INFORMATION TO PROTECT HEALTH CARE WORKERS ON THE JOB FROM INFECTIOUS DISEASES THAT CAN BE TRANSMITTED BY BLOOD, BODY FLUIDS AND HUMAN TISSUE

         This information is provided to inform you of our program of Universal Precautions to protect you against blood-borne pathogens, including viruses that cause hepatitis and AIDS.

THESE VIRUSES ARE PASSED FROM PERSON TO PERSON BY BLOOD OR BODY FLUIDS

1.   The hepatitis B and C viruses.  Hepatitis B and C cause hepatitis or liver diseases.

2.   The human immunodeficiency virus.  This virus is also call HIV.  HIV is the cause of AIDS.

  3.   Cytomegalovirus.  This virus is also called CMV.  CMV causes an infection which can lead to birth defects.

4.   Be aware that blood and bodily fluids and human tissue can carry other infectious diseases as well.

5.   If a pregnant woman is infected with a blood borne pathogen, it may infect the baby.

YOU SHOULD KNOW

Hepatitis B is a disease that causes 200 to 300 deaths each year in health care workers.  A vaccine to protect health care workers from hepatitis B is available at your physicians’ office or local health department.  The vaccine is highly recommended for all health care providers who have routine or occasional contact with the blood or body fluids of patients.  Hepatitis B is passed from person to person by exposure to blood and some body fluids.  HIV is passed the same way.

HIV has infected some heath care workers on the job.  Most got infected so by a “sharps injury” such as a needle stick.  Others got infected with HIV by getting blood splashed on their chapped skin or in their eyes, noses or mouths.  The risk of getting infected while working in the home health setting is low but not zero.  For example, the risk of infection by an accidental needle stick with an HIV contaminated needle is about three to four chances out of 1000.  However, the risk of coming down with AIDS and dying is high if you get infected with HIV.  A health care worked infected with a blood borne pathogen may pass it on to his or her partner by sexual contact.

A person who is infected with the cytomegalovirus (CMV) may not have any signs of illness.  This virus may be passed from person to person by exposure to infected saliva and urine.  If a pregnant woman becomes infected with CMV, it may cause damage to the fetus (unborn child).

Often, we do not know that a patient has one of these diseases.  Many times a patient does not look sick.  However, if you are exposed, you can still get one of these diseases.  You can protect yourself from exposure by following special precautions know as UNIVERSAL PRECAUTIONS.

WHAT IS EXPOSURE?

Significant exposure to blood or body fluids is defined as:

1.   Injury with a contaminated sharp object (e.g., needle sticks, scalpel cuts)

2.   Spills or splashes of blood or body fluids into non-intact skin (e.g., cuts, hangnails, dermatitis, abrasions, chapped skin) or into a mucous membrane (i.e., mouth, nose, eyes)

3.   Blood exposure covering a large area of apparently intact skin. 

Here is a list of examples of exposures.

1.   Getting blood or body fluids in cuts or in breaks in your skin, or in skin sores or on large areas of skin.

2.   Getting blood or body fluids in your eyes, mouth, or nose.

3.   Getting cut or stabbed with any needles or sharp instruments which were used on a patient.

4.   Getting cut on the broken glass that was used to hold blood, body fluids, or human tissue (glass tubes, blood collection tubes, bottles, jars, etc.)

WHAT IS NOT EXPOSURE?

1.   Handling food trays or furniture.

2.   Handling assistive devices or wheelchairs with patients.

3.   Using public bathrooms or telephones.

4.   Personal contacts with patients such as shaking hands, giving information, touching intact skin as when bathing intact skin or giving a back rub.

