Download COMMUNICABLE DISEASES POLICY 1 Preface: It

COMMUNICABLE DISEASES POLICY
Preface:
It is not the purpose or the intent of these guidelines to treat
any applicant, employee, client, or citizen any differently than
what the normal procedure or contractual obligation calls for.
It is especially noted that this is true for the PRESENCE,
RECORD, OR PERCEPTION of any bloodborne pathogen illness,
including the fatal infectious disease AIDS, and HIV infection.
These guidelines have been written to provide practical guidance
to
specific
questions
that
will
arise
about
bloodborne
pathogens.
APPROVED BY THE COUNTY BOARD 10/27/87
UPDATED AND APPROVED BY THE COUNTY BOARD 9/22/92
I:\USERS\CHR\wpdata\Itcopol new\communic
1
INTRODUCTION
Bloodborne pathogens are microorganisms in human blood that can
cause disease in humans and are known as communicable diseases.
They include the hepatitis B virus (HBV) and the human
immunodeficiency virus (HIV), which causes acquired immune
deficiency syndrome (AIDS).
(AIDS) was first detected in the United States in 1981 and was
actually present in Central Africa already in 1971.
It is
thought to be an evolutionary descendent of a virus that existed
in monkeys for as many as 50,000 years. Since then, there have
been over 60,000 cases in the United States and the number is
growing daily.
Most persons who are diagnosed as having AIDS
die within a few years of diagnosis.
AIDS is a condition in which the body's normal self-defense
mechanism breaks down leaving it vulnerable to infections and
cancers which normally do not infect healthy people.
It is
caused by the human immunodeficiency virus. The disease is NOT
very contagious. AIDS can only be transmitted by certain kinds
of direct, intimate sexual contact, direct contamination with
infected blood or body fluids, or by sharing an infected
hypodermic needle for injection of drugs.
AIDS is NOT
transmitted by such casual contact as sharing a telephone,
shaking hands, touching door knobs, use of bathroom facilities,
hugging, sneezing, swimming pools, day care centers, etc.
The
possibility of transmission of the disease is extremely remote
or non-existent in most public and work place settings.
Precautions to avoid contamination are necessary for employees
occupationally exposed to blood, other potentially infectious
materials, and certain other body fluids that contain bloodborne
pathogens.
These employees include, but are not limited to
physicians, dentists, dental employees, nurses, morticians,
paramedics, medical examiners, laboratory and blood bank
technologists and technicians, housekeeping personnel, laundry
workers, employees in long-term care facilities and home care
workers.
Other workers who may be occupationally exposed to
blood or other potentially infectious materials, depending on
their work assignments, include research laboratory workers, and
public safety personnel (fire, police, rescue, correctional
officers, etc.)
The State Department of Health projects that 17,000 people in
Minnesota are INFECTED with the HIV virus which means that their
2
COMMUNICABLE DISEASES POLICY
immune system has produced antibodies in response to the
infection. As of August 1992, there were 1,177 confirmed cases
of AIDS in Minnesota.
Itasca County recognizes the need for safeguards to protect
workers against the health hazards related to bloodborne
pathogens and will address this growing problem in a variety of
ways.
Itasca County will keep abreast of current information,
devise operating procedures, participate in information-sharing
and coordination activities with other units of government and
private agencies, and develop and carry out necessary training
programs.
COUNTY OPERATIONS
A.
ITASCA COUNTY GUIDELINES RE:
INFECTIOUS DISEASES
Itasca County will not subject any employee, applicant, or
client to testing, removal of customary status, or be deprived
of any rights, privileges or freedoms because of his/her HIV
infection, AIDS, or other bloodborne pathogen status except for
clearly stated, specific, and compelling medical and/or public
health reasons. Further, Itasca County will ensure that
information and data collected from and about employees and/or
clients be used and disseminated per compliance with the Data
Privacy Act (M.S. Chapter 13) and the Itasca County Retention &
Destruction Schedule.
Note: Definition of HIV virus and AIDS status:
NOTE:
1.
HIV VIRUS:
the scientifically acceptable term for
human immunodeficiency virus and the causative agent of
the medical condition known as AIDS.
2.
ACQUIRED IMMUNE DEFICIENCY SYNDROME or AIDS: breakdown
of the body's natural immune system. Because AIDS
affects the body's ability to fight off infection,
people who suffer from AIDS become susceptible to a
variety of rare illnesses not usually found in people
whose immune system is normal.
