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Bloodborne Pathogens Manual 2010 2011 by niusheng11

VIEWS: 22 PAGES: 108

									 GASTON COUNTY SCHOOLS
  BLOODBORNE PATHOGEN
EXPOSURE CONTROL MANUAL




        Revised May 2010




                           1
                                    Introduction
Gaston County Schools is committed to the planning and implementation of a
comprehensive, accessible and workable Bloodborne Pathogens program. The plan was
developed with the cooperation of Department of Human Resources, Department of
Health Services, and Department of Facility Services Divisions within Gaston County
Schools System. They will serve as the heads of the 3-tiered system that will ensure
compliance to Federal and North Carolina State Occupational Safety and Health
Standards.

On May 16, 2005, representatives from these areas met to review updates to the Gaston
County Schools Bloodborne Pathogens Exposure Control Manual and clarify
responsibilities. These are as follows:
       Human Resources will provide up to date appropriate lists of identified
       employees; maintain records of initial training and Hepatitis B immunization
       status for new employees; maintain annual review records of all Category I and
       Category II employees; maintain surveillance review records for all schools
       within the Gaston County Schools system; maintain employee exposure records
       and coordinate appropriate follow up.

       Health Services, along with the Principals serving our schools, will ensure new
       employees classified as Category I or Category II participate in initial training;
       that current Category I and Category II employees participate in an annual review;
       provide documentation of annual review and surveillance information to Human
       Resources; complete appropriate forms following an employee exposure and
       forward those forms to Human Resources.

       Facility Services will retrieve and dispose of hazardous waste appropriately;
       provide all necessary equipment to ensure compliance of State and Federal
       Mandates.

This comprehensive program was developed to ensure compliance to:

Federal Regulations (Standard 29 CFR) Part 1910: Occupational Safety and Health
Standard; Subpart Z: Toxic and Hazardous Substances; Standard 1910.1030: Bloodborne
Pathogens

as well as

North Carolina Department of Labor’s Division of Occupational Safety and Health
Bloodborne Pathogen Standard. That being the above Federal Standard which was
adopted “As Is” in September 1992.




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3
                                 Table of Contents
                                                                     Page #
Section 1:    Introduction
       Executive Summary***********************************              6
       Federal Register (OSHA Guidelines)**********************          7
       Gaston County Policy**********************************            20

Section 2:   Exposure Determination
       Exposure Classification********************************           39
       Employee Exposure Determination Questionnaire************         41

Section 3:    Methods of Compliance
       Universal Precautions*********************************            44
       Engineering Controls**********************************            45
       Hand Washing***************************************               46
       Handling Needles and Sharps***************************            47
       Availability and Accessibility of Personal Protective Equipment   48
       Use of Protective Equipment****************************           49
       Food and Drink***************************************             50

Section 4:    Housekeeping
       Cleaning of Potentially Contaminated Equipment and Work Areas 52
       Trash and Infectious Waste*****************************       53
       Laundry Handling Practices***************************** 54

Section 5:    Exposure and Evaluation
       Exposure Incident Evaluation and Follow-up**************** 56
       Exposure Incident Report Form*************************** 57
       Consent form Hepatitis B and HIV Antibody Blood Test****** 58

Section 6:    Hazard Communication
       Labeling of Potentially Hazardous Materials****************       65

Section 7:    Training and Information
       General********************************************** 67
       Training Program Content Outline************************ 68
       Training Tools**************************************** 74

Section 8:    Annual Review and Surveillance
       Annual Review**************************************** 82
       Surveillance******************************************* 85

Section 9:   Record Keeping
       Recordkeeping**************************************** 87

Appendix: Bus Driver Training…………………………………………………i-xx


                                                                              4
 Section I



Introduction




               5
OSHA’s Bloodborne Pathogens Standard Executive Summary

OSHA has a new standard (May 5, 1992) that we must meet. The primary purpose of the
standard is to eliminate on-the-job exposure to blood and potentially infectious body
fluids which could result in the transmission of bloodborne pathogens. The major
pathogens are the Hepatitis B Virus (HBV) and the Human Immunodefiency Virus
(HIV).

