Download Exposure Control Plans - Provincial Health Services Authority

Acknowledgements
All materials copyrighted © March 2010.
Course developed by Stephanie Innes with content contributions from Dr. George
Astrakianakis and Phyllis Stoffman.
Thanks to the following reviewers who reviewed and commented on early versions of this
online course:
•
Mike Sagar - WorkSafe BC
•
Deb Niemi - BCNU
•
Joanne Archer - PicNet
•
Jacqueline Per - VCH
•
Bev Dobbyn - VIHA
•
Joe Divitt - OHSAH
•
Georgina Hackett - OHSAH
•
Catherine Ogden - OHSAH
ECP Samples and Template created based on template from: WorkSafe BC publication:
Controlling Exposure: Protecting Workers from Infectious Disease
Definitions and references to WorkSafe BC Regulations from www.worksafebc.com
Table of Contents
Acknowledgements
Table of Contents
Guide Overview ............................................................................................................. 1
Objectives.........................................................................................................................1
Pre-module self assessment ......................................................................................... 2
Exposure Control Plans.................................................................................................. 5
Essential Elements of An ECP ........................................................................................ 7
1: Statement of Purpose.................................................................................................7
2: Key Responsibilities......................................................................................................7
3: Risk Identification, Assessment + Controls ...............................................................9
Sample Job Risk Table................................................................................................. 15
Activity: ......................................................................................................................... 16
Sample Controls Long Term Care .............................................................................. 19
Sample Controls........................................................................................................... 22
Sample Controls........................................................................................................... 28
4: Education and Training ........................................................................................... 33
5: Safe Work Procedures ............................................................................................. 33
6: Hygiene and Decontamination Procedures ....................................................... 34
7: Health Monitoring..................................................................................................... 34
8: Documentation ........................................................................................................ 35
Activity: ECP Implementation Action Sheet .............................................................. 36
Summary....................................................................................................................... 38
Post-module self assessment...................................................................................... 39
Appendices .................................................................................................................. 42
Correct Answers to Self Assessment .......................................................................... 43
Glossary .......................................................................................................................... 45
Useful Websites............................................................................................................. 51
WorkSafeBC Requirements in Relation to an Exposure Control Plan ..................... 52
Education and Training ............................................................................................... 52
Records of Training....................................................................................................... 55
Excerpts from the WorkSafeBC Regulations ............................................................ 56
Guide Overview
Welcome to OHSAH’s Exposure Control Plan creation training for respiratory
infections.
These training materials were prepared by the Occupational Health and Safety
Agency for Healthcare in British Columbia (OHSAH), a bipartite agency that works
collaboratively to reduce workplace injuries and illness in healthcare workers and
return injured workers back to the job quickly and safely.
Objectives
This course was designed for JOHS Committee members who work in healthcare
settings.
This course will give you the information to:
•
Define an Exposure Control Plan (ECP)
•
Identify the goals and outcomes of creating an Exposure Control Plan
•
Demonstrate understanding of the eight elements of an Exposure Control
Plan
As a JOHS Committee member, you may be involved in developing or reviewing an
Exposure Control Plan. It’s important that you take the time to review this
information and understand all the elements of an ECP so that you can do your part
to help create the most effective ECP possible.
Pre-module self assessment
Before we begin the self study guide, you are welcome to complete the following
self assessment so that you can compare what you knew at the beginning of the
course to what you know at the end of the course. If you don’t want to do the self
assessment just flip past it to the start of the course content.
Complete the following 10 questions to the best of your ability, but don’t worry if you
don’t know the answers yet. We’ll be covering all of this information in detail in this
self paced workbook.
1. When is an Exposure Control Plan required?
a) Annually
b) In response to an identified risk
c) When the JOHS Committee identifies a hazard
2. The elements of an Exposure Control Plan are:
a) Statement of Purpose, Routes of Transmission, Engineering Controls, Risk
Assessment, Written Work Procedures and Education and Training
b) Statement of Purpose, Responsibilities, Risk Identification, Assessment and
Controls, Education and Training, Written Work Procedures, Hygiene and
Decontamination Procedures, Health Monitoring, and Documentation
c) Statement of Purpose, Responsibilities, Exposure limits, Risk Identification and
Assessment, Risk Controls, Education and Training, Written Work Procedures,
Hygiene and Decontamination Procedures, Health Monitoring, Personal
Protective Equipment, Worker Policies, and Documentation
3. The outcome of an effective Exposure Control Plan is:
a) Protecting the health and safety of the workers
b) Protecting the health and safety of everyone in the workplace environment
c) Protecting the health and safety of the patients and visitors
4. Installing a glass barrier at reception is an example of what type of control?
a) Administrative
b) Engineering
c) With the worker
5. Wearing Personal Protective Equipment is an example of what type of control?
a) Administrative
b) Engineering
c) With the worker
6. A policy that states you should delay non-essential tasks until the infectious person
is recovered is an example of what type of control?
a) Engineering
b) Administrative
c) With the worker
7. Posters explaining proper hand-washing techniques are an example of:
a) Education and training
b) Written Safe Work Procedures
c) Documentation
8. According to WorkSafe BC, who has the overall responsibility for the Exposure
Control Plan?
a) JOHS Committee
b) Supervisor
c) Employer
d) Worker
9. An Exposure Control Plan is a:
a) Document created for a specific workplace in response to an identified risk
which outlines ways to eliminate or minimize the risk
b) Guideline determined by WorkSafe BC and implemented in all workplaces
c) Document that contains all infection control policies and written safe work
procedures
10. A risk assessment must be conducted by a qualified person. According to
WorkSafe BC, a qualified person means:
a) The employer or a designate of the employer
b) A person knowledgeable of the work, the hazards and the means to control
the hazards
c) The Joint Occupational Health and Safety Committee
Great work! You will have another opportunity at the end of the self study guide to
revisit these questions but right now, let’s look at Exposure Control Plans in more
detail.
Exposure Control Plans
Before you can be involved in developing or reviewing an effective ECP, you need
to know what an ECP is.
An Exposure Control Plan (ECP) is a document created by a workplace in response
to an identified risk, and it documents the specific and appropriate controls that will
minimize or eliminate that risk.
Every workplace is responsible for developing an Exposure Control Plan in response
to identified risk of exposures including some chemical exposures, blood borne
diseases, and contact diseases. And according to WorkSafe BC, the ECP must be
reviewed annually.
In this self study guide, we will focus on how to create an ECP for respiratory
infections such as influenza, pneumonia, tuberculosis, measles, mumps, and chicken
pox. But please note that if there is no risk of exposure to a respiratory infection in
your organization, then there’s no need to create an ECP specific to respiratory
infections. Instead, your ECP will focus on your specific workplace hazards.
The most important goal of an ECP is to prevent workplace exposure and to help
you minimize or eliminate the risk of your workforce having their health affected by a
workplace exposure.
