Exposure Control Plan (Bloodborne Pathogens) 
Index with Appendices A, B, C, D & Quiz  Revised-6-29-05
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ICPH 

ICPH Subject Index

Index

App A

App B

App C

App D

Quiz

1.      Purpose
In accordance with the WISHA Bloodborne Pathogens standard WAC 296-62-08001, Island County has developed the following exposure control plan to eliminate or minimize employee occupational exposure to blood or other potentially infectious materials as detailed in the Bloodborne Pathogens standard.

2.      Administration and Compliance
Vickie Chambers, Assistant Director GSA/Safety Coordinator, is the administrator of this plan and is responsible for its implementation. Employees who are identified as having occupational exposure are required to comply with the procedures and work practices outlined in this exposure control plan. Failure to follow these procedures can result in disciplinary action.

3.      Definitions
 For purposes of this section, the following shall apply: 

"Blood" means human blood, human blood components, and products made from human blood.

"Bloodborne pathogens" means pathogenic microorganisms that are present in human blood and can cause disease in humans. These pathogens include, but are not limited to, hepatitis B virus (HBV) and human immunodeficiency virus (HIV).

"Clinical laboratory" means a workplace where diagnostic or other screening procedures are performed on blood or other potentially infectious materials.

"Contaminated" means the presence or the reasonably anticipated presence of blood or other potentially infectious materials on an item or surface.

"Contaminated laundry" means laundry that has been soiled with blood or other potentially infectious materials or that may contain contaminated sharps.

"Contaminated sharps" means any contaminated object that can penetrate the skin including, but not limited to, needles, scalpels, broken glass, broken capillary tubes, and exposed ends of dental wires.

"Decontamination" means the use of physical or chemical means to remove, inactivate, or destroy bloodborne pathogens on a surface or item to the point where they are no longer capable of transmitting infectious particles and the surface or item is rendered safe for handling, use, or disposal.

"Director" means the director of the Washington State Department of Labor and Industries — the state designee for the Washington State plan.

"Engineering controls" means controls (e.g., sharps disposal containers, self-sheathing needles, safer medical devices, such as sharps with engineered sharps injury protections and needleless systems) that isolate or remove the bloodborne pathogens hazard from the workplace.

"Exposure incident" means a specific eye, mouth, other mucous membrane, non-intact skin, or parenteral contact with blood or other potentially infectious materials that results from the performance of an employee's duties.

"Handwashing facilities" means a facility providing an adequate supply of running potable water, soap and single use towels or hot air drying machines.

"Licensed healthcare professional" is a person whose legally permitted scope of practice allows him or her to independently perform the activities required by subsection (6) of this section, entitled Hepatitis B vaccination and post-exposure evaluation and follow-up.

"HBV" means hepatitis B virus.

"HIV" means human immunodeficiency virus.

"Needleless systems" means a device that does not use needles for:
• The collection of bodily fluids or withdrawal of body fluids after initial venous or arterial access is established;
• The administration of medication or fluids; or
• Any other procedure involving the potential for occupational exposure to bloodborne pathogens due to percutaneous injuries from contaminated sharps.

"Occupational exposure" means 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.

"Other Potentially Infectious Materials" (OPIM) means:

(a) 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, and all body fluids in situations where it is difficult or impossible to differentiate between body fluids;
(b) Any unfixed tissue or organ (other than intact skin) from a human (living or dead); and
(c) HIV-containing cell or tissue cultures, organ cultures, and HIV- or HBV-containing culture medium or other solutions; and blood, organs, or other tissues from experimental animals infected with HIV or HBV.

"Parenteral" means piercing mucous membranes or the skin barrier through such events as needle sticks, human bites, cuts, and abrasions.

"Personal protective equipment" is specialized clothing or equipment worn by an employee for protection against a hazard. General work clothes (e.g., uniforms, pants, shirts, or blouses) not intended to function as protection against a hazard are not considered to be personal protective equipment.

"Production facility" means a facility engaged in industrial-scale, large-volume or high concentration production of HIV or HBV.

