Download UVA Exposure Control Program - Upper Valley Ambulance, Inc.

Upper Valley Ambulance, Inc.
PO Box 37, 5445 Lake Morey Road
Fairlee, VT 05045
802-333-4043 * 800-683-9196 * Fax 802-333-4234
Website: www.uppervalleyambulance.comEmail: [email protected]
Upper Valley Ambulance, Inc
EXPOSURE CONTROL
PROGRAM
Updated May 2007
-1-
UPPER VALLEY AMBULANCE, INC.
EXPOSURE CONTROL TABLE OF CONTENTS
I.
DEFINITION OF TERMS/POLICY STATEMENT
2.
EXPOSURE DETERMINATION
A. HIGH RISK DEPARTMENT PERSONNEL
B. LOW RISK DEPARTMENT PERSONNEL
3.
ROLES AND RESPONSIBILITIES
A. GENERAL CREW MEMBER RESPONSIBILITIES
B. DEFINED RISK TASKS AND PERSONAL PROTECTION OPTIONS
4.
GENERAL WORKPLACE CONTROLS
A. BODY SUBSTANCE ISOLATION POLICY
B. PERSONAL PROTECTIVE EQUIPMENT
1. PPE POLICY
a. DISPOSABLE AND NON-DISPOSABLE GLOVES
b. EYE PROTECTION
c. FACEMASKS/ NIOSH APPROVED RESPIRATORS
d. GOWNS
e. CPR SHIELDS
2. HANDWASHING
3. SHARPS
4. VENTILATION ADJUNCTS
C. HOUSEKEEPING
1. BIO-HAZARD AREAS
D. DECONTAMINATION/DISINFECTION TECHNIQUES
1. DECONTAMINATION DEFINITION
2. DISINFECTION DEFINITION
3. STERILIZATION
Updated May 2007
-2-
E. WORKPLACE EXPOSURE CONTROLS
1. CONTAMINATED REUSABLE EQUIPMENT
2. CONTAMINATED LINEN
3. CONTAMINATED UNIFORMS
4. CONTAMINATED PATIENT CLOTHING
5. RETRIEVAL OF CONTAMINATED EQUIPMENT
6. DISPOSAL OF REGULATED MEDICAL WASTE
7. AMBULANCE CLEANING/DECONTAMINATION
8. SCENE CLEAN-UP
5.
HAZARD COMMUNICATION
6.
HEPATITIS B IMMUNIZATION PROGRAM
7.
EXPOSURE CONTROL EDUCATION
A. TRAINING OBJECTIVES
B. TRAINING RECORDS
8.
MEDICAL RECORD KEEPING
9.
MYCOTUBERCULOSIS PROGRAM
A. PERSONNEL AT HIGHEST RISK
B. PERSONNEL AT LOWEST RISK
C. POST EXPOSURE MANAGEMENT OF TUBERCULOSIS
D. TB EDUCATION
E. RESPIRATORY PROTECTION PROGRAM
F. RESPIRATOR INDICATIONS
G. RESPIRATOR DISPOSAL INDICATORS
H. MEDICAL CONTRAINDICATIONS
I. RESPIRATOR STORAGE
10.
NOTIFICATION OF DESIGNATED OFFICER BY RECEIVING FACILITIES
A. RYAN WHITE LAW
B. DESIGNATED OFFICER POSITION
C. REPORTABLE DISEASES
D. NOTIFICATION OF FIRST RESPONDERS
Updated May 2007
-3-
11.
POST EXPOSURE MANAGEMENT FOR AIRBORNE/BODY FLUID EXPOSURES
A. PURPOSE
B. POLICY
C. DEFINITION OF EXPOSURE
D. SPECIFIC POST EXPOSURE REPORTING STEPS
E. FOLLOW-UP CONSULTATION
F. DOCUMENTATION/RECORD KEEPING
12.
COMPLIANCE MONITORING
DEFINITION OF TERMS
BLOODBORNE PATHOGENS- Pathogenic microorganisms existing in human blood that
cause disease in humans. These include but are not limited to Hepatitis B, Hepatitis C,
HIV, and Syphilis.
CONTAMINATED- The presence or the reasonably anticipated presence of blood or other
potentially infectious materials on an item or surface.
COMMUNICABLE- An disease which may be transmitted READILY either directly or
indirectly from one individual to another. A disease can be infectious without being
communicable.
DECONTAMINATION- The first step of two to remove, inactivate, or destroy bloodborne
pathogens by physical and/or chemical means from the surface of an item to the point
where they can no longer transmit infectious particles.
DISINFECTION- The second step of two to kill remaining bacteria/pathogens, usually by
chemical means of an item on the surface
DESIGNATED OFFICER- Person responsible for designing, implementing, evaluating
and researching an agency’s exposure control system.
DOSAGE- The number of organisms that are present in the exposure. A specific number
is required to be present in order for infection to occur. Each disease has a different
number requirement, and if that number is not present, no infection will occur.
ENGINEERING CONTROLS- Devices and techniques which serve to reduce or eliminate
the risk for airborne/blood borne disease transmission. Disposal containers for sharps and
hand washing options are just a few examples.
EXPOSURE- Contact with a potentially infectious agent (such as blood or body fluid)
through the eyes, mouth, mucous membrane, non-intact skin, percutaneous injection or
cuts by contaminated sharp objects.
HOST RESISTANCE- The ability of the individual to fight off infection. The healthier
you are, the less chance for infection.
INFECTIOUS- Illness resulting from the invasion of the body by a bacteria, virus, fungi,
or parasite. The term infectious only means caused by a pathogen.
Updated May 2007
-4-
MDRO- Multiple Drug Resistant Organism is a bacteria that is resistant to many
antibiotics. If bacteria are “resistant” to an antibiotic it means that certain drug
treatments will not work. A person can be either “colonized” or“infected” with an
MDRO. Colonized means that a person has the bacteria present on the skin or in body
openings but has no signs of infection. Infected means that a person has signs of an
infection (swelling,drainage, fever).
OCCUPATIONAL EXPOSURE- Reasonably anticipated skin, eye, mucous membrane, or
parenteral contact with blood or Other Potentially Infectious Materials (O.P.I.M) in the
performance of job duties. All confirmed occupational exposures will be covered by
Workman’s Compensation.
O.P.I.M.- Other Potentially Infectious Materials include: respiratory droplet spray,
semen, vaginal secretions, cerebrospinal, synovial, pleural, pericardial, amniotic, and
peritoneal fluid.