An effective ECP will:
•
Protect all workers’ health
•
Prevent and contains infection
•
Protect the health of others including patients and visitors
•
Establish consistent safe work procedures
•
Promote appropriate and proper use of personal protective equipment
An effective ECP may also draw from information already developed in other plans,
policies and priorities that interact with your ECP. These include:
Infection Control Policies Most health care agencies have an Infection Control
Manual which consists of policies that are intended to prevent the spread of
infections from patient to patient, from staff to patient and from patient to staff
within the health-care setting
Patient Safety Patient safety is a healthcare priority that emphasizes the reporting,
analysis, and prevention of medical errors that may lead to adverse healthcare
events – such as giving the wrong medication to a patient
Pandemic Planning Pandemic planning is completed by governments, health care
agencies, and businesses in order to develop a preparedness plan to help reduce
the impacts on the health and safety of healthcare workers, health services,
essential services and daily life during an influenza or other infectious disease
pandemic (worldwide epidemic)
•
Immunization Policies Employee Health and Wellness or Occupational Health
departments will have immunizations polices in place regarding staff
immunization requirements. Usually, individuals working in direct patient care
areas are required to be immunized for measles, mumps and rubella and
Hepatitis B. Influenza vaccine is also offered annually in BC. It should be noted
that direct care providers who have not received their influenza vaccine
during an outbreak on their unit will be reassigned to another area or they
may be placed on unpaid leave
There are eight essential elements of an ECP, however, it doesn’t matter what order
the elements are completed in. Ultimately, each organization must decide what fits
the needs of their ECP.
1. Purpose
2. Responsibilities
3. Risk identification and assessment, and risk controls
4. Education and training
5. Safe work procedures
6. Hygiene and decontamination procedures
7. Health monitoring
8. Documentation
Now let’s look at each of the elements in more detail.
Essential Elements of an ECP
1: Statement of Purpose
The purpose describes the requirement or need for the plan. In the end, even at
different organizations, ECP statements of purpose will often be very similar. Let’s
look at an example of a Statement of Purpose:
“Our organization is committed to providing a safe and healthy work environment
for all our staff. A combination of measures will be used to minimize worker exposure
to respiratory infections.
This Exposure Control Plan is designed to protect the health and well-being of our
staff and any contracted staff working in our facilities. All employees must follow the
procedures outlined in this plan in order to prevent or reduce exposure to respiratory
infections.”
2: Key Responsibilities
Everyone in the organization has responsibilities around preventing exposure. Your
organization’s ECP will detail employer, supervisor, and worker responsibilities and
the duties of the JOHS Committee specific to your workplace. The overall
responsibility for developing, implementing and maintaining the plan rests with the
employer.
Now, what are some of the key responsibilities that may appear on any
organization’s ECP? To learn more about who is responsible for which parts of an
ECP, review the following responsibilities listed in each category.
Employers
•
Ensuring that the safety equipment such as surgical masks, gowns, goggles,
N95 respirators, alcohol-based hand rubs, hand washing facilities and other
resources required to fully implement and maintain the ECP are readily
available where and when they are required.
•
Ensuring supervisors and workers are educated and trained to an acceptable
level of competency
•
Ensuring that a copy of the exposure control plan (ECP) is available to all
workers
•
Ensuring that workers are using the proper personal protective equipment
including gloves, surgical masks, and N95 respirators
•
Conducting a periodic review with the involvement of the JOHS Committee
or Worker Health and Safety Representative to measure the effectiveness of
the ECP. This will include a review of the available control technologies to
ensure these are selected and used when practical
•
Maintaining records of training, inspections and incident investigations
Supervisors
•
Providing adequate instruction to workers around the precautions specified in
the ECP.
•
Ensuring that workers receive up-to-date training
•
Directing work in a manner that ensures risk to workers is minimized and
adequately controlled
•
Ensuring that workers are using the proper personal protective equipment (as
required)
Workers
•
Knowing how and when to report exposure incidents.
•
Knowing the hazards of workplace
•
Following established safe work procedures and policies as directed by their
employer or supervisor
•
Reporting any unsafe conditions or acts to their supervisor
•
Using the appropriate personal protective equipment in an effective and
safe manner
JOHS Committee or Worker Health Representative Duties
•
Completing an annual review of the Exposure Control Plan.
•
Ensuring that the Exposure Control Plan is properly implemented
•
Recommending improvements to the Exposure Control Plan
•
Ensuring that any worker concerns about the Exposure Control Plan or
potential exposures are addressed
•
Participating in the development of the ECP
3: Risk Identification, Assessment + Controls
Risk identification is extremely important, and includes identifying who may be
exposed (risk of exposure) and understanding how they might become infected
(modes of transmission). It might sound complicated but it’s actually relatively
simple.
If the risk is respiratory infections, we just need to ask:
•
How are respiratory infections transmitted?
•
What staff might have contact with clients/patients/residents with respiratory
infections?
Once you understand how respiratory infections are spread from person to person,
you will know how to assess and minimize your risk of exposure.
So first let’s look at the different ways infections spread.
Modes of transmission describe how an infection spreads from person to
person. Respiratory infections are caused by bacteria and viruses that are able to
enter the body through your eyes, nose or mouth and then infect your respiratory
system.
These infections attack either the upper airway (your nose and throat) causing mild
illness or the lower airway (your bronchial tubes and lungs), usually causing a more
serious illness.
The key modes of transmission for respiratory infections are through contact and
through the air, so let’s review these modes in more detail.
One: Contact
Transmission through contact means coming into physical contact with someone
with a respiratory infection. This contact can be direct or indirect.
Direct contact If we touch someone with a
respiratory infection and then touch our
eyes, mouth, or nose, we might become ill.
For example, if someone coughs and then
shakes our hand, the infection can be
transmitted
Indirect contact If we touch an object that
has been contaminated by someone with
an infection, and then we touch our eyes,
mouth or nose, and the virus or bacteria is
transmitted
Two: Airborne
Airborne transmission means breathing in the virus or bacteria. For example, if
someone with a respiratory infection talks, coughs or sneezes on us within close
range, we can get a respiratory infection. This contact can be made through either
droplet or airborne spread:
Droplet spread Large-particle respiratory droplets generally travel only a short
distance (<2 meters) through the air, and then settle out of the air quickly. Influenza,
pneumonia, TB, mumps, and SARS are usually transmitted in large particle respiratory
droplets
Airborne spread Small particle airborne droplets are evaporated droplets that are
extremely light and therefore can remain suspended in the air for a long time in dust
particles, and can travel much further via air currents. Chicken pox and measles
viruses are transmitted in small particle airborne droplets
Risk Assessment
Risk assessment is about assessing a worker’s potential exposure to a hazard while
completing the assigned tasks of their job. Once the risk has been identified, it’s
important to assess how that risk will affect specific jobs. It’s important to note,
WorkSafe BC, being a qualified person means being “knowledgeable of the work,
the hazards involved and the means to control the hazards, by reason of education,
training, experience or a combination thereof.” And the qualified person may not
be just one person but could be a team of people including:
•
JOHS Committee members
•
Infection control specialists
•
Public health nurse
•
Occupational hygienists
•
OH&S members
There are several questions the qualified person can ask when completing a
risk assessment:
What are the observed or expected levels of exposure?
