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Southern Kennebec Child Development Corporation Bloodborne Pathogen Exposure Control Plan SKCDC is committed to providing a safe and healthful work environment for our entire staff. The following Exposure Control Plan (ECP) is provided to eliminate or minimize occupational exposure to bloodborne pathogens in accordance with OSHA standard 29 CFR 1910.1030, “Occupational Exposure to Bloodborne Pathogens.” Program Administration: The Health/Nutrition Manager is responsible for the implementation of the ECP. Implementation includes: ECP reviews and annual updates. All necessary PPE (personal protective equipment) will be provided to Program Supervisors. All necessary follow up after an exposure incident. All necessary recordkeeping to ensure documentation and maintenance of all records. All employee training and documentation. ***This Plan outlines appropriate behavior and responsibility of employees. Those employees, who are determined to have occupational exposure to blood or other potentially infectious materials (OPIM), must comply with the procedures and work practices outlined in this ECP. Failure to adhere to the expectations as outlined may result in disciplinary action. *** This ECP Includes: 1. Determination of Employee Exposure 2. Implementation of various methods of Exposure Control, including: A. Exposure Control Plan B. Universal Precautions C. Engineering and Work Practice controls D. Personal Protective Equipment (PPE) E. Housekeeping 3. Hepatitis B Vaccination 4. Post Exposure Evaluation and Follow Up 5. Employee Training. 6. Record Keeping M:\Plans, Policies, Procedures\Bloodborne Pathogens Exposure Control Plan Revised 6/1/13 1 1. Employee Exposure Determination The following is a list of all job classifications at SKCDC in which all employees have occupational exposure. Job Title Assistant Teacher Program Supervisors Center Supervisor/Teacher Teachers Home Visitors Cooks Cook Assistants Education Technicians The following is a list of job classifications and tasks in which some SKCDC employees have occupational exposure. Job Title Tasks Custodians Disposal of trash/clean up activities Family Services Coordinators Classroom duties Program Managers Classroom duties Substitute Positions: Teachers, Assistant Teachers, Cooks are covered by this standard. 2. Methods of Implementation and Control A. Exposure Control Plan All new Employees and Substitutes covered by this standard receive training upon employment by SKCDC, and all employees and substitutes receive thereafter, an annual BBP refresher training. (BBP Update-Attachment A) A copy of the Exposure Control Plan is available at each center, for the employee to review at any time. B. Universal Precautions All employees and substitutes as listed above will use universal precautions. (Attachments C & D) C. Engineering Controls and Work Practices Engineering controls and work practice controls will be used to prevent or minimize exposure to bloodborne pathogens. D. Personal Protective Equipment (PPE) PPE is provided to our employees at no cost to them. It is chosen based on the anticipated exposure and acts as a barrier to prevent blood or OPIM from reaching their skin or mucous membranes. Training is provided to employees, by the Health/Nutrition Manager, at the time of employment and on an annual basis, on the use of the appropriate PPE, based on their job classifications. PPE is available to employees, at all centers, which includes gloves and Bloodborne Pathogens Kits (Attachment B). It is the employee’s responsibility to ask their Supervisor where the PPE is located at each center, and obtain the PPE to use when performing the tasks, required by their job title. It is the responsibility of the Supervisor to ensure that all PPE is available at each center. All employees using PPE must observe the following precautions: All employees administering first aid, changing diapers etc. will wear protective gloves when dealing with blood or OPIM. The employee is responsible to carry their gloves with them at all times while performing their work. First aid will be administered by designated individuals, i.e., Teacher, Assistant Teacher, or his/her designee. M:\Plans, Policies, Procedures\Bloodborne Pathogens Exposure Control Plan Revised 6/1/13 2 Wash hands immediately or as soon as possible after removal of gloves or other PPE. One pair of gloves per child will be worn once, and then immediately and appropriately disposed of. Replacement gloves can be obtained at designated areas in each center. Remove PPE after it becomes contaminated, and before leaving the work area. Wear the face and eye mask, & apron which is provided in the BBP Kit, if OPIM poses a hazard to the employee. E. Housekeeping (Attachment E) All spills of blood or OPIM will be cleaned up using an approved agent. A bleach solution in a 1:64 ratio is