Download 2005PWW078 - City of Edmonton

Agenda Item No.: G.1.b.
Waste Management – Handling of Harmful Materials
c. Costs associated with lost
employee time due to those
incidents;
d. Recommendations for more
aggressive global strategies to
deal with workplace risks of
handling hazardous materials,
including an educational
component for the public and
City employees.
3. That Administration prepare a report
for the Transportation and Public
Works Committee meeting,
outlining requirements for the City
of Edmonton to be designated a Safe
Community by the World Health
Organization.
Recommendation:
That the June 8, 2005, Asset Management
and Public Works Department report
2005PWW078 be received for information.
Report Summary
This report responds to questions related to
the safeguarding of civic employees who
handle harmful materials and to the City
seeking designation as a World Health
Organization (WHO) Safe Community.
Previous Council/Committee Action
At the February 1, 2005, Transportation and
Public Works Committee meeting, the
following motion was passed:
1. That the January 17, 2005, Asset
Management and Public Works
Department report 2005PWW016 be
received for information.
2. That Administration prepare a report
for the June 14, 2005, Transportation
and Public Works Committee
meeting on corporate efforts made to
address workplace risks of handling
improperly discarded waste
materials (such as sharp objects,
needles and bodily fluids),
including:
a. Information on the protocols,
policies and preventative
measures in place to deal with
workplace incidents of handling
harmful materials;
b. The number of workplace
incidents in the past five years,
related to handling improperly
discarded waste materials;
Routing:
Delegation:
Written By:
June 8, 2005
File: 2005PWW078
Report
Protocols, Policies and Preventative
Measures

Procedures are in place to assist the City
workforce to avoid needle stick injuries
and to provide guidance for needle sticks
or exposure to blood in their line of
work. Examples are:
1. The Community Leisure Centres
Infection Control Resource
Manual that contains preventative
measures extracted as Attachment
#1.
2. The Waste Management Branch
procedure for employees to follow
should a needle stick injury occur
(Attachment #2).
3. The Emergency Medical Services
Branch’s use of a needle free
injection method for patient care
Transportation and Public Works Committee
W. D. Burn/D. Kloster/J. Tustian
D. Gray/R. Neehall
Asset Management and Public Works Department
(Page 1 of 4)
G
1
b
Waste Management – Handling of Harmful Materials (D. Thiele)


as a means to reduce potential
injury to EMS workers.
A list of operational policies, protocols
and preventative measures currently
used to safeguard city employees who
handle hazardous materials while at
work is included as Attachment #3. The
special nature of the services performed
by Emergency Medical Services and
Fire Rescue Services require an
Infection Control Program and dedicated
support of an Infection Control Officer.
Attachment #4 is the information
specific to these services.
These operational policies, protocols and
preventative measures notwithstanding,
the City’s Occupational Health & Safety
Business Plan (OHSBP) is reviewed
annually and revised as required by the
Occupational Health and Safety Steering
Committee. The Committee uses the
Provincial Occupational Health and
Safety Code and emerging issues to
guide it. Needle sticks/sharps were
among a number of items identified in
2004 as issues requiring further
attention, and action has been taken in
this regard as explained later on in this
report.
resulted in a work-related injury or illness had
the circumstances been slightly different –
accounted for one.
- 'No Treatment' - a minor injury or illness was
incurred, but the worker did not receive any
treatment – accounted for eight.
- 'First Aids'- minor injury or illness was
incurred, and first aid was applied (wound
dressing etc.) – accounted for three.
- 'Medical Aids'- an event in which medical
attention is sought (emergency room,
medicentre, trip to a family physician etc.) –
accounted for 26.
- 'Lost Time' - an event in which an injury or
Statistics on Workplace Incidents

stick injuries based upon the
incident description.
2. AMPW reported five (one in
Mobile Equipment Services
Branch, one in Lands and
Buildings Branch, three in Waste
Management Branch).
3. Community Services reported 28
(two in Parkland Services Branch,
six in Fire Rescue Services
Branch, 20 in Emergency Medical
Services Branch).
4. Edmonton Police Service
reported nine.
 A breakdown of the 42 incidents
follows:
- 'Near Miss' - an event which could have
Following are corporate statistics related
to needle stick injuries between January
1, 2000, and April 30, 2005. These data
represent incidents that are reported by
staff.
1. Overall, 42 or 0.55 percent of the
total 7,658 injury incidents
reported can be classified as needle
illness was incurred, and the affected worker did
not complete their next scheduled work shift –
accounted for four, all from Edmonton
Police Service.
Costs Associated with Lost Time

(Page 2 of 4)
There is no direct costing information
readily available.
Waste Management – Handling of Harmful Materials (D. Thiele)

An estimated cost incurred through the
Health Care System for testing and
treatment after a needle stick is $1,500 to
$2,000, based on a negative outcome
after one year.

Strategies


The development of corporate infectious
disease protocols is included in the 2005
workplan of the OHSBP. Completion is
expected in the spring of 2006.
In addition, the 2005 workplan of the
OHSBP includes the development and
delivery of the Safe Needle Disposal and
Awareness Plan. This is described in
Attachment #5 and is underway.

