RFP 25084 Attachement 7 Control Exposure Plan.pdf

Suffolk Fire & Rescue Exposure Control Plan Page 1

Suffolk Fire & Rescue

EXPOSURE CONTROL PLAN

ADDRESSING OCCUPATIONAL

EXPOSURE TO BLOODBORNE

PATHOGENS, AIRBORNE & DROPLET

TRANSMITTED DISEASES

Established April, 2004. Updateed 2011, 2015, 2021, 2023

Attachment 7

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This Plan has been developed solely for Suffolk Fire & Rescue (SFR). The format of this Plan is proprietary and to be used only for SFR. This Plan may not be copied without written permission of Katherine West, RN, BSN, MSEd.

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SCOPE

SFR recognizes that many of its employees are involved in job responsibilities that may place them at risk for direct contact with blood and other potentially infectious materials. It is the goal of the Department to strive to reduce exposure in the employee population and thus reduce the incidence of occupational health risk. It is also the goal of the Department to ensure that the patients served are offered protection from infection. SFR’s exposure Control Plan shall address bloodborne pathogens, airborne & droplet transmitted diseases.

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TABLE of CONTENTS

Definition of Terms Pages 5 - 9

General Policies 14 - 18

Exposure Determination 19 - 23

Education & Training 24 - 28

Vaccines/Immunizations 29 - 56

Work Restriction Guidelines 57 - 63

Engineering Controls/Work Practices 64 - 81

Post-Exposure Management 82 - 114

Medical Waste Regulation 115 - 132

Compliance Monitoring 133 - 138

Recordkeeping 139 - 142

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DEFINITION of TERMS

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Definition of Terms

OSHA — Occupational Safety & Health Administration

U.S. Department of Labor

1910.1030(a) Scope and Application. This section applies to all occupational exposure to blood or other potentially infectious materials as defined in the Definitions of this document.

1910.1030(b) Definitions. For purposes of this section, the following shall apply:

Assistant Secretary means the Assistant Secretary of Labor for Occupational Safety and Health, or designated representative.

Blood means human blood, human blood components, and products made from human blood.

Bloodborne Pathogens means pathogenic microorganisms that are present in human blood and can cause disease in humans. These pathogens include, but are not limited to, hepatitis B virus (HBV) and human immunodeficiency virus (HIV).

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 sharps.

Contaminated Sharps means any contaminated object that can penetrate the skin including, but not limited to, needles, scalpels, broken glass, broken capillary tubes, and exposed ends of dental wires.

Decontamination means the use of physical or chemical means to remove, inactivate, or destroy bloodborne pathogens on a surface or item to the point where they are no longer capable of transmitting infectious particles and the surface or item is rendered safe for handling, use, or disposal.

Director means the Director of the National Institute for Occupational Safety and Health, U.S. Department of Health and Human Services, or designated representative.

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Engineering Controls means controls (e.g., sharps disposal containers, self-sheathing needles, safer medical devices, such as sharps with engineered sharps injury protections and needleless systems) that isolate or remove the bloodborne pathogens hazard from the workplace.

Exposure Incident means a specific eye, mouth, other mucous membrane, non-intact skin, or parenteral contact with blood or other potentially infectious materials that results from the performance of an employee/volunteer'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 whose legally permitted scope of practice allows him or her to independently perform the activities required by hepatitis B vaccination and post-exposure evaluation and follow-up

HBV means hepatitis B virus.

HIV means human immunodeficiency virus.

Needleless systems means a device that does not use needles for: (1) the collection of bodily fluids or withdrawal of body fluids after initial venous or arterial access is established; (2) the administration of medication or fluids; or (3) any other procedure involving the potential for occupational exposure to bloodborne pathogens due to percutaneous injuries from contaminated sharps.

Occupational Exposure means reasonably anticipated skin, eye, mucous membrane, or parenteral contact with blood or other potentially infectious materials that may result from the performance of an employee/volunteer's duties.

Other Potentially Infectious Materials means (1) the following human body fluids: semen, vaginal secretions, cerebrospinal fluid, synovial fluid, pleural fluid, pericardial fluid, peritoneal fluid, amniotic fluid, saliva in dental procedures, any body fluid that is visibly contaminated with blood, and all body fluids in situations where it is difficult or impossible to differentiate between body fluids; (2) any unfixed tissue or organ (other than intact skin) from a human (living or dead); and

(3) HIV-containing cell or tissue cultures, organ cultures, and HIV- or HBV-containing culture medium or other solutions; and blood, organs, or other tissues from experimental animals infected with HIV or HBV.

Parenteral means piercing mucous membranes or the skin barrier through such events as needle sticks, human bites, cuts, and abrasions.

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Personal Protective Equipment is specialized clothing or equipment worn by an employee/volunteer 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 HIV 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 state 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.

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.

Sharps with engineered sharps injury protections means a non-needle sharp or a needle device used for withdrawing body fluids, accessing a vein or artery, or administering medications or other fluids, with a built-in safety feature or mechanism that effectively reduces the risk of an exposure incident.

