2.11Attachment 9 NAVAVSCOLSCOMINST 5100.1 Chapter 23 SAFETY AND OCCUPATIONAL HEALTH AND HIGH-RISK TRAINING SAFETY PROGRAMS.pdf

NAVAVSCOLSCOMINST 5100.1E

N7

23-1

CHAPTER 23

EXPOSURE CONTROL PLAN AND BLOODBORNE PATHOGENS PROGRAM

23.01 Background. Human Immunodeficiency Virus (HIV), Hepatitis B Virus (HBV), as well as other diseases are transmitted through exposure to blood and body components. HIV, for example, has been isolated from blood, blood products, semen, vaginal secretions, saliva, tears, and is likely found in other bodily fluids, secretions, and excretions. Cumulative epidemiological data indicates these diseases are transmitted via percutaneous (including open wound) and mucous membrane exposure to contaminated blood or body fluids. The guidelines set forth in this chapter emphasize all patients are potentially infected with HIV, HBV, and other bloodborne pathogens (BBP) and mandate strict adherence to Body Substance Isolation (BSI) precautions to minimize risk of exposure to contaminated blood/body fluids.

23.02 General. BSI precautions are utilized to prevent potential skin, eye, and mucous membrane exposure to blood or other potentially infectious materials that may result during the performance of an employee’s duties. Supervisors must assure instructors and students comply with guidelines for bloodborne pathogens.

23.03 Purpose. Per reference (a), (j), and (l), NASC shall establish a Bloodborne Pathogen

Program, exposure control plan, and bloodborne pathogen training plan which will limit risk of exposure to infectious diseases normally associated with bloodborne pathogens. The diseases associated with these pathogens are preventable when the appropriate precautions are taken.

23.04 Policy. BSI precautions, as set forth in this directive and reference (j), will be implemented for every instructor/student rendering first aid at the command. Supervisors must assure instructor/students comply with guidelines for bloodborne pathogens.

23.05 Responsibilities.

a. Department Heads/OICs and Supervisors

(1) Identify and list all job classifications in which employees (military, civilian, and contractor) in those positions risk occupational exposure to blood or other potentially infectious body fluids and materials.

(2) List all tasks and procedures or groups of procedures in which occupational exposure occurs.

(3) Review all procedures in the department to include requirements for personal protective equipment and the management of wastes and soiled equipment.

(4) Ensure PPE and other necessary supplies are available in accessible locations and ensure that they are used in the performance of duties.

23-2

(5) Ensure compliance to include an element of performance standards for evaluation as appropriate and initiate and document disciplinary action for continued non-compliance.

b. Command Safety Officer

(1) Assist in compliance evaluations and review of guidelines for BSI Precautions. Submit changes as required.

(2) Maintain a list of duties with a risk of occupational exposures.

(3) Oversee BBP program and maintain a record of risk of occupational exposure within

NAVAVSCOLSCOM.

(4) Provide ongoing consultation regarding implementation of BSI Precautions.

c. Department/Division Medical Representative (DMR)

(1) Ensure a sufficient amount of PPE supplies are available for staff use.

(2) Establish and maintain a bloodborne pathogen exposure log to keep records of all students and staff who have been exposed to a bloodborne pathogen.

(3) Monitor compliance and maintain records regarding the HBV Vaccination Program.

(4) Monitor compliance with the BBP Exposure Control Plan at their training site.

(5) Maintain current procedures for post-exposure follow-up care as needed.

(6) Ensure personnel assigned to job risk category II receive annual BBP training and maintain rosters of such training. The BBP course found on web training in ESAMS meets this requirement.

(7) Select and use engineering controls to include safer medical devices used to prevent percutaneous injuries before, during, and after use through safer medical design.

23.06 Body Substance Isolation (BSI) Precautions.

a. Policy

(1) It is command policy to consider all patients’ blood and body fluids as potentially infectious and barriers must be used to prevent exposure.

(2) Hands must be thoroughly washed after first aid treatment and/or after handling soiled or contaminated equipment or items.

(a) Hands and other skin surfaces must be washed immediately and thoroughly if

23-3 contaminated with blood or potentially infectious body fluids or materials.