Safe Communities/World Health
Organization





The first step in receiving World Health
Organization (WHO) designation is to
become a Safe Community. Once a city
or region has operated as a Safe
Community for three years, it is eligible
to seek WHO designation.
Criteria for becoming a Safe Community
are described in Attachment #6
Edmonton is well positioned to
transition to Safe Community status if
funding were made available for a fulltime position and promotional materials
dedicated to this effort. If office space
and administrative support were
provided for this position, the budget
need for one staff and promotional
material could be limited to $100,000
annually for two to three years.
In addition, Edmonton already has in
place a network supportive of Safe
Communities, including the Capital


Region Health Authority, private
businesses, Safer Cities, and
Administration.
A coordinator from Safe Communities is
available to assist dedicated City staff to
establish contact with key stakeholders,
identify existing programs and determine
areas of need, and begin development of
a business plan (a requirement for Safe
Communities designation).
As information, Calgary City Council
passed a proclamation in support of Safe
Communities and allocated $200,000 in
the first year to facilitate the
development and implementation of
Safer Calgary.
At the time of application, the City of
Calgary had 24 members on the Safer
Calgary Board representing the areas of
violence prevention, injury prevention,
environment safety and urban safety,
with participation from members
representing aboriginal persons, persons
with disability, elders, youth, children,
women, gay and lesbian persons and
persons of racial diversity.
Also at the time of application to
become a Safe Community, a City of
Calgary Alderman was appointed to
chair the organizing committee.
A similar approach to Calgary proclamation, chair occupied by
Councillor and adequate funding - is
desirable if Edmonton were to proceed
towards Safe Community status.
Background Information Attached
1. Preventative measure
2. Needle Stick Injury Procedure
(Page 3 of 4)
Waste Management – Handling of Harmful Materials (D. Thiele)
3. Protocols, policies and preventative
measures
4. Emergency Medical Services and Fire
Rescue Services Summary Report
5. Safe Needle Disposal Awareness Plan
6. Safe Communities Criteria
Others Approving this Report



