BOLES ISD BLOOD BORNE PATHOGENS EXPOSURE CONTROL PLAN

Annual Evaluation for Start of School

 

The Boles ISD Blood Borne Pathogen Exposure Control Plan has been reviewed and all job classifications have been evaluated for BBP exposure Risk.  As result of the Risk Assessment completed by each job classification the Policy is to be amended to include additional job classifications as having a possible risk of exposure to BBP and therefore will be offered Hepatitis B Vaccination at employer cost:

 

a.   Clinic/Health Room Staff

b.  Secretaries whose job assignment includes assisting students with testing or medication administration involving sharps such as lancets and/or needles.

c.  Special Education or other Teacher or employee whose job assignment includes assisting students with testing or mediation administration involving sharps such as lancet and/or needles.

d.  Staff assigned to relieve Clinic staff during lunch.

e.   Janitorial staff.

f.    Coaching staff.

g.  Kindergarten and Pre Kindergarten Staff

h.  Middle School Principal

 

September, 2002

 

 

Signatures:

Health Professional Reviewer: ___Marcy Reese, RN____________

 

 

Administrative Reviewer:  ______________________________

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Boles ISD BLOOD BORNE PATHOGENS EXPOSURE CONTROL PLAN

 

This Blood borne Pathogen Control Plan is designed to minimize or eliminate occupational exposure to blood borne pathogens (BBP) in compliance with Texas HB 2085 and according to Texas Department of Health (TDH) rules published in the Health and Safety Code, Chapter 81, Subchapter H1.

 

EXPOSURE DETERMINATION

TDH Blood borne Pathogens Exposure Control Plan (plan) requires employers to perform an exposure determination for employees who have occupational exposure to blood or other potentially infectious materials.  The exposure determination is made without regard to the use of personal protective equipment (PPE). This exposure determination is required to list all employees having a risk of occupational exposure to sharps, blood or other potentially infectious materials.

 

The following is a list of job classifications at our establishment in which employees have a risk of occupational exposure:

 

i.      Clinic/Health Room Staff

j.     Secretaries whose job assignment includes assisting students with testing or medication administration involving sharps such as lancets and/or needles.

k.   Special Education or other Teacher or employee whose job assignment includes assisting students with testing or medication administration involving sharps such as lancet and/or needles.

 

The "Occupational Risk Worksheet: Guidelines for School Employees" (Form 1) will be used during the annual evaluation of this Exposure Control Plan (ECP) to determine the degree of risk, if any, employees in other job classifications may have of exposure to BBP.

 

Compliance Methods

 

Universal precautions are observed to prevent contact with blood or other potentially infectious materials.  All blood or other potentially infectious materials are considered infectious regardless of the perceived status of the source individual.

 

Engineering and work practice controls are used to eliminate or minimize exposure to employees. Where occupational exposure remains after institution of these controls, PPE is used.  Engineering controls include use of sharps containers. PPE used at this facility includes but is not limited to disposable gloves, reusable gloves, protective goggles and pocket masks or CPR barrier devices. Supervisors and workers examine and maintain engineering and work practice controls within the work area on ongoing basis and report problems and new equipment needs to their supervisor.

 

Hand washing facilities are available to employees who incur exposure to blood or other potentially infectious materials.  The plan requires that these facilities be readily accessible after incurring exposure. (Appendix A describes proper hand washing technique.)

 

Where hand-washing facilities are not immediately available antiseptic cleanser in conjunction with clean paper towels, antiseptic towelettes or waterless disinfectant are to be made available by the department head.  If these alternatives are used hands are to be washed with soap and running water as soon as feasible

 

After removal of personal protective gloves, employees wash hands and any other potentially contaminated skin area immediately or as soon as feasible with soap and water.  If employees incur exposure to their skin or mucous membranes those areas are washed with soap and water or flushed with water (as appropriate) as soon as feasible following contact.  (Appendix B describes proper glove removal technique.)  *(to be copied and inserted)

 

Needles

 

Contaminated needles and other contaminated sharps are not recapped, removed, bent, sheared, or purposely broken. TDH allows an exception to this if no alternative is feasible and the action is required by specific medical procedure.  If such action is required, then the recapping or removal of the needle must be done by the use of a device or a one-handed technique.

