals are present in the work area or containment module, a hazard warning sign incorporating the universal biohazard symbol shall be posted on all access doors.The hazard warning sign shall comply ,,:,ith sub-division/item (7)(a)(ii)of this section. All activities involving other potentially infectious materials shall be conducted in biological safety cabinets or other physical-eontainment devices within the containment module. No work with these other potentially infectious materials shall be conducted on the open bench. Laboratory coats, gowns, smocks, uniforms, or otber appropriate protective clothing shall be used in tbe work area and animal rooms.Protective clothing shall not be worn outside of the work area and sball be decontaminated before being laundered. Special care shall be taken to avoid skin contact with other potentially infectious materials. Gloves sball be worn when handling infected animals and when making hand contact with other potentially infectious materials is unavoidable. Before disposal all waste from work areas and from animal rooms shall either be incinerated or decontaminated by a method such as autoclaving known to effectively destroy bloodbome pathogens. Vacuum lines shall be protected with liquid disinfectant traps and high-efficiency particulate air (HEPA)filters or filters of equivalent or superior efficiency and which are checked routinely and maintained or replaced as necessary. Part J.Page 11 (4/92 Issue) Chapter 196-61 WAC Biological AsJeots WAC 296-62-08001 (Cont.) (1) Hypodermic needles and syringes shall he used only for parenteral injection and aspiration of fluids from laboratory animals and diaphragm bottles. Only needle-locking syringes or disposable syringe-needle units (i.e.,the needle is integral to the syringe) shall he used for the injection or aspiration of other potentially infectious materials. Extreme caution shall he used when handling needles and syringes. A needle shall not he beat,sheared,replaced in the sheath or guard, or removed from the syringe following use. The needle and syringe shall he promptly placed in a puncture-resistant container and autoclaved or decontaminated hefore reuse or disposal. (K) All spills shall he immediately contained and cleaned up by appropriate professional staff or others properly trained and equipped to work with potentially concentrated infectious materials. (L) A spill or accident that results ill an exposure incident shall he immediately reported to the laboratory director or other responsible person. (M) A biosafety manualshall he prepared or adopted and periodically reviewed and updated at least annually or more often if necessary.Personnel shall he advised of potential hazards,shall he required to read instructions on practices and procedures,and shall he required to follow them. (iii)Containment equipment. (A) Certified biological safety cabinets (Class I, II, or Ill)or other appropriate combinations of personal protection or physical containment devices,such as special protective clothing, respirators, centrifuge safety cups, sealed centrifuge rotors,and containment caging for animals, shall he used for all activities with other potentially infectious materials that pose a threat of exposure to droplets, splashes, spills, or aerosols. (B) Biological safety cabinets shall he certified when installed,whenever they are moved and at least annually .. (c) HIV and HBV research laboratories shall meet the following criteria: (i) Each laboratory shall contain a facility for hand washing and an eyewash facility which is readily available within the work area. (ii)An autoclave for decontamination of regulated waste shall he available. (d) HIV and HBV production facilities shall meet the following criteria: (i) The work areas shall he separated from areas that are open to unrestricted traffic flow .within the building.Passage through two sets of doors shall he the basic requirement for .entry into the work area from access corridors or other contiguous areas. Physical separation of the high-containment work area from access corridors or other areas or activities may also be provided by a double-doored clothes-change room (showers may be included), airlock, or other access facility that requires passing through two sets of doors hefore entering the work area, Part J.Page 12 (4/911ssuel Cho",...29&-62 WAC lIiologkal A8eot.l WAC 296-62-68001 (Cont.) (ii) The surfaces of doors, walls, floors and ceilings in the work area shall be waler resistant so that they can be easily cleaned.Penetrations in these surfaces shall be sealed or capable of being sealed to facilitate decontamination.' (iii) Each work area shall contain a sink for washing hands and a readily