J. Tustian, General Manager, Corporate
Services Department
D. Kloster, General Manager,
Community Services Department
R. Millican, General Manager,
Transportation and Streets Department
(Page 4 of 4)
Attachment 1
Community Leisure Centres Infection Control Resource Manual ……Universal Precautions
Universal Precautions
The concept of `universal precautions"(UP) was developed by the Centre for Disease Control (CDC) in the United
States in 1987 to protect health care workers from blood born pathogens, specifically the Hepatitis B and Human
Immunodeficiency viruses. This concept was accepted in the same year in Canada by the Laboratory Centre for
Disease Control (LCDC), Health and Welfare Canada. "Universal precautions," as defined by CDC, are a set of
precautions designed to prevent transmission of human immunodeficiency virus (HIV), hepatitis B virus (HBV), and
other bloodborne pathogens when providing first aid or health care. Under universal precautions, blood and certain
body fluids of all patients are considered potentially infectious for HIV, HBV and other bloodborne pathogens. Since
medical history and examination cannot reliably identify all patients infected with HIV or other blood-borne
pathogens, blood and body fluid precautions should be consistently used for ALL patients. This approach referred to
as "universal blood and body-fluid precautions" or "universal precautions," should be used in the care of ALL
patients, especially including those in emergency-care settings in which the risk of blood exposure is increased and
the infection status of the patient is usually unknown.
Body Substance Isolation (BSI) was introduced in 1987. It is a strategy intended to prevent transmission of
potential pathogens between patients using protective barriers and changing workplace design. BSI expands the
principles of UP to all fluids. BSI replaces traditional isolation strategies with the exception of isolation for airborne
infection.
Infection Control protocols are evolving as the knowledge and awareness of infection control issues increase and the
need for better or more complete protocols becomes apparent. In 1994, the CDC put out a draft infectious disease
isolation strategy entitled Standard Precautions. Standard Precautions has been proposed as a total system of isolation
to replace UP, BSI and all other isolation strategies in the United States. Standard Precautions has not been widely
accepted, UP is still the `industry standard. The LCDC m Canada does not endorse Standard Precautions at this time.
Universal precautions do not deal with infectious diseases e.g. meningitis, TB, hepatitis A that can be transmitted by
the body fluids that are listed above. As well, the emergency service worker may not always be able to tell if blood
is present in a body fluid. FOR THIS REASON, ALL BODY FLUIDS MUST BE CONSIDERED HAZARDOUS.
Body Fluids to Which Universal Precautions Apply
Universal precautions apply to blood and to other body fluids containing visible blood. Occupational transmission of
HIV and HBV to health-care workers by blood is documented. Blood is the single most important source of HIV,
HBV, and other bloodborne pathogens in the occupational setting. Infection control efforts for HIV, HBV, and other
bloodborne pathogens must focus on preventing exposures to blood as well as on delivery of HBV immunization.
Universal precautions apply to semen and vaginal secretions. Although both of these fluids have been implicated in
the sexual transmission of HIV and HBV, they have not been implicated in occupational transmission from patient to
health-care worker.
Universal precautions also apply to cerebrospinal fluid (CSF)) (surrounds brain and spinal cord), synovial fluid
(found inside joints), pleural fluid (found inside chest cavity but outside lung), peritoneal fluid (found `inside
abdominal cavity), pericardial fluid (surrounds the heart), and amniotic fluid (surrounds fetus in the uterus). The risk
of transmission of HIV and HBV from these fluids is unknown; epidemiologic studies in the health-care and
community setting are currently inadequate to assess the potential risk to health-care workers from occupational
exposures to them.
Attachment 1 - (Page 1 of 1)
Attachment 1
Community Leisure Centres Infection Control Resource Manual ……Universal Precautions
______________
Body Fluids to Which Universal Precautions Do Not Apply
Universal precautions do not apply to feces, nasal secretions, sputum, sweat, tears, urine, and vomitus unless they contain visible
blood. The risk of transmission of HIV and HBV from these fluids and materials is extremely low or nonexistent.
Saliva of some persons infected with HBV has been shown to contain HBV-DNA at concentrations 1/1,000 to 1/10,000 of
that found in the infected person's serum. HBsAg-positive saliva has been shown to be infectious when injected into
experimental animals and in human bite exposures. However, HBsAg-positive saliva has not been shown to be infectious
when applied to oral mucous membranes in experimental primate studies or through contamination of musical instruments or
cardiopulmonary resuscitation dummies used by HBV carriers.
Use of Protective Barriers
Protective barriers reduce the risk of exposure of the lifeguards skin or mucous membranes to potentially infective materials.
For universal precautions, protective barriers reduce the risk of exposure to blood, body fluids containing visible blood, and
other fluids to which universal precautions apply. Examples of protective barriers include gloves, gowns, masks, and protective
eyewear, Gloves should reduce the incidence of contamination of hands, but they cannot prevent penetrating injuries due to
needles or other sharp instruments. Masks and protective eyewear or face shields should reduce the incidence of contamination
of mucous membranes of the mouth, nose, and eyes.
Universal precautions are intended to supplement rather than replace recommendations for routine infection control, such as
handwashing and using gloves to prevent gross microbial contamination of hands. Because specifying the types of barriers
needed for every possible situation is impractical, some judgment must be exercised.
Protective Barriers as Part of Universal Precautions
All staff should routinely use appropriate barrier precautions to prevent skin and mucous membrane exposure during contact
with any patient's blood or body fluids that require universal precautions.
Gloves should be worn for touching blood and body fluids, mucous membranes, or non-intact skin of all patients, for handling
items or surfaces soiled with blood or body fluids.
Gloves should be changed after contact with each patient.
Hands and other skin surfaces should be washed immediately and thoroughly if contaminated with blood or other body fluids.
Hands should be washed immediately after gloves are removed.
Although saliva has not been implicated in HIV transmission, to minimize the need for emergency mouth-to-mouth
resuscitation, mouthpieces, or other ventilation devices should be available for use in areas in which the need for resuscitation is
predictable.
Staff who has exudative lesions or weeping dermatitis should refrain from all direct patient care and from handling patient-care
equipment until the condition resolves.
Pregnant health-care workers are not known to be at greater risk of contracting HIV infection than health-care workers who are
not pregnant; however, if a health-care worker develops HIV infection during pregnancy, the infant is at risk of infection
resulting from Perinatal transmission. Because of this risk, pregnant health-care workers should be especially familiar with and
strictly adhere to precautions to minimize the risk of HIV transmission.
Attachment 1 - (Page 2 of 1)
Attachment 2
Waste Management Branch Needle Stick or Blood Exposure Procedures
Why Are Needles Dangerous?
Hepatitis B and C is a concern for workers who may be exposed to blood, as in the case of a needlestick
injury. After needles and syringes have been used, they can contain very small amounts of blood. If the
blood came from an infected person, it may contain viruses, which can cause such diseases as Hepatitis
B, Hepatitis C and AIDS (Acquired Immune Deficiency Syndrome). HIV is the virus responsible for the
eventual development of AIDS. Since even small amounts of blood can contain these viruses, it is
possible that a person could become infected following an injury with a used needle. To minimize the risk
of exposure to infectious agents, blood and body fluids should all be considered potentially infected.
Employees should be issued puncture resistant gloves and proper storage containers if they are likely to
encounter used needles during the course of their workday.
Steps to Follow
1. Puncture or cuts should be allowed to bleed, then washed thoroughly, with soap and water. Blood
splashes to eyes require immediate washing.
2.
Contact your supervisor. Seek medical attention promptly. Go to the emergency department at either
the University of Alberta (U of A) or Royal Alexandra Hospital (RAH). The doctor on duty will do a risk
assessment, draw a blood sample, and decide whether to prescribe medication to you. (Ask that the
results of testing also be sent to Dr. P. Sperka at Employee Health Services, City of Edmonton, 9th
Floor Century Place, 9803-102A Avenue, Edmonton, AB T6J 3A3)
3.
Depending on specific circumstances, blood should be drawn by the medical personnel for Hepatitis
