Download Appendix U Communicable Diseases

1151LAFOURCHE
PARISH SHERIFF’S OFFICE
SHERIFF CRAIG WEBRE
Appendix U
Effective Date
PROCEDURAL ORDER
10/31/2008
Amended Date
COMMUNICABLE DISEASES - WORKPLACE HEALTH AND SAFETY
ISSUES
BY ORDER OF
CRAIG WEBRE, SHERIFF
I.
Purpose
A person with an infectious disease may or may not display overt symptoms of disease. From time
to time employees may be exposed to blood or other body fluids that have human
immunodeficiency virus/acquired immunodeficiency syndrome, hepatitis, tuberculosis, or other
communicable diseases. Additionally those persons in our care and custody should not
unnecessarily be subjected to these health risks. It is the desire of the Lafourche Parish Sheriff’s
Office to minimize the health risks involved in these situations through education, prevention,
and preparation. All employees shall take appropriate precautions to reduce the risk of
contracting infectious diseases. The purpose of this policy is to set departmental guidelines
regarding the general health and workplace safety for all employees.
II.
Policy
It is the responsibility of the Lafourche Parish Sheriff's Office to ensure that all employees are
able to perform their duties in a safe and effective manner. Therefore, it shall be the policy of this
agency to provide employees with up-to-date safety procedures, precautionary measures and
communicable disease information which assist in minimizing potential exposure, while
increasing understanding of the nature and potential risks of communicable diseases.
A.
The Lafourche Parish Sheriff’s Office shall offer the Hepatitis B vaccine series to all
employees with the first injection followed by a second one (1) month later and the final
dose delivered six (6) months after the initial injection. Although the vaccine is available,
it is not mandatory.
1.
Employees who have potential risk or occupational exposure shall be offered the
Hepatitis B vaccine series at no cost. Those employees who receive the vaccine
series shall also receive any future vaccines for Hepatitis B deemed necessary.
a.
Employees who may come into contact with suspects are considered to
have potential risk or occupational exposure to blood and/or other bodily
fluids. All body fluids should be considered potentially infectious.
Whenever possible, employees should avoid direct contact with:
(1)
(2)
(3)
(4)
(5)
(6)
(7)
(8)
b.
Saliva;
Tears;
Sweat;
Blood;
Urine;
Semen;
Feces; or
Vomit.
For the purpose of this policy, an occupational exposure is defined as
specific exposure to the eye, mouth, other mucous membrane, non-intact
skin, or parenteral contact with blood or other potentially infectious
materials that results from the performance of the employee’s duties.
1
COMMUNICABLE DISEASE
(1)
Parenteral is defined as piercing the mucous membranes of the
skin barrier through such events as;
(a)
(b)
(c)
c.
Needle sticks;
Human bites; and/or
Cuts/abrasions.
Whenever practical, Universal Precautions shall be followed whenever
there is a potential for contact with any body fluid. Universal
Precautions, at a minimum, means the wearing of gloves. Other Personal
Protective Equipment (PPE) such as protective masks and face shields
should be used as practical.
2.
All other employees may receive the HBV vaccine at the time of employment or at
the start of the POST Regional Academy at no cost. Afterwards, the vaccine shall
be available, at the employee’s expense, at various times during the year.
3.
If an employee declines the vaccine, the Vaccine Declination Form shall be signed
by the employee, submitted to the Personnel Division and stored in the
employee’s confidential medical file.
a.
B.
PROCEDURAL ORDER
At anytime during employment with the Lafourche Parish Sheriff’s Office
should the employee decide to receive the Hepatitis B vaccine series, the
declination form shall reflect the change.
All employees shall undergo a medical screening including a test for Tuberculosis (TB)
unless a previously positive reaction can be documented, or after completion of
appropriate preventative therapy or adequate therapy can be documented.
1.
Those who undergo the TB screening shall return to have the test read by a
qualified medical professional within forty-eight (48) to seventy-two (72) hours of
the skin test.
a.
The result shall be documented and given to the individual tested. A
copy shall be forwarded to the Personnel Division for inclusion in the
individual’s confidential medical record.
2.
Any employee exhibiting a first time positive reaction to the skin test shall be
cleared by a physician or local health unit prior to returning to work. Clearance
shall be documented in writing and given to the employee.
3.
Employees with a documented history of a positive skin test or adequate
treatment of latent infection or active diseases are exempt from further testing,
unless signs and symptoms of TB develop.
4.