 

Contaminated Sharps Discarding and Containment

 

Contaminated sharps are discarded immediately or as soon as feasible in containers that are closable, puncture resistant, leak proof on sides and bottom, and labeled as contaminated.

 

During use, containers for contaminated sharps are:

·        easily accessible to personnel

·        located as close as feasible to the immediate area where sharps are being used or can be reasonably anticipated to be found (clinic and other locations where procedures requiring use of sharps are performed)

·        maintained upright throughout use

·        are not allowed to overfill;

·        replaced as needed.

 

Work Area Restrictions

 

In work areas where there is a reasonable likelihood of exposure to blood or other potentially infectious materials, employees are not to eat meals.  Food and beverages are not to be kept in refrigerators, freezers, shelves, cabinets, or on counter/bench tops where blood or other potentially infectious materials are present.

 

All procedures are conducted in a manner to minimize splashing, spraying, splattering, and generation of droplets of blood or other potentially infectious materials.

 

Contaminated Equipment

 

Equipment which may become contaminated with blood or other potentially infectious materials is examined prior to servicing or shipping and decontaminated as necessary unless the decontamination of the equipment is not feasible.  Employers place a label on all portions of contaminated equipment that remain to inform employees, service representatives, and/or the manufacturer, as appropriate.

 

Personal Protective Equipment (PPE)

 

All PPE used is provided without cost to employees.  PPE is chosen based on the anticipated exposure to blood or other potentially infectious materials.  The protective equipment is considered appropriate only if it does not permit blood or other potentially infectious materials to pass through or reach the employee's clothing, skin, eyes, mouth, or other mucous membranes under normal conditions of use and for the duration of the time which the protective equipment is used.  Examples of PPE include gloves, safety goggles and CPR barrier devices.  All PPE is fluid resistant.

 

Disposable gloves and CPR barrier devices are available to teaching staff and First Aid Providers from School Health Services.  The Athletic Department will provide PPE for use during athletic activities and events.  The Housekeeping Department will provide PPE used by housekeeping personnel.

 

All garments that are penetrated by blood are removed immediately or as soon as feasible, placed in a plastic bag and labeled as contaminated laundry.  All PPE is removed prior to leaving the work area and placed in the designated trash receptacle or decontamination solution. (Decontamination solution and procedures are detailed in Appendixes C and D)

 

Gloves are worn where it is reasonably anticipated that employees will have hand contact with blood, other potentially infectious materials, non-intact skin and mucous membranes.  Latex sensitive employees will be provided with vinyl gloves or other suitable replacements.

 

Disposable gloves are not to be washed or decontaminated for re-use.  Gloves are to be replaced as soon as practical when they become contaminated, are torn or punctured, or when their ability to function as a barrier is compromised.

 

Utility gloves may be decontaminated for re-use provided that the integrity of the glove is not compromised. (Appendix D)  Utility gloves are discarded if they are cracked, peeling, torn, punctured, exhibit other signs of deterioration, or when their ability to function as a barrier is compromised.

 

Eye protection devices, such as goggles or glasses with solid side shield are required to be worn whenever splashes, spray, splatter, or droplets of blood or other potentially infectious materials may be generated and eye contamination can reasonably be anticipated.

 

Housekeeping

 

The District shall ensure that the worksite is maintained in a clean and sanitary condition.  A written schedule for cleaning and method of decontamination based upon the location within the facility, the type of surface to be cleaned, type of soil present, and tasks or procedures being performed in the area will be determined by the Housekeeping Department.  This schedule will be available no later then the end of the 4^th Six Weeks of the 2000-2001 school year and evaluated and amended as needed within the 1^st Six Weeks of each school year thereafter.

 

All contaminated work surfaces are decontaminated after completion of procedures, immediately or as soon as feasible after any spill of blood or other potentially infectious materials and at the end of the work shift.  Clinic personnel will be responsible for cleaning/decontaminating cots and work surfaces in the Clinic daily and after any spill of potentially infectious materials.  If the Clinic is not staffed daily the building principal is responsible for assigning daily decontamination of clinic surfaces.  Clinic floors and restrooms will be cleaned by the Housekeeping Department as per attached schedule.