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/volunteer. Examples include, but are not limited 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 is an approach to infection control. According to the concept of Universal Precautions, all human blood and certain human body fluids are treated as if known to be infectious for HIV, HBV, and other bloodborne pathogens.

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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 technique).

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Ride Along Program Informed Consent

I understand that there is a potential risk for exposure to bloodborne pathogens or airborne/droplet diseases when participating in an observation program in the fire-rescue work environment.

I have been offered an opportunity to ask questions about the diseases and the risk for exposure and to have those questions answered.

Should I become exposed to blood or other potentially infectious materials, I shall be advised by SFR to seek medical attention at the location specified in their Exposure Control Plan. I understand that SFR is NOT responsible for covering the costs associated with post-exposure medical treatment/counseling.

I also understand that I may not discuss or share information regarding patients or the care they received. This is considered confidential information.

Signature: __________

Print Name: _________________________Date: _____

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SCHEDULE FOR IMPLEMENTATION

EXPOSURE CONTROL PLAN

Bloodborne/tuberculosis

2004, 2011, 2015, 2021

EDUCATION AND TRAINING

Bloodborne/tuberculosis

1993, 2021

HEPATITIS B VACCINE

ENGINEERING CONTROL/SOP’S

1993, 2001

POST-EXPOSURE/MEDICAL

1993, 2001

FOLLOW-UP

RECORDKEEPING

TUBERCULIN SKIN TESTING

RESPIRATORY PROTECTION

COMPLIANCE MONITORING

2004, 2021

SHARPS RISK ASSESSMENT

2003, 2010, 2014, 2021

WORK RESTRICTION

GUIDELINES

2004, 2021

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GENERAL STATEMENT

This Exposure Control Plan shall be:

1. Accessible to employees within 15 working days of their request;

2. Reviewed and updated at least on an annual basis by the Designated Officer;

3. Reflective of all current Centers for Disease Control (CDC) recommended practices for protection of patients and staff; and

4. Reflective of applicable scientific portions of the NFPA 1581, Infection Control Standard for SFR and 1582 Health & Safety.

POLICY STATEMENT:

It shall be the policy of all supervisors and managers of the SFR organization to:

A. Support and enforce compliance with the Exposure Control Program;

B. Correct any unsafe acts and refer any individuals for remedial training if required;

C. Mandate safe operating practices on-scene and in-station;

D. Refer any individual for medical evaluation who may possibly be unfit for work for infection control or other reasons;

E. Ensure initial medical evaluations, immunizations and infection control training have been completed prior to allowing any individual to begin Emergency Medical Services (EMS) response;

F. Participate in education and training programs prior to activation with the Department and attend on-going education and training programs;

G. Report off-the-job illness in accordance with the work restriction guidelines program;

H. Comply with Department policy that prohibits artificial fingernails or extensions; and

I. Ensure staff obtains their vaccine/immunization records.

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This plan represents the minimum level of practice. Failure to comply with the requirements of this plan shall result in disciplinary action.

HEALTH MAINTENANCE

Policy Statement

1. No member of the SFR shall be assigned to any emergency response duties until certified as fit-for-duty by the Department and NowCare.

2. Applicants shall provide written proof of any previous TB skin/blood test results within two weeks of hire.

3. Applicants shall be offered TB blood tests, HBV immunization, infection control education and training, and physical exams after completion of the application process.

4. Applicants shall show written proof of immunity for measles, mumps and rubella

5. Applicants shall show proof of immunity for chickenpox.

6. Personnel exposed to a communicable disease off-duty shall contact the Designated Officer.

7. All illnesses listed under the work restriction guidelines program shall be reported to the Designated Officer.

8. Personnel shall obtain copies of vaccine/immunization records from their schools or previous employer.

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EXPOSURE CONTROL PLAN DEVELOPMENT

This Exposure Control Plan was developed by Katherine H. West, BSN, MSEd, CIC, an Infection Control Consultant with Infection Control/Emerging Concepts, Inc., in conjunction with James Broglin (SFR’s Chief Safety Officer). Any questions regarding the development of this plan should be addressed to both Katherine West and Battalion Chief James Broglin, or SFR’s current Chief Safety Officer.

Implementation of this plan is the responsibility of Suffolk Fire & Rescue.

Katherine H. West

Katherine West, BSN, MSEd, CIC

Infection Control Consultant

February, 2021 (updated)

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DOCUMENTS USED IN THE PREPARATION OF THIS PLAN:

1. APIC Core Curriculum - Infection Control

2. 29 CFR Part 1910.1030- Bloodborne Pathogens

3. 29 CFR Part 1910.1020 - Medical Records

4. Centers for Disease Control and Prevention – 1994 Guidelines for Prevention and Control of Tuberculosis

5. Centers for Disease Control- 1989 Guidelines for Public Safety Workers

6. 42 CFR Part 84 Subpart K, Volume 60, Federal Register June 8, 1995:30338

7. West KH: Infectious Disease Handbook for Emergency Care Personnel, ACGIH, 1994, 3rd. Edition

8. NIOSH Alert, Latex Glove Sensitivity, June, 1997

9. CDC Guidelines for Health Care Worker Infection Control, Draft, Federal Register, September, 1998

10. The Source, IC/EC, Inc., 1998, Springfield, Virginia

11. Guidelines for Infection Control in Health-Care Personnel, 1998, AJIC, June, 1998

12. Medical Waste Regulations – State of Virginia

13. CPL 2-2.44D – Enforcement Document for Occupational Exposure to Bloodborne Pathogens, OSHA, Nov. 5, 1999

14. Updated U.S. Public Health Service Guidelines for the Management of Occupational Exposures to HBV, HCV, and HIV and Recommendations for Postexposure Prophylaxis, MMWR, June 29, 2001