available eye wasb facility. The sink shall be foot, elbow, or automatically operated and shall be located near the exit door of the work area. (iv) Access doors to tbe work area or containment module shall be self-closing. (v)An autoclave for decontamination of regulated waste shall be available witbin or as near as possible to the work area. (vi) A ducted exhaust-air ventilation system shall be provided.This system shall create directional airflow that draws air into tbe work area through the entry area.The exbaust air shall not be recirculated to any other area of tbe building,shall be discharged to the outside,and shall be dispersed away from occupied areas and air intakes.The proper direction of the airflow shall be verified (i.e.,into the work area.) (e)Training Requirements.Additional training requirements for employees in HIV and HBV research laboratories and HIV and HBV production facilities are specified in sub-divisionlitem (7)(b)(ix). (6)Hepatitis B vaccination and post-exposure evaluation and follow-up. (a)General. (i) The employer shall make available tbe bepatitis B vaccine and vaccination series to all employees who have occupational exposure,and post-exposure evaluation and follow-up to all employees who have had an exposure incident. (ii)The employer shall ensure'that allmedical evaluations and procedures including the hepatitis B vaccine and vaccination series and post-exposure evaluation and follow-up, including prophylaxis,are: (A)Made available at no cost to the employee; (B)Made available to the employee at a reasonable time and place; (C)Performed by or under the supervision of a licensed physician or by or under the supervision of another licensed healthcare professional;and (D)Provided according to recommendations of the U.S.Public Health Service current at the time these evaluations and procedures take place, except as specified by this subsection (6). ,, (iii)The employer shall ensure that all laboratory tests are conducted by an accredited laboratory at no cost to the employee.' Part J,Page13 (4/921ssoo) Chapler 196-62 WAC Biological Ageat.s WAC 296-62-08001 (Cont.) (b)Hepatitis B Vaccination. (i)Hepatitis B vaccination sball be made available after the employee has received the training required in sub-division/item (7)(b)(vii)(I)and within 10 working days of initial assignment to all employees who have occupational exposure unless the employee has previously received the complete hepatitis B vaccination series,antibody testing has revealed that the employee is immune,or the vaccine is contraindicated for medical reasons. (ii)The employer shall not make participation in a prescreening program a prerequisite for receiving hepatitis B vaccination. (iii)If the employee initially declines hepatitis B vaccination but at a later date while still covered under the standard decides to accept the vaccination,the employer shall make available hepatitis B vaccination at that time. (iv)The employer shall assure that employees who decline to accept hepatitis B vaccination offered by the employer sign the statement in WAC 296-62-08050,appendix A. (v)If a routine booster dose(s)of hepatitis B vaccine is recommended by the U.S.Public Health Service 81 a future date, such booster dose(s)shall be made available in accordance with sub-division/item (6)(a)(ii). (c)Post-exposure Evaluation and Follow-up.Following a report of an exposure incident,the employer shall make immediately available to the exposed employee a confidential medical evaluation and follow-up,including at least the following elements: (i)Documentation of the route(s)of exposure,and the circumstances under which the exposure incident occurred; (ii)Identification and documentation of the source individual,unless the employer Can establish that identification is infeasible or prohibited by state or local law; (A)The source individual's blood shall be tested as soon as feasible and after consent is obtained in order to determine HBV and HIV infectivity.If consent is not obtained,the employer shall establish that legally required consent cannot be obtained.When the source individual's consent is not required by law,the source individual's blood,if available,shall be tested and the results documented. (B)When the source individual is already known to be infected with HBV or HIV, testing for the source individual's known HBV or HIV status need not be repeated. (C)Results of the source individual's testing shall be made available to the exposed employee,and the employee shall be informed of applicable laws and regulations concerning disclosure of the identity and infectious status of the source individual. (iii)Collection and testing of blood for HBV and HIV serological status; (A)The exposed employee's blood shall be collected as soon as feasible and tested after consent is obtained. Part J,Page 14 (4192 Issue) ..