BLOODBORNE PATHOGENS EMPLOYEE HANDBOOK 1 POLICY EMPLOYEE ORIENTATION AND IN-SERVICE TO BLOODBORNE PATHOGENS AWARENESS It is the policy of Healthcare Services Group, Inc., to ensure that all employees with exposure to blood or other potentially infectious materials participate in a training and education program. Material appropriate in content and vocabulary to educational level, literacy, and language background of employees shall be used. The person conducting the training shall be knowledgeable in the subject matter as it relates to the workplace. It is the responsibility of the Regional Manager to ensure that training of all employees for this Program has taken place prior to their initial work assignment. The Regional Manager must make certain that all District and Account Managers have gone through the training program prior to their presenting the Program to facility employees. The Regional Manager must review the training and compliance with all of the stated procedures of the Program on an on-going basis. 2 What are Bloodborne Pathogens? Bloodborne Pathogens are microorganisms present in blood that can cause disease in humans. These include, but are not limited to, the hepatitis B virus (HBV) and the human immunodeficiency virus (HIV or AIDS). The Occupational Safety and Health Administration (OSHA) has established regulations to ensure that employees with potential occupational exposure to bloodborne pathogens are protected from this exposure. The Healthcare Services Group, Inc., Exposure Control Plan outlines exactly how this must be done. 3 1
What Is HIV? HIV is the virus that causes AIDS. AIDS is a very serious illness that prevents the body s immune system from fighting off disease. Symptoms of AIDS include swollen glands, chronic fatigue, fever, loss of appetite and weight, diarrhea, yeast infections and night sweats. Currently there is no cure for AIDS. 4 What is Hepatitis B? Hepatitis B is a disease of the liver. Symptoms of hepatitis B are flu-like symptoms, jaundice (yellow skin and eyes), weakness or fatigue, lack of appetite, vomiting, stomach pains, and diarrhea. Although HIV is more deadly, HBV is more contagious. The risk of getting HIV from a needlestick is less than 1%. The risk of getting hepatitis B from a needlestick is 6% to 30%. 5 How is HIV & HBV Transmitted? You can be exposed to bloodborne pathogens through sexual intercourse, needlesticks, and by getting blood or other potentially infectious body fluids into your blood through cuts in your skin, eyes, mouth, and nose. You cannot tell by looking if blood is infected. Use Universal precautions. This means to treat all blood as if it is infected. 6 2
How can HIV & HBV be transmitted on the job? Housekeeping employees can be exposed to blood or other bodily fluids and needles when handling and sorting soiled linen, cleaning patient areas, and removing waste. Laundry employees can be exposed to blood or other body fluids and have a risk of getting needlesticks when handling soiled linens. Food Service employees can be exposed to blood or other bodily fluids when serving, clearing, and scraping patient food trays. 7 Hepatitis B Vaccination Information HEALTHCARE SERVICES GROUP, INC., WILL MAKE THE HEPATITIS B VACCINATION SERIES AVAILABLE TO ALL EMPLOYEES WHO HAVE OCCUPATIONAL EXPOSURE. THIS WILL BE PROVIDED AT NO COST TO THE EMPLOYEE AND WILL BE MADE AVAILABLE AT A REASONABLE TIME AND PLACE. 8 What is the Hepatitis B Vaccine? The vaccination series consists of three vaccines. The first in the series of hepatitis B vaccinations will be offered within 10 working days of an employee starting their work assignment or initial assignment to a job having occupational exposure. The second vaccination must be provided within 30 days of the initial vaccine. The third vaccine must be provided within 5 months of the second vaccine. 9 3
Hepatitis B Vaccine, cont d. The hepatitis B vaccination series must be followed with testing to confirm immunization. Interpretation of that test and any follow-up booster dosing for an employee who does not achieve an immune status after three doses should be at the direction of a physician at the local occupational health facility. Corporate Wellness can be utilized as an additional resource. 10 Do I have to have the vaccine? Employees are not required to accept the vaccination series. If they decline the vaccination, they must sign the Vaccination Declination Waiver Form. Make a copy of the form located in Appendix B of the Exposure Control Plan for the employee to sign. Keep the signed form in the employee personnel file. Any employee declining the vaccination series may later receive the vaccination series at no cost to him/her if still covered by the OSHA standard. 11 Any equipment or furniture that is contaminated with visibly large quantities of blood or other bodily fluids will be referred to nursing personnel of the client facility for decontamination and will not be handled by employees of Healthcare Services Group, Inc.. Healthcare Services Group, Inc. employees are only to clean previously decontaminated areas or small areas requiring clean up (i.e. drips of blood or urine). 12 4