15. Needlestick Prevention Act, US Congress, March, 2001

16. Hand Hygiene Guidelines, October 2002, Centers for Disease Control

17. CPL 2-2.69 Compliance Directive, Bloodborne Pathogens, November 27, Suffolk Fire & Rescue Exposure Control Plan Page 16

18. Hepatitis B vaccination requirements for employee/volunteers providing first aid as a collateral duty, OSHA 11/1/2000, Standard Number 1910.1030(f)(2);1960

19. State of Virginia Presumption Law, 2000

20. Controlling Tuberculosis in the United States, Centers for Disease Control and Prevention, September 30, 2005

21. Guidelines for Preventing the Transmission of Mycobacterium Tuberculosis in Health-Care Settings, 2005. Centers for Disease Control & Prevention, December 30, 2005

22. Updated US Public Health Service Guidelines for the Management of Occupational Exposures to HIV, Recommendations for Postexposure Prophylaxis, Centers for Disease Control and Prevention, September 30,

23. Guidelines for Preventing the Transmission of Mycobacterium Tuberculosis in Health-Care Settings, 2005, MMWR, December 30, 2005

24. Influenza Vaccination of Health-Care Personnel, MMWR, February 24, 2006, Centers for Disease Control & Prevention, Atlanta, GA

25. A Comprehensive Immunization Strategy to Eliminate Transmission of Hepatitis B Virus in the United States: Recommendations of the Advisory Committee on Immunization Practices (ACIP) Part II: Immunization of Adults, December 8, 2006, Centers for Disease Control & Prevention, Atlanta, GA.

26. Influenza Vaccination 2015/2061, March, 20105 Centers for Disease Control and Prevention, Atlanta, GA

27. Federal Register Volume 76, Number 212 (Wednesday, November 2, 2011);

[Notices] [Pages 67736-67743

28. Immunization for Health Care Personnel, MMWR, CDC, November 2011

29. Testing for HCV Infection: An Update of Guidance for Clinicians and Laboratorians, CDC, MMWR, May 7, 2012/62 (Early Release);1-4

30. CDC Guidelines for Evaluating Health-Care Personnel for Hepatitis B Virus Protection and for Administering Postexposure Management, MMWR, December 20, 2013

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31. OSHA/VOSH version of the Bloodborne Pathogen Standard is used for this Plan.

32. Prevention of Hepatitis B Virus Infection in the United States:

Recommendations of the Advisory Committee on Immunization Practices, MMWR, January, 2018

33. Screening and Testing of Healthcare Workers for Tuberculosis, CDC, May 17, 2019

34. Ventilation and air conditioning in public spaces and buildings and COVID-

19. World Health organization, July 29, 2020

35. Emergency Temporary Standard Infectious Disease Prevention: SARS- CoV-2 Virus that Causes COVID-19, Safety and Health Codes Board, July 15, 2020, Department of Labor & Industry, VOSH, July 17, 2020

36. Interim Recommendations for Emergency Medical Services (EMS) Systems and 911 Public Safety Answering Points/Emergency Communication Centers (PSAP/ECCs) in the United States During the Coronavirus Disease (COVID-19) Pandemic, Centers for Disease Control & Prevention, July 15

37. Respiratory protection Standard 1910.134. Occupational Safety & Health Administration

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EXPOSURE DETERMINATION

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EXPOSURE DETERMINATION

1. This Plan identifies employees who are deemed to be at-isk. This determination is assigned without the consideration of the use of personal protective equipment. The exposure determination assignments for personnel were made based on if it could be "reasonably anticipated" that an employee would come into contact with blood or other potentially infectious materials (OPIM). Thus, the core of this Plan shall deal with exposure to blood and

OPIM.

2. As all employees may have the opportunity to be exposed to an airborne/droplet transmissible disease, this plan shall address education and training with regard to tuberculosis (TB), childhood diseases, risk assessment, notification of exposure, testing and medical follow-up.

The following employee/volunteer groups were reviewed for the purpose of exposure determination assessment:

DEEMED NOT TO BE AT-RISK (But covered in this plan):

• Administrative Staff (non-patient care)

• Dispatch Staff

• Administrative Secretary

It should be noted; however, that if these individuals should sustain an exposure, they shall be covered under the Department’s policy for post-exposure management.