B surface antigen (HBsAG), Hepatitis B Antibody (HBs Ab), HIV and Hepatitis C.
4.
If negative for the Hepatitis B Antibody (HBs Ab), a vaccination against Hepatitis B is usually
recommended within 7 days of exposure, preferably within 24 hours. This vaccine is Hepatitis B
immuniglobulin (HBIG) which is administered only at hospital emergency departments.
5.
Persons receiving HBIG as a result of a needlestick exposure should start a course of Hepatitis B
vaccine within one month of administration of HBIG. Hepatitis B vaccine is given at 0-1-6 month
intervals.
6.
Follow up blood testing for HIV, Hep B and Hep C is usually carried out at three-month intervals up
to six months. This should be arranged through Employee Health Services at the City of Edmonton
(Phone: 496-7850) or the individual's own physician.
7.
Report all incidents of needlestick injuries, blood or body fluid exposures to the departmental safety
unit.
8.
For further information or post-exposure counseling please contact Employee Health Services at
496-7850. Our hours are Monday to Friday, 7:30 a.m. – 4:00 p.m.
G:/Hdalth/Needlestick/Needlestickprocedure
Updated: May 17, 2005
Attachment 2 - (Page 1 of 1)
Attachment 3
Operational Policies, Protocols and Preventative Measures
______
The following Departments and Branches have operational policies, protocols and preventative
measures in place to safeguard city employees who handle hazardous materials while at work.
Asset Management and Public Works
1. Drainage Services – Follow operational procedure “Handling, Storage and Disposal of Used
Fluids and Solids that identifies “Sharps” as a potential hazard.
2. Land and Buildings
 Custodial Services – civic staff use “Procedure to Follow in the Case of Needle Stick Injury
or Blood Exposure” and contracted staff are required, under contract, to follow safety
program provisions under C.O.R. (Certificate of Recognition).
3. Mobile Equipment Services – existing policies and procedures under review.
4. Waste Management – Branch uses “Procedure to Follow in the Case of Needle Stick Injury or
Blood Exposure” and procedure “Avoiding Sharps”. Continually work to improve Personal
Protective Equipment.
Community Services
1. Parkland Services – conduct hazard assessments and use “Procedure to Follow in the Case of
Needle Stick Injury or Blood Exposure”.
2. Recreation/Community Leisure Centres - Follow Infectious Control Resource Manual
3. Emergency Medical Services and Fire Rescue Services – Comprehensive Infection Control
Program in place complete with dedicated Infection Control Officer.
Transportation and Streets
1. Roadways - use “Procedure to Follow in the Case of Needle Stick Injury or Blood Exposure”
and Hypodermic Syringe Collection Procedure
2. Transit – Bus and LRT Inspectors follow “Guideline for the cleaning of Body Fluids on LRV
Trains, Universal Precautions for Exposure to Potentially Infections Material, Handling Needles
Safely and “Procedure to Follow in the Case of Needle Stick Injury or Blood Exposure” and
receive information on immunizations for “Hepatitis B and Hepatitis B Vaccine”
Attachment 3 - Page 1 of 1
Attachment 4
Emergency Medical Services and Fire Rescue Services Summary Report
Background
In the early 1990’s the federal government commenced hearings on issues related to the reduction of risk
and prevention of exposure to infectious diseases in the line of duty for emergency response workers. In
September 1994 a National Symposium on Risk Prevention of Infectious Diseases for Emergency
Response Personnel was held in Ottawa. The consensus at this symposium was that a Notification
Protocol following a potential infectious disease exposure “must be part of an overall occupational
exposure management program”. The outcome of this symposium which included first responders from
major Canadian agencies such as police, fire and emergency medical services was A National Consensus
on Guidelines for Establishment of a Post-0Exposure Notification Protocol for Emergency Responders.
(CCDR Vol 21-19; 15 October 1995).
These guidelines form the basis for the 1998 Alberta Emergency Services Post Exposure Notification
Protocol developed by Alberta Health and Alberta Labour with extensive input from both ERD and EPS.
A key component of this document is the role of the designated officer. It states that each Emergency
Response organization will appoint a Designated Officer (DO) and describes the knowledge base
expected of that DO and adds that education about occupational risks and how to use preventative
measures is an important component of the DO role.
Both the Edmonton Police Service and Emergency Response Department have nurses designated as
Infection Control Officers (ICO). These positions evolved from this Alberta Post Exposure Notification
Protocol. The protocol recommends that each emergency response organization have a designated officer
who is the key contact person in the organization for not only blood/body fluid exposures but also for
direct contact with diseases such as meningoccocaemia and tuberculosis. The protocol outlines the
content of the program which includes policies and procedures, appropriate personal protective equipment
(PPE), education, pre exposure standards and education, immunization and post exposure follow-up.
To address this protocol in the large urban ERD and EPS the ICO position was created. A small part of
the ICO responsibility is to be on 24/7 call to assist first responders through the occupational blood/body
fluid exposure follow up process. Margaret McKenzie (ERD) and Diane Paltzat (EPS) are the DO’s for
their respective groups. Their role is adapted from that outlined in the Alberta Protocol as initially
assessing the exposure and facilitating the employee to the appropriate facility for treatment, liaising with
the emergency physician regarding drug therapy, counsel on prevention of secondary spread and ensuring
referral to an Infectious Disease physician when drug treatment has been started. The City of Edmonton
Employee Health Services, as keepers of medical records on employees, receives the blood results to be
put on the employees file; offers medical consultation from the Occupational physician if required and
completes the 3 and 6 month follow up for employees.
Emergency Medical Services & Fire/Rescue
Policies and Protocols
In 1996 an Infection Control Manual was written which incorporates the Alberta document. In 1999 a
protocol was developed with extensive consultation with Department of Emergency Medicine and
Department of Infectious Diseases. A protocol was developed.
Changes within Capital Health, and reported inadequacy in the consultation process has caused a review
of this protocol.
Attached please find the revised internal protocol as contained in the EMS and Fire/Rescue exposure
packages. Appendix 1.
Attachment 4 - Page 1 of 12
Attachment 4
Emergency Medical Services and Fire Rescue Services Summary Report
We also have a variety of SOP’s; SOG’s which refer to the use of the Personal Protective equipment
provided by both departments. This equipment is extensive, available, based on the type of work done by
each specialty and education on its use is continual.
Discussion has resumed with the Department of Emergency Medicine and the Department of Infectious
Diseases not necessarily to change our protocol but to re acquaint both departments with our requirements
and make any changes deemed necessary.
Number of Incidents 2000 – 2004
It is of note that of the 94 exposures to blood &/or body fluid reported from 2000 to 2004 inclusive, none
were attributed to incidental needles or sharps in the community. All were associated with the provision
of care in our normal business operation.
Attached please find Tables referring to numbers of exposures, types of exposures in EMS and where
they occur. Appendix 2.
Fire/Rescue receives calls through Dispatch to pick up discarded needles in the community. These may
be found in school grounds, city parks, hedges, etc.
Cursory reviews of that “Material Disposal” Code from CAD reveal needle/syringe pickup events as
follows:
2003 – 110 events
2004 - 126 events
2005 – 10 events (up to February 28th)
No exposures were associated with any “Materials Disposal” events of this specificity.
Fire Prevention has a large role in the Safer Cities initiative related to Community needle disposal boxes.
Fire Prevention checks on the number of needles in each box, empties them as necessary and prepares
regular reports for the committee. Reference: Kate Gunn, Safer Cities Initiatives Coordinator, Visit
www.edmonton.ca/SaferCities for their 2003 Annual Report
From June 2004 to April 2005 approximately 5500 needles have been collected from 11 boxes. No
exposures have occurred as a result of this project.
Review of any incidents reported occurs at the monthly Fire/Rescue OH&S Committee meetings and the
EMS Health & Support Services Committee meetings. Each incident is discussed and administrative,
engineering or education controls changed or reinforced as deemed necessary.
Please contact Margaret McKenzie RN, BScN, CIC Emergency Response Infection Control Officer with
any questions. (780) 944 5681.
Attachment 4 - Page 2 of 12
Attachment 4
Emergency Medical Services and Fire Rescue Services Summary Report
ERD Blood & Body Fluid
Exposure Follow-up Process
Exposed Employee
IMMEDIATELY:
RINSE, WASH, CLEAN
Remove contaminated clothing
REPORT TO SUPERVISOR
Infection
Control Officer
Supervisor
Supervisor:
Assess exposure, record details