Work Clothes Employees are to report for work in appropriate pants, closed shoes and a uniform shirt or top which is provided by Healthcare Services Group, Inc.. If a uniform shirt or top becomes soiled with blood or other body fluids, it is to be placed in an appropriately designated soiled linen bag and sent to the facility laundry for proper laundering (a clean top will be provided by the Manager or Assistant Manager). 13 Handwashing Handwashing stations are available to employees who incur exposure to blood or other body fluids. Employees are required to employ good handwashing practices at all times. Training includes information and demonstration of proper handwashing technique. At most facilities handwashing facilities are located in patient rooms, procedure areas, employee restrooms, and nursing stations. In the unusual circumstance where handwashing stations are not within easy access, Healthcare Services Group, Inc. provides Epi-Clenz. If this alternative is used, hands are to be washed with soap and running water as soon as possible. 14 Personal Protective Equipment After removal of personal protective gloves, employees must wash hands and other potentially contaminated skin area IMMEDIATELY or as soon as feasibly possible with soap and running water. If employees incur exposure to their skin or mucous membranes, then those areas must be washed with soap and water as soon as possible following contact. 15 5
Exposure Sources Healthcare Services Group, Inc. employees are not directly involved in the use of needles or other sharps, such as scalpels, broken capillary tubes, stylets or exposed ends of dental wire. However, exposure may occur when client personnel fail to follow proper disposal techniques. Healthcare Services Group, Inc employees are not responsible for disposal of these materials. If one is found, the Healthcare Services Group, Inc. employee will contact the nursing supervisor or charge nurse who will arrange for disposal. 16 Proper Hygiene In work areas where there is a reasonable likelihood of exposure to blood or other potentially infectious body fluids, employees are not to eat, drink, apply cosmetics or lip balm, smoke, or handle contact lenses. Food and beverages are not to be kept in refrigerators, freezers, shelves, cabinets, or on counter tops or bench tops where blood or other potentially infectious materials are present. 17 Personal Protective Equipment (PPE) All employees are required to wear personal protective equipment when performing job duties where there is occupational exposure to blood or other bodily fluids. All personal protective equipment will be provided at no cost to the employee. Personal protective equipment will be considered appropriate only if it does not permit blood or other body fluids to pass through or reach the employees clothing, skin, eyes, mouth, or other mucous membranes under normal conditions of use. Personal protective equipment that is torn or punctured must be replaced as soon as possible. The job duties and the proper protective equipment is described in the following sections by department. 18 6
Personal Protective Equipment Removal All garments which are penetrated by blood shall be removed immediately or as soon as possible. All personal protective equipment shall be removed before leaving the work area. Gowns must be disposed in the hampers located in soiled utility rooms. Used gloves and other disposable equipment must be discarded in biohazard bags located either inside or immediately outside patient rooms, located in procedure rooms, in most nursing stations and all soiled utility rooms. Non-disposable personal protective equipment is to be carefully transported to the nearest soil utility room. 19 Personal Protective Equipment for Clean-ups Masks in combination with eye protection devices, such as goggles or glasses with shields or face shields, are required to be worn whenever splashes, spray, splatter, or droplets of blood or other body fluids may be generated and eye, nose, and mouth contamination can reasonably be anticipated. Such activities may include clean up of broken glass or other sharps, clean up of blood or body fluid spills or splashes, or decontamination of equipment or furniture. 20 Housekeeping Housekeeping employees are required to clean up minor spills or splashes of blood or other body fluids. Employees are required to wear latex gloves, protective eye wear and surgical gowns when performing this job duty. All contaminated work surfaces are to be decontaminated after completion of procedures and immediately or as soon as possible after any spillage of blood or other body fluids. A 1:10 bleach solution must be used for decontamination. Bottles of the bleach solution must be made-up daily. All bins, pails, cans, and similar receptacles shall be inspected and decontaminated on a daily basis by heavy housekeepers (floormen). 21 7