The Lafourche Parish Sheriff’s Office shall make TB testing available throughout
the year at times announced to all employees.
C.
The Lafourche Parish Sheriff’s Office shall offer the flu vaccine annually to all employees
and their families at their expense.
D.
All vaccines dispensed shall be properly documented.
1.
All vaccine payments shall be recorded on the appropriate receipt. All payments
collected shall be submitted to the Finance Section for deposit.
2.
Each dosage given shall be recorded and made part of the employee’s confidential
medical record at the Personnel Division. In the case of flu shots, the Personnel
Division shall keep one log of all dosages given annually.
2
COMMUNICABLE DISEASE
III.
PROCEDURAL ORDER
Approach to Human Blood & Body Fluids
In order to minimize potential exposure to communicable diseases, employees should assume
that all persons are potential carriers of a communicable disease.
A.
All employees shall utilize the body substance isolation approach handling all human
blood and body fluids as if they are infected with an infectious disease or other blood
borne pathogens. Employees shall:
1.
Use disposable gloves while conducting searches, handling items, equipment, or
persons with body fluids on them;
2.
Wear masks, protective eyewear and coveralls during catastrophic unusual
occurrences in which body fluids may splash on an officer;
3.
Cover open cuts or sores with bandages.
4.
Wash hands with soap and water or sanitize hands once gloves are removed;
5.
Avoid large rings, jewelry, or long fingernails;
6.
Use of leather gloves when searching for or handling sharp objects;
a.
Deputies shall avoid blindly placing their hands in areas which could
contain hypodermic needles or other sharp objects when searching
persons, buildings, vehicles, purses, etc. An initial visual search may be
conducted, using a flashlight where necessary.
(1)
IV.
A search of a purse can be accomplished by carefully dumping
the contents onto a flat surface.
b.
Needles shall not be recapped, bent, broken, removed
disposable syringe, or otherwise manipulated by hand.
from
a
c.
Needles shall be placed in a puncture-resistant container when being
collected for evidentiary or disposal purposes.
7.
Not smoke, eat, drink, apply makeup or otherwise put their hands near their face
while working in areas where blood and other body fluids are present;
8.
Wear masks when working in areas that could be contaminated by an airborne
pathogen; and
9.
Use an approved CPR mouth barrier to prevent direct mouth contact during any
resuscitation efforts.
Transport and Custody
No deputy shall refuse to arrest or otherwise physically handle any person who may have a
communicable disease. Deputies shall use appropriate PPE’s when coming into contact with such
individuals.
A.
Deputies shall not put their fingers in or near any person’s mouth unless, utilizing
protective gloves, the deputy is attempting to clear an obstructed airway.
B.
Individuals with body fluids on their persons shall be transported in separate vehicles
from other individuals. The individual may be required to wear a suitable protective
covering if bleeding or otherwise emitting body fluids.
3
COMMUNICABLE DISEASE
C.
V.
PROCEDURAL ORDER
Deputies have an obligation to notify relevant support personnel and document on the
Report of Arrest or Incident Report during a transfer of custody when the suspect
has body fluids present on their person, or has stated that they have a communicable
disease.
Evidence Handling
Evidence or other materials coming into the custody of the Lafourche Parish Sheriff's Office and
suspected of being contaminated shall be treated with extraordinary care. Employees shall always
use appropriate personal protective equipment.
VI.
A.
All materials contaminated with blood or other body fluids, whether wet or dry, shall be
handled with disposable rubber gloves.
B.
Hypodermic needles and other sharp objects shall be packaged in puncture resistant
containers to prevent needle stick injuries. Needles SHALL NOT be capped, bent, broken,
removed from the syringe, or otherwise manipulated by hand.
C.
Disposable items contaminated with blood should be treated as if the blood contained a
communicable disease. They shall be placed in securely sealed red plastic “BIOHAZARD”
bags and submitted for analysis or for storage as evidence.
Employee Exposure to Contaminants
A.
B.
Employees potentially exposed to airborne or bloodborne contaminants due to direct or
indirect disease transmission shall immediately wash the affected area as soon as
possible with hot water and soap, bleach, or other disinfectants. Mucous membranes
such as the eyes, nose and mouth shall be flushed with warm water. Potential exposure
includes, but is not limited to:
1.
Coughing or sneezing;
2.
Contaminated needle stick;
3.
Blood and or body fluid contact with mucous membrane of eyes, nose, mouth, or
skin;
4.
Blood or body fluid in contact with open skin (non-intact skin);
5.