The standard covers any employee who risks occupational exposure –contact with blood
and/or potentially infectious materials on the job..Good Samaritan Acts such as assisting
a student or co-worker with a nosebleed are not considered occupational exposure. Our
responsibility is to develop and implement an exposure control plan. This plan should
include:

       1. Methods of compliance
             a. Universal Precautions – procedures outlined by the Center for Disease
                Control; always wearing protective equipment
             b. Engineering and work practice controls
             c. Personal protective equipment – i.e. gloves
             d. Cleaning and disposal
             e. HBV vaccination
             f. Hazard communication – to inform and accurately document any
                exposure
             g. Record keeping – every step MUST be carefully documented.
             h. Training – two hour training session before vaccination to teach and
                inform employees about pathogens and safety precautions.

       2. Identification of all job classification and tasks that involve occupational
          exposure
       3. A schedule to meet the activities outlined in the exposure control plan.

Once completed, the exposure control plan must be updated annually and should be
retroactive to May 5, 1992.

We estimate that we have 580 employees that need the vaccination and training,

Vaccination cost: 580 X $105 = $60,900
Training cost: negotiable




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Bloodborne pathogens. - 1910.1030

    Regulations (Standards - 29 CFR) - Table of Contents

•   Part Number:                        1910
•   Part Title:                         Occupational Safety and Health Standards
•   Subpart:                            Z
•   Subpart Title:                      Toxic and Hazardous Substances
•   Standard Number:                    1910.1030
•   Title:                              Bloodborne pathogens.

• Appendix:                             A

1910.1030(a)Scope and Application. This section applies to all occupational exposure to blood or other
potentially infectious materials as defined by paragraph (b) of this section.
1910.1030(b)Definitions. For purposes of this section, the following shall apply:
Assistant Secretary means the Assistant Secretary of Labor for Occupational Safety and Health, or designated
representative.
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 which has been soiled with blood or other potentially infectious materials or
may contain 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 National Institute for Occupational Safety and Health, U.S. Department of Health
and Human Services, or designated representative.
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 paragraph (f) 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: (1) The collection of bodily fluids or withdrawal of
body fluids after initial venous or arterial access is established; (2) The administration of medication or fluids; or (3)
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 means (1) The following human body fluids: semen, vaginal secretions,
cerebrospinal fluid, synovial fluid, pleural fluid, pericardial fluid, peritoneal fluid, amniotic fluid, saliva in dental


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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; (2) Any unfixed tissue or organ (other than intact skin) from a
human (living or dead); and (3) 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 needlesticks, 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 nonneedle 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 is 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).

1910.1030(c)Exposure Control --1910.1030(c)(1)Exposure Control Plan.1910.1030(c)(1)(i)
Each employer having an employee(s) with occupational exposure as defined by paragraph (b) of this section shall
establish a written Exposure Control Plan designed to eliminate or minimize employee exposure.
1910.1030(c)(1)(ii)The Exposure Control Plan shall contain at least the following
requirements:1910.1030(c)(1)(ii)(A)The exposure determination required by paragraph
(c)(2),..1910.1030(c)(1)(ii)(B)1910.1030(c)(1)(ii)(B)The schedule and method of implementation for
paragraphs (d) Methods of Compliance, (e) HIV and HBV Research Laboratories and Production Facilities, (f)
Hepatitis B Vaccination and Post-Exposure Evaluation and Follow-up, (g) Communication of Hazards to Employees,
and (h) Recordkeeping, of this standard, and1910.1030(c)(1)(ii)(C)The procedure for the evaluation of
circumstances surrounding exposure incidents as required by paragraph (f)(3)(i) of this
standard.1910.1030(c)(1)(iii)Each employer shall ensure that a copy of the Exposure Control Plan is
accessible to employees in accordance with 29 CFR 1910.1020(e).
1910.1030(c)(1)(iv)The Exposure Control Plan shall be reviewed and updated at least annually and whenever
necessary to reflect new or modified tasks and procedures which affect occupational exposure and to reflect new or
revised employee positions with occupational exposure. The review and update of such plans shall also:
1910.1030(c)(1)(iv)(A)Reflect changes in technology that eliminate or reduce exposure to bloodborne
pathogens; and
1910.1030(c)(1)(iv)(B)Document annually consideration and implementation of appropriate commercially
available and effective safer medical devices designed to eliminate or minimize occupational exposure.