description, event #

employee’s name, phone # &
AHC #

source name, DOB, AHC #

Confirm and clarify details of exposure
with Infection Control Officer
Emergency Room Physician:

Address significance of exposure,
risk factors, prophylactic
medication, counseling and
precautions necessary.

If prophylactic medication given,
ER Physician should call ERD
Infection Control Officer.

Physician will arrange for blood
work from employee.

ERD package contains lab reqs
that must be used

Note further info in package
Call Infection Control Officer or
designate immediately
944-5681 for pager # (24 hrs)

If deemed exposure:
Send employee with Exposure
Package to same hospital as source
patient.
See Doctor for assessment,
counseling and blood work



Supervisor / DC
Stay with employee to ensure
appropriate attention. Remember to
allow privacy for doctor/employee
discussion
Call Infection Control Officer after
Emergency Room visit to confirm
appropriate follow up





Complete follow-up as recommended
by attending Infectious Disease
physician or Infection Control Officer.
Attachment 4 - Page 3 of 12
Call Emergency Triage
Notify of employee exposure
Name of source patient and
known source risk factors
Request blood be taken from
employee and source patient
If prophylactic medical is necessary,
ER physician should contact ERD
Infection Control Officer or designate

Differences of opinion/concerns should be IMMEDIATELY addressed.

D/C / Captain / Supervisor can contact Infection Control Officer on behalf of
employee