ALL PERSONNEL AT-RISK FOR EXPOSURE:

• Paramedics

• EMTs (all levels)

• Firefighters (all levels)

• Fire Marshals, Fire Inspectors, Plans Reviewers

• Chief Officers (all levels)

• CPR/First Aid Responders

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RISK TASKS, PROCEDURES LISTING

AND RECOMMENDED PERSONAL

PROTECTIVE EQUIPMENT

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GUIDE FOR THE USE OF PERSONAL PROTECTIVE

EQUIPMENT

Task Gloves Eyewear/Mask Gown

Airway X available available

CPR X none none

Drawing Blood X none none

Decon Equipment utility If splatter or splash anticipated If splatter or splash anticipated

Extrication X If splatter or splash anticipated

If splatter or splash anticipated

Field Delivery (child birth) X X If splatter or splash anticipated

Injection none None None

Intubation X X available

IV Start X If splash or splatter anticipated available

Monitor none none none

Oxygen none none none

Suction X available available

Trauma X X X

Vital Signs none none none

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SHARPS RISK ASSESSMENT

SFR began addressing the issue of sharps injury reduction in January 2003.

In 2003, three contaminated sharps injuries occurred. These were the result of lancet injuries. Retractable lancets are now available and in use.

Sharps Risk Assessment – 2010

There were no contaminated sharps injuries reported. This Department began using needle safe devices in 2006.

Retractable lancets are in place (Unistick II by Owen Mumford). All Advanced Life Support (ALS) providers were asked to evaluate and provide input to selection.

All additional sharps safe devices were selected and furnished by the medical facility.

Sharps Risk Assessment – 2013 - 2015

Two contaminated sharps injuries were reported. All sharp safe devices were furnished by the medical facility and this Department had no input to the selection or evaluation of the devices.

Sharps Risk Assessment – 2018 - 2020

There were no contaminated sharps injuries reported. All sharp safe devices were furnished by the medical facility and this Department had no input to the selection or evaluation of the devices.

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RISK ASSESSMENT FOR EXPOSURE TO

TUBERCULOSIS

2019 - 2020 Risk assessments were conducted by contacting the Virginia Public Health

Department Office of TB Control to obtain numbers of cases reported in our general department area between 2019 and 2020. The Public Health Department releases the total number of cases for each area of the state. They reported 204 active cases for 2020, statewide. No TB patients were treated or transported by the staff of SFR.

Based on the 2019-20 caseload, the areas serviced by SFR fall in the “low risk” category. This finding is based on the CDC’s 2005 TB Guidelines, which OSHA is currently enforcing. Under the “low risk” heading, the implementation of a respiratory protection program is recommended or required when there have been documented exposures to Department employees. Based on this determination, there is no formal requirement for a Respiratory Protection Program based on the CDC 2005 Guidelines for TB.

It should also be noted that on a national level there has been a decrease in the number of TB cases since 1992. For 2020, there were 8,916 cases reported nationally, which represents over an 84% decrease in cases since 1993.

Employees shall be instructed to screen patients for TB. Suspect patients shall be masked and windows shall be opened for risk reduction. If the patient cannot be masked (surgical mask), the care provider shall wear a surgical mask. This process developed, reviewed and agreed to by Katherine West, BSN, MSEd, CIC, Infection Control Consultant, who assisted in this process. Data shall be monitored closely to determine the need to alter this risk determination. Data shall be tracked by the Designated Officer. Should the numbers change or a shift in the Purified Protein Derivative (PPD) and Tuberculin Skin Test (TST) testing results be noted, this risk assessment shall be revisited.

Blood testing for TB is a recommended alternative to skin testing (CDC, 2004). SFR in conjunction with NowCare, moved to the blood test effective January 1, 2020.

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EDUCATION AND TRAINING

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GENERAL GUIDELINES FOR EDUCATION AND

TRAINING

The Designated Officer shall participate in a training program that will assist in preparing all new employees for their new roles. The certificate awarded as a result of this training program shall be placed on file with the Department.

The Department shall allow for attendance at a train-the-trainer session to prepare key employees to serve as trainers in each specific workplace setting. All employees shall be provided training offered during normal working hours and at no cost. Training is the responsibility of the company officers and medical coordinator.

Training shall be provided at the time of initial assignment and on an annual basis. The trainer shall reserve the right to require additional training if he/she feels previous training was not in keeping with standards. Annual training for all current employees shall be completed within one year of their previous training.

Annual training shall update personnel on the diseases and Department changes in policy/procedure. All training content shall be reviewed on a continual basis and when changes in procedures or equipment are noted, additional training shall be scheduled. SFR shall ensure that training is offered using appropriate language and in such a manner as to ensure all employees are able to thoroughly understand the material.