"Regulated waste" means liquid or semi-liquid blood or other potentially infectious materials; contaminated items that would release blood or other potentially infectious materials in a liquid or semi-liquid state if compressed; items that are caked with dried blood or other potentially infectious materials and are capable of releasing these materials during handling; contaminated sharps; and pathological and microbiological wastes containing blood or other potentially infectious materials.

"Research laboratory" means a laboratory producing or using research-laboratory-scale amounts of HIV or HBV. Research laboratories may produce high concentrations of HIV or HBV but not in the volume found in production facilities.

"Sharps with engineered sharps injury protections" means a non-needle sharp or a needle device used for withdrawing body fluids, accessing a vein or artery, or administering medications or other fluids, with a built-in safety feature or mechanism that effectively reduces the risk of an exposure incident.

"Source individual" means any individual, living or dead, whose blood or other potentially infectious materials may be a source of occupational exposure to the employee. Examples include, but are not limited to, hospital and clinic patients; clients in institutions for the developmentally disabled; trauma victims; clients of drug and alcohol treatment facilities; residents of hospices and nursing homes; human remains; and individuals who donate or sell blood or blood components.

"Sterilize" means the use of a physical or chemical procedure to destroy all microbial life including highly resistant bacterial endospores.

"Universal precautions" are an approach to infection control. According to the concept of universal precautions, all human blood and certain human body fluids are treated as if known to be infectious for HIV, HBV, and other bloodborne pathogens.

"Work practice controls" means controls that reduce the likelihood of exposure by altering the manner in which a task is performed (e.g., prohibiting recapping of needles by a two-handed technique.

4.      Exposure Determination
WISHA requires employers to perform an exposure determination to identify employees who have occupational exposure to blood or other potentially infectious materials. Occupational exposure means “reasonably anticipated skin, eye, mucous membrane or parenteral contact with blood or other potentially infectious material that may result from the performance of an employee’s duties.” For purposes of the determination, employees are considered to have occupational exposure even if they utilize PPE while performing duties that put them at risk for exposure. Below, is a list of all job classifications and tasks in which employees may be expected to incur such occupational exposure, regardless of frequency.

5.      Compliance 

     a.  Universal Precautions  

Universal precautions will be observed at this facility in order to prevent contact with blood or other potentially infectious materials. This means that all blood or OPIM will be considered infectious regardless of the perceived status of the source individual. (See appendix D.)

     b.   Engineering Controls

Island County conducts ongoing evaluation of tasks and medical devices that carry a risk of exposure and implements safer medical devices whenever feasible. A Committee made up of managerial and non-managerial health department staff will evaluate tasks and devices on a yearly basis.  A checklist for each mechanical device will be utilized, and is included in this policy.  (See appendices A and B)

A representative sample of non-managerial employees is included in all evaluations. We have developed the following engineering controls to prevent or minimize exposure to bloodborne pathogens. New technology will be implemented and evaluated whenever possible. Our engineering controls will be evaluated and maintained as described below:

We have identified the following tasks and devices that utilize non-safer devices or allow exceptions to defined work practice controls:

 c.   Work Practice Controls

The following work rules apply where there is a potential for contact with blood or OPIM:

Hand and Body Washing

• Handwashing facilities are available to employees who are exposed to blood or other potentially infectious materials. 
• Employees shall wash hands after removal of personal protective gloves and whenever there is a likelihood of contamination. In addition, any contaminated skin area will be washed as soon as possible.
• When handwashing facilities are not readily available. The use of waterless handwashing products is permitted as an interim means of washing the hands or other parts of the body after contamination with blood or OPIM.
• If blood or other potentially infectious material contacts mucous membranes then those areas shall be washed or flushed with water as appropriate as soon as possible following contact.