-----_._----- Cbapl'"19&-61 WAC BioIogM:al All"" WAC 296-62-08001 (Conl.) (B)If the employee consents to baseline blood collection,but does not give consent at that time for HIV serologic testing, tbe sample shall be preserved for at least 90 days. If, within 90 days of the exposure incident, the employee elects to have the baseline sample tested. such testing shall be done as soon as feasible. (iv)Post-exposure prophylaxis,when medically indicated, as recommended by the U.S. Public Health Service; (v) Counseling; and (vi)Evaluation of reported illnesses. (d)Infonnation Provided to the Healthcare Professional. (i) The employer shall ensure that the healthcare professional responsible for the employee's Hepatitis B vaccination is provided a copy of this regulation. (ii) The employer shall ensure that the healthcare professional evaluating an employee after an exposure incident is provided the following information: (A) A copy of this regulation; (B) A description of the exposed employee's duties as they relate to the exposure incident; (C)Documentation of the route(s)of exposure and circumstances under which exposure occurred; (D) Results of the source individual's blood testing, if available;and (E)Air medical records relevant to the appropriate treatment of the employee including vaccination status which are the employer'S responsibility to maintain. (e)Healthcare Professional's Written Opinion. The employer shall obtain and provide the employee with a copy of the evaluating healthcare professional's written opinion within 15 days of the completion of the evaluation.. (i) The healthcare professional's written opinion for Hepatitis B vaccination shall be limited to whether Hepatitis B vaccination is indicated for an employee,and if the employee bas received such vaccination. (ii) The healthcare professional's written opinion for post-exposure evaluation and follow-up shall be limited to the following information: (A) That the employee has been informed of the results of the evaluation; and (B) That the employee has been told about any medical conditions resulting from exposure to blood or other potentially infectious materials which require further evaluation or treatment. (iii) All other findings or diagnoses shall remain confidential and shall not be included in the written report. Part J,Page 15 (4/91 Issue) Cba"er 296-62 WAC Biological Agents WAC 296-62-08001 (Cont.) (I)Medical recordkeeping. Medical. records required by this standard shall be maintained in accordance with subdivision (8)(a)of this section. Cl)Communication of hazards to employees. (a) Labels and signs. (i) Labels. (A) Warning labels shall be affixed to containers of regulated waste,refrigerators and freezers containing blood or otber potentially infectious material; and otber containers used to store, transport or sbip blood or other potentially infectious materials, except-as provided in sub-division/items (7)(a)(i){E), (F) and (G). ,(B)'Labels required by this section shall include the following legend: BIOHAZARD Part J,Page 16 (4/92 Issue) Chapler 196-Q WAC Biological A/t ...... WAC 296-62-08001 (Cont.) (C)These labels sball be fluorescent orange or orange-red or predominantly so, witb lettering or symbols in a contrasting color.' (D)Labels are required to be affixed as close as feasible to the container by string, wire,adbesive,or otber method that prevents their loss or unintentional removal. (E) Red bags or red containers may be substituted for labels. (F)Containers of blood, blood components,or blood products that are labeled as to their contents and bave been released for transfusion or other clinical use are exempted from the labeling requirements of subsection (7). (0)Individual containers of blood or other potentially infectious materials that are placed in a labeled container during storage,transport,shipment or disposal are exempted from the labeling requirement. (H)Labels required for contaminated equipment shall be in accordance with this sub-division/item and shall also Slate which portions of the equipment remain contaminated:,..' (I)Regulated waste tbat has been decontaminated need not be labeled or color-ceded. (ii)Signs. (A) The employer'sball post signs at the entrance to work areas specified in subsection (5),HIV and HBV Researcb Laboratory and Production Facilities, which shall bear the following legend: BIOHAZARD (Name of the Infectious Agent) (Special requirements for entering the area) (Name,telephone number of the laboratory director or other responsible person.) Part J,Page 17 (4/92 