PARENTERAL- Piercing through the skin barrier via needlestick injury, human bite, or a
cut or scrape.
REGULATED WASTE- Items contaminated with blood or O.P.I.M. and would release
these substances in a liquid or semi-liquid state if compressed.
SHARPS- Items caked with fresh or dried blood or O.P.I.M. and are capable of releasing
these materials via parenteral contact during handling.
VIRULENCE- The strength of the organism outside the human body. Organisms like HIV
and TB die quickly when exposed to light and air, but Hepatitis B can survive days to
weeks on a surface.
Updated May 2007
-5-
I . POLICY STATEMENT
Purpose: To provide a comprehensive infection control system which maximizes protection
against communicable diseases for all UVA members and the public which they serve.
UVA Administration recognizes the potential exposure of all crew members to communicable
diseases in the performance of duties and in the normal pre-hospital environment. UVA is
committed to a program that will reduce this exposure to a minimum and take feasible measures
to protect the health of its members.
This document is intended to act as an overall exposure control plan for UVA.
The goal of this program is to provide all members with the best available protection from
communicable disease acquired in the line of rescue duties.
This exposure control plan applies to all UVA personnel and is effective immediately, and will
adhere to the following standards:
29CFR 1910.1030 Final Ruling on Bloodborne Pathogens Standard
29CFR 1910. 20 Medical Records Standard
29CFR 1910.134 Respiratory Protection Standard
29CFR 1913.10 TB Record keeping
Public Law 101-381 Ryan White Law
Guidelines for Preventing the Transmission of Mycobacterium Tuberculosis in Health Care
Facilities, 1994 Notice, Federal Register.
It is the policy of UVA:
A) To provide emergency medical services to the public without regard to known or suspected
diagnosis of communicable disease in any patient.
B) To regard all patients as potentially infectious. Standard Precautions will be observed at all
times upon patient contact. Standard Precautions is the concept that ALL blood and body fluids
are to be considered to pose a risk for transmission of bloodborne diseases.
C) To oversee the required squad training and immunization programs and develop standards for
Personal Protective Equipment (PPE) use, needed for protection from occupationally acquired
communicable disease.
D) To regard all medical information as strictly confidential. No member health information will
be released without the signed written consent of the member. All crew member medical records
will be kept/released at the Director’s Office separately from the personnel files.
II. EXPOSURE DETERMINATION
The following UVA personnel are considered to be at risk of exposure due to their assignment to
field duty and performance of emergency medical care and rescue duties. This definition
includes job-related tasks that involve an inherent potential for mucous membrane or skin
contact with blood, body fluids, or tissue or potential for spills or splashes of them.
A.
UVA personnel at highest risk of encountering bloodborne pathogens from blood and
body fluids include:
Emergency Care Attendants
Emergency Medical Technician-Basic
Emergency Medical Technician-Intermediate
Updated May 2007
-6-
Emergency Medical Technician- Paramedic
Administrative Field Personnel
Third Riders, Trainees (if involved in patient care)
B. The following personnel are considered employees that have tasks involving no exposure to
blood, body fluids or tissues;
Non-field Administrative Personnel
III. ROLES AND RESPONSIBILITIES
Crew Members - Must assume responsibility for their own health and safety and must use
appropriate PPE as situations dictate. In addition, crew members are responsible for reporting
any “on the call” exposures as well as diagnosis of communicable or infectious diseases acquired
outside of UVA duties to the Designated Officer. See Personal Health Appendix.
The following includes crew member job tasks possible in the delivery of patient care, with
appropriate personal protective equipment for those tasks. Wearing EVERY piece of PPE listed
may not be appropriate in each situation and it shall be the professional judgment of the crew
member to wear the appropriate piece(s) of equipment.
RISK TASK
PERSONAL PROTECTION RECOMENDED
Bleeding Control (Arterial)
Disposable Non Latex Gloves, Mask,
Protective Eye Wear, Gown.
Bleeding Control (Venous)
Disposable Non-Latex Gloves.
Blood Drawing
Disposable Non-Latex Gloves.
Emergency Childbirth
Disposable Non-Latex Gloves, Mask,
Protective Eye Wear, Gown.
Intravenous Catheter Insertion
Disposable Non-Latex Gloves
Esophageal/Endotracheal
Airway Management,
Disposable Non-Latex Gloves,
Face Mask, Protective Eyewear, Gown
CPR, Mouth to Mask, CPR Mask
Disposable Non-Latex Gloves
Oral/Nasal Suctioning
Disposable Non-Latex Gloves
Projectile Vomiting
Disposable Non-Latex Gloves, Face Mask,
Gown.
Airway Management With Vomiting
Disposable Non-Latex Gloves, Face Mask,
Gown if Splashing
MDRO Patient(Wound Colony) (Multiple Drug Resistant Organism)
Disposable Non-Latex Gloves
MDRO Patient(Respiratory Source)
Surgical Masks/Non-Latex Gloves
Updated May 2007
-7-
Cleaning Ambulance/Equipment
Utility Gloves, Face Mask(if splashing
anticipated)
Known or Suspected Airborne Disease
N95 Respirator. Conical or Oxygen Mask on
Patient, Open Ambulance Windows if
possible.
IV. GENERAL WORKPLACE CONTROLS
A. BODY SUBSTANCE ISOLATION
As the infectious disease status of patients is frequently unknown, it must be assumed that all
patients are potential carriers of Human Immunodeficiency Syndrome (HIV), Hepatitis B+C
virus (HBV),(HCV), MRSA, VRE other blood borne pathogens, and Airborne Pathogens from
droplet nuclei. Standard precautions are to be followed during every patient contact with
blood/bodily fluids. These guidelines require personnel to treat all direct contact with body fluids
as potentially infectious.
Standard Precautions shall be observed to prevent potential contact with ALL blood, bodily
fluids, airborne, or other potentially infectious materials during all patient contacts, except during
extraordinary circumstances where the use of Personal Protective Equipment (PPE) would
prevent the delivery of emergency care or pose a significantly decreased safety risk to the rescuer
or patient.