5.   Doing clerical or administrative duties for a patient.

UNIVERSAL PRECAUTIONS

1.       You must wear gloves if you touch blood, body fluids, mucous membranes or human tissue of any patient.  To touch a patient’s skin that is broken or cut, wear gloves.  Gloves must be worn when cleaning and debriding a surgical incision or open wound, while performing any EMG/NCV diagnostic testing procedure, or suctioning a patient.  You must wear gloves when performing any vascular access procedures – such as venipuncture.  You must wear gloves when touching any surface or object which is reasonably anticipated to be contaminated even if not visibly contaminated, such as the outside of patient specimens.  Always change gloves when they are torn.  Always change gloves after contact with each patient.  Always remove contaminated gloves before touching clean items such as doorknobs, light switches, etc.  Always wash hands immediately after taking off gloves.  Do not wash or disinfect surgical or examination gloves for reuse.  Do not use non-intact or discolored gloves.

2.       When mucous membranes (i.e., mouth, nose, or eyes) come in contact with blood or body fluids, you must flush (irrigate) them with large amounts of water.  If you have blood or a body fluid splashed into a skin cut, skin puncture or skin lesion, first wash the area with soap and water for at least 10 seconds, then put 70% isopropyl alcohol on the area.  You must report any exposure that occurs either as a part of your job or through an emergency outside the scope of your job to The Company as soon as possible.  Follow the same procedures used for incident reporting.

3.       Do not eat, drink, apply cosmetics, lip balm or handle contact lenses in work areas where there is a potential for occupational exposure to blood or body fluid contaminated surfaces or objects.

4.       Wear fluid resistant gowns or plastic aprons if soiling of clothes with blood or body fluids is likely.

5.       You must wear a mask and eye protection or a face shield if spraying, splashing, or splatter to your face is possible.  Minimal facial protection would consist of a surgical mask and eye glasses with solid side shields.  Eyeglasses without solid side shields are never acceptable for the purpose of protection.

6.       All personal protective equipment (gloves, masks, eye protection, and fluid resistant gowns or aprons) shall be removed immediately upon leaving the work area and placed in a designated container for washing or disposal.  If contaminated, personal protection equipment should be removed immediately or as soon as feasible.  If a pullover item is contaminated, remove it in a way that contamination of head or face does not occur.  If this is not feasible, then pullover item should be cut off with scissors.

7.       CPR masks are essential when performing mouth-to-mouth resuscitation, and are available at the clinic.  Gloves, CPR masks, and proper hand washing are essential.

8.       Handle anything sharp with care to prevent accidental cuts or punctures.  Do not recap, bend or break used disposable needles.  Discard all sharp items immediately by placing them in a puncture-resistant needle box or a puncture-resistant contaminated materials container (CMC).  Broken glassware that may be contaminated shall not be picked up directly with the hands.  Use a mechanical device such as brush and dustpan, tongs or forceps.  Remove vacutainer needles only from clean vacutainer holders.  Use the needle removal device to do this.  Do not remove needles from visibly bloody vacutainer holders.  Discard both holders and needles if they are visibly bloody.  Needle boxes and CMCs should be closed when nearly full.  They should never be allowed to become overfilled.  They should also never be placed above eye level.

9.       Clean blood or body fluid spills promptly.  Wear gloves and use a freshly made dilution of one-part chlorine bleach to 9 parts of water to clean a spill.  Place paper towels over spill.  Flood the spill area with bleach dilution.  Leave on for 10 minutes.  Discard the paper towels in a contaminated materials container.

10.    All patient specimens may be contaminated on the outside of the container and must be handled with gloves.  Place them inside plastic bags before sending them to a laboratory.  Be careful not to contaminate the outside of the plastic bad by handling it with potentially contaminated gloves.  If the container is enclosed in a clean dry plastic bad, gloves need not be used for handling the bag.  Do not send soiled containers to a laboratory.  Do not place food or drink in refrigerators, freezers, cabinets or other areas where any patient specimens are placed.

11.    A provider should report to The Company if you have a draining skin cut or sore.  You must report before you take care of patients or touch patient care equipment.  If there is a question about a provider’s ability to safely care for patients, they should be cleared through The Company.  Cover any non-draining lesions with waterproof dressing before entering the home environment. 