The levels of exposure depend on the type of work being done, frequency of
contact and how close the contact is. Direct care givers are most likely to be
exposed to infected patients, while workers who do not give direct care but may
work in the vicinity of either infected patients or contaminated surfaces and or
equipment have a lower risk of exposure.
What is the likelihood of becoming sick given the task and exposure?
Chance of exposure resulting in infection increases the longer you are in the vicinity
of the infected person (exposure) and the closer you are to that person (task).
You’re less likely to become infected from a short exposure to contaminated air
because you are breathing in fewer numbers of viruses or bacteria.
The other factor which determines your risk of contracting an infection is your
immune status and general health. You’re more likely to become infected and ill
from the exposure if you:
•
Are high risk (have underlying lung, heart or other infection)
•
Have a poorly functioning immune system (immunocompromised)
•
Are not vaccinated against respiratory infections that have vaccinations
available
What is the impact of becoming sick due to the disease or illness to the
worker?
Mild symptoms include sneezing, coughing, sore throat or serious respiratory
complications causing shortness of breath that may require hospitalization.
What is the impact to the organization if workers are affected by the disease
or illness?
It will impact issues such as staffing, supplies, and will support the need for
environmental and administrative controls early on.
Risk Levels
Now let’s review the risk levels that will be assigned to each worker based on their
job and the tasks they are required to do.
There are three levels of risk that may be assigned when completing a risk
assessment for respiratory infections.
•
Low Risk: Low-risk workers rarely come into contact
with potentially infected people or contaminated
surfaces or materials
•
Moderate Risk (Indirect Contact): These workers
rarely come into contact with infected people but
may work in areas where infected people have
been. They also may handle potentially
contaminated items
•
High Risk (Airborne, Direct and Indirect Contact):
High-risk workers care for people who are or may
be infected with a respiratory illness
Each job within a department will need to be assessed to determine what level of
risk applies. Assigning risk levels to jobs will help you understand how the risk of
infection will affect your organization. And every organization has different tasks
associated with each job, so the risk level table in each ECP will be unique.
The following sample Job Risk Table describes the different levels of risk that might
apply to different jobs in your organization. People in these jobs may be exposed to
ill patients, residents, and clients, so take a moment to review it.
Sample Job Risk Table
Sample Job Risk Table for Long Term Care
Low Risk
Moderate Risk
High Risk
Risk Assessment of Exposure
Workers who typically
Workers who may be
Workers who are
have no contact with
exposed to Novel H1N1
involved in performing
Novel H1N1 infected
infected persons through
Aerosol Generating
persons
providing indirect or
Medical Procedures
direct care.
(AGMPs)
(CPR, Nebulized Therapy)
Work category
(List names of employees in each category)
Maintenance
Reception
LPN’s
Clerical
Supervisory Staff
RN’s
Administration
Care Aides
Home & Community
Care Workers
LPN’s
RN’s
OT
PT
Community Health
Worker
Activity: Complete your Job Risk Table
Now, take a moment to fill out the Sample Job Risk Table for your organization. This
will help you get a sense of what the risk levels are for the different positions in your
organization.
Job Risk Table
Low Risk
Moderate Risk
High Risk
Risk Assessment of Exposure
Workers who typically
Workers who may be
Workers who are
have no contact with
exposed to Novel H1N1
involved in performing
Novel H1N1 infected
infected persons through
Aerosol Generating
persons
providing indirect or
Medical Procedures
direct care.
(AGMPs)
(CPR, Nebulized Therapy)
Work category
(List names of positions and employees in each category)
Once your organization has assessed which jobs will be at risk, you need to do
everything possible to reduce the risk to the workers in those jobs. Let’s look at the
ways organizations can minimize or eliminate the risks to their workers.
Risk Controls
Principles of Control are the accepted occupational best practices to reduce any
kind of potential exposure to a risk. Principle of control means different ways to
reduce the risk of an exposure in the workplace. Every employer has an obligation
to implement appropriate controls, and to implement them according to a
hierarchy.
The controls are implemented in a hierarchy beginning at the Source, then moving
along the Path and finally ending up at the Worker.
At the Source controls deal with the hazard itself either by eliminating it or
substituting it for something less hazardous. In most situations, this may not be
possible. However, an example of an at the source control in a hospital setting
would be to place a patient with a respiratory infection in an airborne isolation
room.
•
Along the Path controls
deal with the hazard
before it reaches workers
by eliminating or
minimizing the risk of
exposure. There are two
types of controls along
the path: Engineering
and Administrative.
•
Engineering controls
involve doing things
which alter the physical
space – installing glass
barriers at reception or
installing alcohol based
hand rub stations are an
example of engineering
controls.
•
Administrative controls involve altering the way that work is done, usually
through policies and procedures. An example of this may be a policy to
group infectious patients or residents in rooms along one section of a nursing
unit.
•
At the Worker controls include the personal protective equipment that must
be worn to provide the worker with additional protection from a hazard. To
prevent an exposure to an infectious respiratory hazard, the workers usually
need gloves, gowns, a face shield and a surgical mask or N-95 respirator.
It’s important that you understand the principles of control because the JOHS
Committee is often involved in reviewing risk level tables, making recommendations
about controls and evaluating whether controls have been implemented and are
effective. In many cases, more than one level of control may be necessary.
For specific examples of the controls used in different settings, look at the following
tables. There are samples for home and community care, acute care, and long
term care controls.
Sample Controls Long Term Care
Examples of Controls For Long Term Care
1. Engineering
2. Administrative Controls
Room ventilation (number of air changes,
Develop and implement screening
proportion of fresh air to re-circulated air)
tool/questions (especially for screening of
meets standards for type of facility.
staff and residents for symptoms of ILI.)
Use private rooms, where available, for
Establish and communicate safe zone
isolation of patients with ILI respiratory
distances (at least 2 meters) between
infections.
infected residents and staff.
3. PPE
Gloves
Surgical Masks
Minimize number of workers exposed to
Design and/or arrange workspace so that
risk i.e. group care tasks so multiple
patients with influenza cannot access
activities are performed at one time with
other parts of the facility
minimum staff rather than multiple
Gowns/aprons
people or room visits
If there are no private rooms, design or
arrange workspace so there are barriers /
Ensure potentially contagious patients
space between infected and uninfected
wear a surgical mask (if tolerated)
Eye protection
residents
Design or arrange entrance to facility so
Check to see if there are private rooms
N95 Respirators
access is limited/restricted unless visitors
ECP Self Study Guide 19
Examples of Controls For Long Term Care
1. Engineering
2. Administrative Controls
3. PPE
Staff have been screened for symptoms
of ILI in a reception area.
Provide handwashing sinks.
Supervise and coach in safe work
procedures and use of PPE
Provide liquid soap containers and paper
Develop and implement patient isolation
towels
procedures
Provide alcohol gel in wall mounted in all
Set up procedures for refilling soap/paper
areas for residents, visitors, staff
towels alcohol gel at the hand-washing
facilities/alcohol gel stations
Provide personal alcohol gel containers-
System in place to monitor that the hand-
pocket sized for staff.
washing facilities/alcohol gel stations are
replenished.