These illnesses are
referred to as "opportunistic infectious or diseases"
and can be fatal.
"Clearly stated, specific and compelling medical reasons"
3
refers to the medical treatment of the patient with AIDS and HIV
infection and related conditions by medical and health personnel
as determined by a team of health professionals including the
Public Health Agent of the County Board in cooperation with
local medical doctors, and/or other expert personnel.
Public
health reasons refers to the transmission of the disease from
infectious persons to members of the public by known means of
transmission or where the real possibility of infection, as
determined by the County's health officer, exists.
NOTE:
Exhibit A lists other laws and guidelines under which
Itasca County operates which prohibit discrimination because of
HIV infection or AIDS status or which may be relevant to related
issues.
B.
EMPLOYEE RELATIONS AND PERSONNEL POLICIES
TESTING EMPLOYEES/APPLICANTS FOR AIDS POLICY: Testing for AIDS,
HIV infection, or any other bloodborne pathogen should not be
done as a screening for employment, re-assignment or promotion,
except for positions which require specific work-related health
conditions, as outlined in Medical Evaluation and Employee
Assistance, of the Personnel Policy and in accordance with labor
contracts.
See Attachment B.1 for reference to the policy on
Medical Evaluation and Employee Assistance.
DISCUSSION:
Testing for bloodborne pathogens such as AIDS,
except as provided for in the Personnel Policy, is not needed
because these diseases are not transmitted by casual contact.
Screening for such may be construed as discrimination. Current
personnel rules and labor contracts adequately address the
medical testing issue and provide adequate safeguards for the
employee and others.
TESTING AS PART OF EMPLOYMENT POLICY:
Employees will not be
required to have or be offered testing for AIDS, HIV infection,
or bloodborne pathogens except when they are involved in an
incident in the course of their work during which transmission
might occur or where the employee's ability to perform the
duties and/or responsibilities of the position involved are
impaired.
Itasca County has adopted a definition of incident
which follows in Attachment B.2. In the case of uncertainty or
dispute, a physician designated by Itasca County will determine
if a situation meets the definition of an incident on a case-bycase basis.
4
COMMUNICABLE DISEASES POLICY
DISCUSSION:
The Itasca County Medical Evaluation and Employee
Assistance policy provides that "In the event an employee
appears to have a mental or physical condition that would impair
the
employee's
ability
to
perform
the
duties
and/or
responsibilities of the position involved or causes the employee
to use sick leave in a manner which appears to be excessive, the
Human Resources Director may require such employee to be
examined by a qualified physician designated by the Personnel
Department at the expense of the county." This is sufficient
authority to cover AIDS, HIV infection, and other bloodborne
pathogen related incidents.
The County's personnel system, as
well as the legal system, provides extensive recourse and
ensures due process in the unlikely event that an employee might
object to examination.
With regard to emergencies, protection
is that which is possible given the situation.
If an employee
with a bloodborne pathogen is injured, care must be taken with
handling blood; the best protection is the use of personal
protective equipment such as gowns, gloves, laboratory coats,
face shields, masks, eye protection, mouthpieces, and other
ventilation devices, thorough hand washing and care not to get
infected blood on mucous membranes, i.e. mouth. Since there is
no treatment, the rationale for examination or testing would be
to determine if infection can be related to the work incident.
MODIFICATION OF WORK ASSIGNMENTS OF BLOODBORNE PATHOGEN STATUS
EMPLOYEES POLICY: Employees who are known to have a bloodborne
pathogen status shall not have their job assignments modified
except as provided for in the Itasca County Medical Evaluation
and Employee Assistance Program policy. Exceptions may be made
by the Human Resources Department on a case-by-case basis at the
request of the employee or employing department in the case of
compelling medical and/or public health reasons.
DISCUSSION: There may be rare instances with AIDS, as with any
potentially disabling situation or situation involving an
infectious disease, in which there are compelling medical or
public health reasons to modify, temporarily or permanently, an
infected employee's work assignment.
This could be for the
protection of the employee, others or both.
BENEFIT ISSUES POLICY: Itasca County will continue to negotiate
insurance packages for all employees with no preferential
treatment regarding or disregarding AIDS.
No person will be
required to supply information of a nature not required of all
5
persons
in
County-negotiated
insurance
packages.