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1910.1030(c)(1)(v)An employer, who is required to establish an Exposure Control Plan shall solicit input from
non-managerial employees responsible for direct patient care who are potentially exposed to injuries from
contaminated sharps in the identification, evaluation, and selection of effective engineering and work practice controls
and shall document the solicitation in the Exposure Control Plan.1910.1030(c)(1)(vi)The Exposure Control
Plan shall be made available to the Assistant Secretary and the Director upon request for examination and copying.
1910.1030(c)(2)Exposure Determination.
1910.1030(c)(2)(i)Each employer who has an employee(s) with occupational exposure as defined by
paragraph (b) of this section shall prepare an exposure determination. This exposure determination shall contain the
following:1910.1030(c)(2)(i)(A)A list of all job classifications in which all employees in those job
classifications have occupational exposure;..1910.1030(c)(2)(i)(B)1910.1030(c)(2)(i)(B)A list of job
classifications in which some employees have occupational exposure, and1910.1030(c)(2)(i)(C)A list of all
tasks and procedures or groups of closely related task and procedures in which occupational exposure occurs and that
are performed by employees in job classifications listed in accordance with the provisions of paragraph (c)(2)(i)(B of
this standard.1910.1030(c)(2)(ii)This exposure determination shall be made without regard to the use of
personal protective equipment.1910.1030(d)Methods of Compliance --
1910.1030(d)(1)General. Universal precautions shall be observed to prevent contact with blood or other
potentially infectious materials. Under circumstances in which differentiation between body fluid types is difficult or
impossible, all body fluids shall be considered potentially infectious materials.
1910.1030(d)(2)Engineering and Work Practice Controls
1910.1030(d)(2)(i)Engineering and work practice controls shall be used to eliminate or minimize employee
exposure. Where occupational exposure remains after institution of these controls, personal protective equipment shall
also     beused...1910.1030(d)(2)(ii)1910.1030(d)(2)(ii)Engineering controls shall be examined and
maintained or replaced on a regular schedule to ensure their effectiveness.
1910.1030(d)(2)(iii)Employers shall provide handwashing facilities which are readily accessible to
employees.1910.1030(d)(2)(iv)When provision of handwashing facilities is not feasible, the employer shall
provide either an appropriate antiseptic hand cleanser in conjunction with clean cloth/paper towels or antiseptic
towelettes. When antiseptic hand cleansers or towelettes are used, hands shall be washed with soap and running water
as soon as feasible.
1910.1030(d)(2)(v)Employers shall ensure that employees wash their hands immediately or as soon as
feasible after removal of gloves or other personal protective equipment.
1910.1030(d)(2)(vi)Employers shall ensure that employees wash hands and any other skin with soap and
water, or flush mucous membranes with water immediately or as soon as feasible following contact of such body areas
with blood or other potentially infectious materials.
1910.1030(d)(2)(vii)Contaminated needles and other contaminated sharps shall not be bent, recapped, or
removed except as noted in paragraphs (d)(2)(vii)(A) and (d)(2)(vii)(B) below. Shearing or breaking of contaminated
needles is prohibited...1910.1030(d)(2)(vii)(A)
1910.1030(d)(2)(vii)(A)Contaminated needles and other contaminated sharps shall not be bent, recapped or
removed unless the employer can demonstrate that no alternative is feasible or that such action is required by a specific
medical or dental procedure.
1910.1030(d)(2)(vii)(B)Such bending, recapping or needle removal must be accomplished through the use
of a mechanical device or a one-handed technique.
1910.1030(d)(2)(viii)Immediately or as soon as possible after use, contaminated reusable sharps shall be
placed in appropriate containers until properly reprocessed. These containers shall
be:1910.1030(d)(2)(viii)(A)Puncture resistant;1910.1030(d)(2)(viii)(B)Labeled or color-coded in
accordance with this standard;1910.1030(d)(2)(viii)(C)Leakproof on the sides and bottom;
and1910.1030(d)(2)(viii)(D)In accordance with the requirements set forth in paragraph (d)(4)(ii)(E) for
reusable sharps.
1910.1030(d)(2)(ix)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.1910.1030(d)(2)(x)Food and drink shall not be kept in refrigerators, freezers, shelves, cabinets or on
countertops or benchtops where blood or other potentially infectious materials are present...1910.1030(d)(2)(xi)
1910.1030(d)(2)(xi)All procedures involving blood or other potentially infectious materials shall be
performed in such a manner as to minimize splashing, spraying, spattering, and generation of droplets of these
substances.1910.1030(d)(2)(xii)Mouth pipetting/suctioning of blood or other potentially infectious materials