Post information on cough/sneeze
etiquette
Create a system for admission screening,
and procedures to reduce risks of
transmission from new admissions
ECP Self Study Guide 20
Examples of Controls For Long Term Care
1. Engineering
2. Administrative Controls
3. PPE
Implement a system to take meals to
residents with influenza
Establish appropriate housekeeping
procedures (frequency and level) and
monitor cleaning outcomes
Implement policies and procedures for
staff with ILI to take sick leave
Implement policies and procedures to
cancel day trips and restrict visitors during
an influenza outbreak in the community
or in the facility
Educate and train staff in hazards, safe
work procedures, and correct use of PPE
Procedures for reporting suspected or
probable influenza cases to public
health; investigating occupational
exposures.
ECP Self Study Guide 21
Sample Controls Acute Care
Examples of Controls For Acute Care
1. Engineering (Along the Path)
2. Administrative Controls
3. At the Worker
(Along the Path)
At the Worker includes PPE and other things workers
can do to prevent transmission
Always follow Routine Practices (see above)
Airborne Transmission Route:
Place patients with probable or
confirmed infections with respiratory
infections spread through the
airborne route in isolation rooms with
negative air pressure: Tuberculosis,
Establish a respiratory protection
Use N95 respirators that are fit tested and do a
program that includes fit testing N95
fit check before use.
respirators.
Don and doff PPE in the proper sequence.
SARS
Establish a TB skin test program to
document TB exposure status for new
employees and to follow-up suspected
workplace tuberculosis exposures.
ECP Self Study Guide 22
Examples of Controls For Acute Care
1. Engineering (Along the Path)
2. Administrative Controls
3. At the Worker
(Along the Path)
At the Worker includes PPE and other things workers
can do to prevent transmission
Always follow Routine Practices (see above)
Vaccine Preventable Respiratory Infectious Diseases
Establish an occupational health
Place patient with suspected or
confirmed vaccine preventable
airborne or droplet spread respiratory
infection in negative pressure
isolation rooms.
(measles, chicken pox, mumps,
rubella)
program that checks all new and
current employees for immunity to
measles, mumps, rubella and chicken
pox. Offer vaccine to all employees
who are not immune. Employees who
are not immune will not be assigned
to any patients with suspected or
confirmed measles, Mumps, rubella or
chicken pox infection.
Airborne and Contact Transmission Route
Room ventilation (number of air
Develop and implement a screening
changes, proportion of fresh air to re-
tool/questions (especially for
Report any respiratory symptoms according to
circulated air) meets standards for
screening of staff and patients for
facility policy.
type of facility.
fever and cough: symptoms of
ECP Self Study Guide 23
Examples of Controls For Acute Care
1. Engineering (Along the Path)
2. Administrative Controls
3. At the Worker
(Along the Path)
At the Worker includes PPE and other things workers
can do to prevent transmission
Always follow Routine Practices (see above)
respiratory infection.)
Use private rooms, preferably with
negative pressure ventilation, where
available, for isolation of patients with
fever and cough: suspected or
confirmed Influenza and viral
Establish and communicate safe zone
distances (at least 2 meters) between
infected patients and staff.
N95 respirators when performing an AGMP
Surgical Masks
Gloves, Gowns/aprons
pneumonia.
Design and/or arrange workspace so
that patients with respiratory
infections cannot access other parts
of the facility
Minimize number of workers exposed
to risk i.e. group care tasks so multiple
activities are performed at one time
with minimum staff rather than
multiple people or room visits
If there are no private rooms, design
or arrange workspace so there are
Ensure potentially contagious patients
barriers / space between infected
wear a surgical mask (if tolerated)
and uninfected patients
ECP Self Study Guide 24
Examples of Controls For Acute Care
1. Engineering (Along the Path)
2. Administrative Controls
3. At the Worker
(Along the Path)
At the Worker includes PPE and other things workers
can do to prevent transmission
Always follow Routine Practices (see above)
Design or arrange entrance to facility
so access is limited/restricted unless
visitors /staff have been screened for
fever and cough symptoms in a
reception area.
Provide hand washing sinks.
Supervise and coach in safe work
procedures and use of PPE
Provide liquid soap containers and
Develop and implement patient
paper towels
isolation procedures
Use PPE as per policies and wash hands before
and after all patient contact and contact with
contaminated surfaces and materials.
Set up procedures for refilling
Provide alcohol gel in wall mounted
soap/paper towels and alcohol gel at
in all areas for patients, visitors, staff
the hand-washing facilities/alcohol
gel stations
Provide personal alcohol gel
containers-pocket sized for staff.
System in place to monitor that the
hand-washing facilities/alcohol gel
stations are replenished.
ECP Self Study Guide 25
Examples of Controls For Acute Care
1. Engineering (Along the Path)
2. Administrative Controls
3. At the Worker
(Along the Path)
At the Worker includes PPE and other things workers
can do to prevent transmission
Always follow Routine Practices (see above)
Provide ‘no-touch’ garbage disposal
and ensure that pick up schedules
Post information on cough/sneeze
and frequency are adjusted
etiquette
Follow cough/sneeze etiquette.
according to waste disposal needs.
Create a system for admission
screening, and procedures to reduce
risks of transmission from newly
admitted patients with fever and
cough symptoms by using private
and/or isolation rooms.
Establish appropriate housekeeping
procedures (frequency and level)
and monitor cleaning outcomes
Implement policies and procedures
Report fever and cough symptoms to supervisor
for staff with fever and cough to take
and take sick leave until symptoms have
sick leave
resolved.
Procedures for reporting suspected or
probable reportable respiratory
ECP Self Study Guide 26
Examples of Controls For Acute Care
1. Engineering (Along the Path)
2. Administrative Controls
3. At the Worker
(Along the Path)
At the Worker includes PPE and other things workers
can do to prevent transmission
Always follow Routine Practices (see above)
infection cases
(Influenza, TB, measles, mumps,
chicken pox,) to public health;
investigating occupational exposures.
Educate and train staff in hazards,
safe work procedures, and correct
use of PPE
ECP Self Study Guide 27
Sample Controls Home and Community Care
Examples of Controls For Home & Community Care
1. Engineering
2. Administrative Controls
3. PPE
Design or arrange entrance to
Develop and implement screening
Gloves
organization office so access is
tool/questions (especially for screening of
limited/restricted unless visitors /staff have
staff and residents for symptoms of ILI.)
been screened for symptoms of ILI in a
reception area.