Other Work Practices

• Contaminated needles may not be recapped, bent or broken off. Shearing or breaking of contaminated needles is prohibited. They must be deposited in a sharps container immediately or as soon as possible after use. If recapping is a necessary part of a procedure, such recapping must be accomplished through the use of a recapping device or a one-handed technique.
• Sharps containers must be closed prior to removal or replacement to prevent spilling or protrusion of the contents during handling or storage.
• Eating, drinking, smoking, applying cosmetics or lip balm, and handling contact lenses are prohibited in work areas where there is a reasonable likelihood of occupational exposure.
• Food and drink must not be kept in refrigerators, freezers, shelves, and cabinets or on countertops or bench tops where blood or other potentially infectious materials are present.
• All procedures will be conducted in a manner that will minimize splashing, spraying, splattering, and generation of droplets of blood or other potentially infectious materials.
• Mouth pipetting/suctioning of blood or other potentially infectious materials is prohibited.
• Specimens of blood or other potentially infectious materials must be placed fluid proof, biohazard labeled shipping containers.   If the outside of the containers becomes contaminated, then it must be placed in a second container. 
• Regulated waste material must be placed in a biohazard labeled container, which is to be closed before removal to prevent spillage or protrusion of contents. If the outside of the container becomes contaminated, then it must be placed in a second bio-hazard labeled container
• Equipment, which may be contaminated with blood or infectious materials, must be examined prior to service or shipping and shall be decontaminated as necessary.  If decontamination is not feasible then a readily observable biohazard label shall be attached to the equipment and the contaminated portions documented.  Employees shall observe universal precautions and utilize appropriate PPE when handling such equipment.

  d.  Personal Protective Equipment (PPE)

All PPE used at this facility will be provided without cost to employees. PPE will be chosen based on the anticipated exposure to blood or other potentially infectious materials. The PPE will be considered appropriate only if it does not permit blood or other potentially infectious materials to pass through or reach the employees’ clothing, 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. Employees will receive training on the appropriate use of PPE provided for specific tasks.

  (See Universal Precautions Policy, appendix D)

The following personal protective equipment is provided for workers:

If required PPE is not available, contact appropriate department head, elected official, or supervisor who will insure that supplies are replenished.

Gloves

• Gloves shall be worn where it is reasonable anticipated that employees will have hand contact with blood, other potentially infectious materials, non-intact skin, and mucous membranes.
• Disposable gloves used at this facility are not be washed or decontaminated for re-use and are to be replaced as soon as practical when they become contaminated or as soon as possible if they are torn, punctured, or when their ability to function as a barrier is compromised.
• Utility gloves may be decontaminated for re-use if the integrity of the glove is not compromised. Utility gloves will be discarded if they are cracked, peeling, torn, punctured, or exhibit other signs of deterioration or when their ability to function as a barrier is compromised.

Other PPE

• Appropriate face and eye protection is worn when splashes, sprays, spatters, or droplets of blood or other potentially infectious materials pose a hazard to the eyes, nose or mouth.
• Gowns, aprons, and other protective body clothing are worn whenever there is a risk of splash to the body.
• Surgical caps or hoods and shoe covers or booties are worn when gross contamination can be reasonably anticipated.
• All garments, which are penetrated by blood, are removed immediately or as soon as possible. All personal protective equipment are removed and placed in a designated area or container prior to leaving the work area.

 e.   Housekeeping

Work surfaces must be decontaminated with an approved disinfectant as soon as possible after contamination with blood or OPIM, and at the end of the work shift if the surface may have become contaminated since the last cleaning.

The following locations require cleaning and decontamination on a scheduled basis:

       Handling of Waste Material

• Used sharps containers are to be closed and transported to the nearest Immunization room, where it is to be placed in the Infectious waste disposal container furnished by “Stericycle”.  Stericycle will pick up bio-hazardous waste once per month.  Never manually open, empty, or clean reusable contaminated sharps disposal containers. They must be cleaned according to the manufacturer’s instructions.
• Other infectious waste shall be placed in a red bag and placed in the Infectious waste disposal container furnished by “Stericycle”.
•  Always use mechanical means such as tongs, forceps or a brush and dustpan to pick up contaminated broken glassware. Never pick up with hands – even if gloves are worn!

  f.   Laundry

• Handle contaminated laundry as little as