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Training shall include:

1. OSHA standards, the Department’s Exposure Control Plan, and where to obtain copies of each;

2. A general explanation of the epidemiology of bloodborne disease and their symptoms;

3. Education on the epidemiology and symptoms of TB;

4. Bloodborne pathogens, including HIV, hepatitis B, hepatitis C, syphilis, and

TB;

5. A review of tasks that each employee performs and how they might be at risk for exposure;

6. A review of the use of PPE, the limitations of PPE in certain circumstances, and available PPE and their uses;

7. In depth information on the HBV program and TB skin testing program;

8. Information on how to report and document an exposure;

9. Information relating to what action shall be taken following an exposure, including what action, by whom, how to seek medical attention, and what follow-up medical attention should be sought after an exposure;

10. Explanation of the signs and labels to be used in the handling and storage of medical waste;

11. Access to Information relating to how employees can request their own medical records upon request;

12. Latex glove allergy/sensitivity issues;

13. Work restriction guidelines;

14. Needle safe devices;

15. Hand hygiene;

16. West Nile Virus;

17. State presumption law;

18. MRSA;

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19. Flu vaccine program;

20. Donning and doffing of PPE;

21. Ebola;

22. New influenza vaccines; and

23. SARs-CoV-2/COVID-19.

** All programs shall allow for interactive questions and answers with a knowledgeable instructor. The instructor shall be knowledgeable in communicable diseases and infection control and be able to relate this information to each specific work area. Training shall be conducted by the training officers for the agency who has attended a certified course in infection control training.

2021 Trainers: Captain Raymond Willet, DICO and FFMII Robert Barrett, DICO

Certificates shall be on file.

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Suffolk Fire & Recue

Continuing Education Sign-In Sheet

Program Title:

Date: Time:

Presenter:

Presenter Credentials:

Target Audience:

Participants

Name Job Title

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VACCINATION/IMMUNIZATION

TB TESTING PROGRAM

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SFR has a screening program allowing new hires to ascertain their vaccine and immunization status for childhood diseases. All new hires shall bring documentation of their vaccination status, including measles, mumps, rubella (MMR), chickenpox, and pertussis (whooping cough). This is in keeping with the current CDC Guidelines referenced by OSHA in its Compliance Directive (CPL 02-02.069) and NFPA 1581 Infection Control Standard.

All current at-risk employees shall obtain their own vaccine/ immunization records as well. Review of these records shall enable the Department to determine who is in need of protective vaccines.

In accordance with the CDC’s request, the Department shall ensure that vaccine/immunization records are available at all times in order to jumpstart post-exposure management. These records shall be computerized and secured, and shall be available to the Designated Officer through NowCare Suffolk.

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Communicable Disease Health History

Name:

This information is confidential

Disease Date of Illness

Measles (Rubeola)

Measles (Rubella)

Mumps

Chickenpox

Hepatitis Type

Tuberculosis Type

Meningitis Type

Malaria Type

HIV infection

Latex Allergy/Sensitivity YES ____NO

Signature: Date:

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Immunization Record

Name: __________________________

Confidential

Immunization/Vaccine Date of Administration

Hepatitis B Vaccine

Measles, Mumps, Rubella

Tetanus/Diphtheria

Chickenpox Vaccine

Flu Vaccine

Tdap Booster x1

COVID-19 Vaccine

TB Skin Test Result ___________________

Antibody Titer Result ___________________

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HEALTH HISTORY & IMMUNIZATION HISTORY

Declination Form I have attended education and training on bloodborne pathogens & TB and I have reviewed the forms requesting health and immunization/vaccination history.

I understand that this information is to be confidential and would only be used to assist in evaluation of whether I should be offered a vaccine or immunization as a prevention measure prior to any exposure event or for post-exposure evaluation and treatment.

I decline submitting this information to the Designated Officer. I understand that if I change my mind, I shall be able to complete the forms and receive any recommended immunizations or vaccinations.

Date:

Employee Name: ________________

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CHICKENPOX PREVENTION AND CONTROL

Upon hire, each employee shall complete a health history form which shall address chickenpox immunity. New employees who do not have immunity to chickenpox by reported history of the disease as a child, shall be advised to obtain the new chickenpox vaccine, VARIVAX.

It should be noted that SFR is responsible for payment of this prevention method. Employees shall be advised to contact the local health department for immunization clinic hours and fees.

Employees who receive the chickenpox vaccine shall submit proof of vaccination for inclusion in their medical record.

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Varicella Vaccine Consent Form

Employee Name:

Yes No

1. Have you ever had an allergic reaction to a vaccine or medication? _________

2. Are you allergic to neomycin or gelatin? __________

3. Are you pregnant or breast-feeding? __________

4. Are you under a physician’s care? __________

5. Are you currently ill, fever or cold? __________

6. In the past 5 months, have you received a blood transfusion __________

7. Have you received immune globulin or varicella immune globulin (VZIG)? ___________

I have read the information packet on VARIVAX, the chickenpox vaccine. I have been given the opportunity to ask questions and I understand the benefits and risks associated with this vaccine. I understand that I should avoid becoming pregnant for 4 weeks following receipt of this vaccine, and that

I should avoid the use of aspirin for 6 weeks after vaccination. If I develop a rash, I must remain off work until the rash subsides and receive clearance from Infection Control/Safety Officer to return to work.