Cuts with sharp instruments covered with blood and or body fluids;
6.
Any injury sustained while cleaning contaminated equipment; and
7.
Human bites.
a.
Any deputy bitten by a person, or who has had physical contact with
blood or bodily fluids of another person, while in the line of duty, shall be
considered to have been exposed to a communicable disease.
b.
Any deputy sustaining such an injury shall wash the wound with warm
running water and soap for 15 seconds before drying. If soap and water
are not immediately available alcohol or antiseptic towelettes or germicidal
cleaner shall be used;
The employee’s supervisor and the Division Commander shall be notified of the incident
immediately. The supervisor shall review the Exposures Flow Chart (Appendix U, Page
13) to determine the next course of action.
1.
If the supervisor and/or employee are not clear that an exposure has occurred,
4
COMMUNICABLE DISEASE
PROCEDURAL ORDER
the employee shall immediately proceed to the nearest hospital to consult with
proper medical authorities.
2.
C.
After the immediate emergency is under control, the injured employee shall
submit an Incident Report indicating the mode of exposure and action taken to
remedy the exposure.
The procedure for testing the person who is the source of the exposure shall follow Article
222 of the Louisiana Code of Criminal Procedure:
Art. 222. Blood and saliva testing; expedited, nonincriminating procedure
D.
A.
Any person who commits any act which exposes a law enforcement officer to a
serious infectious disease by any means resulting in contact with the officer during
the course and scope of an arrest for any offense shall be required to submit within
seventy-two hours of the exposure to a test designed to determine whether he is
infected with a sexually transmitted disease, acquired immune deficiency
syndrome (AIDS), the human immunodeficiency virus (HIV), HIV-1 antibodies, any
other probable causative agent of AIDS, viral hepatitis, or any other serious
infectious disease.
B.
Any law enforcement officer who believes he has been the victim of an act which
has exposed him to a serious infectious disease as provided in Paragraph A of this
Article shall notify by affidavit, subject to penalty for false swearing, the criminal
district court that the exposure has occurred. The court may order the testing, as
provided in this Article.
C.
The court shall include in its order the designation of an appropriate facility for the
procedure and shall require that the result be reported to the court. The court shall
provide the results to the law enforcement officer and the alleged offender and
shall provide them to health authorities in accordance with law.
D.
The state shall not use the fact that the medical procedure or test was performed
on the alleged offender under this Article, or the results thereof, in any criminal
proceeding arising out of the alleged offense.
E.
For purposes of this Article:
(1)
"Law enforcement officer" means a commissioned police officer, sheriff,
deputy sheriff, marshal, deputy marshal, correctional officer, constable,
wildlife enforcement agent, probation and parole officer, or any officer of
the court.
(2)
"Act" is spitting, biting, or scratching, or the throwing of blood or other
bodily substances by any means.
F.
The costs associated with testing as authorized by this Article shall be paid by the
offender.
G.
If the person tested under the provisions of this Article tests positive for a sexually
transmitted disease, AIDS, HIV, HIV-1 antibodies, any other probable causative
agent of AIDS, viral hepatitis, or any other serious infectious disease, the court
shall inform that person of available counseling, health care, and support services.
Any employee potentially exposed to an infectious or communicable disease while
transporting or otherwise providing emergency treatment an individual taken to a hospital
shall notify their supervisor immediately. The Personnel Division or Deputy Commander’s
name shall be listed as the contact person for the agency in the event the hospital in
question seeks contact information. Under no circumstances is an employee to contact a
hospital or other health care provider directly regarding the possible exposure during a
5
COMMUNICABLE DISEASE
PROCEDURAL ORDER
transport incident. Employees shall be notified of unwitting exposure in such a
circumstance as described in Louisiana Revised Statute 40:1099:
R.S. 40:1099. Infectious diseases; notification
A.(1)
If, while treating or transporting an ill or injured patient to a hospital, an emergency
medical technician, paramedic, firefighter, police officer, or other person who is
employed by or voluntarily working with a firm, agency, or organization which
provides emergency treatment or transportation comes into direct contact with a
patient who is subsequently diagnosed as having untreated pulmonary tuberculosis
or acute meningococcal meningitis, or comes in contact with the blood or body fluid of
a person who is subsequently diagnosed as having acute hepatitis virus B infection,
or is a chronic hepatitis B carrier, or is infected with human immunodeficiency virus,
the hospital receiving the patient shall notify the appropriate firm, agency, or
organization which shall notify its emergency medical technician, paramedic,
firefighter, police officer, emergency medical transportation service employer, or other
person treating or transporting the patient of the individual’s exposure to the
infectious disease within forty-eight hours of confirmation of the patient’s diagnosis
and shall advise the same of the appropriate treatment, if any. Notification shall be
made in a manner that protects the confidentiality of the patient and the emergency
medical technician, paramedic, police officer, or other person treating or transporting
the patient.