 

All surfaces contaminated with body fluids should be cleaned with a disinfectant such as ethyl or isopropyl alcohol 70%, household bleach solution (Appendix D) or other hospital grade disinfectant.  All equipment and working surfaces must be cleaned and disinfected after contact with blood or other potentially infectious materials.  All bins, pails and trash receptacles intended for reuse must be inspected and decontaminated immediately if there is visible contamination.  Restrooms and clinics will be cleaned and decontaminated on a regularly scheduled basis, as per attached Janitorial Schedule.  The trash generated in the normal clinic (bandages, gauze, cotton balls and gloves) may be disposed of in the lined trashcan without any additional treatment.

 

Blood or body fluid spills are treated differently depending on the size and amount of fluid.  A small spill is less than 100 cc (about 1/2 cup) and can be cleaned up with absorbent material such as paper towels or pads without dripping the absorbent material.  It must be contained in such a way so as not to cause pooling, puddling or dripping.  The person doing the cleaning will wear gloves and other appropriate PPE as necessary for the procedure.  Used paper towels or other absorbent material can be placed in a regular trash bag or enclosed within discarded gloves without contaminating the environment.  The area will be immediately wiped of all traces of blood or body fluid by an approved disinfectant.  If these conditions can not be met, the spill will be considered a large spill and treated as follows. 

 

A large spill consists of 100cc or more of blood or other potentially infectious material, cannot be easily cleaned up with paper towels or other absorbent pads, and causes pooling, puddling or dripping.  A custodian will be called to the scene to perform the clean-up procedure.  The area will be kept clear of personnel and steps will be taken to prevent further contamination of the environment.  PPE will be worn as needed to protect the individual during the clean-up process.  Any used mops or similar cleaning devices will be disinfected.  All material and disposable PPE would be double bagged and labeled "Contaminated" using a marker or masking tape. 

Any broken glassware that may be contaminated is picked up using mechanical means such as brush and dustpan and will not be picked up by hand.

 

Protective coverings (i.e., cot paper, plastic wrap, etc.) used to cover equipment and environmental surfaces are removed and replaced as soon as feasible when they become contaminated or at the end of the work shift.

 

Contaminated Waste Disposal

 

All contaminated waste is placed in containers that are closable, constructed to contain all contents and prevent leakage, appropriately labeled as contaminated with blood or body fluids and closed prior to removal.

 

Sharps are discarded as soon as feasible in sharps containers located as close to the point of use as feasible in each work area.  Sharps containers are located in the Clinic and in any Campus office in which procedures involving the use of sharps are preformed.  Sharps containers will be disposed of when full.

 

Any container that has been used as a receptacle for vomitus or other body fluids will be decontaminated as soon as feasible after visible contamination.

 

All contaminated waste is double bagged marked "Contaminated" and placed in appropriate trash receptacle as soon as feasible.

 

Laundry Procedures for Clothing or Laundry Contaminated with Body Fluids

 

It is important to remember that the transmission of HIV/HBV/HCV from laundry has never been linked.  Although the risk is minimal, following the guidelines and common-sense hygienic practices for handling and washing soiled clothing will reduce the risk even further.  Clothing or laundry contaminated with body fluids will be laundered in laundry facilities in the Athletic Department.

 

1.      Contaminated linen should be handled as little as possible with a minimum of agitation, wearing gloves as needed.

2.      All soiled items should be placed in plastic bags at the location where it was contaminated.

3.      The contaminated laundry should be removed from the plastic bags at the laundry site using utility or disposable gloves. Care should be taken to prevent contact between the employees clothing and the contaminated laundry.  Dispose of plastic bags in the trash after removal of contaminated laundry.

4.      The contaminated laundry should be washed separately from other items.

5.      Pre-soak in cold water in washing machine to remove gross contamination materials and blood if needed.

6.      If the article is machine washable and dryable:

a.       Wash with commercial laundry soap and the hottest water possible; 160 degrees F for at least 25 minutes;

b.      Add bleach for an extra margin of safety if the fabric allows its use

c.       If temperatures below 160 degrees F are used, chemicals such as 1 cup household bleach to a full washer load of cold water followed by drying at high heat is recommended

d.      Dry on the hottest setting possible (hanging in direct sunlight is an alternative to drying at 160 degrees F.)