No
modifications regarding HIV infection, AIDS or other bloodborne
pathogen illnesses will be made to current disability or sick
leave
policies
unless
agreed
to
through
the
collective
bargaining process.
DISCUSSION: Current policies are adequate to insure and protect
employees who become sick with HIV infection, AIDS, or other
bloodborne pathogen illnesses.
Although there are indications
of
attempts
to
discriminate
against
persons
of
certain
demographic groups or lifestyles for insurance purposes in other
parts of the country, thus far no such insurance practice has
been instituted in Minnesota. If new diseases or technologies,
such as transplants, come along which increase the cost of
health care for County employees as a group, premiums go up and
everyone pays more. There is no reason to modify this position
at this time. In the case where an employee is using sick leave
or disability provisions of the County, and a doctor's statement
is required, there is no need to identify the bloodborne
pathogen status of the employee; the doctor may just indicate
the debilitating symptoms which are affecting the employee's
ability to work.
6
COMMUNICABLE DISEASES POLICY
Attachment B.1
(from the Itasca County Policy Manual on Medical Evaluation &
Employee Assistance)
A.
Medical Evaluation
1.
Physical requirements. For the positions which require
specific work-related health conditions, employment will
be contingent upon passing a medical evaluation
conducted by a qualified physician designated by the
Human Resources Department at the expense of the County.
A medical examination report shall be prepared for the
examined applicant which contains the findings and
recommendations of the physician. This report shall be
placed on file with the Human Resources Director and it
shall be considered part of the employee's record. In
the event the medical evaluation report indicates that
the applicant has a mental or physical condition which
would impair his/her ability to perform the duties
and/or responsibilities of the position, the Human
Resources Director may declare the applicant ineligible
for appointment.
2. Special Medical Evaluation. In the event an employee
appears to have a mental or physical condition that would
impair the employee's ability to perform the duties
and/or responsibilities of the position involved or
causes the employee to use sick leave in a manner which
appears to be excessive, the Human Resources Director may
require such employee to be examined by a qualified
physician designated by the Human Resources Department at
the expense of the County. Any employee who is required
to discontinue work may not return until authorized by
the physician designated by the Human Resources
Department. If it is found that the employee will not be
able to perform the duties of his/her position, every
effort shall be made within the scope of these rules to
place the employee in gainful employment within the
County, provided a vacant position within an existing
classification exists. If a position does not exist for
which the employee may qualify, the appropriate
employment rules and/or contracts covering layoff,
dismissal, etc. shall be followed.
3. Notice of Medical Information Used in Employment Decision
7
Section 363.03, Unfair Discriminatory Practices, Subd.
1a, of the Minnesota Human Rights Act was amended in
1989 to state that, "If any health care records or
medical information adversely affects any HIRING, FIRING,
or PROMOTIONAL decision concerning an applicant or
employee, the employer must notify the affected party of
that information within ten (10) working days of the
final decision." THE HIRING AUTHORITY HAS AN
AFFIRMATIVE DUTY TO PROVIDE THIS INFORMATION REGARDLESS
OF WHETHER THE EMPLOYEE REQUESTS IT OR WHETHER SUCH
INFORMATION IS THE PRIMARY BASIS FOR AN EMPLOYMENT
DECISION.
B.
Employee Assistance.
Employees not able to continue in their duties due to
medical reasons and/or employees needing counseling due to
depression, marital problems, family tensions, family
abuse, financial difficulties, or alcohol, or drug abuse
may seek assistance through the County's employee
assistance program in a confidential outside-of-work
setting. Professional counselors are available and
employees are encouraged to seek any assistance they need.
The Human Resources Department shall act as liaison to the
service provider; however, actual involvement of the
employer is not necessary unless deemed by the professional
counselor as necessary to carry out the care plan.
8
COMMUNICABLE DISEASES POLICY
Attachment B.2
DEFINITION OF RELATED WORK INCIDENT
An HIV infection, AIDS, or bloodborne pathogen related work
incident involves significant exposure to regulated body fluids
including blood, semen, blood products, vaginal secretions
(including menstrual blood), amniotic (pregnancy) fluid,
cerebrospinal (brain and backbone) fluid, perioteneal
(abdominal) fluid, and pericardial (heart) fluid. Such
significant exposure is considered an occupational exposure and
occurs when an employee's skin or mucous membrane is exposed to
the above-mentioned regulated body fluids through needlestick,
cut, splash, or when the employee's skin is chapped, abraided,
or otherwise not intact and which occurs during the performance
of an employee's job.