mixed daily at each center, and will be used for decontamination. Each Center will designate a specific staff person and a back-up staff person to perform this duty daily. All blood stained materials or OPIM materials, are placed in a plastic bag, double bagged, and immediately removed to the trash disposal area. Staff should have an extra set of clothing available at the center. Employees are expected to change into clean clothing, if their clothing becomes contaminated with blood or OPIM. The blood stained clothing will be double bagged, and removed from the center. Contaminated broken glass and other materials are not picked up with the hands. It is swept up or picked up by mechanical means, such as a brush and dust pan. Equipment used for cleanup and contaminated equipment (such as toys or playground equipment) is cleaned and decontaminated as soon as possible after contamination. 3. Hepatitis B Vaccination All employees identified as having an exposure incident, which has been determined by Work Place Health, are offered the vaccine free of charge, within twenty-four hours of exposure. Vaccinations are provided at Maine General Medical Center- Workplace Health, in Augusta or Waterville. Employees who do not want the vaccine must sign a Hepatitis B Vaccine Declination Form. (Attachment F) Employees who decline the vaccine can change their minds for a future occupational exposure and have the vaccine at a later date, provided at no cost to the employee. Documentation of the declination form is kept at SKCDC. 4. Post Exposure Evaluation and Follow Up All employees who have an exposure are offered post exposure evaluation and follow-up by Maine General Hospital - Work Place Health in Augusta or Waterville. Employees are also encouraged to contact their PCP. The post exposure evaluation and follow-up includes: Documentation of route of exposure and circumstances of the incident. Documentation of source individual and his/her HIV/HBV status if known. Reasonable efforts are made to obtain permission to test the source individual’s blood for HIV/HBV. If the source individual is tested, the results are made available to the exposed employee. The employee must obey all confidentiality requirements. The exposed employee is offered testing for HIV/HBV. The blood sample is saved for 90 days to allow the employee to decide if he/she wants it to be tested for HIV. If the employee decides during this period, the blood sample can be dealt with appropriately. The exposed employee is offered post exposure treatment based on the latest US Public Health Service Recommendations. The exposed employee is given counseling regarding precautions to take during the period after the exposure incident. In addition, the employee is informed of any medical condition that may result from the exposure that could require evaluation and treatment. The employee is asked to report related experiences to appropriate personnel. The Health/Nutrition Manager consults as necessary with the Consulting Physician to ensure the effective implementation of the plan. M:\Plans, Policies, Procedures\Bloodborne Pathogens Exposure Control Plan Revised 6/1/13 3 A. Exposure Procedure: Provide appropriate First Aid and tell your Program Supervisor or designee immediately. If a child is involved fill out the Child Incident Form (Attachment G) and attach it to Bloodborne Exposure Incident Report Form (Attachment H). Have Supervisor fill out Bloodborne Exposure Incident Report Form (Attachment H). Call Workplace Health - Augusta, 626-7250, 7:30 a.m. to 4:40 p.m. or Waterville, 872-4260, 7:30 a.m. to 5:00 p.m., as soon as possible to describe the incident and get guidance as to medical follow-up that may be needed. Follow the instructions of Workplace Health. Call your Primary Care Provider as soon as possible. Complete Exposure Report Form with your supervisor or designee. Call SKCDC Main Office at 582-3110 and ask to speak to a staff person from BOTH departments listed below. Please call in the order listed and DO NOT LEAVE MESSAGES: Health 1. Health/Nutrition Manager, Ext. 38. Human Resources/Fiscal 2. HR Assistant - Ext. 40 or if not available HR Director- Ext. 21 or if not available Fiscal Office - Ext. 15 5. A written opinion is obtained from the health care professional who evaluates the employee. Documentation of the evaluation is obtained in the following instances: Whenever the employee is sent to a health care professional for evaluation, following an exposure incident. Whenever the Hepatitis B vaccine is indicated and the employee receives the vaccination following an incident. When the employee has been informed of the results of the evaluation. When the employee has been told about any medical conditions resulting from exposure to blood or other potentially infectious materials. Meet in person or have a telephone conversation with the Health/Nutrition Manager to