Employee can attend own family physician

Employee can return to Emergency Dept. for reassessment
Discuss supervisors assessment,
collect information.
Confirm and clarify details of
exposure with employee
Provide reassurance and
preliminary counseling
Receive blood test results from
Lab
Notify employee and advise re:
follow up
Forward record of exposure to
ERD’s OH&S file
Arrange referral to ID physician if
required
Attachment 4
Emergency Medical Services and Fire Rescue Services Summary Report
SUPERINTENDENT/DISTRICT CHIEF Information
A. BLOOD or BODY FLUID EXPOSURE
TIME SENSITIVE – Requires IMMEDIATE Action
Blood &/or Body fluid exposures occur when:
 an employee has a needle stick
 cut by an object contaminated (or suspected to be contaminated) with blood &/or body fluid
 blood /body fluid comes in contact with mucous membrane (eyes, nose, mouth) or non intact
skin.
The employee is to notify a supervisor immediately.
RECORD DETAILS of the exposure, including:
ERD Event #
Employees name; employee #; home phone number; DOB; Personal Health#
Source patients name; DOB; PH#
Any other relevant details
REPORT IMMEDIATELY to Infection Control Officer or Designate
CALL 944 5681 (24 hour PAGER # is recorded on message)
The Infection Control Officer will:
 assess the exposure
 counsel the employee
 communicate with the ER physician to ensure that source blood is collected if necessary
 arrange further consultation & follow up if required
For a KNOWN SOURCE exposure the employee is to:
 GO to EMERGENCY at the SAME HOSPITAL as the source (patient)
This facilitates follow up.
For an UNKNOWN SOURCE exposure (e.g: needle stick from sharps container), employee is to:
 GO to the NEAREST EMERGENCY Department
Employee is to take the Exposure Reporting Package to hospital and provide the Emergency staff with the
Lab requisitions (yellow forms) in the package. These have information on them which facilitates
effective follow up.
Note: Appropriate first aid should immediately be administered on scene as detailed in EXPOSED
WORKER information of Exposure Reporting Package
The Emergency Physician or the Medical Officer of Health will be contacted by the ICO or
designate if further assessment is required. If a consultation is required with Infectious Diseases,
this may be arranged by either the Emergency Physician or the ICO.
Attachment 4 - Page 4 of 12
Attachment 4
Emergency Medical Services and Fire Rescue Services Summary Report
Infection Control Officer will be notified of the results of the blood work by phone within 24
hours. ICO will then make arrangements with employee for the appropriate follow up.
Written results of the lab tests will be sent to the City of Edmonton Medical Services
Department for inclusion in employee’s file. Long-term follow up will be done by this
department or by employee’s own physician.
B. TUBERCULOSIS
Exposures to patients with suspected TB DO NOT REQUIRE IMMEDIATE NOTIFICATION
of the Infection Control Officer. Employees should notify their supervisor immediately.
Supervisor will record exposure details:
Employees: Name & payroll #; Event #
Source:
Name; DOB; PH#; Address, etc
How the exposure occurred: Was the ERD member wearing Personal Protective Equipment?
Notify ICO of details: voice mail (944 5681)
e-mail: [email protected]
Subsequent follow up will be done by the Infection Control Officer or Designate.
If follow up is required it is NOT TIME SENSITIVE.
C. MENINGITIS
A significant exposure requires that the worker’s mucous membrane contact with the source patient’s
respiratory, throat or nasal secretions. Health care workers are seldom at risk even when caring for
infected patients as only intimate contact (mouth to mouth resuscitation and intubating or suctioning
without wearing a mask) warrants prophylaxis (preventive medication).
If direct contact has occurred notify ICO immediately. Otherwise, record details and notify Infection
Control Officer as above.
Complete Incident Investigation Data Collection Forms for all exposures and forward to the appropriate
individuals – (Incident Reporting Packages in Station).
EXPOSED WORKER INFORMATION
A. BLOOD or BODY FLUID EXPOSURE
1. ASSESS:
 Was this a needle-stick, mucous membrane or non-intact skin exposure to any blood or body
fluid?
 What type of fluid were you exposed to? Blood; saliva; saliva containing blood;
amniotic fluid etc.
 Check that your skin is intact: Look for nicks in the skin; hang nails; open rashes; abrasions;
cracks or cuts in the skin.
2. IMMEDIATELY ADMINISTER APPROPRIATE FIRST AID:
remove blood/body fluid soaked clothing if the fluid has soaked through to the
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Emergency Medical Services and Fire Rescue Services Summary Report
skin and wash the area with soap and water or an antiseptic solution.
 For percutaneous (needle-stick, cut or scratch ) exposure: force bleeding immediately at the
site, then rinse & wash with water and soap or with an antiseptic solution.
e.g Betadine or Chlorhexidine swabs, Alcohol based hand rinse product

For mucosal exposure (eyes, or inside mouth/nose) flush the area thoroughly
Note: can use distilled water, IV solution, or saline solution