Specific to the HIV infection, the virus has been found in tears
and saliva, but no one has become infected with HIV as a result
of contact with tears or saliva. The probability of infection
from mucous membrane or blood contact with infected saliva or
tears is extremely low.
If a situation arises, and concern or doubt about the
possibility of infection occurs, the Coordinator/Human Resources
Department should be contacted immediately so that a physician
can be designated by the County to determine if a situation
meets the definition of an incident.
9
C.
CLIENT RELATIONS
TESTING FOR, OBTAINING OR RECORDING CLIENTS' BLOODBORNE PATHOGEN
STATUS
POLICY: Clients of Itasca County and its vendors shall not be
tested for HIV infection, AIDS, or other bloodborne pathogen
status unless there is, in the judgement of the County's Health
Officer or designee, sufficient medical and/or public health
reason to do so. This may be in the presence of clinical signs,
in order to prescribe treatment, or if some unique aspect of the
client's situation presents the danger of transmission.
POLICY: The bloodborne pathogen status of clients of Itasca
County or its vendors shall not be obtained and/or recorded,
either voluntarily or involuntarily, unless there are compelling
medical and/or public health reasons to do so.
DISCUSSION: County policy must provide for the (1) rights of
clients who have HIV infection, AIDS, or other bloodborne
pathogen illness (2) rights of employees to know if a hazard
exists in the work place, and (3) rights of clients who do not
have a bloodborne pathogen illness. County employees perform a
wide variety of functions. The legitimate concerns of employees
concerning knowledge of a client's bloodborne pathogen status
should and must be addressed. However, employee concerns may
not be justification for practices which are contrary to medical
knowledge and which would subject clients to unwarranted
invasion of their privacy and violation of their rights. Good
infection control practices should be in place where an entire
clientele, because of its nature, is more likely to have been
exposed to a bloodborne pathogen than the general population.
As a matter of management practice, such infection control
practices should be required and maintained.
PRIVACY OF CLIENTS' BLOODBORNE PATHOGEN STATUS
POLICY: Itasca County will strictly enforce the privacy of
health records and will exercise the necessary and customary
precautions so that unauthorized dissemination of information
about the HIV infection, AIDS, or other bloodborne pathogen
status of Itasca County clients or its vendors does not occur.
In cases where bloodborne pathogen status information is
obtained, only authorized persons will have access to this
information to use for work-related reasons and all such persons
should be required to be trained in the medical facts concerning
10
COMMUNICABLE DISEASES POLICY
the transmission of illness.
POLICY: State requirements regarding the reporting of the
identities of persons who are infected with HIV, AIDS or other
bloodborne pathogens only affects the examining physician.
Itasca County will, of course, comply with any laws, rules or
regulations promulgated by the State Department of Health to the
degree expected or required.
DISCUSSION: Since the disease of AIDS is a recent development,
and most knowledge concerning the disease has not reached the
public in a systematic fashion, there is much unwarranted
concern and partial or mis-information about the disease. Until
the public can be educated about the disease, its transmission
and degree of infectiousness, it is important to be
extraordinarily concerned about over reaction and hysteria which
might occur and be focused on a few unfortunate individuals
whose health status has been made public knowledge.
Further, since there is no "cure" for AIDS, the only means of
preventing the spread of the disease is through prevention. Any
policies or procedures which have the effect of deterring
persons who may be infected from being tested to determine their
HIV or AIDS status and adjusting their contacts accordingly are
counter productive and may have the effect of harming the
public.
WORK UNIT OPERATIONS AND CLIENTS' BLOODBORNE PATHOGEN STATUS
POLICY: Work units are expected, if it is appropriate or
necessary, to change their operations to incorporate medically
sound infectious disease control practices, which
apply to all clients.
There will be no changes in work unit operation because of an
individual client's HIV infection, AIDS, or other bloodborne
pathogen status except where there are unique and compelling
medical and/or public health reasons. Changes must be
consistent with these guidelines and other policies and rules,
and must be in the form of a written document which clearly
states the client's identity, his/her bloodborne pathogen
status, the nature of the change, the reason for the change, who
shall know about and/or implement the change and the duration of
the change. The document must be approved in writing by the
appropriate Department Head.