12.    Laundry visibly soiled with blood or body fluids must be handled with gloves.  All laundry must be placed in a fluid proof bag.  Do not place laundry in a red bag.  If the outside of the bag is visibly soiled with blood or body fluids, the bag must be placed inside another bag.  If personal clothing becomes contaminated with blood or other potentially infectious material, it cannot be taken home until it is laundered or disinfected.

13.    To get rid of large quantities of blood or body fluids, carefully pour them down a toilet.  The drain connects to a sewer system.  If splash or splatter is likely, you must wear protection for your eyes and a mask or a face shield.  You must also protect your cloths – wear a fluid resistant gown or apron.  Place small, closed samples of blood in a puncture-resistant contaminated materials container.  DO NOT SQUIRT IT IN!

14.    ANY MATERIALS OR ITEMS VISIBLY CONTAMINATED WITH BLOOD, BODY FLUIDS OR HUMAN TISSUE MUST BE PUT INTO A CONTAMINATED MATERIALS CONTAINER (CMC).  A CMC must be available at your work site if you work with contaminated materials.

15.    The following policies and documents are available for your review at the office of The Company.  A copy of any or all of the following policies or documents is available to you upon request.

a.        Occupational Exposure Training Policy

b.       Hepatitis B Vaccine for Employees Policy

c.        Blood borne Pathogens Exposure Control Plan Policy

d.       Provision of Personal Protective Equipment Policy

e.        CPL 2-2.60 - “Exposure Control Plan for OSHA Personnel with Occupational Exposure to Blood borne Pathogens.”

f.        Federal Register, “Blood borne Pathogens Regulatory Text”, OSHA Standard 1910.1030

UNIVERSAL PRECAUTIONS

1.       Personnel will wear gloves for contact with mucous membranes, non-intact skin and moist body substances for all patients.  Wash hands after removing gloves and use clean gloves with each patient.

2.       Gowns, masks, and protective eyewear are to be worn in addition to gloves during procedures where splashing or spattering of bodily fluids may occur.

3.       Category specific isolation will be used for those patients with droplet/airborne diseases (list attached).

4.       Gloves are to be worn for collecting, transporting and processing of all lab specimens.

5.       Environmental cleaning will be performed routinely after each patient’s use.

6.       Needles and sharps are to be disposed of, uncapped in a rigid impervious container.

7.       For infectious waste disposal, refer to the posted “Infectious Waste Policy.”

RATIONALE

1.       Persons of all ages and backgrounds may be carriers of the AIDS virus.  IN addition, the majority of organisms associated with nosocomial infections are commonly found in faces, airway secretions, blood, urine, and wound drainage.  Category specific isolation is usually initiated only after a diagnosis is made.  Emphasis is placed on transmission of pathogens via hands of personnel.

2.       Gowns protect clothing from soilage; clothing has rarely been known to be   associated with transmission of infectious agents.  Masks protect mucous membrane of the wearer as well as prevent droplet transmission to active patients.  Private rooms offer additional barriers for airborne disease transmission.

3.       Lab specimens treated in an identical manner addresses the issue of unknown cases as well as known cases.

4.       The environment of all patients should be treated in the same manner.  If soilage is present, it should be cleaned promptly.  When the patient is discharged, their environment should be cleaned with the same attention to detail that would be used if the patient was known to have an infection.

5.       Most needle stick injuries occur during the recapping process.  Blood borne pathogens are a threat to health care workers via needle stick injuries.

PRIVATE ROOM/MASKS REQUIRED

Disease                                            Category                               Comment

Acute respiratory infection                 Contact

in infants and young

children, including croup,

bronchitis and bronchiolitis

caused by respiratory syncytial

virus, adenovirus, coronavirus,

influenza viruses, parainfluenza

viruses and rhinovirus.

Chickenpox                                       Strict                                    Persons who are not

         (Varicella)                                                                             susceptible do not

                                                                                                         need to wear a mask.

                                                                                                         Susceptibles should

                                                                                                         Stay out of room.