For cutaneous ( on skin) exposure, wash the exposed area thoroughly with soap and water or
with an antiseptic solution or gel
Note: In the field, distilled water, IV or saline solution may be used for rinsing followed by
thorough cleaning with the alcohol based hand gel
3. REPORT INCIDENT to SUPERVISOR IMMEDIATELY
4. SUPERVISOR NOTIFIES INFECTION CONTROL OFFICER (ICO)
or DESIGNATE for risk assessment to determine whether follow up procedures
( #5 & #6) are required.
CALL 944 5681 FOR THE ICO PAGER NUMBER (24 hours)
5. KNOWN SOURCE
 GO to EMERGENCY at the SAME HOSPITAL as the source (patient)
This facilitates follow up.
UNKNOWN SOURCE (e.g. needle stick from sharps container)
 GO to the NEAREST EMERGENCY Department.
6. Take the Exposure Reporting Package with you and provide the Emergency staff
with the Lab requisitions (yellow forms) in the package. These have information on
them which facilitates effective follow up.
7. The Emergency Physician or the Medical Officer of Health will be contacted by the
ICO or designate if further assessment is required. If a consultation is required with
Infectious Diseases, this may be arranged by either the Emergency Physician or the
ICO.
8. Infection Control Officer will be notified of the results of the blood work by
phone within 24 hours and will then make arrangements with you for the
appropriate follow up.
9. Written results of the lab tests will be sent to the City of Edmonton Medical Services Department for
inclusion in your file. Long-term follow up will be done by this department or, if you wish, by your
own physician.
B. TUBERCULOSIS
Exposures to patients with suspected TB DO NOT REQUIRE IMMEDIATE NOTIFICATION of the
Infection Control Officer. Employees should notify their supervisor immediately.
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Emergency Medical Services and Fire Rescue Services Summary Report
Supervisor will record exposure details:
Employees: Name & payroll #; ERD Event #
Source:
Name; DOB; PH#; Address, etc
How the exposure occurred: Was the ERD member wearing Personal Protective Equipment?
Notify ICO of details: voice mail (944 5681)
e-mail: [email protected]
Subsequent follow up will be done by the Infection Control Officer or Designate.
If follow up is required it is NOT time sensitive.
C. MENINGITIS
A significant exposure requires that the worker’s mucous membrane contact with the source patient’s
respiratory, throat or nasal secretions. Health care workers are seldom at risk even when caring for
infected patients as only intimate contact (mouth to mouth resuscitation and intubating or suctioning
without wearing a mask) warrants prophylaxis (preventive medication).
If direct contact has occurred notify ICO immediately. Otherwise, record details and notify Infection
Control Officer as above.
INFORMATION SHEET EMERGENCY RESPONDERS
EXPOSED TO BLOOD OR BODY FLUID (BBF)
Needle-sticks or other BBF exposures in the community can be a terrifying event. Overall, the risk of
transmission of a blood-borne virus is very low. This information sheet will provide general information
about the risks of transmission.
Risk of Infection
The average risk of HIV infection due to all types of percutaneous exposures to HIV-infected blood is
0.3%. That is, 99.7% of emergency responders who are exposed to HIV will not be infected, even if
treatment is not provided. Risk factors for transmission include: (1) a deep injury, (2) visible blood on the
device causing the injury, (3) a device previously placed in the source patient’s artery or vein (e.g.. a
needle) or (4) the source patient is acute/early or end-stage AIDS.
The risk after mucous membrane and skin exposure to HIV-infected blood is estimated to be 0.1% and
less than 0.1%, respectively.
Most exposures in the Capital Health Region involve source patients of unknown status who will prove to
be HIV-negative when tested. The risk of HIV is almost zero in this situation.
The risk of Hepatitis B transmission from a chronic carrier (positive HBsAg) ranges from 10-30%.
Fortunately, most emergency responders should have received Hepatitis B vaccine and are immune. For
those who are not immune, Hepatitis B Immune Globulin is available to provide immediate protection;
vaccination will be also be commenced to provide future protection.
The risk of Hepatitis C transmission is 2-3% in recent studies.
Hepatitis C is by far the most common blood-borne virus in our community. Unfortunately, nothing is
currently available to reduce the risk of transmission of Hepatitis C. Immune Globulin has been used
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Emergency Medical Services and Fire Rescue Services Summary Report
previously but does not provide protection and is not recommended.
Thus, the risk of transmission of a blood-borne virus following a Needle-stick from a patient having such
a ‘virus is approximately 30% for Hepatitis B, 3% for Hepatitis C and 0.3% for HIV.
Symptoms of Disease
Some individuals infected with HIV or hepatitis experience a viral syndrome within a few weeks of
exposure. Fever is frequent and symptoms may include headache, nausea, decreased appetite, and sore
throat. Enlarged lymph nodes and rash may accompany the symptoms. Abdominal pain and jaundice may
also occur with hepatitis. If you develop such symptoms within the first few weeks following exposure to
blood or body fluid, do not panic. There are a variety of infections that can cause similar symptoms. You
should contact your Family Doctor for assessment.
Precautions to Prevent Secondary Spread
Individuals who have had a significant exposure to blood or body fluids infected with HIV, Hepatitis B or
Hepatitis C should use a condom when engaging in sexual intercourse and should refrain from openmouth kissing until testing at 6 months post-exposure confirms lack of seroconversion Sharing of shaving
instruments and toothbrushes should be avoided. Individuals should also refrain from any type of blood,
tissue or organ donation. Breast feeding or becoming pregnant should also be avoided.
These recommendations are very conservative but are appropriate for emergency responders with definite
exposure to a blood-borne virus. If the source patient is of unknown status or known to be negative but
you are awaiting follow-up serology, it is difficult to provide definitive advice. Knowing that your risk of
acquiring a blood-borne virus is very low, you and your partner will have to decide how much risk you
are prepared to take while waiting for your follow-up blood tests.
If you have questions or would like to talk further about your exposure and risks, counseling is readily
available.
Contact the Infection Control Officer at 944 5681
POST_EXPOSURE PROPHYLAXIS AGAINST HIV
(Preventive medication treatment)
Two (2) Drug Protocol
The drugs in this packet are offered to you because you have had an exposure to blood or other material
which may contain Human Immunodeficiency Virus (HIV), the virus which causes AIDS. It is believed
that your risk of becoming infected with HIV as a result of this exposure, which is already less than 1%,
can be reduced even more by taking these drugs. The following guidelines will help you to take these
drugs in the most effective manner and to recognize side effects which may occur. The drugs which you
are being given are Zidovudine (AZT; Retrovir) and Lamivudine (3TC), however, there is a combination
pill available.
1.
Begin taking these drugs immediately.
2.
Contact your Infection Control Officer.
3.
Continue taking both drugs until you discuss your situation with the ICO or
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Emergency Medical Services and Fire Rescue Services Summary Report
your Doctor.
A full course following definite exposure to HIV is 4/weeks, however, if
information from the source patient and serological testing make it unlikely that you
have been exposed to HIV, the anti-retroviral drugs will be discontinued. You may
only get a 24/48 hour supply of drugs from the emergency physician to start
immediately until the source blood results are available.
4.
Take these drugs according to the following schedule:
Zidovudine (AZT): Two (2) capsules (100 mg each) three (3) times a day.
(total 6/day). Side effects may be decreased if you take AZT with food.
Lamivudine (3TC): One (1) capsule (150 mg each) twice a day (total of 2/day).
3TC may be taken with food.
5.
Following is a list of the most common side effects:
If you experience any of these, contact the Infection Control Officer or your doctor. In some cases you
can keep taking the drugs. If more serious side effects occur, another regimen may be substituted.
Zidovudine: Most people have no side effects, but nausea, headache and fatigue are fairly common,
especially during the first week or two. Nausea may be decreased by taking Zidovudine with food or an
anti-nauseant such as Gravol. You may take small amounts of Tylenol, Aspirin or Ibuprofen for headache.
These symptoms usually subside with time. Zidovudine also causes anemia and a low white blood cell
count which will be monitored. A blood test will be performed to check for these after about two weeks of
taking Zidovudine. Other side effects are rare but have included rash, agitation/insomnia, and rarely,
pancreatitis.
6. Check with your doctor or pharmacist before taking any other medications to be sure they do not
interact with AZT or 3TC.
IMPORTANT: You should be aware that we have relatively limited information about the effects of antiretroviral drugs (aside from AZT) in the healthy Emergency Care Worker. As their use in this situation is
new we have no information about possible long-term toxicity. The benefits of using these drugs to
reduce transmission of HIV in the workplace must be weighed against the known risks and our
incomplete knowledge of long-term effects.
Risk of Infection
The average risk of HIV infection following a needle-stick with HIV-infected blood
0.3%. That is, 99.7% of emergency responders who are exposed to HIV will not be infected, even if no
drugs are taken. Features which increase transmission risk include:
(1) a deep injury, (2) visible blood on the device causing the injury, (3) a device previously placed in the
source patient’s artery or vein (e.g.. a needle) or (4) the source patient acute/early or end stage AIDS.
The risk after mucous membrane or skin exposure to HIV infected blood is estimated to be 0.1% and less
than 0.1%, respectively.
The risk of Hepatitis B transmission from a chronic carrier (positive HBsAg) ranges from 10-30%. Most
emergency responders have received Hepatitis B vaccine and are immune. The risk of V Hepatitis C
transmission is 2-10% (2-3% in recent studies). Hepatitis C is by far the most common blood-borne virus
in our community.
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Symptoms of Disease
Some individuals infected with HIV experience a viral syndrome within a few weeks of exposure. Fever
is frequent and symptoms may include headache, nausea, decrease appetite, and sore throat. Enlarged
lymph nodes and rash may accompany the symptoms. Similar clinical presentations are commonly due to
other agents and are not cause panic. If you develop such symptoms, you should seek the opinion of the
Infection Control Officer and/or your own doctor.
Precautions to Prevent Secondary Spread
Individuals who have had a significant exposure to blood or body fluids infected with HIV/ Hepatitis B or
Hepatitis C are advised to use a condom when engaging in sexual intercourse and should refrain from
open-mouth kissing until testing at 6 months post-exposure confirms lack of seroconversion. Sharing of
shaving instruments and toothbrushes should be avoided. Individuals should also refrain from any type of
blood, tissue or organ donation. Breast feeding or becoming pregnant should also be avoided.
If you have questions or would like to talk further about your exposure and risks, please call your
Infection Control Officer 944 5681
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Emergency Medical Services and Fire Rescue Services Summary Report
ERD Exposures Per Branch
Years 2000 - 2004
N=94
20
19
18
18
16
14
Number of Exposures
14
13
12
10
9
8
7
6
5
4
4
2
2
2
1
0
0
0
0
0
2000
2001
2002
EMS
Fire/Rescue
2003
2004
Other
All ERD Staff - Exposures Per Year
2000 to 2004
12
10
10
Number of Exposures
10
8
8
8
7
6
5
5
5
4
5
4
4
3
3
3
3
2
2
2
2
1
1
1
0
1
1
0
0
IV cath
IM needle
Other
Non Intact skin
Mucous Membrane
Type of Exposure
2000
2001
2002
2003
Attachment 4 - Page 11 of 12
2004
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Emergency Medical Services and Fire Rescue Services Summary Report
Location of Exposure Incident - EMS Staff
2000 - 2004
25
20
20
Number of Exposures
18
15
10
9
9
8
5
3
2
2
1
3
2
1
1
1
0
0
On scene
2000
During Transportation
2001
2002
In Hospital Emergency
2003
Attachment 4 - Page 12 of 12
2004
Attachment 5
Safe Needle Disposal Awareness Plan
Plan Outline