While standard precautions are designed to prevent contact with ALL body fluids, the National
Center for Disease Control has identified the following HIV/HBV/HCV risk factors with the
listed body fluids:
1) HIGH EXPOSURE RISK FOR HIV/HBV/HCV
a) Blood
b) Semen
c) Vaginal/Cervical Secretions
2) POSSIBLE EXPOSURE RISK FOR HIV/HBV/HCV
a) Pericardial, peritoneal fluid
b) Synovial fluid
c) Cerebro-spinal fluid(CSF)
d) Amniotic Fluid
3) LOW EXPOSURE RISK FOR HIV/HBV/HCV (unless mixed with the above substances)
*It must be remembered that these fluids may carry other diseases and therefore must still be
considered potentially infectious.
a) Sweat, tears, saliva
b) Feces, urine, vomitus
c) Sputum, nasal secretions, respiratory secretions
d) Breast milk)
Updated May 2007
-8-
*The following situations have been determined to pose a significant risk of exposure via direct
contact and
require the use of PPE:
a) Multiple Trauma
b) Vomiting/Productive Coughing
c) Bleeding - Peripheral or GI/Rectal
d) Bandaging/Splinting Open Injuries
e) Childbirth
f) Cardiopulmonary Resuscitation
g) Intravenous Administration
h) Airway Maintenance or Suctioning
i) Handling or Cleaning/Disinfecting Contaminated Materials, Linen or Waste
B. PERSONAL PROTECTIVE EQUIPMENT
1) PERSONAL PROTECTIVE EQUIPMENT (PPE) will be provided, repaired and replaced as
necessary by UVA at no cost to crew members.
PPE is utilized to prevent exposure to infectious materials and shall be chosen based on
anticipated exposure to blood or potentially infectious materials. *Members must protect any of
their open wounds from exposure by covering with bandaids or dressings prior to using PPE.
a) GLOVES: are available in several types. Disposable, non-latex gloves shall be stocked in
each ambulance and be accessible for routine use, and be accessible in the patient
compartment as well as being cab accessible. Non-latex gloves can also be found in both first
in oxygen bags, as well as both trauma kits, as well as in each paramedic kit.
Disposable gloves shall be worn routinely upon each patient encounter which poses a
significant risk of contact with bodily fluids or potentially infectious materials.
LIMITATIONS OF DISPOSABLE GLOVES: Gloves are only an additional barrier to
protect against gross contamination of the skin. Gloves WILL NOT protect against a
needlestick or penetrating injury. However, studies have shown that contaminated
needles passed through gloves decreased blood transfer by 50%. Also, small holes can
occur in gloves from normal use, making handwashing mandatory.
Leather gloves are to be worn (over disposable gloves) during mechanical extrication to
prevent puncture. If blood or body fluids contact leather/suede gloves, they shall be disposed
of, due to impossibility of disinfection. Leather gloves are available in each ambulance.
Sterile gloves are not routinely necessary unless the procedure calls for maintenance of strict
sterile procedure (as in interfacility transfers; this and any other specialized equipment may
be provided by hospital staff).
b) EYE PROTECTION: Every UVA employee is issued a pair of protective glasses. In
addition, eye protection shall be stocked in each ambulance and be accessible for routine use.
Eye protection shall be worn when there is significant risk of splashing or spurting body
fluids or potentially infectious materials into the providers’ eyes. Eye protection shall be
worn over prescription eye wear.
Updated May 2007
-9-
LIMITATIONS OF EYE PROTECTION: Those wearing eyeglasses may have fit problems
with the goggles or face shields carried on our ambulances.
c) N95 RESPIRATORS shall be available in each ambulance and accessible for routine use.
Masks are beneficial to prevent transmission of potential airborne infections and shall be
worn in emergent cases where concern about airborne pathogens exists. N95 respirators are
located in the first in bags and in each ambulance with the body isolation kits.
d) GOWNS: shall be available in each ambulance and accessible for routine use. They are to
be worn in situations where large amounts of body fluids or potentially infectious material is
present.
GOWN LIMITATIONS: Gowns may be difficult to don, and expose the crew member to
dangers in the presence of machinery or limit the members range of motion.
e) CPR SHIELDS: Pocket masks are available to all personnel and are located in the first in
bags. In the event mouth to mouth resuscitation is indicated and other means of
ventilating(i.e. bag valve mask or demand valve) are not available, a pocket mask shall be
utilized to prevent exposure to potentially infected body fluids.
All procedures involving blood or other potentially infectious materials shall be performed so as
to minimize splashing, spraying or splattering of these substances.
The use of common sense and the exercise of good judgment cannot be overemphasized.
2) HANDWASHING PROCEDURE
a) Hand washing is critical in preventing transmission of infectious disease. GLOVES ARE
NOT A SUBSTITUTE FOR HAND- WASHING. Members shall wash hands and
contaminated skin surfaces with soap and water, rubbing vigorously for ten to fifteen
seconds, and thoroughly rinsing with water.
b) Facilities for hand washing are available at receiving facilities and at the ambulance
station, and when hand washing facilities are not available (at the scene), crews shall use the
waterless disinfectant hand cleaner located in each ambulance. Crew members shall first
remove all dirt and organic material first with moist towelletes, then utilize the waterless,
alcohol based solutions to complete the hand washing regimen. Crew members shall wash
with soap and water at the destination location as soon as practical.
Crew members shall wash their hands as soon as possible:
a) AFTER EACH PATIENT CONTACT
b) After removing PPE
c) After handling potentially infectious materials
d) After cleaning or decontaminating equipment, including after daily inventory.
e) After using the bathroom
f) Before eating
g) Before and after handling or preparing food
Updated May 2007
- 10 -
3) SHARPS - All used needles, pre-filled syringe/needle units, scalpels, catheter stylets, glass
and other sharp objects shall be handled with extraordinary care. Used needles will not be
recapped. Recapping is the leading cause of accidental needle sticks.
UVA uses sheathed IV catheters, that encase the needle as it exits the IV venipuncture site. Each
ambulance carries only the sheathed IV catheters. All sharp objects shall be immediately placed
in the puncture proof red sharps containers located in all ambulances, taking care to not insert
fingers into the container. Sharps containers shall be exchanged at the DHMC when ¾ full.
Portable sharps shuttles are available in the first in bags.
4) VENTILATION ADJUNCTS - Bag Valve Masks shall be made available to members by
UVA to minimize rescuer contact with blood, body fluids and respiratory secretions. They shall
be used whenever possible during resuscitation to eliminate the need for mouth-to-mouth
contact, which shall be considered a last resort method of ventilation.
C. HOUSEKEEPING
1) BIO-HAZARD AREAS - UVA recognizes that the nature of emergency service often dictates
using work areas as multi-use areas and therefore emphasizes the need for body substance
isolation to be a part of daily routine.