                                                                                                           9
is prohibited.
1910.1030(d)(2)(xiii)Specimens of blood or other potentially infectious materials shall be placed in a
container which prevents leakage during collection, handling, processing, storage, transport, or
shipping.1910.1030(d)(2)(xiii)(A)The container for storage, transport, or shipping shall be labeled or color-
coded according to paragraph (g)(1)(i) and closed prior to being stored, transported, or shipped. When a facility utilizes
Universal Precautions in the handling of all specimens, the labeling/color-coding of specimens is not necessary
provided containers are recognizable as containing specimens. This exemption only applies while such
specimens/containers remain within the facility. Labeling or color-coding in accordance with paragraph (g)(1)(i) is
required when such specimens/containers leave the facility.1910.1030(d)(2)(xiii)(B)If outside contamination
of the primary container occurs, the primary container shall be placed within a second container which prevents
leakage during handling, processing, storage, transport, or shipping and is labeled or color-coded according to the
requirements of this standard...1910.1030(d)(2)(xiii)(C)1910.1030(d)(2)(xiii)(C)If the specimen could
puncture the primary container, the primary container shall be placed within a secondary container which is puncture-
resistant in addition to the above characteristics.
1910.1030(d)(2)(xiv)Equipment which may become contaminated with blood or other potentially infectious
materials shall be examined prior to servicing or shipping and shall be decontaminated as necessary, unless the
employer can demonstrate that decontamination of such equipment or portions of such equipment is not
feasible.1910.1030(d)(2)(xiv)(A)A readily observable label in accordance with paragraph (g)(1)(i)(H) shall
be attached to the equipment stating which portions remain contaminated.1910.1030(d)(2)(xiv)(B)The
employer shall ensure that this information is conveyed to all affected employees, the servicing representative, and/or
the manufacturer, as appropriate, prior to handling, servicing, or shipping so that appropriate precautions will be taken.
1910.1030(d)(3)Personal Protective Equipment --
1910.1030(d)(3)(i)Provision. When there is occupational exposure, the employer shall provide, at no cost to
the employee, appropriate personal protective equipment such as, but not limited to, gloves, gowns, laboratory coats,
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.1910.1030(d)(3)(ii)Use. The employer shall ensure that the employee uses
appropriate personal protective equipment unless the employer shows that the employee temporarily and briefly
declined to use personal protective equipment when, under rare and extraordinary circumstances, it was the employee's
professional judgment that in the specific instance its use would have prevented the delivery of health care or public
safety services or would have posed an increased hazard to the safety of the worker or co-worker. When the employee
makes this judgement, the circumstances shall be investigated and documented in order to determine whether changes
can be instituted to prevent such occurrences in the future.
1910.1030(d)(3)(iii)Accessibility. The employer shall ensure that appropriate personal protective equipment
in the appropriate sizes is readily accessible at the worksite or is issued to employees. Hypoallergenic gloves, glove
liners, powderless gloves, or other similar alternatives shall be readily accessible to those employees who are allergic
to the gloves normally provided.1910.1030(d)(3)(iv)Cleaning, Laundering, and Disposal. The employer
shall clean, launder, and dispose of personal protective equipment required by paragraphs (d) and (e) of this standard,
at no cost to the employee...1910.1030(d)(3)(v)1910.1030(d)(3)(v)Repair and Replacement. The employer
shall repair or replace personal protective equipment as needed to maintain its effectiveness, at no cost to the
employee.1910.1030(d)(3)(vi)If a garment(s) is penetrated by blood or other potentially infectious materials,
the garment(s) shall be removed immediately or as soon as feasible.1910.1030(d)(3)(vii)All personal
protective equipment shall be removed prior to leaving the work area.1910.1030(d)(3)(viii)When personal
protective equipment is removed it shall be placed in an appropriately designated area or container for storage,
washing, decontamination or disposal.1910.1030(d)(3)(ix)Gloves. Gloves shall be worn when it can be
reasonably anticipated that the employee may have hand contact with blood, other potentially infectious materials,
mucous membranes, and non-intact skin; when performing vascular access procedures except as specified in paragraph
(d)(3)(ix)(D); and when handling or touching contaminated items or
surfaces.1910.1030(d)(3)(ix)(A)Disposable (single use) gloves such as surgical or examination gloves, shall
be replaced as soon as practical when contaminated or as soon as feasible if they are torn, punctured, or when their
ability to function as a barrier is compromised...1910.1030(d)(3)(ix)(B)1910.1030(d)(3)(ix)(B)Disposable
(single use) gloves shall not be washed or decontaminated for re-use.1910.1030(d)(3)(ix)(C)Utility gloves
may be decontaminated for re-use if the integrity of the glove is not compromised. However, they must be discarded if