(2)
Prior to October 30, 1988, the Department of Health and Hospitals shall, in
accordance with the Administrative Procedure Act, promulgate rules and regulations
for the notification procedures required under the provisions of this Subsection.
B.(1)
Whenever a patient is admitted to a hospital or nursing home by a physician, and
that physician has actual knowledge that the patient is infected with one or more of
the conditions described in Subsection A hereof, and is aware of the transfer, the
physician shall notify the hospital or nursing home of the patient’s condition.
(2)
Whenever a patient is transferred from a nursing home to a hospital, or from a
hospital to a nursing home, and the transferor’s records reflect that patient is
infected with one or more of the conditions described in Subsection A hereof, the
transferor shall notify the transferee of the patient’s condition.
(3)
Whenever a patient is admitted to or treated at a hospital or nursing home and the
hospital or nursing home has actual knowledge that the patient is infected with one
or more of the conditions described in Subsection A hereof, the hospital or nursing
home shall notify all health care providers involved in the treatment of that patient of
the patient’s condition.
C.
For purposes of this Subpart, “hospital” means any institution, place, building or
agency, public or private whether operated for profit or not, devoted primarily to the
maintenance and operation of facilities for the diagnosis, treatment, or care of
persons admitted for overnight stay or longer who are suffering form illness, injury,
infirmity, deformity, or other physical conditions for which obstetrical, medical, or
surgical services would be available or appropriate. The term “hospital” specifically
includes any emergency room or outpatient clinic operated in connection with a
hospital as herein defined, whether or not the patient is admitted for an overnight
stay.
E.
If the source of the exposure is deceased, actions shall be taken to have a test sample
drawn from the source at the medical facility, morgue, or funeral home by a medical
professional.
F.
The Personnel Division Commander shall follow up on all potential employee exposures
as appropriate.
6
COMMUNICABLE DISEASE
1.
The Centers for Disease Control and the Department of Health and Hospitals
shall be notified of any confirmed and documented employee exposure to a
communicable disease which occurs on the job.
2.
Unless the disclosure to an appropriate agency official is authorized by the
employee or by state or federal law, all communication and information related to
the results of any employee’s exposure to or other contact with a communicable
disease shall be strictly confidential.
a.
3.
VII.
Employees who do not abide by state and federal laws which mandate
privacy and confidentiality shall face disciplinary action up to and
including termination.
The On the Job Injury or Illness Form shall be completed as soon as possible and
submitted to the Personnel Division.
a.
G.
PROCEDURAL ORDER
A blood test may be conducted within ten (10) days of the event to test
for bloodborne/airborne exposure.
4.
Any follow-up treatment and/or counseling shall be coordinated confidentially.
5.
The agency shall ensure continued testing of the employee for evidence of
infection and provide psychological counseling as deemed necessary.
Employees who test positive for a communicable disease may continue working as long
as they are able to perform their assigned duties do not pose a safety or health threat to
themselves, their coworkers or the public.
1.
Employees have an affirmative duty to inform the Sheriff, Chief Deputy or the
Personnel Commander directly of their health status so a proper evaluation can
be made as to appropriate job placement and potential terms and conditions of
employment including possible reassignment of duties and/or termination.
2.
Employees who refuse to work with an employee identified as having a
communicable disease shall be neglecting their duty and shall be referred to the
Employee Assistance Program through the Police Social Services Section for
counseling.
Decontamination
A.
B.
Contaminated items including disposable equipment, cleaning materials, clothing, or
other objects exposed to body fluids shall be placed in securely sealed red biohazard bags
and disposed of appropriately (at a hospital, fire station or other location which accepts
and destroys biohazard material).
1.
All such items shall be turned over to the employee’s immediate supervisor who
shall determine if the items can be destroyed or shall be logged as evidence.
2.
All items identified for destruction shall be disposed of appropriately (at a
hospital or other location which accepts and destroys biohazard material).