Use of body substance isolation often requires the exercise of common sense. After patient
contact, all areas of potential contamination (including medical equipment, patient compartment,
drive compartment, door handles, steering wheel, clothing, etc.) are to be thoroughly cleaned and
disinfected as surfaces become contaminated with blood and body fluids. Although a surface
may seem clean, unseen contamination can exist.
Food and beverages are not to be kept in/on refrigerators, freezers, shelves, cabinets, countertops
or areas where blood or other potentially infectious materials are present.
Eating, drinking, smoking, applying cosmetics or lip balm and handling contact lenses is not
permitted: *Hand cream is NOT considered to be a “cosmetic” and is permitted, however, it
should be noted that some petroleum-based hand creams can adversely affect glove integrity.
a) On emergency scenes
b) In work areas where there is a reasonable likelihood that exposure to blood or potentially
infectious materials could occur. (such as the patient compartment of the ambulance)
D. DECONTAMINATION AND DISINFECTION TECHNIQUES
Cleaning procedures are broken down into three categories:
1) DECONTAMINATION - the physical removal of contaminants by scrubbing with soap and
water. A surface cleaned with soap and water is now ready to be disinfected. Any surface soiled
with blood and/or body fluids must be cleaned BEFORE being disinfected.
2) DISINFECTION - the process of killing an infectious agent by physical or chemical means.
Proper disinfection results in a clean surface unable to transmit disease.
Types of effective disinfectant agents include:
SANICARE QUAT-128 - One step germicidal disinfectant. Contact time 10 minutes
Advantages: No rinse, multi purpose germicide/virucide
Updated May 2007
- 11 -
ALCOHOL (70% Isopropyl) - Contact time should be 5 - 30 minutes.
Advantages: Does not corrode metal, does not leave residue, may be used on non-live electrical
equipment.
Disadvantages: Flammable, evaporates quickly, inactivated by blood and dirt.
BLEACH SOLUTION (1:100 dilution) - 1 part bleach to 100 parts water, which equals ¼ cup of
bleach to 1 gallon of water.
Advantages: A powerful, inexpensive and readily available disinfectant; agent of choice for
cleaning small, undried blood spills.
Disadvantages: May discolor fabrics; damage electrical equipment; corrode metal; cause
skin/respiratory irritation.
FRESH SOLUTION MIXED FOR EACH USE, BLEACH DEACTIVATES AFTER 24 HOURS.
DETERGENT CLEANSERS - These may be utilized for general disinfection of equipment
surfaces. Follow individual manufacturer instructions for use.
IODOPHERS (Betadyne) - Not recommended for equipment disinfection. An effective one step
skin antiseptic, but must dry to be effective. Betadyne scrub brushes are very effective at
removing gross skin contamination.
HYDROGEN PEROXIDE - Although not a disinfectant, Hydrogen Peroxide is effective in
dissolving dried blood and body fluids. The cleanser of choice for gross removal of dried blood.
3) STERILIZATION - the killing of microbial life by steam, gas or liquid agents. This is
required for items that will come into contact with sterile tissue or enter the vascular system.
Most prehospital items requiring sterility are disposable. In the case of inter-facility transfer, the
sending facility shall provide any specialized sterile equipment.
E. WORKPLACE EXPOSURE CONTROLS
1) CONTAMINATED REUSABLE EQUIPMENT
The following equipment shall be cleaned and disinfected prior to being placed into service.
Equipment cleaning should take place at the receiving facility if at all possible. Although listed
here, specific cleaning procedures appear as appendices at the end of this document.
Ambulance stretcher
Suction units
All back boarding supplies
All reusable airway management supplies
P.A.S.G.
2) CONTAMINATED LINEN
Shall be placed in appropriate linen containers at all receiving facilities. ALL USED LINEN
SHALL BE CONSIDERED POTENTIALLY CONTAMINATED.
Updated May 2007
- 12 -
3) CONTAMINATED UNIFORMS
Shall not be removed from the station or taken home prior to being cleaned or decontaminated.
In the event of contamination with blood or body fluids, clothing should be
cleaned/decontaminated as soon as practical, and red bagged to await laundering. Appropriate
body substance isolation shall be taken while handling contaminated clothing. Any clothing
should be turned in on themselves to minimize body fluid contact clothing and comes in contact
with skin surfaces, a shower shall be taken as soon as possible. UVA shall be responsible for
cleaning uniforms/turnout clothing soiled on a response at no expense to the member.
4) CONTAMINATED PATIENT CLOTHING - Shall be red-bagged and left with the patient at
the hospital.
5) RETRIEVAL OF CONTAMINATED EQUIPMENT - UVA shall ensure that each receiving
facility either decontaminate OR red bag any soiled UVA equipment prior to placing it in
locations to be recovered.
6) DISPOSAL OF MEDICAL WASTE - All disposable items which have come into contact
with blood or body fluids shall be considered medical waste, and disposed of at the receiving
facility.
a) Sharps Containers - shall be sealed/replaced when ¾ full.
b) Other Disposable Waste - shall be disposed of at the receiving hospital in designated red
bags. AT NO TIME IS CONTAMINATED WASTE TO BE DISPOSED OF IN NONDESIGNATED CONTAINERS.
c) Medical waste not disposed of at receiving facility, and generated either at the ambulance
station or on a call shall be red bagged and placed in the designated container in each
ambulance. ALL red bagged material shall be disposed of at either a receiving facility or at
DHMC’s medical waste receptacle.
7) AMBULANCE CLEANING AND DECONTAMINATION - shall be done regularly and
after each patient contact producing blood or body fluids per procedures in the attached appendix
on routine vehicle cleaning.
8) SCENE CLEAN UP - shall be the responsibility of responding crew members and applicable
first responders. Medical waste shall be gathered and disposed of by red bagging any non-sharps
medical waste described above while taking appropriate Body Substance Isolation precautions.
Any sharps medical waste shall be disposed of in a puncture resistant, labeled container. See
Blood Spill Cleanup Appendix.
V. HAZARD COMMUNICATION
A. Red or Brown plastic bags shall be considered to contain bio-hazard contents. They may or
may not have a bio-hazard insignia affixed. Appropriate body substance isolation procedures
shall be taken whenever handling red /brown -bagged or red-containered substances.
Updated May 2007
- 13 -
B. Blood or body fluid samples shall be considered bio-hazard substances but are not required to
be labeled as such. They shall be identified with the date, patient’s name, and person drawing the
sample. All samples shall be delivered to hospital staff upon patient transfer.