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Measles, Mumps, Rubella Vaccine Consent Form

Employee Name:

Yes No

1. Have you ever had an allergic reaction to a vaccine or medication? ______

2. Are you pregnant? ______

3. Are you under a physician’s care? ______ ______

4. Do you currently have a fever or viral illness? ______ ______

5. Are you allergic to eggs? ______ ______

6. Are you immunocompromised? ______ ______

7. Have you recently received any blood products/transfusions? ______ ______

Consent:

I have read the information packet on the measles, mumps, and rubella vaccine (MMR). I have been given the opportunity to ask questions and I understand the benefits and risks associated with this vaccine. I understand that I should avoid becoming pregnant for 4 weeks following receipt of this vaccine. If I develop any side effects, I shall report them to the designated medical care provider.

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INFLUENZA VACCINATION PROGRAM

SFR shall provide influenza (flu) vaccinations to all employees at no cost.

The flu vaccine shall be administered by NowCare Suffolk. Beginning in mid-

September and ending when advised by the CDC. A consent form for the flu vaccine shall be signed by the employee and shall be retained on file in the employee medical record.

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Influenza Vaccine Consent Form

I have read the information about influenza and the vaccine that is being offered. I have read the information on possible side effects and allergies. I have had the opportunity to ask questions and to have my questions answered. Based on this, I elect to participate in this vaccine program.

Employee Signature:

Printed Name: ______________________________ Date:

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Influenza Vaccination Declination Form

This form is to document that I have been offered an annual influenza (flu) vaccine by my employer free of charge.

I have received education and training regarding the benefits of participating in the annual flu vaccine program in conjunction with the Centers for Disease Control and Prevention Guidelines. I have been given the opportunity to ask questions and to have those questions answered, however, I have chosen to decline this offer.

Employee Signature: ________________________________________

Employee Name: _______________ ____________ Date:__________

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HEPATITIS B VACCINE ADMINISTRATION

PROGRAM

The hepatitis B vaccine, Recombinant-Engerix-B, shall be administered in the form of an on-going, 3-dose vaccine program and shall be made available to all employees that have been deemed to be at-risk for occupational exposure. The Vaccine shall be administered at no cost to the employee. The Vaccine shall be administered within 10 days of initial assignment to a position that would place the employee at risk. The vaccine program shall be administered under the direction of a physician designated by SFR. Injections shall be administered by NowCare Suffolk. Post-vaccine titer testing shall also be conducted by NowCare Suffolk and billed directly to SFR. If additional times are needed, employees shall contact the Designated Officer. Administration shall be in accordance with the published standard set forth by the CDC. A laboratory that is accredited shall conduct any laboratory testing. Testing shall be offered at no cost to the employee. The designated medical care provider at shall keep exclusive records of the injections.

HEPATITIS B VACCINE PROGRAM

Each employee deemed to be at-risk shall be educated regarding the disease, efficiency and safety of the vaccine, route of administration, administration schedule and benefits. There shall be ample opportunity for each employee to ask questions and have questions answered. This informational session allows each employee to make an informed decision whether to participate. Employees shall sign an informed consent sheet which shall be kept on file. Each employee participating in the vaccine program shall receive a personal record documenting the vaccine series.

Employees who decline to participate shall be asked to sign a declination form in accordance with the provision of OSHA Standard 1910.1030 that shall also be kept on file in the employee’s medical record. Employees who elect to sign a declination form shall be advised that if they should change their mind, the vaccine shall be made readily available to them. Employees who can show proof of previous vaccination against HBV or who can document that they are antibody positive shall not be candidates for the vaccine because they have immunity.

Employees with a documented allergy to yeast shall be offered HEPTAVAX HB, a plasma-derived vaccine. If such employee declines the vaccine, they shall sign a declination form including information relating to their allergy status.

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Titer testing shall be offered one to two months after completion of the vaccine series per CDC guidelines. Responders shall be offered an additional series in accordance with the CDC’s guidelines.

Because this country has universal vaccination, all employees coming into the workforce from high school or college should already be vaccinated.

Accordingly, titers are not required to be performed on newly hired employees.

BOOSTER DOSES

Currently, there is no formal recommendation from the CDC for booster doses of the hepatitis B at any interval. Should a formal recommendation for a booster be published, SFR shall make booster doses available to at-risk employees free of charge.

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Hepatitis B Vaccination Program Consent Form I have received education and training regarding the hepatitis B vaccine. I have had the opportunity to ask questions and to have those questions answered to my satisfaction. I believe I understand the benefits and risks of the vaccine and consent to receive this vaccine.

Employee Signature: ________________________________________

Employee Name: _______________ ____________ Date:__________

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Hepatitis B Vaccinations Program Declination Form 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 the HBV vaccine, at no charge to myself, however, I decline the HBV vaccination at this time. I understand that by declining this vaccine, I continue to be at risk of acquiring HBV, 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 the HBV vaccine, I can receive the vaccination series at no charge to me.

Employee Signature: ________________________________________

Employee Name: _______________ ____________ Date:__________

Reason: (optional)

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Hepatitis B Vaccine Immunization Record

This vaccine shall be administered in three doses. It shall be given in the deltoid muscle of the arm only. The schedule for doses shall be:

Initial dose

Four weeks after the first dose, give second dose

Six months after the first dose, give the last dose

EMPLOYEE NAME:

First Dose

Second Dose

Third Dose

2- Dose Series

First dose:

Second dose: ____________________

Post-Vaccine Testing

Date: Result

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RECORDKEEPING FOR HEPATITIS B VACCINE

PROGRAM

Each employee shall receive an immunization card, for their personal records, which notes the administration dates for each dose of the vaccine.