(b) Hands must be washed:

1. Immediately after gloves are removed.

2. After using restroom facilities.

3. After performing first aid procedures.

(3) First Aid providers with broken skin, whether from dryness, dermatitis, or other skin conditions characterized by fissures or crevices, are at high risk of exposure to bloodborne disease agents such as HIV and HBV, which can enter the blood stream through non-intact skin. Use of gloves, in addition to good hand-washing technique is essential prior to anticipated exposure to patient blood or body fluids.

b. Personnel Protective Equipment. All personnel must routinely use PPE when there is a potential for exposure to blood or other infectious body fluids or materials. PPE is to be maintained and readily available in the work area.

(1) Gloves. Only non-latex gloves shall be used. Gloves must be worn when the employee has the potential to have direct skin contact with blood, other potentially infectious body fluids or materials, mucous membranes, non-intact skin, and when handling items or surfaces soiled with blood or other potentially infectious body fluids or materials. Gloves must be worn whenever there is a potential for exposure to the following items or to any item contaminated by them:

(a) Blood/blood products/body fluids with visible blood.

(b) Urine.

(c) Feces.

(d) Saliva.

(e) Mucous membranes.

(f) Wound drainage.

(g) Non-intact skin.

(2) Mouth-to-Mouth Resuscitation Equipment. Mouthpieces, resuscitation bags, or other ventilation devices shall be strategically located and available for use in areas where the need for resuscitation is likely.

(3) Additional Protection. Additional PPE may be required in specific cases.

23-4

(4) Prohibited Work Practices.

(a) When there is a potential for occupational exposure; eating, drinking, smoking, applying cosmetics, or handling contact lenses are prohibited after performing first aid skills until hands are thoroughly washed.

(b) Students and staff should not be allowed to share items which may be contaminated with blood or other body fluids.

(5) Disinfection. All equipment and environmental working surfaces shall be properly cleaned and disinfected after contact with blood or other potentially infectious materials.

(a) Chemical germicides that are approved for use by the CSO/TSA shall be used to decontaminate spills of blood or other body fluids.

(b) Fresh solutions of diluted household bleach (made up every 24 hours, 1:10 bleach to water) should be used to disinfect spills of blood and body fluids. Secondary hazardous material bottles should be labeled with contents, appropriate warnings, and SDS numbers.

(c) Gloves must be worn for cleaning spills of blood, other body fluids, or when handling infectious waste.

(d) Red biohazard bags or appropriately labeled bags with the universal biohazard symbols are to be available in all areas where infectious waste may be generated.

(e) When there is a potential for bags to tear, they should be double-bagged.

(6) Warning Labels. Only red bags and red containers shall be used to hold and dispose of infectious waste, blood, blood products, or other potentially infectious materials and shall clearly display biohazard-warning labels. The label shall be fluorescent orange using the accepted biohazard symbol, affixed in such a way as to prevent unintentional loss or removal.

23.07 Categories of Exposure Risk.

a. Category I. Personnel may be routinely exposed to blood-borne pathogens. Examples of, but not limited to: Phlebotomy, clinicians, etc.

b. Category II. Personnel not routinely exposed, but may be so under certain circumstances.

Examples of, but not limited to: Emergency response, medical repair, housekeeping, etc.

c. Category III. Personnel are never exposed. Examples include, but are not limited to:

Administrative, Red Cross volunteers, clerks, etc.

23-5

23.08 Occupational Exposure Job Classification Risk. Patient Care staff exposure risk:

a. Corpsman (II).

b. Training Medical Providers (II).

c. Safety/Security Staff (III).

d. Other support staff (safety observers and swimmers etc.) (II).

23.09 Medical Record Documentation for Exposure Risk II Employees. All Category II personnel shall have their records reviewed by the DMR upon reporting to ensure compliance with the HBV requirements.

23.10 Tasks and Procedures with Risk Exposure.

a. Procedures

(1) General first aid.

(2) Cardiopulmonary Resuscitation (CPR).

(2) Suctioning.

(3) Handling samples of blood or body fluids

b. Environmental Control

(1) Infectious waste management.

(2) Disinfection of contaminated equipment.

(3) Cleaning, housekeeping of blood or body fluids.