C. Biohazard insignia shall denote bio-hazard substances. This insignia shall be on any bags or
containers used to transport potentially infectious waste.
VI. HEPATITIS B IMMUNIZATION PROGRAM
UVA has a voluntary Hepatitis B immunization program and makes immunization available to
all crew members free of charge and without any pre-testing required. Education on infection
control, HBV/HIV and bloodborne pathogens must be made available to all new crew members
during initial squad orientation and continuing education.
UVA shall ask crew members to either accept or decline the HBV vaccination in writing in
compliance with OSHA standard 29 CFR Part 1910.1030.
A. HBV Immunization will continue as a voluntary program for all crew members. All
members shall be offered initial vaccination during orientation. The first injection shall
be administered and appointments scheduled for subsequent injections prior to
assignment of field duties by the respective squad.
B. If a crew member initially declines the vaccine but decides he/she wants it at a later
date, he/she may receive it at no charge.
C. UVA will make booster doses of the vaccination available and administer them at
appropriate intervals, as recommended by the CDC. .
UVA will strongly recommend and offer each crew member free of charge HBV titers to ensure
antibody response. All HBV vaccinations and titer results will be recorded and remain
confidential in the crew members files, maintained by the Designated Officer.
D. All members are strongly encouraged to accept the Hepatitis B immunization series to
prevent the spread of this disease. Accordingly, members will be required to accept or
decline the series in writing.
E. The Hepatitis B vaccination program consists of the following:
1. Three (3) injections will be administered by intramuscular injection. The injection will
be given in the deltoid region of the arm.
a. The initial injection on day 0
b. The second injection one (1) month after the first.
c. The third injection 6 months after the first.
d. Laboratory test (titer) to determine immunity 30 days after the
third injection.
e. See schedule listed above for possible additional doses.
Updated May 2007
- 14 -
2. The following are just a few of the reactions that have been reported in 10% or less of the
injections:
a. Local reactions at the injection site. Pain and/or swelling, redness.
b. Sweating, malaise, chills, weakness, flushing tingling and fever, flu-like
symptoms.
c. Possible hypotension
d. Nausea, vomiting, abdominal pain/cramps, constipation and/or diarrhea
e. Pain/stiffness in arm, shoulder or neck, back pain.
f. Rash
g. Insomnia, irritability, agitation, headache and dizziness.
3. A post-test (titer) will be required 1 month after the third injection. An additional dose will be
administered to those not converting on the third dose. Refer to the above schedule for additional
injection schedule.
4. If a crew member fails to convert after receiving their third dose of vaccine, the subsequent
doses will be administered as follows:
The fourth dose will be given 30 days after the result of the initial titer. The fifth
dose will, if necessary, be given 30 days after the fourth dose titer. A final titer
will be administered after the fifth dose.
VII. EXPOSURE CONTROL EDUCATION
All crew members shall receive mandatory training in infection control, body substance isolation
and blood borne pathogens during orientation. In addition, refresher information are required
annually through in-service education programs.
A. INFECTION CONTROL TRAINING OBJECTIVES - A copy of the OSHA
regulatory requirements shall be made accessible for crew member reference. Both initial
and refresher training will be targeted to the following objectives:
Initial training for new crew members shall be held by UVA prior to assignment of field duties,
and all personnel will receive additional training annually.
1) Making accessible a copy of the regulatory text of OSHA Blood borne
Pathogen Final Standard (1910.30) and explanation of its contents.
2) Discussion on the Following Blood borne Pathogens, Their Origins and
Transmissions:





Updated May 2007
Hepatitis A
Hepatitis B
Hepatitis C
HIV (Human Immunodeficiency Virus)Syphilis
- 15 -


Mycobacterium Tuberculosis (an Airborne Pathogen)
Meningitis (All Forms)
3) Review of Department Exposure Control Program
4) Engineering and Work Practice Controls
5) Selection, Use, Location, Handling Limitation and Disposal of PPE
6) Hepatitis B Vaccine Program/Tuberculosis Testing Procedure and Respiratory
Protection Program
7) Additional Education Updates When There Are Changes In Tasks and/or
Procedures
8) Interactive Education Opportunity With Qualified Instructor
9) Exposure Education and Incident Reporting Procedure and Follow-up Action
Requirements
B. TRAINING RECORDS - Infection control training records are kept with each member’s
personnel file, including:
1) Date, content of training
2) Instructor name and qualifications
Training records must be maintained for 3 years from the date on which the training occurred,
and are NOT considered to be confidential. UVA shall ensure that all records required to be
maintained shall be made available upon request to the Assistant Secretary of Labor and the
Director for examination and copying. Employee training records shall be provided upon request
for examination and copying to employees, and to employee representatives.
VIII. MEDICAL RECORD KEEPING
Crew member health files shall be maintained for the duration of active duty plus thirty (30)
years. Each member’s file shall be confidential and not disclosed or reported to any person in or
outside of the workplace without the member’s written consent. All medical records will be kept
separate from other crew member medical records.
If specific written consent from the employee is obtained, employee health files shall be
provided upon request for examination and copying to the subject employee, and to the Assistant
Secretary of Labor. No records will be released unless a written consent is obtained from the
crew member.
Hepatitis B and Tuberculosis related records shall include:
A. Crew member name, date of birth and social security number.
B. A copy of the crew member’s hepatitis B vaccination status and dates of vaccination, and lot
number of vaccine, including all titer results.
C. A copy of the crew member’s examinations, medical testing and follow-up procedures
D. Records to indicate the crew member was fit tested with a NIOSH N95 respirator.
Updated May 2007
- 16 -
E. A copy of any exposure incident report to airborne or blood borne pathogens.
F. A copy of the Workplace Injury Report filled out by the Designated Officer.
IV. TUBERCULOSIS PROGRAM
A. UVA personnel at highest risk of encountering Mycobacterium Tuberculosis include:
b) Emergency Care Attendants
c) Emergency Medical Technician-Basic
d) Emergency Medical Technician-Intermediate
e) Emergency Medical Technician-Paramedic
f) Administrative Field Personnel
g) Field Trainees and/or Observers
B. The following personnel are considered to be at lowest risk for encountering
situations/patients infected with TB:
a) Non-field Administrative Personnel
b) All other personnel not involved in the performance of emergency medical care, or
rescue duties (example: any support or clerical staff)
C. POST EXPOSURE MANAGEMENT FOR TUBERCULOSIS
1. All post exposure management for TB will follow the attached protocols and are summarized
as follows:
a) The crew member receives a PPD test after exposure.
b) If the test is negative, the member is retested in 12 weeks.
c) If the member’s PPD is positive, the member is referred to a physician who will order a chest
X-Ray if indicated.
d) Positive chest X-ray members will be evaluated for preventative therapy.
e) Therapy will be determined by chosen Healthcare Professional, with INH being provided by
the Vermont Dept. of Health, if indicated.
f) Members with previous positive PPD’s or with contact with TB positive persons need not
undergo chest X-rays. Annually, the member will will be referred to the healthcare professional
if symptomatic. The chest X-ray schedule will be ordered by provider.