Provide personal alcohol gel containers-
Minimize number of workers exposed to
pocket sized for staff.
risk i.e. establish protocols for cluster care
Surgical Masks
or essential services
Develop and implement patient isolation
Gowns/aprons
procedures: i.e. establish service provision
expectations such as family members
with ILI respiratory infections remaining in
a separate room while HCC worker
present
Ensure potentially contagious patients
Eye protection
wear a surgical mask (if tolerated)
ECP Self Study Guide 28
Examples of Controls For Home & Community Care
1. Engineering
2. Administrative Controls
3. PPE
Supervise and coach in safe work
N95 Respirators
procedures and use of PPE
Establish expectations for service with
client ie: client wearing masks if required,
client providing access to sinks, soap,
paper towels, and/or alcohol gel
Provide clients / family members with
information on cough/sneeze etiquette
Create and implement effective
communication plan for HCC worker. For
example, provide information on
cough/sneeze etiquette with posters,
brochures, mailouts, in-serivces, and
phone messages. Communicate similar
information to schedulers and supervisors.
Establish expectations for cleaning with
client, and procedures with HCC worker s
as required
ECP Self Study Guide 29
Examples of Controls For Home & Community Care
1. Engineering
2. Administrative Controls
3. PPE
Implement policies and procedures for
staff with ILI to take sick leave
Create a system for intake screening / risk
assessment: i.e. identify clients who are
essential service, identify client ability to
comply with respiratory hygiene practices
Educate and train staff in hazards, safe
work procedures, and correct use of PPE
Implement procedures for reporting
suspected or probable influenza cases to
public health; investigating occupational
exposures.
ECP Self Study Guide 30
Activity: Fill in examples of controls for your organization
Now that you have viewed some examples of controls, write down some of the controls that you could use in your
organization in each category.
Examples of Controls
1. Engineering
2. Administrative Controls
3. PPE
ECP Self Study Guide 31
Examples of Controls
1. Engineering
2. Administrative Controls
3. PPE
ECP Self Study Guide 32
4: Education and Training
Once the ECP has been developed, employers must ensure that the plan is put
into practice by informing workers about the contents of the ECP and educating
and training them to work safely.
For this reason, ECP’s should describe the worker education and training
required and how that training will be carried out. Education and training is
particularly important for new workers.
Your organization’s training plan will need to:
• Educate staff on the specific hazard or risk
•
Educate staff on the ECP
•
Educate staff on the appropriate safe work procedures and how best to
use them
Include training for new hires and annual training where appropriate.
5: Safe Work Procedures
Documenting and making Safe Work Procedures available to staff is an
important component of your ECP. And while the ECP only has to list what
already exists in the work environment in terms of Safe Work Procedures, it is
important to ensure that all of the relevant Safe Work Practices are included.
Some examples of written Safe Work Procedures might be:
• Staff self-assessments
•
Surface and equipment disinfection
•
Proper hand washing
•
Correct donning and doffing of PPE
Providing education and training sessions is one good way of communicating
Safe Work Procedures, but posters and adequate supervision can also remind
staff to follow safe work procedures.
In some sectors, creating pocket size hand washing cards and other reminders
may be more appropriate. You can download these and other OHSAH posters
at: www.ohsah.bc.ca/EN/posters.
ECP Self Study Guide 33
6: Hygiene and Decontamination Procedures
An ECP will need to incorporate procedures for hygiene and disinfection, which
are a very important precautionary measure.
For example, the organization
should provide an adequate
supply of hand hygiene stations –
either sinks with running water,
soap and paper towels, or
alcohol-based hand rub
containers. There should also be
procedures in place to ensure
regular and thorough cleaning of
frequently touched surface areas
with hospital approved
disinfectant.
7: Health Monitoring
The health monitoring section of the ECP should detail how and to whom
workers are to report symptoms. For example, as soon as symptoms arise,
someone must notify the First Aid attendant, Supervisor, or Occupational Health
Nurse.
The organization will also need to designate and train a staff member to:
•
Monitor staff infection (keep a record of workers with cough and fever
(respiratory symptoms), days off sick, etc.)
•
Report illness and daily absenteeism rates to Occupational Health
•
Communicate with public health about how you will record and report
exposures and respiratory infections in your staff
•
Teach staff self-screening for symptoms: new or worsening cough,
productive cough, fever, sore throat, or rashes are all signs of a possible
contagious respiratory infection
•
Conduct ongoing monitoring
•
Confirm immunization history of all new hires
ECP Self Study Guide 34
8: Documentation
Your organization also needs to maintain and create a variety of documents as
part of their ECP, and in order to support its use. These may include:
•
Written Safe Work Procedures
•
Workplace inspections
•
Joint Occupational Health and Safety Meetings
•
Investigations that take place after exposure incidents
•
Records of exposed workers and any health monitoring required
•
Immunization records
•
Staff attendance at training
ECP Self Study Guide 35
Activity: ECP Implementation Action Sheet
We have included an action sheet to help you plan what you will need to do in
order to complete and implement your Exposure Control Plan. You can use this
sheet to determine what action you will need to take to complete each step of
the ECP as well as what information you require and who will be responsible.
Step
Action Needed
Input/Information
Completed
for
Required
By
Implementation
(date/person)
Statement of
Purpose
Risk Identification &
Assessment
Risk Controls:
Engineering
Risk Controls:
Administrative
Risk Controls:
PPE
Education & Training
ECP Self Study Guide 36
Step
Action Needed
Input/Information
Completed
for
Required
By
Implementation
(date/person)
Written Work
Procedures
Hygiene Facilities
Decontamination
Procedures
Health Monitoring
Documentation
Annual Review
ECP Self Study Guide 37
Summary
Now that you have completed the self study guide, we hope that you have all
of the information necessary to participate in developing or reviewing an ECP.
When we started the module, we outlined three objectives. We hope the guide
has helped you to:
•
Define an Exposure Control Plan (ECP)
•
Identify the goals and outcomes of creating an Exposure Control Plan
•
Demonstrate understanding of the eight elements of an Exposure Control
Plan
We have created sample ECPs for each sector so that you will have a sample to
refer to if you need one.
Remember, these are samples and they do not cover every situation. Every
organization must create a unique ECP that addresses the specific risks and jobs
in their own organization. However, taking a look at some sample ECPs can give
you some ideas about what should be in an ECP.
If you would like to print a sample of what a completed ECP looks like in your
sector, please go to the OHSAH website and you will find:
•
ECP Sample - Acute Care
•
ECP Sample - Home Care
•
ECP Sample - Long Term Care
OHSAH also has a variety of health and safety resources to help you participate
in creating or reviewing an ECP. There is a template that you can download
from our website: www.ohsah.bc.ca
•
And you can always access products and online databases using the
Resources link on the OHSAH website.
Thank you for taking the time to complete OHSAH’s Exposure Control Plan course
for respiratory infections! This information will play a vital role in your capacity as
a JOHS Committee member, so we hope this training has helped you to
understand all the elements of an ECP. You can review this self study guide at
any time for reference or review.
ECP Self Study Guide 38
Post-module self assessment
If you want to compare how much you know now to how much you knew
before you started this self study guide, you are welcome to complete the
following self assessment. If you don’t want to do the self assessment just flip past
it to the appendix.
Complete the following 10 questions to the best of your ability.