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they are cracked, peeling, torn, punctured, or exhibit other signs of deterioration or when their ability to function as a
barrier is compromised.1910.1030(d)(3)(ix)(D)If an employer in a volunteer blood donation center judges
that routine gloving for all phlebotomies is not necessary then the employer
shall:1910.1030(d)(3)(ix)(D)(1)Periodically reevaluate this
policy;1910.1030(d)(3)(ix)(D)(2)Make gloves available to all employees who wish to use them for
phlebotomy;1910.1030(d)(3)(ix)(D)(3)Not discourage the use of gloves for phlebotomy;
and1910.1030(d)(3)(ix)(D)(4)Require that gloves be used for phlebotomy in the following
circumstances:1910.1030(d)(3)(ix)(D)(4)(i)When the employee has cuts, scratches, or other breaks in his
or her skin;1910.1030(d)(3)(ix)(D)(4)(ii)When the employee judges that hand contamination with blood
may occur, for example, when performing phlebotomy on an uncooperative source individual;
and1910.1030(d)(3)(ix)(D)(4)(iii)When the employee is receiving training in
phlebotomy...1910.1030(d)(3)(x)1910.1030(d)(3)(x)Masks, Eye Protection, and Face Shields. Masks in
combination with eye protection devices, such as goggles or glasses with solid side shields, or chin-length face shields,
shall be worn whenever splashes, spray, spatter, or droplets of blood or other potentially infectious materials may be
generated and eye, nose, or mouth contamination can be reasonably anticipated.1910.1030(d)(3)(xi)Gowns,
Aprons, and Other Protective Body Clothing. Appropriate protective clothing such as, but not limited to, gowns,
aprons, lab coats, clinic jackets, or similar outer garments shall be worn in occupational exposure situations. The type
and characteristics will depend upon the task and degree of exposure anticipated.1910.1030(d)(3)(xii)Surgical
caps or hoods and/or shoe covers or boots shall be worn in instances when gross contamination can reasonably be
anticipated (e.g., autopsies, orthopaedic surgery).1910.1030(d)(4)Housekeeping --
1910.1030(d)(4)(i)General. Employers shall ensure that the worksite is maintained in a clean and sanitary
condition. The employer shall determine and implement an appropriate written schedule for cleaning and method of
decontamination based upon the location within the facility, type of surface to be cleaned, type of soil present, and
tasks or procedures being performed in the area.
1910.1030(d)(4)(ii)All equipment and environmental and working surfaces shall be cleaned and
decontaminated after contact with blood or other potentially infectious materials...1910.1030(d)(4)(ii)(A)
1910.1030(d)(4)(ii)(A)Contaminated work surfaces shall be decontaminated with an appropriate disinfectant
after completion of procedures; immediately or as soon as feasible when surfaces are overtly contaminated or after any
spill of blood or other potentially infectious materials; and at the end of the work shift if the surface may have become
contaminated since the last cleaning.1910.1030(d)(4)(ii)(B)Protective coverings, such as plastic wrap,