All costs for occupationally acquired TB post exposure management shall be provided free of
charge to the exposed individual. All positive PPD readings with or without a positive chest Xray will be reported to the Health Department.
Updated May 2007
- 17 -
D. EDUCATION
1. Although the Vermont Department of Health lists Vermont as a “low risk” state, the status of
this can change, and the following population sub-groups have identified as higher risks for TB:
1. HIV Infected Persons
2. Nursing Home Residents
3. Immigrants/Refugees from TB Prevalent Nations
4. Homeless Persons of All Ages
5. Correctional Facility Inmates
2. UVA shall educate all crew members at the time of orientation and annually, the following:
1. Epidemiology, modes of transmission, risks and symptoms of TB
2. Situations and tasks presenting higher risk of exposure
3. PPE options for rescuer and patient, NIOSH Approved mask review, inspections
limitations, and maintenance procedures.
4. Decontamination procedures for equipment, workplace, and ambulance.
5. Proper disposal of PPE
6. Specific post exposure action requirements.
E. RESPIRATORY PROTECTION PROGRAM
In the orientation phase and annually, a crew member shall be educated to meet the requirements
of 29 CFR 1910.134 (OSHA’s Respiratory Protection Standard).
UVA keeps two of each size N95 NIOSH approved respirators on each truck. Staff are
authorized to use these only after the member meets testing and the following education
components:
1. Respirator selection, use and maintenance.
2. A hands-on demonstration of use after the mask has been fitted to the individual user
properly, complete with appropriate face seal.
3. Evaluation of fit and adjustment procedures by user.
4. Assurance that facial hair or eye glasses do not interfere with face seal.
F. INDICATIONS FOR RESPIRATOR USE
1. Respirators shall be utilized in the following circumstances:
a. Patients with forceful coughing(both productive or not) and sneezing.
b. Patients who expose rescuers to contact with oral/nasal or bronchial secretions.
c. Patients with suspected/confirmed positive airborne illnesses.
Updated May 2007
- 18 -
G. RESPIRATOR DISPOSAL INDICATORS
The respirator shall be used until:
1. It is visibly contaminated
2. You cannot breathe through it anymore.
3. It becomes physically damaged.
4. You cannot get a proper face seal.
H. MEDICAL CONTRAINDICATIONS
1. If at any time a feeling of lightheadedness, shortness of breath, chest pain or any adverse
symptoms arise while donning the respirator, remove the respirator, leave the room or patient
compartment and seek medical attention as soon as feasible. Notify the Designated Officer at the
earliest opportunity of any difficulties with the respirator.
I. STORAGE
1. The respirator is designed to be fitted to one face for the best seal, and thus is not for multiple
person use. Suggested storage technique is in a plastic sealed bag. Do not crush or otherwise
manipulate respirator to alter shape.
X. NOTIFICATION OF DESIGNATED OFFICER BY RECEIVING FACILITIES
A. RYAN WHITE LAW
The Ryan White Comprehensive AIDS Resources Emergency Act of 1990, (P.L. 101-381)
includes 3 major components applicable to the emergency responder.
1. It provides a list of potentially life-threatening infectious diseases that emergency
responders can acquire occupationally, and hospitals/healthcare receiving facilities are
required to report to each emergency agency.
2. The law requires emergency agencies to assign a designated officer to coordinate
exposure requests from crew members to receiving facilities, and to serve as a sole
contact point if a patient is discovered to be infectious by a receiving facility.
3. The law specifies the procedure to report exposures and outlines the options,
responsibilities and actions that all parties must take to address the notification and postexposure procedures.
B. DESIGNATED OFFICER POSITION
UVA will appoint a qualified representative to assume responsibilities of this position. Duties
include, but are not limited to:
1) Assisting in policy development
2) Developing criteria for infection control supplies and PPE
3) Developing and monitoring infection control training
Updated May 2007
- 19 -
4) Monitoring delivery of vaccination/testing programs
5) Evaluating reported exposures and coordinating post-exposure follow-up and counseling
6) Working in conjunction with APD’s Infection Control staff to implement policies in this
document and upgrade when indicated.
7) Coordinate compliance monitoring programs.
8) Be available 24-hours a day or designate replacement(s)
9) Be listed on the VT. Department of Health Ambulance Service License, renewed annually.
C. REPORTABLE DISEASES
The following infectious diseases are included as reportable under Ryan White and apply to
emergency response employees that include all Department members. The Centers for Disease
Control has grouped the list of diseases into three categories:
1. AIRBORNE DISEASE:
Infectious Tuberculosis (Mycobacterium Tuberculosis)
Reportable Within 48 Hours.
2. BLOODBORNE DISEASES:
Hepatitis B and C
Human Immunodeficiency Virus Infection (Including Acquired Immunodeficiency
Syndrome (AIDS)
3. UNCOMMON OR RARE DISEASES:
Diphtheria
Meningococcal Diseases
Plague (Yersinia Pestis)
Hemorrhagic fevers (Lassa, Marburg, Ebola, Congo-Crimean, and Others Yet to Be
Identified)
Rabies
The law requires the receiving facilities to provide immediate (within 48 hours) notification of a
“designated officer” only in cases involving tuberculosis. All other cases are to be communicated
as soon as practical. The designated officer shall present requests for information to the receiving
facility about suspected exposures in the following way:
1. Contact the receiving facility’s Designated Officer ONLY.
2. Supply with date and time of incident, name of source person,(if known).
3. Include report of exposure details via exposure reporting form. (See Appendix)
Updated May 2007
- 20 -
UVA shall await response not longer than 48 hours after the request for information. The
medical facility can respond in three ways:
1. A confirmed exposure situation exists, and post-exposure management begins
immediately, as applicable.