A corporate-wide education program to reduce the risk of needle stick injury to city
employees is an initiative for 2005 under the City’s Occupational Health and Safety Business
Plan.
 Employees find discarded needles in parks, streets, public buildings and during waste
collection activities. While infection from a needle puncture has not been the cause of
reported loss time among civic workers, the emotional health impact on workers who are
stuck is high.
 The Safer Cities Initiative has developed a focused program to reduce the number of needles
on Edmonton streets. The expertise and resources of the Safer Cities initiative will be applied
to reduce the risk of needle sticks among city employees.
 Targeting City staff who come into contact with needle debris will better equip these staff to
deal with needles. These staff could also serve as ambassadors to the community for safe
needle disposal. The staff to whom this plan will be targeted include:
- Waste collectors (garbage and recycling), Employees at the Materials Recovery
Facility (recycling plant) and Eco Station employees
- River Valley Rangers, other Community Services staff working in playgrounds and
recreation programs, Recreation Facilities and Parkland Services staff
- Land and Buildings staff who provide maintenance services
- (Edmonton Police Service and ERD are not part of this initiative’s target audience but
will be consulted as experts in the development of workshop materials)
 Workshops tailored to meet the needs of the department or branch will incorporate any
existing procedures or unique circumstances.
 A series of articles will appear in City Link, fact sheets will be distributed to all directors and
supervisors and a modified version of the Safe Needle Disposal Toolkit will be created for
distribution at the workshops and on e-city.
 Other target audiences include the EFCL and 144 community leagues; community
organizations such as Edmonton Neighbourhood Watch and Block Parents: and other parent
groups that may want to address the issue of needles in their neighbourhood.
 Other related initiatives such as the Edmonton Police Service’s Needle Injury Prevention
Program aimed at school children will be rolled together in a media relations program to
avoid confusion among the public. These events will also be leveraged to increase awareness
among city employees.
Attachment 5 – Page 1 of 1
Attachment 6
Safe Communities Criteria
Attachment 6 – Page 1 of 2
Attachment 6
Safe Communities Criteria
Attachment 6 – Page 2 of 2