Issue) Cbapter ~%-62 WAC Biolog;w Ai"" WAC 296-62-08001 (Cont.) (B)These signs sball be fluorescent orange-red or predominantly so,witb lettering or symbols in a contrasting color. (b)Information and Training. (i)Employers shall ensure that all employees witb occupational exposure participate in a training program wbich must be provided at no cost to the employee and during working bours. (ii)Training sball be provided as follows: (A) (B) (C) At the time of initial assignment to tasks wbere occupational exposure may take place;, , Within 90 days after the effective date of the standard;and At least annually thereafter. (iii) (iv) (v) (vi) (vii) For employees who bave received training on bloodborne pathogens in the year preceding the effective date of the standard,only training witb respect to the provisions of the standard which were not included need be provided. Annual training for all employees sball be provided within one year of their previous training. Employers sball provide additional training wben changes sucb as modification of tasks or procedures or institution of new tasks or procedures affect the employee's occupational exposure.The additional training may be limited to addressing tbe new exposures created. Material appropriate in content and vocabulary to educational level,literacy,and language of employees sball be used. The training program shall contain at a minimum the following elements: (A) (B) (C) (0) (E) (F) An accessible copy of the regulatory text of this standard and an explanation of its conten~;'~"<~'-:.-:".": A general,explanation of tbe epidemiology and symptoms of bloodbome diseases;.'. An explanation of the modes of transmission of bloodborne patbogens; An explanation 'of the employer's exposure control plan and the means by wbicb the employee can obtain a copy of tbe written plan; An explanation of the 'appropriate methods for recognizing tasks and other activities that may involve exposure to blood and other potentially infectious materials; An explanation of the use and limitations of methods that will prevent or reduce exposure including appropriate engineering controls,work practices,and personal protective equipment; Part J,Page 18 (4/91 Issue) Chapter 29~WAC BioIogkal Ageau WAC 296-62·08001 (Cont.) (G)Information OD the types, proper use,location.removal,handling, decontamination and disposal of personal protective equipment; • (H)An explanation of the basis for selection of personal protective equipment; (I)Information OD the hepatitis B vaccine,including information on its efficacy, safety,method of administration,the benefits of being vaccinated,and that the vaccine and vaccination will be offered free of charge; (J)Information on the appropriate actions to take and persons to contact in an emergency involving blood or other potentially infectious materials; (K)An explanation of the procedure to follow if an exposure incident occurs, including the method of reporting the incident and the medical follow-up that will be made available;. (L)Information on the post-exposure evaluation and follow-up that the employer is required to provide for tbe employee following an exposure incident; (M)An explanation of the signs and labels andlor color coding required by subdivision (7)(a); and (N)An opportunity for interactive questions and answers with the person conducting the training session .. (viii).The person conducting the training shall be knowledgeable in the subject mailer covered .by the elements contained in the training program as it relates to the workplace thattbe training will address. (ix).Additional Initial Training for Employees in HIV and HBV Laboratories and Production Facilities.Employees in HIV or HBV research laboratories and HIV or HBV production facilities shall receive the following initial training in addition to the above training requirements: (A)The employer sball assure that employees demonstrate proficiency in standard microbiological practices and techniques and in the practices and operations specific 10the facility before being allowed to work with HIV or HBV. (B)The employer shall assure that employees have prior experience in the handling of human pathogens or tissue cultures before working with HIV or HBV. (C)The employer shall provide a training program to employees wbo have no prior experience in handling human pathogens. Initial work activities shall not include the handling of infectious agents. A progressioD of work activities shall be assigned as techniques are learned and proficiency is developed.The employer shall assure that employees participate in work activities involving infectious agents only after proficiency has been demonstrated. (8)Recordkeeping. (a) Medical