7.      Commercial dry cleaning is a safe option.  Rinse the area of the spill as well as possible and send in an appropriately labeled container.

 

Hepatitis B Vaccine

 

All employees who have been identified as having occupational exposure to blood or other potentially infectious materials are offered the hepatitis B vaccine, at no cost to the employee, under the supervision of a licensed physician or licensed healthcare professional.  The vaccine is offered after blood borne pathogens training and within 10 working days of their initial assignment to work unless the employee has previously received the complete hepatitis B vaccination series, antibody testing has revealed that the employee is immune, or that the vaccine is contraindicated for medical reasons.  Employees receive the vaccine at the Greenville Hunt County Health Department on the 4^th floor of the Courthouse in Greenville. Employees who decline the Hepatitis B vaccine must sign a declination statement. (Forms 2,3). The Superintendent or designee will keep these records.

 

Employees who initially decline the vaccine but whom later elect to receive it may then have the vaccine provided at no cost to the employee.

 

Post Exposure Evaluation and Follow up

 

Exposure incident means a specific eye, mouth, non-intact skin, mucous membrane, or parenteral (piercing of the skin barrier by human bites, cuts, abrasions, needle sticks) contact with blood or other potentially infectious materials that result from the performance of the employee's duties.

 

When the employee incurs an exposure incident, the employee reports to School Health Services and/or building principal if during normal school hours, Hunt Memorial Hospital Emergency Room if incident occurs outside of normal school hours.  All employees who incur an exposure incident are offered a confidential medical evaluation and follow up as follows:

 

1.      Documentation of the route(s) of exposure and the circumstances related to the incident (Exposure Incident Report, Form 4).  TDH Form 59-10666 must also be completed if the exposure is the result of a contaminated sharp.  This form must be submitted to the County Health Department.  *copy to be inserted

 

2.      Identification and documentation of the source individual unless the employer can establish that identification is infeasible or prohibited by state or local law.  After obtaining consent the blood of the source individual should be tested for HIV/HBV/HCV infectivity unless the District can establish that testing of the source is infeasible or prohibited by law.  (Source Individual Consent for Blood Testing (Form 5) or Source Individual Refusal for Blood Testing (Form 6)

 

3.      The results of testing of the source individual are made available to the exposed employee unless prohibited by law.  The employee will be informed of the applicable laws and regulations concerning disclosure of the identity and infectivity of the source individual.  (Appendix E)

 

4.      The employee is offered the option of having his/her blood collected for testing of the employee's HIV/HBV/HCV serological status. The blood sample is preserved for at least 90 days to allow the employee to decide if the blood should be tested for HIV serological status.  If the employee decides prior to that time that the testing will be conducted, then testing is done as soon as feasible.

 

5.      The employee is offered post exposure prophylaxis in accordance with the current recommendations of the Texas Department of Health and U.S. Public Health.

 

6.      The employee is given appropriate counseling concerning infection status, results and interpretations of tests, and precautions to take during the period after the exposure incident.  The employee is informed about what potential illnesses can develop and to seek early medical evaluation and subsequent treatment.

 

7.      The Superintendent/ Assistant Superintendent with the cooperation of the School Nurse are designated to assure that the plan outlined here is effectively carried out and appropriate records relating to this plan are maintained.

 

Interaction with Healthcare Professionals

 

A written opinion is obtained from the healthcare professional that evaluates employees of this facility or organization after an exposure incident.  In order for the healthcare professional to adequately evaluate the employee, the healthcare professional is provided with:

 

1.      documentation of the route(s) of exposure and circumstances under which the exposure occurred;

2.      results of the source individual's blood test, if available;

3.      medical records relevant to the appropriate treatment of the employee (to be provided by the employee;)

Written documentation is obtained from the healthcare professional in the following instances:

 

1.      when the employee is sent to obtain the Hepatitis B vaccine, or

2.      whenever the employee is sent to a healthcare professional following an exposure incident.