1. When is an Exposure Control Plan required?
a) Annually
b) In response to an identified risk
c) When the JOHS Committee identifies a hazard
2. The elements of an Exposure Control Plan are:
a) Statement of Purpose, Routes of Transmission, Engineering Controls, Risk
Assessment, Written Work Procedures and Education and Training
b) Statement of Purpose, Responsibilities, Risk Identification, Assessment and
Controls, Education and Training, Written Work Procedures, Hygiene and
Decontamination Procedures, Health Monitoring, and Documentation
c) Statement of Purpose, Responsibilities, Exposure limits, Risk Identification
and Assessment, Risk Controls, Education and Training, Written Work
Procedures, Hygiene and Decontamination Procedures, Health
Monitoring, Personal Protective Equipment, Worker Policies, and
Documentation
3. The outcome of an effective Exposure Control Plan is:
a) Protecting the health and safety of the workers
b) Protecting the health and safety of everyone in the workplace
environment
c) Protecting the health and safety of the patients and visitors
ECP Self Study Guide 39
4. Installing a glass barrier at reception is an example of what type of control?
a) Administrative
b) Engineering
c) With the worker
5. Wearing Personal Protective Equipment is an example of what type of
control?
a) Administrative
b) Engineering
c) With the worker
6. A policy that states you should delay non-essential tasks until the infectious
person is recovered is an example of what type of control?
a) Engineering
b) Administrative
c) With the worker
7. Posters explaining proper hand-washing techniques are an example of:
a) Education and training
b) Written Safe Work Procedures
c) Documentation
8. According to WorkSafe BC, who has the overall responsibility for the Exposure
Control Plan?
a) JOHS Committee
b) Supervisor
c) Employer
d) Worker
ECP Self Study Guide 40
9. An Exposure Control Plan is a:
a) Document created for a specific workplace in response to an identified
risk which outlines ways to eliminate or minimize the risk
b) Guideline determined by WorkSafe BC and implemented in all
workplaces
c) Document that contains all infection control policies and written safe
work procedures
10. A risk assessment must be conducted by a qualified person. According to
WorkSafe BC, a qualified person means:
a) The employer or a designate of the employer
b) A person knowledgeable of the work, the hazards and the means to
control the hazards
c) The Joint Occupational Health and Safety Committee
Great work! To check your answers, flip to the first page of the Appendix.
ECP Self Study Guide 41
Appendices
ECP Self Study Guide 42
Correct Answers to Self Assessment
1. When is an Exposure Control Plan required?
a) Annually
b) In response to an identified risk
c) When the JOHS Committee identifies a hazard
2. The elements of an Exposure Control Plan are:
a) Statement of Purpose, Routes of Transmission, Engineering Controls, Risk
Assessment, Written Work Procedures and Education and Training
b) Statement of Purpose, Responsibilities, Risk Identification, Assessment and
Controls, Education and Training, Written Work Procedures, Hygiene and
Decontamination Procedures, Health Monitoring, and Documentation
c) Statement of Purpose, Responsibilities, Exposure limits, Risk Identification and
Assessment, Risk Controls, Education and Training, Written Work Procedures,
Hygiene and Decontamination Procedures, Health Monitoring, Personal
Protective Equipment, Worker Policies, and Documentation
3. The outcome of an effective Exposure Control Plan is:
a) Protecting the health and safety of the workers
b) Protecting the health and safety of everyone in the workplace environment
c) Protecting the health and safety of the patients and visitors
4. Installing a glass barrier at reception is an example of what type of control?
a) Administrative
b) Engineering
c) With the worker
5. Wearing Personal Protective Equipment is an example of what type of control?
a) Administrative
b) Engineering
c) With the worker
ECP Self Study Guide 43
6. A policy that states you should delay non-essential tasks until the infectious person is
recovered is an example of what type of control?
a) Engineering
b) Administrative
c) With the worker
7. Posters explaining proper hand-washing techniques are an example of:
a) Education and training
b) Written Safe Work Procedures
c) Documentation
8. According to WorkSafe BC, who has the overall responsibility for the Exposure Control
Plan?
a) JOHS Committee
b) Supervisor
c) Employer
d) Worker
9. An Exposure Control Plan is a:
a) Document created for a specific workplace in response to an identified risk
which outlines ways to eliminate or minimize the risk
b) Guideline determined by WorkSafe BC and implemented in all workplaces
c) Document that contains all infection control policies and written safe work
procedures
10. A risk assessment must be conducted by a qualified person. According to WorkSafe
BC, a qualified person means:
a) The employer or a designate of the employer
b) A person knowledgeable of the work, the hazards and the means to control the
hazards
c) The Joint Occupational Health and Safety Committee
ECP Self Study Guide 44
Glossary
Airborne Transmission:
Transmission of microorganisms by inhaling infectious
aerosols (solid or liquid particles in the air). This can occur as
a result of an infected person coughing, sneezing or talking,
or during some medical procedures.
Ambulatory Care Settings:
Facilities that provide health care to patients who do not
remain overnight (e.g., hospital-based outpatient clinics,
non-hospital-based clinics and physician offices, urgent
care centers, surgi-centers, free-standing dialysis centers,
public health clinics, imaging centers, ambulatory
behavioral health and substance abuse clinics, physical
therapy and rehabilitation centers, and dental practices.
Caregivers:
All persons who are not employees of an organization, are
not paid, and provide or assist in providing healthcare to a
patient (e.g., family member, friend) and acquire technical
training as needed based on the tasks that must be
performed.
Case:
An individual who is infected with an infectious disease
Cohorting:
This term applies to the practice of grouping patients
infected or colonized with the same infectious agent
together to confine their care to one area and prevent
contact with susceptible patients (cohorting patients).
During outbreaks, healthcare personnel may be assigned to
a cohort of patients to further limit opportunities for
transmission (cohorting staff).
Cohort Staffing:
The practice of assigning specified personnel to care only
for clients/patients/residents known to be colonized or
infected with the same microorganism. Such personnel
would not participate in the care of
clients/patients/residents who are not colonized or infected
with that microorganism.
ECP Self Study Guide 45
Contact:
An individual who is exposed to a person colonized or
infected with a contagious infectious disease in a manner
that allows transmission to occur (e.g. roommate).
Contact Precautions:
A type of Additional Precautions to reduce the risk of
transmitting infectious agents via contact with an infectious
person. Contact Precautions are used in addition to Routine
Practices. They are a set of practices used to prevent
transmission of infectious agents that are spread by direct or
indirect contact with the patient or the patient’s
environment. Healthcare personnel caring for patients on
Contact Precautions wear a gown and gloves for all
interactions that may involve contact with the patient or
potentially contaminated areas in the patient’s
environment. Donning of gown and gloves upon room
entry, removal before exiting the patient room and
performance of hand hygiene immediately upon exiting.
Client/Patient/Resident:
Any person receiving health care within a health care
setting.
Contact Transmission
Direct contact occurs when microorganisms are transferred
(Direct And Indirect):
directly from an infected person (body surface to body
surface). Some bacteria and viruses can survive on surfaces
for several hours or days. Indirect contact involves the
transfer of microorganisms from a contaminated
intermediate source (e.g., door handle, table surface, and
tray), contaminated instruments or hands.