NowCare Suffolk shall maintain complete records on vaccine administration for the duration of the employee’s service to SFR plus an additional thirty (30) years.

This is in keeping with the requirements of OSHA Standard 1910.1030 and the OSHA medical record standard 1910.1020.

Any employee who declines to participate in the program shall sign a declination form. NowCare Suffolk shall keep this form on file for the duration of the employee’s service to the Department plus an additional thirty (30) years.

Employees who decline the vaccination and decline to sign the declination form shall be referred for counseling and possible administrative action under the disciplinary action policy.

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COVID-19 VACCINATION PROGRAM

Employees of emergency response agencies are in the priority group for the

COVID-19 vaccine, accordingly this Department shall ensure that employees are offered the vaccine. The COVID-19 vaccine is issued under an Emergency Use

Authorization (EUA) by the Food & Drug Administration. Employees shall be given education and training regarding the vaccine. Consent/declination forms shall be signed by all employees.

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COVID-19 Vaccination/Immunization Declination Form I have received counseling regarding the COVID-19 vaccine and have been informed that it has been approved for Emergency Authorization Use (EUA) by the Food & Drug Administration. I am aware that I am in a priority group for receipt of this vaccine. I have had the opportunity to ask questions, have had my questions answered. I do not wish to participate in the COVID-19 vaccine program at this time. I have been informed that I may elect to receive the COVID- 19 vaccine at a later time.

Employee Signature: ________________________________________

Employee Name: __________________________ Date:____________

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COVID-19 Vaccination/Immunization Consent Form I have received counseling regarding the COVID-19 vaccine and have been informed that it has been approved for Emergency Authorization Use (EUA) by the Food & Drug Administration. I am aware that I am in a priority group for receipt of this vaccine. I have had the opportunity to ask questions, have had my questions answered, and have been asked about any allergies that might preclude me from taking this vaccine. Based on this, I elect to participate in this vaccine program.

Employee Signature: ________________________________________

Employee Name: __________________________ Date:____________

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TESTING

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EMPLOYEES DEEMED AT-RISK FOR

TUBERCULOSIS

AT-RISK PERSONNEL: Personnel with direct patient contact

Employees listed in the at-risk group for possible exposure to TB shall be offered baseline QFT-TB blood testing and post-exposure testing if indicated by the current CDC guidelines. QFT administration for baseline and post-exposure testing shall be administered at the office of NowCare Suffolk located at 3060

Godwin Blvd. Suffolk, VA 23434. Phone: 757-935-5310.

TESTING FOR EXPOSURE TO TUBERCULOSIS

All personnel deemed to be at-risk for exposure to TB shall be blood tested upon joining the Department to establish a baseline, and then tested on a post-exposure basis. Testing for TB shall be done using a TB blood test. Each employee shall sign a consent or denial form, which shall be kept on file in the employee medical records file. QFT testing does not require a return visit. Testing shall be conducted under the direction of NowCare Suffolk.

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Tuberculosis Screening Test Consent Form

I have attended an educational session on Tuberculosis (TB). This session included information regarding the TB blood test, which is used to determine if the bacteria which causes TB is residing in my body.

I understand that I may be occupationally exposed to TB and that I may be at risk for acquiring TB. I understand that the Centers for Disease Control and

Prevention (CDC) and the Occupational Safety & Health Administration (OSHA) recommend that I be tested for exposure to TB.

I have been given the opportunity to be tested using a blood test, at no charge to myself. I have had the opportunity to ask questions regarding TB and the skin testing program. Based on this information, I elect to participate in this program.

Employee Signature: _________________________

Employee Name: _______________ Date:_________

Administered by: __________________________

Result: ______________________

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Tuberculosis Screening Test Informed Denial Form

I have attended an educational session on Tuberculosis (TB). This session included information regarding the TB blood test, which is used to determine whether the bacteria causing TB is residing in my body.

I understand that I may be occupationally exposed to TB and that I may be at risk for acquiring TB. I understand that the Centers for Disease Control and Prevention (CDC) and the Occupational Safety & Health Administration (OSHA) recommend that I be tested to for exposure to TB.

I have been given the opportunity to be tested using the TB Blood test, at no cost to myself, however, I decline TB screening at this time. I understand that by declining this screening, I am at risk of having TB without my knowledge. I understand that I shall be able to obtain testing for TB in the future if I choose to change my mind.

Name:

Signature: ____________ Date:

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Tuberculosis (TB) Surveillance

Annual TB Screen for Positive Reactions Employee Name: __________________________________________________

Job Classification: _________________________________________

Records indicate that you have previously tested positive on a Purified

Protein Derivative (PPD) skin or blood test. The following questions must be answered each year as part of our annual TB surveillance program. Please complete this form and return to SFR’s Chief Safety Officer

During the past year have you experienced, or are you now experiencing any of the following signs/symptoms?