Nondisposable, reusable equipment and areas exposed to body fluids shall be disinfected
with a freshly made solution of one part bleach to ten parts water, a
fungicidal/mycobacterial disinfectant or alcohol. All materials used in the process shall
be placed in securely sealed red biohazard bags and disposed of appropriately.
Nondisposable equipment includes, but is not limited to:
1.
Vehicles, vehicle accessories and components;
2.
Weapons and handcuffs;
7
COMMUNICABLE DISEASE
a.
VIII.
PROCEDURAL ORDER
Metal items, such as handcuffs or firearms, require special care after
cleaning to prevent rusting or deterioration. Deputies shall be
responsible for preventative maintenance of their personal equipment.
3.
Leather gear;
4.
Protective vest; and
5.
Camera equipment
Supplies
Protective gloves, other first aid supplies and disinfecting materials shall be made readily
available at all times. Antimicrobial skin wipe towelettes are non-flammable, meet OSHA
standards and may be used to cleanse and disinfect hands, equipment and the interior of a fleet
vehicle. It shall be the responsibility of the deputy to replenish supplies and equipment as
necessary by submitting a Work Order/Repair Requisition, Vehicle and Equipment Checklist to
the Fleet Operations Manager, or assigned designee, to ensure emergency equipment is stocked at
all times.
XI.
Training
A.
XII.
Employees, at risk for potential exposure, shall participate in mandatory training.
Training shall be provided during odd years in Basic First Aid Training. Instructors shall
have formal training in the area of the transmission of infectious diseases. Training shall
include, but not limited to:
1.
Information regarding air and bloodborne pathogens and their mode of
transmission;
2.
Instructions for handling exposure incidents;
3.
Use of personal protective equipment;
4.
The agency vaccination program;
5.
Disposal and care of contaminated items, and
6.
Policy and procedure regarding infectious diseases.
B.
All employees shall receive education and training on air and bloodborne pathogens
through use of lectures, pamphlets, videotapes and/or safety bulletins. Education and
training shall be based on current, accurate, scientific information provided by recognized
authorities on public health. Information may be updated through the use of safety
bulletins or pamphlets and in-service training
C.
Employee Assistance shall be made available to all employees as described in General
Order 22.2.6, Employee Assistance Program.
Record Keeping
A.
All employee medical files shall be stored in a secure location, separate and apart from
their employment folders, at the Personnel Division. An employee’s medical file shall
include, at a minimum:
1.
Documentation of all vaccines administered;
2.
Employee affidavits/declination forms;
8
COMMUNICABLE DISEASE
B.
3.
Treatment records (if appropriate); and
4.
Documentation of actual exposure cases occurring while acting in the line of duty
and related expenses.
All employee medical records shall be stored with their personnel record permanently as
called for in Appendix I.
1.
XIII.
PROCEDURAL ORDER
Access to medical records shall be limited. Information contained in medical
records shall not be disclosed or otherwise reported or disseminated without the
written consent of the employee.
Violation of this policy shall result in
disciplinary action, up to and including termination.
Report Preparation and Release of Information
Deputies assume a certain degree of risk exists in law enforcement and emergency services work
and accept those risks with their individual appointments including the risk of possible exposure
to communicable diseases.
A.
Any deputy who refuses to take proper action in regard to a victim of a communicable
disease, when appropriate protective equipment is available, may be subject to
disciplinary actions up to and including civil and/or criminal prosecution.
B.
Whenever a deputy mentions in a report, that an individual has or may have a
communicable disease, “contains confidential information” shall be written boldly across
the top margin of the first page of the report.
C.
The deputy’s supervisor shall ensure that the above statement is on all reports involving
the case in question at the time those reports are reviewed and initialed.
D.
The Public Information Officer shall make certain that confidential information is not
given out to the news media.
1.
XV.
Any employee who disseminates confidential information in regard to a victim, or
suspected victim, of a communicable disease shall be subject to disciplinary
action up to and including civil and/or criminal prosecutions.
E.
All requests (including subpoenas) for copies of reports marked “contains confidential
information” when the incident involves an indictable or juvenile offense and requests for
similarly marked reports involving lesser adult offenses and non-offenses shall be
referred to the Chief Deputy.
F.
Prior approval shall be obtained from the District Attorney before advising a victim of a
sexual assault that the suspect has, or is suspected of having, a communicable disease.
G.
All circumstances, not covered in this policy, which may arise concerning releasing
confidential information regarding a victim, or suspected victim, of a communicable
disease shall be referred directly to the Sheriff or Chief Deputy.