complete Employee Evaluation and Follow up Form. (Attachment I). Employee Training All new employees and substitutes covered by this standard receive training upon employment by SKCDC, and all employees and substitutes will receive thereafter, an annual BBP refresher training. (BBP Update (Attachment A) Training will include: An explanation of the OSHA Standard for Bloodborne Pathogens. Epidemiology, Symptoms and Transmission of Bloodborne Disease. A copy and explanation of SKCDC’S ECP. Tasks and activities which could cause exposure to blood or OPIM, including what constitutes an exposure incident. Exposure Control Methods, which include Universal Precautions, Work Practice Controls, PPE, and Housekeeping, which is practiced at all centers. Post exposure evaluation and follow-up. Hepatitis B vaccination. Training Materials are available at SKCDC, 337 Maine Avenue, Farmingdale, ME M:\Plans, Policies, Procedures\Bloodborne Pathogens Exposure Control Plan Revised 6/1/13 4 6. Record keeping All employee documented records including Documentation of Training, Exposure Report Forms, and Employee Exposure and Follow up Forms are kept at SKCDC, at 337 Maine Avenue, Farmingdale, ME The Health/Nutrition Manager will coordinate and document the training of staff. The Center/Home Based Supervisor/Teacher or designee is responsible for providing documentation when an exposure incident occurs. Documentation is submitted to the Health/Nutrition Manager immediately following exposure incident (within 24 hours). The Health/Nutrition Manager is responsible for initiating and completing the Employee Exposure and Follow up Form. M:\Plans, Policies, Procedures\Bloodborne Pathogens Exposure Control Plan Revised 6/1/13 5 Bloodborne Pathogen (BBP) Update (Attachment A) Blood /Body Fluids…Barrier...Protect Bloodborne Pathogen Training is 1 hour for all new employees. All other staff need updates on an annual basis. The BBP Update is done by the Health/Nutrition Manager at the Annual Communicable Disease Trainings. Bloodborne Pathogens Policy Review contains a review of: 1. Universal Precautions – Handling All Body Fluids 2. Engineering and Work Practice Controls are used to prevent or minimize exposure to bloodborne pathogens Personal Protective Equipment (PPE) Bloodborne Pathogens Kits, gloves, Hand washing Housekeeping - Bleach, double bag 3. Hepatitis B Vaccination: All employees identified as having an exposure incident, which has been determined by Work Place Health, are offered the vaccine free of charge, within twenty- four hours of exposure. 4. Hepatitis B Vaccine Declination Form. 5. Post Exposure Evaluation and Follow Up Procedures M:\Plans, Policies, Procedures\Bloodborne Pathogens Exposure Control Plan Revised 6/1/13 6 BLOODBORNE PATHOGENS KIT (Attachment B) For Safe Handling, Clean–up, Disinfection and Disposal of Body Fluids Kit Includes: 1 pair Disposable Gloves Small Plastic Bottle of Absorbent Powder 1 Scoop with Detachable Scraper 2 Antiseptic Towelettes (one for cleaning surface, one for cleaning hands) 1 Absorbent Towel 2 Trash Bag with Twist Tie for Closure Mask with Eye Splash Barrier Disposable Plastic Apron NOTE. The Bleach solution (that is mixed daily) is also to be used for blood/ body fluid spill cleanup. Instructions for Use: 1. Put on Gloves. 2. Open the bottle of Absorbent Powder and completely cover the spill (caution may be slippery when wet). 3. Once the spill is solidified, use the scoop and the detachable scraper to pick up the body fluid. 4. Dispose of material, scoop in the trash bag. 5. Thoroughly wet the cleaned surface with one of the Antiseptic Towelettes, and allow to remain wet for 1 minute. 6. If needed dry any remaining residue with the absorbent towel. 7. Remove Gloves, dispose gloves and all materials in the trash bag, and secure with twist tie. 8. Double bag into remaining trash bag, and secure with twist tie. Remove to outside trash containers. 9. Wipe Hands with the remaining Antiseptic Towelette. Air dry. Note: This kit is for use on inanimate, hard, non porous surfaces. M:\Plans, Policies, Procedures\Bloodborne Pathogens Exposure Control Plan Revised 6/1/13 7 Occupational Health and Safety Administration (OSHA) Bloodborne Standard Definitions (Attachment C) (Took effect on March 6, 1992) Blood means human blood, human blood components, and products made from human blood. Bloodborne Pathogens means pathogenic microorganisms that are present in human blood and can cause disease in humans. These pathogens include, but are not limited to, hepatitis B virus (HBV) and human immunodeficiency virus (HIV). Contaminated means the presence or the reasonably anticipated presence of blood or other potentially infectious materials on an item or surface. Decontamination means the use of physical or chemical means to remove, inactivate, or destroy bloodborne pathogens on a surface or item to the point where they are