Contamination:
The presence of an infectious agent on a body surface, on
clothes, gowns, gloves, bedding, toys, surgical instruments,
dressings or other inanimate objects.
Control:
Short for control measure.
A method that controls the risk to workers. Risk controls must
eliminate the risk to workers or, if elimination is not possible,
minimize the risk.
ECP Self Study Guide 46
Controls should be implemented in the following order:
Engineering controls reduce risk by mechanical means (e.g.,
installing barriers, increasing room ventilation, utilizing a
negative pressure isolation room).
Administrative controls involve changes to scheduling or job
rotation, or work procedures to reduce exposure (e.g., hand
washing, respiratory cough/sneeze etiquette).
Personal protective equipment (e.g., gloves, gowns, eye
goggles, surgical masks, respirators).
Direct Care:
Providing hands-on care, such as bathing, washing, turning
client/patient/resident, changing clothes/diapers, dressing
changes, care of open wounds/lesions or toileting. Feeding
and pushing a wheelchair are not classified as direct care.
Disease Transmission:
Refers to the way a pathogen is transmitted (passed) from
person to person or animal to person. Infectious diseases
can be transmitted through blood, through the air, and
through direct contact with contaminated surfaces.
Droplet Nuclei:
Particles that are formed by the evaporation of droplets
(see airborne transmission)
Droplet Transmission:
Transmission occurs when droplets containing a
microorganism are propelled a short distance through the
air and deposited on the mucous membranes (e.g., of the
eyes, nose or mouth).
Exposure:
The condition of being subject to an infectious disease by
contact with an infected person or a contaminated
environment.
Fever:
An elevation of body temperature above the normal range
(37°C.) A low-grade fever is no higher than 38.3°C.
ECP Self Study Guide 47
Health Care Facility:
A set of physical infrastructure elements supporting the
delivery of health-related services. A health care facility
does not include a patient’s home or physician offices
where health care may be provided.
Health Care Setting:
Any location where health care is provided, including
settings where emergency care is provided, hospitals, longterm care homes, mental health facilities, outpatient clinics,
community health centres and clinics, physician offices,
dental offices, offices of allied health professionals and
home health care.
Health Care Worker
Individual providing or supporting health care services that
(HCW):
will bring them into contact with patients/clients/ residents.
Hospital-Grade
A disinfectant that has a drug identification number (DIN)
Disinfectant:
from Health Canada indicating its approval for use in
Canadian hospitals.
Host
In disease transmission host refers to the organism (may be a
human or other animal) in which a parasite (bacteria, virus)
obtains its nutrition and is able to replicate and cause
disease.
Infection:
A condition in which the body is invaded by diseaseproducing microorganisms that multiply and one or more
organs sustain at least temporary damage. Asymptomatic
or sub clinical infection is an infectious process running a
course similar to that of clinical disease but below the
threshold of clinical symptoms. Symptomatic or clinical
infection is one resulting in clinical signs and symptoms
(disease).
Infectious Disease:
A situation in which infection causes signs and symptoms
and is clinically apparent.
Isolation:
The physical separation of infected/colonized individuals
from those uninfected for the period of communicability of
a particular disease
ECP Self Study Guide 48
Patient:
An individual who receives care in a hospital or surgical
centre.
Personal Protective
A variety of barriers used alone or in combination to protect
Equipment (PPE):
mucous membranes, skin, and clothing from contact with
infectious agents. PPE includes gloves, masks, respirators,
goggles, face shields, aprons and gowns.
Precautions:
Interventions to reduce the risk of transmission of
microorganisms (e.g. patient-to-patient, patient-to-staff,
staff-to-patient, contact with the environment, contact with
contaminated equipment).
Public Health Agency Of
A national agency focused on efforts to prevent chronic
Canada (PHAC):
diseases and injuries and to respond to public health
emergencies and infectious disease outbreaks by working
closely with provinces and territories. Some of the PHAC
activities were originally part of Health Canada and some
publications referred to in this document originated in
Health Canada but are now under the jurisdiction of PHAC.
Resident:
An individual who resides in a long-term care facility/or
interim care unit.
Respirator:
Personal protective device that fits tightly around the nose
and mouth and reduces the risk of inhaling hazardous
airborne particles and aerosols (including infectious agents).
Reusable Equipment (Non-
Patient/resident/client care equipment that can be reused
Critical):
on another patient/resident/client that either touches only
intact skin, but not mucous membranes or does not directly
touch them. Reprocessing of these items involves cleaning
and/or low level disinfection with facility approved
disinfectant, e.g. commode.
ECP Self Study Guide 49
Routine Practices:
The system of infection prevention and control practices
recommended by the Public Health Agency of Canada to
be used with all clients/patients/residents during all care to
prevent and control transmission of microorganisms in all
health care settings.
Screening:
A process to identify clients/patients/residents displaying
symptoms that may be associated with a particular disease,
example: Influenza.
Staff:
Anyone conducting activities within a health care setting
that will bring him/her into contact with
clients/patients/residents including
Symptom:
Any perceptible, subjective change in the body or its
functions that indicates disease or phases of disease, as
reported by the affected individual. Example: cough, fever
ECP Self Study Guide 50
Useful Websites
Public Health Agency of Canada – Pandemic Plan
http://www.phac-aspc.gc.ca/cpip-pclcpi/index-eng.php
US Centre for Disease Control
www.cdc.gov
OHSAH
www.ohsah.bc.ca
BC Centre for Disease Control
www.bccdc.org
Provincial Infection Control Network
www.picnetbc.ca
British Columbia Centres for Disease Control:
http://www.bccdc.ca/resourcematerials/newsandalerts/healthalerts/H1N1FluVirusHuma
nSwineFlu.htm
Canadian Centre for Occupational Health and Safety:
http://www.ccohs.ca
Canadian Standards Association:
http://www.csa.ca/Default.asp?language=english
National Institute for Occupational Safety and Health:
http://www.cdc.gov/niosh
NIOSH-Approved Disposable Particulate Respirators (Filtering Facepieces)
http://www.cdc.gov/niosh/npptl/topics/respirators/disp_part/default.html
Occupational Health and Safety Agency for Healthcare in BC:
http://www.ohsah.bc.ca
Provincial Infection Control Network (PICNet):
http://picnetbc.ca
Public Health Agency of Canada
http://www.phac-aspc.gc.ca/alert-alerte/swine_200904-eng.php
US Centers for Disease Control and Prevention:
http://www.cdc.gov/ - http://www.cdc.gov/h1n1flu
World Health Organization:
http://www.who.int/csr/disease/swineflu/en/index.html
ECP Self Study Guide 51
WorkSafeBC Requirements in Relation to an
Exposure Control Plan
Education and Training
Program to Inform Workers about the Exposure Control Plan (ECP):
Section 6.34(1)(f) of the Regulation requires the employer to inform workers about the
contents of the ECP and to provide them with adequate education and training to work
safely with and in proximity to a biological agent designated as a hazardous substance
in section 5.1.1.
This section applies to any worker (including part-time, full-time, temporary, and casual)
who has or may have occupational exposure. No worker with potential occupational
exposure is exempt from this section. The instruction requirement for lab workers who
handle biohazardous materials is covered under section 30.14 of the Regulation.