23.11 Hepatitis B (HBV) Vaccination Plan.

a. Policy

(1) Per reference (j), command personnel, including military, civilian, contractors, part-time and temporary employees in job risk categories I and II, as described in paragraph 23.07, must be immunized against HBV. The vaccine will be offered within ten working days of their initial assignment to work involving the potential for occupational exposure to blood or other potentially infectious materials, unless the employee has previously had the vaccine or wishes to submit to antibody testing which shows the employee to have sufficient immunity.

(2) All command personnel in job risk category II shall have the dates of vaccinations

23-6 documented in their medical records per reference (j). Medical records are maintained at the

Naval Air Station Branch Medical Clinic or at the local medical facility.

(3) Any current or newly reported employee whose assignment is within job risk category

II who is lacking evidence of a complete HBV vaccination must receive a sufficient number of doses of the HBV vaccine to complete the dose.

(4) All vaccinations shall be performed per requirements set forth in reference (j).

(5) Serum HBV titers shall be performed to verify immune status. Booster injections will be provided and serum HBV titer documentation of immunity shall be checked 30 days after booster injections are completed.

(6) The U.S. Public Health Service (USPHS) Advisory Committee on Immunization

Practices (APIC) recommends that pregnancy should not be considered a contra-indication to the use of the HBV vaccine for persons who are otherwise eligible.

23.12 Training.

a. Policy. Upon reporting, all personnel whose assignments fall within job risk Category II shall complete BBP training in ESAMS and be given a NAVAVSCOLSCOM’s BBP Program brief by the DMR. This brief shall include:

(1) An accessible copy of this instruction and reference (j).

(2) An explanation of Exposure Control Plan.

(3) An explanation of the appropriate methods for recognizing tasks and other activities that may involve exposure to blood and other potentially infectious materials.

(4) An explanation of the use and limitations of methods at NAVAVSCOLSCOM that will prevent or reduce exposure, including appropriate engineering controls, work practices, and personal protective equipment.

(5) Information on the types, proper use, location, removal, handling, decontamination, and disposal of personal protective equipment.

(6) An explanation of the basis for selection of personal protective equipment.

(7) Participation by employees in the selection of new devices, which plays a major part in their acceptance and correct use.

(8) Information on the appropriate actions to take and persons to contact in an emergency involving blood or other potentially infectious materials.

(9) An explanation of the procedure to follow if an exposure incident occurs, including the

23-7 method of reporting the incident and the medical follow-up that will be made available.

(10) Information on the post-exposure evaluation and follow-up that NAVAVSCOLSCOM is required to provide for the employee following an exposure incident.

(11) An explanation of the signs, labels, and color-coding required for biohazards.

b. All personnel assigned to job risk categories I and II must receive bloodborne pathogen refresher training at least annually.

c. Copies of all training records are to be maintained in ESAMS.

23.13 Post-Exposure and Evaluation Plan.

a. Policy. When an employee has an exposure incident, it shall be immediately reported to the appropriate medical authority to initiate any immediate first aid required. The CSO/TSA shall also be notified immediately. Additionally:

(1) The employee, once appropriate first aid has been completed, shall be referred to the

MTF for evaluation, counseling, and follow-up. The employee will be provided with a copy of the evaluating health care professional’s written opinion within 15 days of the completion of the evaluation.

(2) It will be the responsibility of the MTF to identify the source individual, if possible.

The source individual, upon consent, shall provide blood samples for HBV and HIV testing, with the findings sent to the sources individual and the MTF. The source member’s most recent HIV status, if known, will also be noted by the MTF.

(3) The MTF will offer the employee the option of HIV testing. The employee shall be informed of the source individual’s HBV and HIV status. The MTF and the Safety Officer must advise the employee of appropriate precautions to be taken after the exposure incident, what potential illnesses to be alert for, and the symptoms to report. The MTF must offer post-exposure prophylaxis in accordance with the current recommendations of the U.S. Public Health

Service and Centers for Disease Control.

(4) The MTF shall direct the employee to be provided HBV vaccination if evidence of a complete HBV vaccination cannot be found.

(5) The DMR must maintain a record of exposure incidents, with a permanent copy of the above actions placed in the employee’s medical record. This record must be maintained for at least the duration of employment plus 30 years.

(6) The appropriate Officer in Charge, Director, Department Head, or Supervisor will submit a completed mishap report via ESAMS to the CSO/TSA.

23-8

(7) In addition, a risk management screen shall be completed and forwarded to the

CSO/TSA.