Definitions
AIDS:
Acquired Immune Deficiency Syndrome, a communicable disease caused by Human
Immunodeficiency) Virus (HIV).
AIRBORNE PATHOGEN: Pathologic microorganisms spread by droplets expelled into the air,
typically through a productive cough or sneeze.
BACTERIA: A type of living microorganism that can produce disease in a suitable host. Bacteria
can self-reproduce, and some forms may produce toxins harmful to their host.
9
COMMUNICABLE DISEASE
PROCEDURAL ORDER
BIOHAZARD BAG: A bag designed for disposal of potentially infectious substances, color coded in
red, and labeled in accordance with applicable laws.
BLOODBORNE PATHOGEN: Pathologic microorganisms that are present in human blood and
that can cause disease in humans. Note: the term 'blood' includes blood, blood
components, and products made from human blood. These pathogens include, but are
not limited to, Hepatitis B virus (HBV) and human immunodeficiency virus (HIV).
BODY FLUIDS: Fluids that have been recognized by the CDC as directly linked to the
transmission of HIV and/or HBV and/or to which Universal Precautions apply: blood,
semen, blood products, vaginal secretions, cerebrospinal fluid, synovial fluid, pericardial
fluid, amniotic fluid, and concentrated HIV or HBV viruses.
BODY SUBSTANCE ISOLATION (BSI): An infection control strategy which considers all body
substances potentially infectious.
COMMUNICABLE DISEASE: Diseases that can be transmitted from one person to another. These
diseases are commonly known as a contagious disease.
CONTAMINANT/CONTAMINATED: Substances or processes that pose a threat to life, health, or
the environment.
DECONTAMINATION: The physical and/or chemical process of reducing and preventing the
spread of contamination from persons and equipment.
DIRECT DISEASE TRANSMISSION: When a communicable disease is transmitted from one
person to another due to direct contact with infected blood, body fluids, or other
infectious materials.
DISINFECTION: A procedure which inactivates virtually all recognized pathogenic
microorganisms, but not necessarily all microbial forms (ex. bacterial endospores) on
inanimate objects.
EXPOSURE: Eye, mouth, other mucous membrane, nonrelated skin, or parenteral contact with
blood, other body fluids, or other potentially infectious material.
HBV: Abbreviation for hepatitis B virus.
HCV: Abbreviation for hepatitis C virus.
HEPATITIS: Inflammation or swelling of the liver. Hepatitis can be caused by certain drugs,
toxins, or infectious agents, including viruses. Hepatitis caused by viruses include
hepatitis A, B, and D (Delta), and non-A, non-B. Non-A, non-B hepatitis includes
hepatitis C, hepatitis E, and other, as yet unclassified, types of hepatitis.
HEPATITIS A: (Infectious Hepatitis) A viral form of hepatitis normally spread by fecal
contamination and generally not a significant risk for emergency care providers.
HEPATITIS B (HBV): (Serum Hepatitis) A viral form of hepatitis spread through blood contact, and
also as a sexually transmitted disease. Hepatitis B is a significant risk for emergency
care workers. Infection may result in death, chronic hepatitis, liver cancer, or cirrhosis of
the liver. A vaccine to prevent spread of hepatitis B is available.
HEPATITIS C (HCV): A recently identified viral form of hepatitis, spread via blood contact.
HEPATITIS D (DELTA, HDV): A viral infection occurring in people with present or past HBV
infection. Delta hepatitis is a complication of HBV infection and can increase the severity
of HBV infection.
10
COMMUNICABLE DISEASE
PROCEDURAL ORDER
HEPATITIS, NON-A NON-B (NANB): Viral hepatitis caused by a virus other than hepatitis A or B.
A disease of exclusion, there are probably several viruses responsible. NANB hepatitis is
a bloodborne infection, and the cause of ninety percent of post-transfusion hepatitis
cases.
HIV: Abbreviation for human immunodeficiency virus.
HIV INFECTION (HIV positive): A person who has tested positive for HIV antibodies on two ELISA
tests, confirmed with western blot testing. HIV infected patients may or may not develop
AIDS, but can spread the virus through blood and other bodily fluids.
HUMAN IMMUNODEFICIENCY VIRUS: This is the causative agent of AIDS. HIV type 1 (HIV-1)
causes most cases of AIDS. A second virus, HIV-2 is a less common cause of the disease.
IMMUNIZATION: The process of rendering a person immune, or highly resistant to a disease.
INCUBATION PERIOD: This is the time from exposure to the disease until the first appearance of
symptoms.