no longer capable of transmitting infectious particles and the surface or item is rendered safe for handling, use, or disposal. Exposure Incident occurs when blood or OPIM (other potentially infectious materials) comes in contact with the employee’s eye, mouth, nose or other mucous membrane, or non-intact skin. A human bite if skin is broken and skin to mouth contact occurs is also an exposure incident. Hand washing Facilities means a facility providing an adequate supply of running potable water, soap and single use towels or hot air drying machines. HBV means hepatitis B virus. HCV means hepatitis C virus HIV means human immune deficiency virus. This is the virus that causes AIDS Occupational Exposure means reasonably anticipated skin, eye, mucous membrane, or other potentially infectious materials that may result from the performance of an employee's duties. Other Potentially Infectious Materials (OPIM) is any body fluid such as mucus, saliva, urine, vomit or feces that has the potential to contain blood. Blood may not be visible. Personal Protective Equipment (PPE) is appropriate personal equipment worn by an employee for protection against the hazards of blood and OPIM. SKCDC makes available to their employees the following personal equipment: Vinyl Gloves, Face and eye shield, and plastic aprons to the body and to protect the clothing. Solution for Blood/OPIM Decontamination and Cleanup Bleach and water solution to be mixed daily to the following ratio: ¼ cup bleach to a gallon of water or 1 Tablespoon bleach to a quart of water Universal Precautions – Handling All Body Fluids of all children and adults. This means using infection control practices (practices that help reduce the spread of illnesses) such as hand washing, using PPE, and decontamination. M:\Plans, Policies, Procedures\Bloodborne Pathogens Exposure Control Plan Revised 6/1/13 8 Universal Precautions (Attachment D) The body fluids of all persons should be considered to contain potentially infectious agents. The table below provides examples of infectious agents that may occur in body fluids and the respective transmission concerns. It must be emphasized that many of the body fluids with which one may come in contact contain microorganisms, some of which may cause disease. Individuals may be at various stages of infection: incubating disease mildly infected without symptoms, or chronic carriers of certain infectious agents. In fact, transmission of communicable diseases is more likely to occur from contact with infected body fluids of unrecognized carriers than from contact with fluids from recognized individuals because simple precautions are not always used. TRANSMISSION CONCERNS IN THE SCHOOL SETTING: POTENTIAL BODY FLUID SOURCES OF INFECTIOUS AGENTS BODY FLUID SOURCE EXAMPLES OF AGENTS OF CONCERN POTENTIAL TRANSMISSION ROUTES Blood cuts/abrasions - nosebleeds - menses Hepatitis B & C viruses HIV virus Cytomegalovirus Inoculation through cuts and abrasions and Mucous Membranes *Feces Salmonella bacteria Shigella bacteria Rotavirus Hepatitis A virus Norovirus E coli Giardia C Diff Cryptosporidiosis Oral inoculation from contaminated hands or surfaces. *Urine Cytomegalovirus Oral or Nasal inoculation from contaminated hands. Respiratory Secretions - saliva - nasal discharge Mononucleosis virus Common cold virus Influenza virus Meningococcal bacteria Oral inoculation from contaminated hands. Direct Droplet Inoculation to Mouth and Nose *Vomitus Gastrointestinal viruses, (e.g., Norovirus& Rotavirus) Oral inoculation from contaminated hands. *Possible transmission of HIV and Hepatitis B and Hepatitis C is of little concern from these sources. M:\Plans, Policies, Procedures\Bloodborne Pathogens Exposure Control Plan Revised 6/1/13 9 Tips for Prevention (Attachment E) 1. Treat all bodily fluids as if they were contaminated.(Universal Precautions) 2. Use disposable non-latex gloves when exposure to bodily fluids is possible. Hands should be washed after gloves are removed and gloves discarded in a plastic bag or lined trashcan, secured, and disposed of daily. 3. Use protective clothing when anticipating spattering of fluids. 4. All personnel (e.g. custodians, bus drivers, maintenance personnel) should use bloodborne precautions when cleaning and disinfecting. Decontamination after Direct Contact Recommended Decontamination Procedure: 1. Wash hands thoroughly with soap and water. 2. Clothing - Rinse and place clothing and other non-disposable items that have been soaked with body fluid, in double plastic bags. a. Use gloves while handling items. b. If presoaking is required to remove stains (e.g., blood, feces) use gloves to rinse or soak item in cold water prior to bagging to be sent home. c. Laundry – Launder contaminated clothing in soap and water adding bleach. Wash separately from other items if clothing is soaked with body fluids. 