Download 6.7 Exposure Control Program

Bald Hills Fire Protection District 17
SUBJECT:
SECTION:
SUB-SECTION:
EFFECTIVE:
6.7 Exposure Control Program
Exposure Control Program
6
Health and Safety
6.7
Exposure Control Program
2016-08-09
Version: Revision 1
Chairman: Roger V. McMaster
Fire Chief: Mark Gregory
1 POLICY
1.1
It is the policy of Bald Hills Fire Protection District 17 to provide a high level of protection
against communicable diseases for all members while providing fire, rescue and
emergency medical services.
1.2
Members shall practice universal precautions at all emergency medical scenes, prior to
initiating patient care.
1.3
Bald Hills Fire Protection District 17 shall provide appropriate personal protective
equipment (PPE), training and immunization for all members for protection from
communicable diseases.
1.4
Bald Hills Fire Protection District 17 shall provide appropriate information prior to, and
follow-up health care for any members involved in an exposure related incident.
1.5
Bald Hills Fire Protection District 17 shall maintain members’ personal health files, in a
confidential manner, for the duration of their service plus thirty (30) years.
1.6
Bald Hills Fire Protection District 17 shall review and update the exposure control plan as
described in WAC 296-823-11010 (7)
2 DEFINITIONS
2.1
Bloodborne Pathogens: Infectious microorganisms in human blood that can cause disease
in humans. These pathogens include, but are not limited to, hepatitis B (HBV), hepatitis C
(HCV) and human immunodeficiency virus (HIV).
2.2
Confidentiality: The protection of medical information and records of personnel and/or
patients as defined in medical ethics and federal and state law, which prohibits the release
of such information without consent from the individual to whom the information or
record pertains to.
2.3
Contaminated: The presence or the reasonably anticipated presence of blood or other
potentially infectious material on an item.
2.4
Exposure: Contact with infectious agents, such as blood and body fluids, through
inhalation, percutaneous inoculation, or contact with an open wound, non-intact skin, or
mucous membrane that results from the performance of duties.
2.5
Exposure incident: A specific eye, mouth, other mucous membrane, non-intact skin or
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6.7 Exposure Control Program
parenteral contact with blood or other potentially infectious materials (OPIM) that results
from the performance of an employee's duties. Examples of non-intact skin include skin
with dermatitis, hangnails, cuts, abrasions, chafing, or acne.
2.6
Exposure Control Officer (ECO): The member that is trained and knowledgeable on current
medical issues, infection control mandates and practices, state and federal laws (e.g.
Confidentiality, Ryan White Notification Act, the Americans with Disabilities Act, Federal
Civil Rights Laws, etc.) and assigned the duties as ECO as defined by district policies.
2.7
Hospital reportable exposure (unsuspected exposure): A hospital reportable or
unsuspected exposure occurs if EMS employees treat or transport a patient who is later
diagnosed as having a serious communicable disease that could have been transmitted by
a respiratory route. Hospital reportable diseases include tuberculosis and meningococcal
meningitis.
2.8
Immediate supervisor: The team leader, assigned lieutenant, or senior member present.
2.9
Occupational exposure: Reasonably anticipated skin, eye, mucous membrane, or
parenteral contact with blood or OPIM that may result from the performance of duties.
2.10 OPIM (Other Potentially Infections Materials): The following human body fluids: semen,
vaginal secretions, cerebrospinal fluid, synovial fluid, pleural fluid, pericardial fluid,
peritoneal fluid, amniotic fluid, saliva in dental procedures, any body fluid that is visibly
contaminated with blood, any unfixed human tissue or organ from a human, and all body
fluids in situations where it is difficult or impossible to differentiate between body fluids.
2.11 Universal Precautions: A set of precautions designed to prevent the transmission of
bloodborne pathogens.
3 RESPONSIBILITIES
3.1
The Fire Chief has the overall responsibility for the implementation of the exposure control
program.
3.2
The exposure control officer, as designated by the Fire Chief, shall ensure that an adequate
exposure control program is developed and all personnel are trained and supervised on
the program.