YES NO

Weight loss (unrelated to dieting)

Persistent cough (2 – 3 weeks duration)

Fever/Night sweats

Weakness or fatigue

Coughing up blood

Employee Signature: ________________________ Date: _______________

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EMPLOYEE PROTECTION

SCREENING FOR TB EXPOSURE:

RATIONALE FOR EXCLUSION

An employee’s job classification may be removed from the at-risk determination based upon review of the job duties outlined in the job description and the requirements contained in the application for the position.

The majority of administrative positions do not demonstrate that there may be "reasonable" risk for exposure. Consideration shall also be given to the aspect of "reasonably anticipated" risk. The ultimate decision regarding risk shall be made by interview with Department personnel. In the event that an individual in the “not at-risk” group is exposed, they shall be covered under the post-exposure management protocol.

Those personnel that are not involved in the transport of patients or the provision of high-risk procedures, are exempt from a high-risk listing.

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HUMAN IMMUNODEFCIENCY VIRUS (HIV) TESTING

HIV testing and counseling shall be made available, upon request, to all employees and volunteers requiring such services for reasons other than an on-the-job exposure.

Any employee/volunteer requesting HIV testing may contact the Designated Officer or may directly contact the Public Health Department Office of HIV testing to obtain free and anonymous testing. It is not the employer’s responsibility to test in a non-work exposure situation.

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Work Restriction Guidelines

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RECOMMENDED WORK RESTRICTIONS

FOR COMMUNICABLE DISEASES IN HEALTHCARE

WORKERS

POST-EXPOSURE WORK RESTRICTIONS DURATION

NOTE: ALL EXPOSURES AT HOME AS WELL AS AT WORK SHOULD BE

EVALUATED

Ebola Virus (and other hemorrhagic fever viruses)

Determine whether physical exposure has actually occurred.

Follow CDC guidelines.

Monitor to assess the presence of fever or other symptomatology.

Through day 21 post-exposure.

Measles (Rubella) (susceptible employees)

Exclude from work. From day 5 through day 21 post-exposure and 4 days after onset of rash.

Meningococcal

• asymptomatic employees No restriction.

Prophylaxis is recommended.

While asymptomatic.

• symptomatic employees (fever, intense headache, lethargy, stiff neck, and/or a rash that does not blanch under pressure)

Exclude from work. Close contacts and family members should be monitored.

Mumps (susceptible employees) Exclude from work. From day 12 through day 26 post-exposure, or until 9 days after onset of parotitis.

Pertussis

• asymptomatic employees No restriction.

• symptomatic employees Exclude from work. Until 5 days after initiation of antimicrobial therapy.

Rubella (susceptible employees)

Exclude from work. From day 7 through day 21 post-exposure.

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Varicella (Chicken Pox or Shingles)

• Non-immune employees exposed to varicella zoster (chicken pox) or uncovered herpes zoster (shingles)

Exclude from work. From day 8 through day 21 post-exposure.

• Vaccinated employees (those who have received 2 doses of vaccine)

Monitor daily during days 8- 21 post-exposure. Exclude from work immediately if symptoms develop (fever, headache, skin lesions).

Until varicella is ruled out or lesions are dry and crusted.

ACTIVE DISEASE WORK RESTRICTIONS DURATION

Acute febrile respiratory illness / influenza-like illness (ILI) (temperature ≥38º C or 100º F)

Exclude from work. Until acute symptoms resolve and temperature <100°for at least 24 hours without the use of antipyretic medications.

Conjunctivitis (Bacterial) Exclude from work. Until discharge (constant tearing) ceases and for 24 hours after effective treatment is initiated.

Conjunctivitis (Viral) Exclude from work if experiencing tenderness in front of ears (pre-auricular lymphadenopathy) temperature ≥100° F, work restrictions recommended by a physician, or eye drainage.

If adenovirus conjunctivitis is diagnosed, may return to work only when medically cleared by a physician (may remain infectious for ≥7 days).

Cytomegalovirus No restrictions.

Diarrheal diseases:

• Acute stage (diarrhea with other symptoms)

Exclude from patient care and food handling.

Until symptoms resolve.

• Clostridium difficile (C-diff) Exclude from work. Until free from diarrheal stools for 72 hours and completion of antibiotic regimen.

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• E. coli Exclude from work. Until symptoms resolve.

Consultation is needed to verify the employee is asymptomatic and is educated on hand hygiene. Food handlers require 2 negative stool cultures.

• Salmonella Exclude from work. Until symptoms resolve.

Consultation is needed to verify the employee is asymptomatic and is educated on hand hygiene. Food handlers require 2 negative stool cultures.

• Shigella Exclude from work. Until symptoms resolve.

Consultation is needed to verify the employee is asymptomatic and is educated on hand hygiene.

Food handlers and direct care providers are required to be asymptomatic and have 2 negative stool cultures 24 hours apart and ≥48 hours from last dose of antibiotics.

Diphtheria Exclude from work. Until symptoms resolve.

Enterovirus

(Hand Foot & Mouth Disease)

Exclud…