Diphtheria, pharyngeal                      Strict

Epiglottitis, H.  flu                              Respiratory                           When close to patient

                                                                                                         for 24 hours after

                                                                                                         start of effective

                                                                                                         therapy.

Erythema infectious                          Respiratory                           Masks only for 7 days

                                                                                                         after onset.

German measles                              Contact                                Masks only for 7 days

(rubella)                                                                                after onset of rash

    persons not

                                                                                                                susceptible do not

                                                                                                                need to wear a mask.

                                         Susceptible

                                         persons should, if

                                         possible, stay out of

                                         room

Hemorrhagic fevers                           Strict

         (e.g. Lassa fever)

Herpes Zoster                                   Contact                                Persons not

(Varicella zoster)                                                               susceptible do

         localized in immune                                                           not need to wear a

         compromised patient,                                                        mask

         or disseminated                                                                Susceptibles should

                                                                                                         stay out of room

Disease                                            Category                              Comment

Influenza, in infants and young children  Contact                               

Marburg virus disease                       Strict

Measles                                           Respiratory                           Masks for those close

         (rubeola)                                                                               to patient.  Persons

    all presentations                                                                    not susceptible do not

                                                                                                         need to wear mask.

                                                                                                         Susceptible persons

                                                                                                         should, if possible,        

                                                                                                         stay out of room

MENINGITIS,                                    Respiratory                           Mask when close to

         H. Influenza                                                                          patient for 24 hours

                                                                                                         after start of effective

                                                                                                         therapy

         N. meningitis                        Respiratory

Meningococcal pneumonia                 Respiratory                           Masks when close to

                                                                                                         patient for 24 hours       

                                                                                                         after start of effective

                                                                                                         therapy

Meningococcemia                             Respiratory                           Same

         (Meningococcal sepsis)

Multiply resistant organisms               Contact                                When close – until

         Infect or colonization                                                             after antibiotics and

         of Respiratory tract                                                               culture negative.

Mumps                                             Respiratory                           When close – 9 days

         (Infectious parotitis)                                                              after onset of

                                                                                                         swelling.  Person

                                                                                                         not susceptible do not  

                                                                                                         need to wear mask.

Pertussis                                          Respiratory                           When close for 7 days

         (“Whooping cough”)                                                              after start of effective

                                                                                                         therapy

Pharyngitis, infectious                       Contact       

in infants and young

children

Plague,                                             Strict                                    For 3 days after start 

         pneumonic                                                                            of effective therapy

Disease                                        Category                              Comment

PHEUMONIA                                Respiratory                           When close for 24

H. influenza                                                                           hours after start of

Infants & children                                                                  effective therapy

Meningococcal                             Respiratory                           When close for 24

                                                                                                         hours after start of

                                                                                                         effective therapy

Multiply resistant                           Contact                                Until after antibiotics

         bacterial                                                                     and culture negative

Staph. aureus                               Contact                                When close for 48

                                                                                                         hours after start of        

                                                                                                         effective therapy

Streptococcal grp. A                      Contact                                When close for 24

                                                                                                         hours after start of

                                                                                                         effective therapy

Viral                                             Contact                   

Rabies                                          Contact                                When close –

                                                                                                         duration of illness

Smallpox                                      Strict

(Variola)

Tuberculosis                                 Respiratory

EXPOSURE REPORT

Date:                                   

Employee’s Name                                                                                                  

SS #                                                                                                                         

Patient’s Name                                                                                                       

Patient’s SS #                                                                                                         

Patient’s address and phone #

Description of incident

Protective equipment used

Reason for exposure                                                                                               

Date reviewed by Risk Management Committee                                                   

Action taken and recommendations

ACKNOWLEDGEMENT OF THE REVIEW OF THE EXPOSURE CONTROL PLAN

I have read the Blood borne Pathogens Policy.  I understand and agree to comply with all provisions of the policy.

Employee Name:  _____________________________________

Employee Signature:  _____________________________________      Date:  ___________