 

Healthcare professionals are instructed to limit their written documentation to:

 

1.      whether the Hepatitis B vaccine is indicated;

2.      whether the employee has received the vaccine;

3.      the evaluation following an exposure incident;

4.      whether the employee has been informed of the results of the evaluation;

5.      whether the employee has been told about any medical conditions resulting from exposure to blood or other potentially infectious materials which require further evaluation or treatment (all other findings or diagnosis shall remain confidential and shall not be included in the written report ); and,

6.      whether the healthcare professional's written opinion is provided to the employee within 15 days of completion of the evaluation.

 

Training

 

Training for employees is conducted prior to initial assignment to tasks where occupational exposure may occur.  Employees also receive annual refresher training.  This training is to be conducted within one year of the employee's previous training.

 

Training for employees is conducted by a person knowledgeable in the subject matter and includes an explanation of the following:

 

1.      Chapter 96.  Blood borne Pathogen Control;

2.      OSHA Blood borne Pathogen Final Rule;

3.      epidemiology and symptomatology of blood borne diseases;

4.      modes of transmission of blood borne pathogens;

5.      Boles  ISD's exposure control plan (i.e., points of the plan,

      lines of responsibility, how the plan will be implemented, where to access plan, etc.);

6.      procedures which might cause exposure to blood or other potentially infectious materials at this facility;

7.      control methods which are used at the facility to control exposure to blood or other potentially infectious materials;

8.      personal protective equipment available at this facility (types, use, location, etc.);

9.      hepatitis B vaccine program at the facility;

10.  procedures to follow in an emergency involving blood or other potentially infectious materials;

11.  procedures to follow if an exposure incident occurs, to include U.S. Public Health Service Post Exposure Prophylaxis Guidelines as per Hunt County Hospital District protocol;

12.  post exposure evaluation and follow up;

13.  signs and labels used at the facility; and,

14.  an opportunity to ask questions with the individual conducting the training.

 

Record keeping

 

According to TDH Blood borne Pathogens Rules, medical records are maintained by Boles ISD Superintendent.  Confidential medical record of exposure incidents must be maintained throughout duration of employment plus 30 years according to OSHA standards.

 

According to TDH's Blood borne Pathogens Rules, training records are maintained by the Building Principal and School Health Services.

 

ANNUAL REVIEW

 

Signature __________________________________________________     Date______________

 

Signature __________________________________________________     Date______________

 

Signature __________________________________________________     Date______________

 

Signature __________________________________________________     Date______________

 

Signature __________________________________________________     Date______________

 

Signature __________________________________________________     Date______________

 

Signature __________________________________________________     Date______________

 

*Adapted from TDH "Blood Borne Pathogens Exposure Control Plan" Chapter 81,Health and Safety Code, Subchapter H available at www.tdh.state.tx.us/schoolhealth/bldbrnpt.hhtm

 

Hepa

Blood Testing

 

 

Boles ISD

7071 FM 2102

Quinlan, TX 75474

 

Name _______________________________________________________

 

Parent/Guardian ____________________________ Phone _____________

 

Address ______________________________________________________

 

Date Employee Exposed ____________________

 

Date Parent/Student notified _________________

 

Exposure Control Office Signature ________________________Date _____

 

          (Please read, sign below, and return to Exposure Control Office at the above address.)

 

I have be informed by ____________________________, that I/my child have/has been identified as being a source individual in an employee exposure incident to blood or other potentially infectious body fluids.

 

I am aware of the risks to the employee; and I have declined blood testing to be performed for HBV, HCV, and HIV.  I have been informed that if I had consented to the testing, this information would only be released to the exposed employee and to the exposed employee’s medical provider.

Signature                                                               Date

 

 

*Form adapted from:  Occupational Exposure to Blood-Borne pathogens:  Implementing OSHA Standards in the School Setting, published by National Association of School Nurses, 1999

 

FORM 7

 

Blood borne Pathogen Training Record

 

Date of In-service:    ___________

 

Trainer:                    ___________

 

Content of Session: BBP video with Question and Answer Session

 

Employee Name and Job Title