INDIRECT DISEASE TRANSMISSION: When a communicable disease is transmitted from one
person to another without direct contact.
INFECTIOUS WASTE: Blood and blood products, pathological wastes, microbiological wastes, and
contaminated sharps.
INFECTIOUS DISEASE: This is an illness or disease resulting from invasion of a host by diseaseproducing organisms such as bacteria, viruses, fungi, or parasites.
MENINGITIS: An infection of the meninges, the covering layers of the brain and spinal cord. May
be caused by a bacteria or virus; considered a communicable disease. The disease is
spread through droplet transmissions from the nose or throat, such as sneezing or
coughing, and direct contact with oral secretions of an infected individual. This includes
things such as kissing, sharing drinks, food, utensils, cigarettes, lip balm, or any object
that has been in someone else’s mouth. Because meningitis is a grave illness and can
rapidly progress to death, it requires early diagnoses and treatment
MUCOUS MEMBRANE: The lining of the nose, mouth, eyes, vagina, and rectum. Mucous
membranes are not as durable as other skin; contact of infected body fluids with intact
mucous membranes may transmit disease.
NEEDLE STICK: A puncture through the skin exposure with a needle contaminated from patient
use.
OCCUPATIONAL EXPOSURE: Reasonably anticipated skin, eye, mucous membrane, or parenteral
contact with blood or other potentially infectious materials that may result from the
performance of an employee's duties. This definition excludes incidental exposures that
may take place on the job, that are neither reasonably nor routinely expected and that
the worker is not required to incur in the normal course of employment.
OCCUPATIONAL ILLNESS: An illness or disease contracted through or aggravated by the
performance of the duties, responsibilities, and functions.
OCCUPATIONAL INJURY: An injury
responsibilities, and functions.
sustained during
the performance of the duties,
PARENTERAL EXPOSURE: This exposure occurs through a break in the skin barrier. This would
include injections, needle sticks, human bites, and cuts contaminated with blood.
PATHOGEN: A microorganism that can cause disease. Pathogens can be bacteria, fungi,
parasites, or viruses.
11
COMMUNICABLE DISEASE
PROCEDURAL ORDER
PERSONAL PROTECTIVE EQUIPMENT (PPE): Specialized clothing or equipment worn by an
employee for protection from a hazard. General work clothes (e.g., uniforms, pants,
shirts) not intended to function as protection against a hazard are not considered to be
personal protective equipment.
PUNCTURE-RESISTANT CONTAINER: A leak proof container designed to safely store and/or
transport contaminated sharps for proper disposal.
SHARPS: Any object that can penetrate the skin including, but not limited to needles, lancets,
scalpels, and broken capillary tubes.
TUBERCULOSIS (TB): A communicable disease caused by the bacteria Mycobacterium
tuberculosis, usually affecting the lungs. The incidence of TB as a multi drug resistant
infection has increased since the advent of AIDS.
UNIVERSAL PRECAUTIONS: A system of infectious disease control which assumes that every
direct contact with body fluids is infectious and requires every employee exposed to direct
contact with body fluids to be protected as though such body fluids were HBV or HIV
infected. Therefore, Universal Precautions are intended to prevent health-care workers
from parenteral, mucous membrane, and nonintact skin exposures to bloodborne
pathogens and should be used by emergency response personnel. (OSHA)
Note: Universal Precautions differ from Body Substance Isolation (BSI) in that Universal
Precautions pertains only to specific body fluids. BSI pertains to all body fluids.
VIRUS: A microorganism usually only visible with the electron microscope. Viruses normally
reside within other living (host) cells, and cannot reproduce outside of a living cell.
XIII.
Staph and MRSA (Methicillin-resistant Staphylococcus aureus)
Staph and MRSA are types of bacteria that can cause infections ranging from skin to severe blood
infections. MRSA is transmitted from person to person by contaminated hands. It is seen more
often in hospital settings, but is increasingly being seen in inmate populations. Therefore,
employees assigned to Corrections are strongly encouraged to look for particular signs and
symptoms and report any potential problems to their supervisors immediately.
A.
B.
Staph or MRSA cause skin infections that often look like spider bites, or red, swollen,
painful bumps. They may also be filled with pus. The infections can appear anywhere on
the body, but more often, they appear in or on the:
1.
Cuts and scrapes;
2.
Areas of the body covered by hair;
3.
Back of the neck;
4.
Groin;
5.
Buttock;
6.
Armpit; or
7.