3. Hard Surfaces -. Use bleach solution the same day as it is prepared. a. Mops should be soaked in the disinfectant after use and rinsed thoroughly or washed in a hot water cycle before rinse. b. Non-disposable cleaning equipment (dustpans, buckets) should be thoroughly rinsed in the disinfectant. Disinfectant solution should be promptly disposed down a drainpipe. 4. Rugs – Use absorbent agents specifically intended for cleaning body fluid spills. Cover spills with absorbent material, gently sweep up and discard in plastic bag. a. Leave for a few minutes to absorb the fluid and then vacuum or sweep up. b. The vacuum bag or sweepings should be placed in a plastic bag, and then disposed of in trash receptacle. c. Broom and dustpan should be rinsed in a disinfectant. d. No special handling is required for vacuuming equipment, except nozzle used to vacuum spill should be wiped with disinfectant. 5. Disposable Items: a. All disposable materials contaminated with blood and/or body fluids will be put in double plastic bags, tied and placed in a trash receptacle not accessible to children. M:\Plans, Policies, Procedures\Bloodborne Pathogens Exposure Control Plan Revised 6/1/13 10 SKCDC HEPATITIS B DECLINATION FORM (Attachment F) I have been offered the Hepatitis B vaccine, at no cost to myself, based on an occupational exposure to blood or other potentially infectious materials. I understand I must receive this vaccine within 24 hours of exposure in order for it to be effective. However, I choose to decline the Hepatitis B vaccination at this time. I understand, by declining this vaccine I could be at risk of acquiring Hepatitis B, a serious disease. If in the future I have another occupational exposure, I will be offered the vaccination series at no cost to me. Employee Signature: ____________________________________ Date: __________________ Signature of Witness: ____________________________________ Date: _________________ M:\Plans, Policies, Procedures\Bloodborne Pathogens Exposure Control Plan Revised 6/1/13 11 SKCDC INCIDENT REPORT FORM (Attachment G) Center: __________________ Classroom: _____________________ Date_____________ Child's Name: _____________________________D.O.B.__________ Time injury/illness occurred: ________________________ a.m. / p.m. (Circle injury/illness) Location: Playground Classroom Other_______________________Equipment/Tool Involved____________________ Parents notified by: ___________________________________________ Time: __________________ Description of injury and how it happened: ______________________________________________________________________ ____________________________________________________________________________________________________________ Illness: _____________________________________________________________________________________________________ Be specific about Illness: (Example: Rash - Prickly heat type over the entire body!) Cause of Injury Nature of Injury & Size Nature of Illness Collided Bite Diarrhea Fell Bruise/Bump Fever Jumped Burn Rash Pushed Cut Vomiting Slipped Pinch Other Tripped Scratch Other Sting Other (ie. Redness) Note: Be Specific If other is checked Note: All Injuries and Illness should be reported to Parent ASAP, especially Face & Head & Neck Injuries. Blood involved: Yes No Blood exposure: Yes No Part of body injured: _________________________________________________________________________________________ (Be specific: for example, upper right arm above elbow) First-aid care given: __________________________________________________________________________________________ (Please be specific about the care given: example scratch washed with soap & water, band aid applied) By Whom: _________________________________________________________________________ Gloves worn by staff member/provider Area cleaned/disinfected with bleach solution Gloves / blood soaked items double-bagged & removed from classroom immediately Action taken: Child remained at center/home start Child sent home - Time: ______ a.m. / p.m. Child taken to hospital/clinic/physician Other (Be Specific) _______________________________________ Recheck Head Injury (With in hour) Symptoms of Head Injury Present: Yes No- If yes be specific______________ Medication given as indicated on IHP/ Health Alert/ Other______________________________________________________ (Be specific: Name of medication, time given) By whom: _____________________Recommendations/FollowupPlan_________________________________________________ ___________________________________________________________________________________________________________ Signature of reporting staff _________________________________________Date:___________ Printed name of reporting staff: ________________________________________________________________________ Signature of witness to accident: __________________________________________ Date: ____________ Signature of Parent: ____________________________________________________ Date: ____________ Reviewed by Center/Home Based Supervisor File in child's folder Give copy to office Reviewed by Program Manager Reviewed by Health/Nutrition Manager Recommendations/Follow up Plan________________________________________________________________Date___________ Injury/Illness must be documented on the day of occurrence! Please submit within 24 hours of Injury/Illness! Please Note: White copy – SKCDC, Yellow copy - Parent M:\Plans, Policies, Procedures\Bloodborne Pathogens Exposure Control Plan Revised 6/1/13 12 Attachment # H (Attachment 4 in Employee Safety and Accident Prevention Plan) Southern Kennebec Child Development Corporation BLOODBORNE EXPOSURE INCIDENT REPORT FORM Employee: _________________________________ Center: _____________________________ Date of Incident: _________ Time of Incident: _________ Date Incident Reported: ___________ Employee reported Incident to: Exposure incident occurred: Center Supervisor Other Person _____________________________ Name of Person Classroom Playground Other __________________________________ Describe Description of Incident: _________________________________________________________________ ____________________________________________________________________________________ _________________________________________________________________________________________ _______________________________________________________________________________ Identification of Source Individual: ________________________________________________________ First Aid Given_________________________________________________________________________ Precautions taken: Gloves worn by staff person/s Area decontaminated, & materials disposed of by ___________________________ Name of Employee Incident Reported to: Work Place Health _____________________________________ Date: _________ Time: _____ Name/Title Primary Care Provider_____________________________________ Date: _________ Time: _____ Name Health Nutrition/Manager_________________________________ Date: _________ Time: _____ Name Human Resources/Fiscal Office: __________________________ Date: _________ Time: _____ Name Follow up/ Recommendations as reported by the Employee: ____________________________________ _________________________________________________________________________________________ _________________________________________________________________________________________ __________________________________________________________________________ Employee Signature: _____________________________________ Date: ________________ Supervisor’s Signature: ___________________________________ Date: _______________ ***Please Note*** Attach a copy of the Child Incident Report Form (If Applicable) This form is to be completed within 24 hours following the incident and forwarded immediately to the Health/Nutrition Manager. Thank you Complete and attach to the Supervisor’s Accident/Work Safety Investigation Report Form Bloodborne Exposure Incident Report Form: (4) Revised 02/25/13 M:\Plans, Policies, Procedures\Bloodborne Pathogens Exposure Control Plan Revised 6/1/13 13 SKCDC - EMPLOYEE BLOODBORNE EVALUATION AND FOLLOWUP FORM (Attachment I) (To be completed by Health/Nutrition Manager) Employee Name: ___________________________________________________Date:__________________ Employee Consulted: Work Place Health Primary Care Provider Other__________________________________ Describe Documentation and copy of previous Hepatitis B Vaccination (If Yes Dates: _____________ _____________ ____________ Dose 1 Dose 2 Post Exposure Hepatitis B Vaccinations: Yes No Dose 3 Received -Dates: _____________ _______________ ______________ Dose 1 Dose 2 Refused – Signed Declination form attached (mandatory) Blood Test Done: Source Individual contacted: Testing of source individual completed Results provided to exposed employee Testing refused Date: __________ Written opinion received from: Date: ______________ Yes Refused: Dose 3 Yes No Date: ______________ No (if yes), by whom: _____________________________ Date: __________ Date: __________ Work Place Health Primary Care Provider Other ______________________________________ Name Documentation of employee evaluation /counseling received. Worker’s Comp notified Documentation completed Date _______________ _____________________________________________ By whom Date _______________ Additional comments/information: ______________________________________________________________________________________________ ______________________________________________________________________________________________ Employee Signature: _______________________________________________ Date: _______________ Health/Nutrition Manager: Date: _______________ _______________________________________ M:\Plans, Policies, Procedures\Bloodborne Pathogens Exposure Control Plan Revised 6/1/13 14