Records. Part J,Page 19 (4/91 Issue) Chapter Z~WAC Biological A,eats WAC 296~2-o8001 (Cont.) (i) The employer shall establish and maintain an accurate record for each employee with occupational exposure, in accordance with WAC 296~2-{)52. (ii) This record shall include: (A) The name and social security number of the employee; (B) A copy of the employee's hepatitis B vaccination status including the dates of all the hepatitis B vaccinations and any medical records relative to the employee's ability to receive vaccination as required by subdivision (6)(b); (C) A copy of all results of examinations, medical testing, and follow-up procedures as required by subdivision (6)(c); (D) The employer's copy of the healthcare professional's written opinion as required by subdivision (6)(e); and (E)A copy of the information provided to the healthcare professional as required by sub-division/items (6)(d)(ii)(B)(C)and (D). (iii) Confidentiality. The employer shall ensure that employee medical records required by subdivision (8)(a) are: (A) Kept confidential; and (B) Are not disclosedor reported without the employee's express written consent to any person within or outside the workplace except as required by this section or as may be required by law. (iv) The employer shall maintain the records required by subsection (8) for at least the duration of employment plus 30 years in accordance with WAC 296-62-{)52.. .j ..";"'." (b) Training Records. (i) Training records shall include the following information: (A)'The dates of the training sessions; (B) The contents or a summary of the training sessions; (C) The names and qualifications of persons conducting the training; and (0)The names and job lilies of all persons attending the training sessions. (ii) Training records shall be maintained for 3 years from the date on which the training occurred. (c) Availability.. (i) The employer shall ensure that all records required to be maintained by this section shall be made available upon request to the Director for examination and copying. Part J,Page 20 (4/92 Issue1 Cbople<2%-62 WAC BioIogkol Agto!! WAC 296-62'()8001 (ConI.) (ii) Employee training records required by this section shall be provided upon request for examination and copying to employees, to employee representatives,to the Director in accordance with WAC 296-62'()52. (iii) Employee medical records required by this section shall be provided upon request for examination and copying to the subject employee, to anyone baving written consent of the subject employee, to the Director in accordance with WAC 296-62-052. (d) Transfer of Records. (i) The employer shall comply with the requirements involving transfer of records set forth in WAC 296-62-052.. (ii) If the employer ceases to do business and there is no successor employer to receive and retain the records for the prescribed period, the employer shall notify the Director, at least three months prior to their disposal and transmit them to the Director, if required by the Director to do so, within that three month period. (9) Dales (a) Effective Date. The standard shall become effective on May 26, 1992. (b) The Exposure Control Plan required by subdivision (3)(b) of this section shall be completed on or before June 26, 1992. (c) Subdivision (7)(b) Information and Training and subsection (h)Recordkeeping shall take effect on or before July 27, 1992. (d) Subdivisions (4)(b) Engineering and Work Practice Controls, (4)(c) Personal Protective Equipment, (4)(d) Housekeeping, subsections (5) HIV and HBV Research Laboratories and Production Facilities, (6) Hepatitis B Vaccination and Post-Exposure Evaluation and Follow-up, and subdivision (7)(a) Labels and Signs, shall takeeffect August27, 1992.ISa•••ory Aulhori.y:Chap.er 49.11 RCW.92.08-100 WSR (Order 92.(1),§296-62.o8ool,f,led 04/01192.err."ive 05/05/92.) WAC 296-62-08050,Appendix A -Hepatitis B Vaccine Declination (Mandatory) I understand that due to my occupational exposure to blood or other potentially infectious materials I may be at risk of acquiring hepatitis B virus (HBV) infection. I have been given the opportunity to be vaccinated with hepatitis B vaccine. at no charge to myself. However, I decline hepatitis B vaccination at this time. I understand that by declining this vaccine, I continue to be at risk of acquiring hepatitis B, a serious disease.If in the future I continue to have occupational exposure to blood or other potentially infectious materials and I want to be vaccinated with hepatitis B vaccine,] canreceivethe vaccination seriesatno charge tome.[Steuncry Authority:Chllpter49.17 RCW.92~8­ 100 WSR (Order 92.(1).§296-62.o8050,filed 04/01192.effective 05/05/92.) Part J,Page 21 W92 Issue)