3.3
Members shall treat all bodily fluids and tissues as potentially infectious materials and shall
promptly report and document all reportable exposures to their immediate supervisor, the
ECO, or the Fire Chief.
3.4
It shall be the member’s responsibility to keep their health history immunization record, up
to date with a current copy in their medical file.
3.5
The immediate supervisor shall mandate safe operating practices and shall support and
enforce compliance with the exposure control program.
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6.7 Exposure Control Program
3.6
The immediate supervisor shall prohibit members from duties that include potential
occupational exposure until HBV vaccination has been offered.
3.7
Reportable exposures shall be reported to the ECO (i.e. notified as soon as possible) and a
completed exposure report form provided within 24hrs.
3.8
The exposure control officer shall be responsible for establishing personnel exposure
protocols so that a process for dealing with exposures is in writing and available to all
personnel.
3.9
The exposure control officer, or their designee, will function as a liaison between area
hospitals and fire department members to provide notification that a communicable
disease exposure is suspected or has been determined by hospital medical personnel. They
will institute the established exposure protocols immediately after report of an exposure.
The exposure control officer shall follow the confidentiality requirements of chapter 246100 WAC and the medical protocol requirements of chapter 296-802 WAC.
3.10 All members must observe the universal precautions as described in policy 3.6.5 Universal
Precautions.
3.11 Personnel shall don emergency medical gloves prior to initiating any emergency patient
care. Personnel shall don emergency medical garments and emergency medical face
protection devices prior to any patient care during which splashes of body fluids can occur
such as situations involving spurting blood or childbirth. Structural turnout gear and gloves
with vapor barriers may be used in lieu of emergency medical gloves and garments.
3.12 Contaminated emergency medical garments, emergency medical face protection, gloves,
devices, and emergency medical gloves shall be cleaned and disinfected, or disposed of, in
accordance with WAC 296-823 (Occupational exposure to bloodborne pathogens).
3.13 The Fire Chief shall ensure that the ECO is qualified to assume and perform the duties as
prescribed above. Qualification must include knowledge of and current training on
appropriate medical practices, infection control standards and applicable laws and rules.
3.14 The duties and responsibilities of the ECO shall include, but not be limited to the following:
3.14.1 Plan and coordinate infection control activities.
3.14.2 Work closely with the Safety Committee.
3.14.3 Ensure that exposures are investigated.
3.14.4 Devise corrective measures to prevent exposures.
3.14.5 Ensure appropriate and timely medical follow-up to exposures as required by law.
3.14.6 Ensure confidential record keeping of all medical prophylactic and post-exposure treatment,
and approve/disapprove the release of any related information for whatever purpose.
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3.14.7 Ensure the application of all requirements of the Federal Ryan White Notification Law and act
as “designated officer”.
4 GUIDELINES
4.1
All members shall be offered and provided the following immunizations or document their
immunity; Hepatitis B (HBV), Tetanus-diphtheria, Measles, Mumps & Rubella (MMR),
Influenza (annual), and Tuberculosis (initial screening).
4.1.1
Initial HBV inoculations shall be provided at no cost to members, and booster shots shall be
provided in accordance with CDC recommendations.
4.1.2
Tetanus-diphtheria inoculations are required every ten years, with a booster being required if
a puncture wound occurs seven years or more since last inoculation.
4.1.3
MMR is not recommended if born prior to 1957 or for members who are pregnant or
anticipate pregnancy within three months.
4.1.4
Influenza vaccine will be available from October through February each year.
4.1.5
Members will receive a baseline Tuberculosis assessment upon joining and thereafter as
indicated for any possible occupational exposure to the disease.
4.2
Members may refuse immunization, or may submit proof of previous immunization.
Members who refuse HBV immunization will be counseled on the occupational risk of
communicable diseases and the ramifications of refusing the immunization and will be
required to sign a refusal of immunization statement. Members who refuse immunization
may later receive immunization upon request.
4.3
Non-reportable exposures include the following:
4.4
4.3.1
Blood on intact skin, clothing or equipment.
4.3.2
Being present in the same room as, touching, or talking to infected person.