11
DISCUSSION: The presence of a person infected with the HIV
virus, AIDS, or other bloodborne pathogen in a client population
is reason for change in operations only if the client has
medical treatment needs which cannot be met under current work
unit operating procedures or if there is a real possibility of
transmission of the disease because of the nature of the client
or the situation. DEPARTMENT HEADS ARE RESPONSIBLE TO ENSURE
THAT KNOWN CLIENTS WITH BLOODBORNE PATHOGENS ARE NOT SUBJECTED
TO DIFFERENTIAL TREATMENT EXCEPT FOR REASONS BASED ON SOUND
MEDICAL AND/OR PUBLIC HEALTH INFORMATION.
D.
TRAINING
EMPLOYEE TRAINING AND PROTECTION
POLICY: Itasca County will make available to all employees
mandatory training concerning bloodborne pathogen illness
including HIV infection and AIDS. Training will be provided for
employees according to their classification into one of three
training categories. The three categories of training are: (1)
basic information and policy training, (2) training for
employees who are in contact with high risk group clients, and
(3) training for employees who are at risk of infection because
of their work assignment. As other training needs are
identified, they will be provided for. As per the Occupational
Safety and Health Administration (OSHA) Bloodborne Pathogen
Standard, training will be provided at no cost to employees with
occupational exposure and given during working hours. The
training should be given at the time of initial assignment and
must be updated on an annual basis.
The County will provide employees with personal protective
equipment, i.e. gloves, mouthpieces. Hepatitis B vaccinations
will be made available to all employees who have occupational
exposure to blood within ten (10) working days of assignment, at
no cost, at a reasonable time and place under the supervision of
a licensed physician or licensed health care professional, and
according to the latest recommendations of the U.S. Public
Health Service (USPHS). It is not necessary for the employee to
be vaccinated if the employee has previously had the vaccine or
an antibody testing which shows the employee to have sufficient
immunity. An employee with occupational exposure to blood or
other potentially infectious materials at risk of acquiring
Hepatitis B may decline the vaccination and choose to have the
vaccination series at no charge in the future should the
12
COMMUNICABLE DISEASES POLICY
employee reconsider his/her declination. Any employee making a
declination is to complete a Hepatitis B Vaccine Declination
form.
DISCUSSION: Training about bloodborne pathogens is necessary to
prevent the development of an atmosphere of fear and hysteria in
the work place and to reduce anxiety and uncertainty about such
diseases as AIDS. In addition, all County employees need to be
aware of the County policies.
Elements of the training will be determined by the
Coordinator/Human Resources Director, the Public Health
Director, and others as deemed necessary by the
Coordinator/Human Resources Director.
Personal protective equipment must be chosen based on the
anticipated exposure to blood or other potentially infectious
materials. The protective equipment shall be considered
appropriate only if it does not permit blood or other
potentially infectious materials to pass through or reach the
employees' clothing, skin, eyes, mouth, or through or reach the
employees' clothing, skin, eyes, mouth, or other mucous
membranes under normal conditions of use and for the duration of
time which the protective equipment will be used. Personal
protective equipment must be cleaned, laundered, and disposed of
by the employer at no cost to employees. All repairs and
replacements must be made by the employer at no cost to
employees.
In addition to the Human Resources and Public Health
Departments, employees may contact the following organizations
or support groups for information:
1.
2.
3.
4.
5.
6.
Minnesota AIDS Hotline: 1-800-752-4281 TDD
Minnesota AIDS Project-AIDS Line:
1-800-248-2437
Duluth Community Health Center: 218/722-1497
Red Door Clinic, Mpls: 612/347-3302
Room 111 Clinic, St. Paul: 612/292-7752
Hospice: 218/327-2851
13
EXHIBIT A
LAWS AND GUIDELINES RELEVANT TO ITASCA COUNTY AND AIDS
Federal Rehabilitation Act of 1973, Sec. 504, prohibits
discrimination based on disability or handicap or perception of
disability.
Minnesota Human Rights Act
Constitutional provisions regarding search and seizure and
invasion of privacy; applicable to testing and obtaining or
disclosing information.
Workers Compensation Legislation
AFL-CIO Guidelines
Labor Contract Provisions
Centers for Disease Control Guidelines; relating to
reasonableness standards.
National Labor Relations Act; Arbitration.
Data Privacy Statute
Minnesota Right to Know Law
I:\USERS\CHR\wpdata\Itcopol new\communic.doc
11/01/96
14