2. More information is needed to confirm exposure.
3. No exposure has been identified.
If a receiving facility deems from the information supplied that an exposure situation exists and
that the source patient has an infectious disease represented in the listed groups, they will
respond by issuing the following to the designated officer:
1. The date of transport.
2. The name of the infectious disease.
In addition, if the receiving facility discovers that a source patient has any of the above diseases,
it will notify the designated officer automatically, with the above information. No names will be
released by the receiving facility to the designated officer.
D. NOTIFICATION OF FIRST RESPONDERS
If a receiving facility notifies UVA’s designated officer about an infectious patient contact, the
officer shall notify all crew members at risk of the exposure, and also ANY first responder
group’s designated officer about the risk of exposure to their members. Information shall ONLY
be released to the organization’s designated officer, No other person shall be granted knowledge
of the exposure situation. Failure to observe this breeches patient, and crew member
confidentiality rights. Requests by chief officers of ANY agency will NOT be honored, unless
these individuals hold designated officer status, AND if their members were involved in the
exposure situation.
XI. MANAGEMENT PROTOCOL FOR ACCIDENTAL AIRBORNE, BLOOD OR BODY
FLUIDS EXPOSURE
A. PURPOSE: UVA crew members who have contact with blood and body fluids are at risk of
acquiring Blood borne diseases. These diseases include but are not limited to Hepatitis B and C,
HIV, and Syphilis.
Airborne exposures include but are not limited to the following diseases, Tuberculosis,
Meningococcal disease and other respiratory pathogens.
B. POLICY: Crew members who believe they have sustained an incident involving unprotected
exposure to blood borne/airborne pathogens by any of the recognized modes of entry are to be
evaluated and treated immediately utilizing the following guidelines:
C. An exposure is defined as contact with a potentially infectious agent (such as blood or body
fluid) through the eyes, mouth, mucous membrane, non-intact skin(as determined by the
designated officer), percutaneous injection or cuts by contaminated sharp objects. Airborne
Updated May 2007
- 21 -
exposures depend on the pathogen and PPE used. The exposure incident is considered job-related
if it occurs during the performance of a crew member’s duties.
D. Whenever a suspected exposure occurs, the following procedure will be followed:
1) The crew member will take IMMEDIATE action to minimize the impact of the
exposure. All exposed areas should be thoroughly washed and flushed with soap and
water, and/or with an alcohol based waterless hand cleanser located on each ambulance
and/or in each first aid/jump kit.
2) The crew member will immediately report to the Designated Officer or his/her
designee, to report the incident, after patient care duties are complete. REPORT
IMMEDIATELY, NO MATTER WHAT TIME OF DAY/NIGHT OR
CIRCUMSTANCES.
Currently, the Department’s Designated Officer is:
John Vose
603-359-5290 Cell
802-296-4433 24-HOUR PAGER
3) The crew member will complete an Infectious Exposure Form as soon as possible, but
not longer than 24 hours after the incident, in the presence of the designated officer,
whether the event is believed to be a confirmed exposure or not. The crew member will
describe the incident in their OWN words. Protocols are included in this plan for some,
but not all, exposures, and will be followed unless specific differing medical direction
states otherwise. It should not be assumed every physician is knowledgeable on the
subject of infection control medical direction, and the designated officer needs to confer
with the medical authority(s) to ensure proper, current post-exposure procedures.
E. Follow-up will be provided per UVA protocol at UVA’s expense. The Infection Control
Practitioner at APD will be contacted on all questions of possible exposures.
1) Consultation will take place between the designated officer and infection control
healthcare provider, who shall assess the exposure and direct appropriate immediate
actions and implement the appropriate post-exposure management protocol.
2) If it is determined that an exposure has occurred, the source person (patient
transported) shall be assessed clinically and epidemiologically (if consent has been
obtained) for the possibility of infection with the diseases listed above. All source testing
will be coordinated through the designated officer with the receiving facility’s infection
control practitioner.
3.) If an exposure has occurred, the circumstances should be recorded in the employee
health file.
Relevant information recorded is as followed:
a) date and time of exposure
b) job duties being performed by crew member at the time of exposure
Updated May 2007
- 22 -
c) details of exposure, including amount of fluid or material, type of fluid or
material, and severity of exposure
d) description of source of exposure- including, if known, whether the material
contained any blood borne pathogen.
e) details about counseling, post-exposure management, and follow-up.
f) all counseling will be conducted by the VT. Department of Health, or their
assigned designees.
4.) Baseline crew member HIV, Hepatitis B Antibody and Antigen , Hepatitis C,
Antibodies are to be drawn as soon as possible following the exposure. The crew member
is to be advised by the clinical provider to report and seek medical evaluation of any
acute febrile illness that occurs within 12 weeks after exposure. HIV sero-negative crew
members shall be retested at 6 weeks, 3 months, and at 6 months post-exposure. During
all phases of follow-up, confidentially of the member should be protected. If the crew
member does not make an immediate decision to be tested, his/her blood sample must be
arranged to be stored for up to 90 days.
5.) A crew member has the right to refuse to submit to the above outlined procedures.
Even when such procedures are medically indicated, no adverse action can be taken on
that ground alone since the procedures are designed to protect the crew member.
1. Workman’s Compensation INITIAL investigation procedures will be started by the designated
officer.
2. A complete exposure incident form will be placed in the employee health file, being accessed
only if the crew member signs a written consent form allowing disclosure to specified
individuals.
3. Additional post-exposure follow-up shall be at the discretion of the clinical provider.
4. The incident is to be investigated by the designated officer and corrective measures are to be
instituted to prevent further occurrences based on these recommendations.
5. UVA will fill out the OSHA 300 Log and Summary of Occupational Injuries and Illnesses
when one of the following indicators is present:
a. The incident is a work-related injury that involves loss of consciousness, transfer to
another job, or restriction of work or motion.
b. The incident results in the recommendation of medical treatment beyond first aid, (e.g.
gamma globulin, immune globulin, Hepatitis B vaccine, or other post-exposure
immunizations) regardless of dosage.
Updated May 2007
- 23 -
c. The incident results in a diagnosis of sero-conversion. The serological status of the
employee shall not be recorded on the OSHA 300. If a case of sero-conversion is known,
it shall be recorded on the OSHA 300 as an injury (e.g. “needlestick” rather than
“seroconversion”) in the following manner:
1. If the date of the event or exposure is known, the original injury shall be recorded with the
date of the event or exposure in Column B.
2. If there are multiple events or exposures, the most recent injury shall be recorded with the
date that sero-conversion is determined in Column B.