The following tasks are activities where personnel can reasonably anticipate that an
exposure to blood or OPIM may occur.
4.4.1
Administering emergency medical care to injured or ill patients.
4.4.2
Rescue victims from hazardous environments, including burning structures, burning vehicles
or other hazardous atmospheres.
4.4.3
Patient extrication from vehicles, machinery, excavations or collapsed structures.
4.4.4
Recovery or removal of bodies from any of the above.
4.4.5
Response to hazardous materials incidents involving potentially infectious substances.
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4.5
4.6
4.7
4.8
6.7 Exposure Control Program
Members will use the following practices to minimize exposure:
4.5.1
Disposable gloves shall be used when handling contaminated clothing and equipment.
4.5.2
Contaminated uniforms shall be washed at the station. Under no circumstances shall
contaminated uniforms be washed at the member’s home.
4.5.3
Each station shall establish a designated cleaning area, which shall be physically separated
from areas of food preparation, personnel hygiene, sleeping, and living areas.
Upon returning to quarters after an incident, the following precautions shall be observed:
4.6.1
Contaminated clothing shall be removed, washed as soon as possible, and replaced with a
clean uniform.
4.6.2
Small stains from body fluids shall be spot cleaned and then disinfected.
4.6.3
Members shall blow their nose with a tissue, and then wash their hands.
4.6.4
Members who experience substantial body fluid contact with the skin shall shower as soon as
possible.
The following actions shall be taken in the event of a reportable exposure:
4.7.1
Member shall initiate immediate self-care of their wound with disinfectant, soap and hot
water; flush eyes, nose, or moth exposures with water or ringer solution.
4.7.2
Members shall make an immediate verbal report of the exposure to their immediate
supervisor, and initiate an infectious exposure report.
4.7.3
The ECO shall report nature of exposure, identify incident number and patient, and request
patient be tested for infectious disease by the receiving hospital staff.
4.7.4
The ECO shall arrange for medical care of members; by a licensed health care professional.
4.7.5
The Health Department shall notify the ECO when the results of the patient’s blood test are
ready.
4.7.6
The ECO shall contact the member during normal business hours and inform the member of
test availability and recommended follow-up procedure; self-treated, members shall forward
all forms as required for treatment of an occupational injury or illness.
4.7.7
If the hospital recommends immediate care of the member after normal business hours, the
hospital shall contact the ECO or Fire Chief who shall arrange for the immediate treatment of
member.
The following should occur in the event of a hospital reportable exposure:
4.8.1
Hospitals shall notify the ECO or Fire Chief of all hospital reportable exposures.
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4.9
6.7 Exposure Control Program
4.8.2
The ECO or Fire Chief shall arrange for the member(s) to receive follow-up medical care as
indicated in the exposure follow-up protocols and as recommended by the reporting hospital.
4.8.3
The ECO or Fire Chief shall contact and inform the member of test availability and
recommended follow-up procedures.
If treated, members shall forward all forms as required, for treatment of an occupational
injury/illness.
4.10 Personnel must be provided training prior to assigning tasks where occupational exposure
might occur and at least annually thereafter. Topics shall include, but not be limited to,
the following:
4.10.1 Education on infectious diseases, symptoms, and modes of transmission;
4.10.2 Recognition of emergency service tasks that may create potential for exposure;
4.10.3 Explanation of types, location, use, and limitations of personal protective equipment
provided;
4.10.4 Explanation of the HBV vaccine, including information on efficacy, safety, methods of
administration, and benefits of being vaccinated; and
4.10.5 Information on post exposure follow up if exposure occurs.
4.11 Universal precautions shall be observed to prevent contact with blood and OPIM. All body
fluids shall be considered potentially infectious materials.
4.12 When the potential for an occupational exposure exists, the fire district shall provide, at no
cost to the personnel, personal protective equipment such as, but not limited to, gloves,
gowns, face shields or masks and eye protection, and mouthpieces, resuscitation bags,
pocket masks, or other ventilation devices. Personal protective equipment will be
considered “appropriate” only if it does not permit blood or other potentially infectious
materials to pass through to or reach the employee s work clothes, street clothes,
undergarments, skin, eyes, mouth, or other mucous membranes under normal conditions
of use and for the duration of time, which the protective equipment will be used.