Inner thighs.
Staph and MRSA infections are usually spread by having contact with someone’s skin
infection or by contact with contaminated objects or surfaces used by an infected person,
including, but not limited to:
12
COMMUNICABLE DISEASE
1.
Towels;
2.
Bandages;
3.
Razors
4.
Bars of soap; or
5.
C.
PROCEDURAL ORDER
Other items or materials that touched the infected skin.
Employees shall watch for, observe, and report any inmates displaying minor skin
infections who seem reluctant to seek health care. Inmates with visible or reported sores
or wounds, or who report “boils”, “insect”, or “spider bites” shall be reported to a health
care professional immediately.
1.
Inmate food handlers shall be routinely examined for visible skin infections.
a.
Food handlers with suspected or confirmed contagious MRSA shall be
removed from their duties until no longer infectious as determined by a
health care professional.
2.
Living, sleeping, bathroom, recreational and all other areas within areas shared
by inmates, where close skin-to-skin contact or sharing of personal hygiene or
communal items is likely to occur, shall be inspected regularly.
3.
Detection of two or more cases of MRSA infections in one facility shall be reported
immediately to a supervisor and Division Commander for potential outbreak
management. Appropriate medical professionals shall be consulted to confirm an
outbreak and assist in proper treatment options for employees and others in the
facility.
D.
All employees shall report all skin infections and confirmed MRSA infections to their
supervisor. Supervisors shall advise employees to seek immediate medical attention from
their doctor. Infectious employees shall have no direct inmate contact with coworkers or
inmates until medically cleared by their health care provider.
E.
Hand washing is the most simple and effective way to prevent an MRSA outbreak. Hands
should be washed with soap and running water for at least fifteen (15) seconds.
Employees shall also take special precautions whenever direct contact is anticipated with
blood, body fluids, nonintact or broken skin and mucous membranes (eyes, nose).
Beyond hand washing, employees shall:
F.
1.
Use gloves and other appropriate PPE (personal protective equipment) whenever
contact with body fluids is anticipated;
2.
Regularly clean and disinfect shared environmental surfaces (including computer
keyboards, file cabinets, desks, etc);
3.
Treat all linen as potentially infectious;
4.
Safely dispose of needles, other sharp instruments and devices; and
5.
Place anyone who may contaminate the environment in a private room after
consultation with a health care professional.
If transfer of an infected person is required for security or medical reasons, the following
procedures shall be followed:
13
COMMUNICABLE DISEASE
PROCEDURAL ORDER
1.
Wounds shall be dressed on the day of transfer with clean bandages that contain
wound drainage;
2.
Gloves and other appropriate PPE’s shall be used to avoid contamination;
3.
Disposable restraints shall be used if feasible, otherwise, restraints shall be
decontaminated; and
4.
A clean sheet shall be placed over cloth seats (not needed if vinyl) and the area
decontaminated after transfer if necessary.
14
COMMUNICABLE DISEASE
PROCEDURAL ORDER
EXPOSURE FLOW CHART
Possible Exposure? (This flow-chart for HIV prophylaxis treatment determination only!)
If practical, remove yourself from exposure source
Irrigate and clean wound (blood and bodily fluid exposures). Take immediate first aid
measures and Call Emergency Medical Services if your exposure or injury is severe.

Notify your supervisor

Review this flowchart and proceed to the nearest Health Care Facility if appropriate, if you
have doubt as to the severity of the exposure. Complete this entire process in three (3)
hours.


Did Exposure Occur?
Blood or infectious body fluids:

Sharps injury

Disruption of skin surface
 Mucous membrane: eye,
nasal, oral cavity
No. No action
other than First
Aid
Yes: Blood or other potentially infectious bodily fluids. First Aid and
cleaning then proceed to nearest Health care Facility Emergency Room.
Mucous Membrane
or Skin Surface
Broken
Intact skin-no
treatment needed
Into or
through the
skin
Severity
Volume
Small: A few drops, short
duration; drug treatment
may not be needed; follow
Emergency Room advice.
Less Severe: A solid needle,
superficial scratch; Basic
drug regimen started.
More Severe:
A large bore hollow needle, deep
puncture, visible blood on device, needle
used in
Source patient’s vein or artery. Probable
expanded drug regimen and infectious
disease consultation.
Large: Several drops, major
splash and/or longer
duration
(several min. or more). Basic
drug regimen probable.
Complete this process within three (3) hours
and follow up with Health Care Authorities
15