3. UVA policy will ensure 24-hour, 365 day coverage of a Designated Officer. UVA will
supply a pager to ensure crew member access to the Designated Officer or his/her designee.
XII. COMPLIANCE MONITORING
Workplace Decontamination/Safe Practice Procedures
a. Cleaning Blood Spills
b. Cleaning Suction Containers
c. Needle Insertion Technique
d. Routine Cleaning of Vehicle
e. P.A.S.G. (Anti-Shock Trousers) Decontamination
f. CPR Mannequin Cleaning and Decontamination
g. Two Rescuer CPR Training Procedures
h. Spot Cleaning Guidelines
CLEANING BLOOD SPILLS Areas of blood spills of any size should be cleaned as soon as
possible.
PROCEDURES
Use Sanicare Quat-128 if available, otherwise Mix one part bleach with 100 parts of water.
PUT ON DISPOSABLE LATEX/VINYL GLOVES!
Soak up the spill with paper towels. Do not use cloth towels that can be left in station
accidentally.
Clean area with Sanicare Quat-128 or Bleach/water solution.
Place ALL blood soaked materials into a red, labeled plastic bag
WASH HANDS THOROUGLY.
Updated May 2007
- 24 -
CLEANING SUCTION CONTAINERS
Suction equipment should be cleaned after each use.
PROCEDURE
Don disposable or utility gloves
For non-disposable systems, secretions should be emptied
carefully.
The collection bottle should be washed with soap and water
first. The bottle should then be washed with a germicidal
solution available at the receiving facility. Suction tubing
should be disposed of after each use, with replacement tubing
supplied at receiving facility.
Remove gloves and dispose
Immediately wash hands after cleaning is complete.
INTRAVENOUS NEEDLE INSERTION TECHNIQUE
PROCEDURE
Wash hands or use waterless hand solution.
Don disposable latex or vinyl gloves.
Apply tourniquet above selected site.
Prepare site with a povidone-iodine solution starting in the center and moving out.
Insert needle at 45 degree angle.
Dispose of needle(sharps) into a sharps container.
NEVER RECAP A USED NEEDLE OR SYRINGE!!
This is the LEADING cause of needlestick injury.
ROUTINE CLEANING OF DEPARTMENT VEHICLES
POLICY: Routine cleaning procedures for all department vehicles should be carried out
regularly. Responsibility for this task is the crew chief on duty.
PROCEDURE: Wear heavy duty gloves, and eye wear when mixing solutions( if applicable.)
Disposable gloves are acceptable if no utility gloves available.
Ambulances should be cleaned routinely after each patient contact that presents with blood or
body fluid contact. Cleaning should concentrate on first cleaning surface debris, followed by a
Updated May 2007
- 25 -
germicidal/virucidal solution obtained at the receiving facility. Areas of cleaning include high
contact areas, such as:
1. Interior walls and equipment cabinets/compartments.
2. Stretcher, including handles and side rails.
3. Bench seat and Captain’s chair.
4. Rails and latches on all interior doors.
5. All exterior door handles, including cab doors, and steering wheel.
6. All jump kits, including defibrillator.
7. Suction Apparatus, both Portable and On-Board.
8. Floor and Stretcher Anchoring Bars.
CPR MANNEQUIN CLEANING AND DECONTAMINATION
BASIC CONSIDERATIONS:
1. Students should be told initially that CPR training will involve “close physical contact” with
their fellow students.
2. Students should not actively participate in CPR training if they have the following:
a. Dermatological lesions on hands or in oral areas
b. If seropositive for Hepatitis B surface antigen
c. Upper respiratory tract infections
d. AIDS-related complications.
e. Exposure to or in the active stages of any infectious process
3. All persons responsible for CPR training should be thoroughly familiar with handwashing
procedures and the cleaning and maintenance of the mannequins. Instructors should adhere to the
standards of decontamination set by the AHA/ARC.
4. Mannequins should be inspected routinely for cracks and tears in plastic surfaces, which make
thorough cleaning more difficult.
5. The clothes and hair of the mannequins should be washed monthly or whenever visibly soiled.
CLEANING AFTER EACH PARTICIPANT
1. After each participant, the mannequin’s mouth and lips should be wiped with a 2 x 2 Gauze
pad or disposable paper product wetted with a solution of 1:100* bleach and water or 70%
isopropyl alcohol. The surface of the mannequin should remain wet for at least 30 seconds before
it is wiped dry.
Updated May 2007
- 26 -
2. If a protective face shield is used, it should be changed for each student.
TWO-RESCUER CPR TRAINING
1. During two-rescuer CPR training, there is no opportunity to disinfect the mannequin between
students when the “switching” procedure is performed. To limit the potential for disease
transmission during this exercise, the second student taking over ventilation on the mannequin
should simulate ventilation. This recommendation is consistent with current training standards
taught to all American Heart Association and American Red Cross Instructors.
2. Training in the adult, child and infant “obstructed airway maneuver” involves the student
using his/her finger to sweep foreign matter out of the mannequins mouth. This action could
contaminate the student’s finger with saliva from previous students and/or contaminate the
mannequin with material from the student’s finger. The finger sweep should either be simulated
or done in a mannequin whose airway was decontaminated before the procedure and will be
decontaminated after the procedure.
3. Rinse all surfaces with fresh water.
4. Wet all surfaces with a sodium hypochlorite solution (1:100 bleach/water) for 10 minutes.
This solution must be made fresh at each class and discarded after each use.
5. Rinse with fresh water and dry all surfaces. Rinsing with alcohol will aid drying of internal
surfaces and will prevent the survival and growth of bacterial or fungal pathogens.
6. UVA will attempt to supply mannequins with disposable airways and faces, where possible, to
decrease the risk of mannequin/student cross contamination
DECONTAMINATION OF IMMOBILIZATION EQUIPMENT
BACKBOARDS—KENDRICK EXTRICATION DEVICE—CERVICAL COLLARS
PROCEDURE
Don Utility Gloves/Face Mask if Splashing Anticipated
Hand wash with soap and water FIRST!!
Apply Hydrogen Peroxide to all affected areas. (Soak collars in solution for 24 hours if
necessary)
Apply Sanicare Quat-128 or 1-100 bleach solution to backboards and collars. DO NOT
use bleach for KED!!
Apply disinfectant to KED.
Rinse all of the above well with water before air drying.
Rinse gloves, clean area and wash hands thoroughly.
Updated May 2007
- 27 -