Housekeeping, cont d. All broken glassware which may be contaminated will not be picked up directly by hand. Employees must use a scraper and disposable pan or a broom and dustpan to clean up these materials. Client facilities are responsible for the disposal of regulated (biohazard) waste. Employees of Healthcare Services Group, Inc. may at times participate in the process of preparing regulated waste for proper disposal or transport to an area for pick up or further transport. Surgical gowns and gloves must be worn for handling regulated waste. 22 Laundry Operations Laundry employees handle soiled linens as part of their job duties. Soiled linens may contain blood or other potentially infectious body fluids. Bags of soiled linens may occasionally contain needles. Bag soiled linens at their point of use (patient care areas) in appropriately marked bags. Never sort or resort in a patient care area. All employees handling soiled linen must wear latex gloves and either a gown, lab coat, apron, or clinic jacket for this activity. 23 Laundry Operations, cont d. Do not handle soiled linens more than necessary. Do not shake them. This may increase the potential for getting blood into your eyes, nose and/or mouth. Do not reach into bags of soiled linen, they may contain needles; dump bags for sorting. Use universal precautions when handling soiled linen with blood or other body fluids. Separate and wash these linens on a heavy soil cycle to ensure that linens will be washed in the appropriate water temperature, with the appropriate chemicals and for an appropriate length of time. 24 8
Food Service Gloves must be worn at all times when handling patient food trays, including delivery of patient food trays, removal of those trays, and scraping/cleaning of trays. Food Service personnel must be familiar with patient isolation signs and are to consult nursing personnel if unclear as to whether or not a patient room should be entered with food trays. If any potentially contaminated item is observed on a patient food tray, a nursing manager is to be contacted immediately to arrange for safe removal and decontamination of the tray and/or area. 25 What do I do if I have an Exposure Incident? IF YOU SHOULD HAVE AN EXPOSURE INCIDENT ON THE JOB, SUCH AS A NEEDLESTICK OR GETTING BLOOD IN YOUR EYES, NOSE, MOUTH OR A CUT IN YOUR SKIN, YOU NEED TO DO THE FOLLOWING TO PROTECT YOURSELF: 26 Immediately notify the account manager of the exposure incident. Go to the nearest handwashing facility and thoroughly wash the exposed area with soap and warm water as quickly as possible. You will be directed to the nearest qualified healthcare professional for evaluation. You may select the nearest emergency room, the facility s local occupational medical facility, or your personal physician. The healthcare professional will determine what follow-up actions are needed. 27 9
Additional Procedures for Exposure Incidents Within one hour of the exposure incident, the Account Manager must complete a Bloodborne Pathogens Exposure Incident Report Form and fax it to: Corporate Wellness, Inc. at 914-764-0537 and D. Smith of Healthcare Services Group, Inc. at 1-800-453-2755. Managers must not hold the report for missing information. There is a combination of medications (which together are called postexposure prophylaxis), which can be given as a preventative measure. If post-exposure prophylaxis medication is recommended as appropriate and the exposed employee opts to take these medications, the first dose should be given within two hours of exposure to be effective. 28 Employees & Corporate Wellness Corporate Wellness will assist you and the Account Manager in selecting a healthcare professional, if necessary, and provide reminders of follow-up activities you need to complete, such as additional doctor s visits and blood testing. For incidents taking place after 5:00 p.m. EST and before 9:00 a.m. EST, the Corporate Wellness, Inc. On-Call manager must be paged by dialing 1-800-410-7942. Corporate Wellness will contact the employee to collect additional information about the incident and follow-up. 29 Post-Exposure Follow-up Corporate Wellness, Inc. will contact the employee at appropriate intervals to remind the employee that he/she is due for follow-up testing or treatment. Those intervals are six weeks, three months, six months, and one year post-exposure (except for the employees who opt for the postexposure prophylaxis who are contacted more frequently). The initial screening will include both an HIV screen and Hepatitis screen. 30 10
Remember to always work safely. It is up to you to follow the proper procedures and protect yourself from exposure incidents. Thank you for your time and commitment to a safe workplace. Please review the following pages for additional information. 31 11