Education and training must be provided before a worker begins work with or in
proximity to a biological agent designated as a hazardous substance in section 5.1.1.
Specifically, training needs to be given when a worker is initially assigned to the task and
when changes are made that affect a worker's occupational exposure, such as when a
task is modified or new procedures are being instituted.
Education and training is an element of an ECP, as required by section 5.54(2). To
comply with the requirements of section 5.54(3) of the Regulation, the employer must
review the ECP at least annually and update it as necessary. Consequently, the
employer may need to provide refresher training annually or whenever the ECP is
updated.
Education and training material must be appropriate to the educational level, literacy,
and language of workers. The content will generally include discussion and explanation
of the following items:
ECP Self Study Guide 52
Applicable sections of the Regulation - applicable sections include section 3.19(1);
sections 5.2, 5.54, and 5.55; sections 6.33 to 6.41; sections 8.2 and 8.3; sections 12.157 and
12.158; Part 30
Applicable sections of the Workers Compensation Act - including section 173 on
incidents that must be investigated
Definition of a biological agent designated as a hazardous substance in section 5.1.1
1. Occupational exposure
•
How it occurs, such as modes of transmission. How to identify tasks
and other activities, such as routine and emergency spills, that
may involve worker exposure to a biological agent designated as
a hazardous substance in section 5.1.1
•
Effects of exposure
•
What to do in the event of exposure, such as emergency
procedures to be followed, and post-exposure treatment
4. Use and limitations of control measures to prevent or minimize exposure
•
Engineering controls
•
Work practice, or administrative, controls
•
Personal protective equipment (PPE). This element should address
selection, care, use, storage, limitations, maintenance, inspection,
decontamination, and availability of PPE
5. Employers ECP and where to access it
6. Required labels and identification for a biological agent designated as a
hazardous substance in section 5.1.1
When necessary, information on the vaccines required under section 6.40 of the
Regulation
The training session should also include the opportunity for an interactive question and
answer period.
ECP Self Study Guide 53
The person providing the education and training must have knowledge about a
biological agent designated as a hazardous substance in section 5.1.1, particularly in the
context of workplace exposure and control. Trainers may be medical or non-medical
professionals. Medical professionals could include infection control practitioners,
registered nurses, and physicians. Non-medical professionals could include occupational
hygienists or other individuals with specialized training in the area of biological agents
designated as a hazardous substance in section 5.1.1. In some workplaces, such as
medical and dental offices, the employer, who is often a physician, may do the training,
provided he or she is familiar with exposure control measures.
To evaluate compliance with this section, it needs to be verified that education and
training was provided before a worker was placed in a position where occupational
exposure may occur. A WorkSafeBC prevention officer should, by observation and
interviews, determine if workers work safely with and in proximity to a biological agent
designated as a hazardous substance in section 5.1.1. Informed workers can be
identified by their ability to answer the following questions:
1. Do you work with biological agents designated as a hazardous substance? If so,
what are they?
2. What precautions are required for preventing exposure?
3. What do you do in case of an emergency?
4. Where would you go for further information?
Record keeping requirements (details for two on your list, not meant to replace your list.)
ECP Self Study Guide 54
Records of Training
Should Include:
•
Date(s) of training
•
Content or a summary of the training sessions
•
Type of education and training (for example classroom, video, interactive, or
on-the-job)
•
Names and qualifications of those conducting the training -Names, job titles,
and work locations (departments) of workers attending the sessions
•
Education and training records should be kept for at least 3 years after the
training session.
Records of Exposure
Under section 6.34(1)(h), employers must keep a record of all workers who have been
exposed to a biological agent designated as a hazardous substance under section
5.1.1. Incidents of occupational exposure may be documented in the following ways:
Incidents of occupational exposure may be documented in the following ways:
•
Accident/incident reports (such as an incident report regarding a needle
stick injury)
•
First aid treatment records - see section 3.19 of the Regulation
•
Medical records (including documentation of post-exposure medical
evaluation, treatment, and counseling, as well as records of hepatitis B and
other vaccinations)
•
Inspection reports of documented exposures
•
Claim forms
•
Worker complaints
•
Results of the risk assessment performed in compliance with section 6.35
•
Records required as part of the exposure control plan, as per section 6.34,
regarding risk identification, assessment, and control
•
(Worker medical records are to be kept confidential and not disclosed or
reported without the worker's written consent to any person within or outside
the workplace except as required by law.)
ECP Self Study Guide 55
Excerpts from the WorkSafeBC Regulations
5.54 Exposure control plan
(1) An exposure control plan must be implemented when
(a) Exposure monitoring under section 5.53(3) indicates that a worker is or may be
exposed to an air contaminant in excess of 50% of its exposure limit,
(b) Measurement is not possible at 50% of the applicable exposure limit, or
(c) Otherwise required by this Regulation.
(2) The exposure control plan must incorporate the following elements:
(a) A statement of purpose and responsibilities;
(b) Risk identification, assessment and control;
(c) Education and training;
(d) Written work procedures, when required;
(e) Hygiene facilities and decontamination procedures, when required;
(f) Health monitoring, when required;
(g) Documentation, when required.
(3) The plan must be reviewed at least annually and updated as necessary by the
employer, in consultation with the joint committee or the worker health and safety
representative, as applicable.
ECP Self Study Guide 56
6.34 Exposure control plan
(1) If a worker has or may have occupational exposure, the employer must develop and
implement an exposure control plan, based on the precautionary principle, that meets
the requirements of section 5.54 and that includes the following:
(a) a risk assessment conducted by a qualified person to determine if there is a
potential for occupational exposure by any route of transmission;
(b) a list of all work activities for which there is a potential for occupational
exposure;
(c) engineering controls and administrative controls to eliminate or minimize the
potential for occupational exposure;
(d) standard or routine infection control precautions and transmission-based
precautions for all work activities that have been identified as having a
potential for occupational exposure, including
(i) housekeeping practices designed to keep the workplace clean and free
from spills, splashes or other accidental contamination,
(ii) work procedures to ensure that contaminated laundry is isolated, bagged
and handled as little as possible, and
(iii) work procedures to ensure that laboratory or other samples containing a
biological agent designated as a hazardous substance in section 5.1.1
are handled in accordance with the Laboratory Biosafety Manual issued
by the World Health Organization, as amended from time to time, and
the Laboratory Biosafety Guidelines issued by Health Canada, as
amended from time to time;
(e) a description of personal protective equipment designed to eliminate or
minimize occupational exposure;
(f) a program to inform workers about the contents of the exposure control plan
and to provide them with adequate education, training and supervision to
work safely with, and in proximity to, a biological agent designated as a
hazardous substance in section 5.1.1;
(g) a record of all training and education provided to workers in the program
described in paragraph (f);
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(h) a record of all workers who have been exposed, while performing work
activities, to a biological agent designated as a hazardous substance in
section 5.1.1.
[Enacted by B.C. Reg. 319/2007, effective February 1, 2008.]
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