4.13 Gloves shall be worn for all patient/victim contact. Gloves will be worn for touching blood
and body fluids, mucus membranes or non-intact skin of all patients, for handling items
soiled with blood or body fluids, and for performing all cleaning of soiled surfaces. Gloves
are to removed and hands washed after contact with each patient or each use for cleaning
or handling potentially infectious materials.
4.14 Appropriate outer garments (e.g. structural firefighting or EMS protective clothing) will be
worn for incidents requiring universal precautions where other hazards also exist (e.g.
motor vehicle accidents). Additionally, latex gloves will be worn under protective gloves
during extrication and patient handling. However, due to the potential for burns, latex
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gloves shall not be worn under structural firefighting gloves when there is a likely exposure
to extreme heat.
4.15 Masks shall be worn in combination with eye-protection whenever droplets of blood or
OPIM may be splashed in the eyes, nose, or mouth. Face shields on structural firefighting
or EMS helmets should not be used for exposure control; however, SCBA masks are
acceptable.
4.16 Gowns, splash-proof clothing, structural firefighting or EMS protective clothing shall be
worn during procedures that are likely to generate splashes of blood or OPIM.
4.17 All members will wash hands and exposed skin with soap and water when feasible, or flush
mucus membranes with water as soon as practical following contact with potentially
infectious materials.
4.18 Members shall select PPE appropriate to the potential for exposure. No standard guideline
or procedure or PPE ensemble can address every situation. Good judgement has to be
used, but when in doubt, select maximal rather than minimal PPE.
4.19 Where possible, emergency medical gloves shall be changed between patients in multiple
casualty incidents (MCI) by initially donning a minimum of two pairs, and removing and
replacing the outer pair after each patient.
4.20 Any other skin, mucus membrane, or body area that has come in contact with potentially
infectious material must be washed as soon as possible.
4.21 All members must follow the following universal precautions as described in policy 3.6.5 of
the same name:
4.21.1 Wear appropriate face and eye protection when splashes, sprays, spatters, or droplets of
blood or other potentially infectious materials (OPIM) pose a hazard to the eye, nose, or
mouth.
4.21.2 Wear appropriate gloves when you can reasonably anticipate hand contact with blood or
OPIM, or handle or touch contaminated items or surfaces.
4.21.3 Replace gloves if torn, punctured, contaminated, or otherwise damaged.
4.21.4 Decontaminate reusable gloves if they do not show signs of cracking, peeling, tearing,
puncturing, or other deterioration.
4.21.5 Never wash or decontaminate disposable gloves for reuse.
4.21.6 Remove blood- or OPIM-contaminated garments immediately or as soon as feasible, in a
manner that avoids contact with the contaminated surface.
4.21.7 Remove PPE after it becomes contaminated, and before leaving the scene.
4.21.8 Dispose of contaminated PPE in designated containers.
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4.21.9 Wash hands immediately or as soon as feasible after removal of gloves or other PPE.
4.22 The exposure control program shall be reviewed and updated at least annual or whenever
necessary to reflect changes; in risk of occupational exposure, changes in technology, new
or modified procedures, as well as to document consideration and/or implementation of
appropriate medical devices to eliminate or minimize occupational exposure.
5 APPLICABILITY
5.1
The exposure control program applies to all operations personnel. Members shall practice
universal precautions at all emergency medical scenes or wherever the likelihood of blood
or OPIM exists, and shall treat all bodily fluids and tissues as potentially infections material.
6 DISCUSSION
6.1
The concept of universal precautions is an infection control system that considers blood
and OPIM from all persons as containing bloodborne disease, whether or not the person
has been identified or suspected of having a bloodborne disease.
7 REFERENCES
WAC 296-27
WAC 296-802
WAC 296-305 01515
WAC 296-305-02501
WAC 296-305-06505
WAC 296-823
Policy 3.6.5 Universal Precautions
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