aluminum foil, or imperviously-backed absorbent paper used to cover equipment and environmental surfaces, shall be
removed and replaced as soon as feasible when they become overtly contaminated or at the end of the workshift if they
may have become contaminated during the shift.1910.1030(d)(4)(ii)(C)All bins, pails, cans, and similar
receptacles intended for reuse which have a reasonable likelihood for becoming contaminated with blood or other
potentially infectious materials shall be inspected and decontaminated on a regularly scheduled basis and cleaned and
decontaminated immediately or as soon as feasible upon visible
contamination.1910.1030(d)(4)(ii)(D)Broken glassware which may be contaminated shall not be picked up
directly with the hands. It shall be cleaned up using mechanical means, such as a brush and dust pan, tongs, or
forceps.1910.1030(d)(4)(ii)(E)Reusable sharps that are contaminated with blood or other potentially
infectious materials shall not be stored or processed in a manner that requires employees to reach by hand into the
containers where these sharps have been placed.
1910.1030(d)(4)(iii)Regulated Waste --
..1910.1030(d)(4)(iii)(A)1910.1030(d)(4)(iii)(A)Contaminated Sharps Discarding and Containment.
1910.1030(d)(4)(iii)(A)(1)Contaminated sharps shall be discarded immediately or as soon as feasible in
containers that
are:1910.1030(d)(4)(iii)(A)(1)(i)Closable;1910.1030(d)(4)(iii)(A)(1)(ii)Puncture
resistant;1910.1030(d)(4)(iii)(A)(1)(iii)Leakproof on sides and bottom;
and1910.1030(d)(4)(iii)(A)(1)(iv)Labeled or color-coded in accordance with paragraph (g)(1)(i) of this
standard.1910.1030(d)(4)(iii)(A)(2)During use, containers for contaminated sharps shall be:
1910.1030(d)(4)(iii)(A)(2)(i)Easily accessible to personnel and located as close as is feasible to the
immediate area where sharps are used or can be reasonably anticipated to be found (e.g.,
laundries);1910.1030(d)(4)(iii)(A)(2)(ii)Maintained upright throughout use;
and1910.1030(d)(4)(iii)(A)(2)(iii)Replaced routinely and not be allowed to
overfill.1910.1030(d)(4)(iii)(A)(3)When moving containers of contaminated sharps from the area of use,



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the containers shall be:1910.1030(d)(4)(iii)(A)(3)(i)Closed immediately prior to removal or replacement
to prevent spillage or protrusion of contents during handling, storage, transport, or
shipping;1910.1030(d)(4)(iii)(A)(3)(ii)Placed in a secondary container if leakage is possible. The second
container shall
be:1910.1030(d)(4)(iii)(A)(3)(ii)(A)Closable;1910.1030(d)(4)(iii)(A)(3)(ii)(B)Constructed
to contain all contents and prevent leakage during handling, storage, transport, or shipping;
and1910.1030(d)(4)(iii)(A)(3)(ii)(C)Labeled or color-coded according to paragraph (g)(1)(i) of this
standard.
1910.1030(d)(4)(iii)(A)(4)Reusable containers shall not be opened, emptied, or cleaned manually or in any
other manner which would expose employees to the risk of percutaneous injury.
1910.1030(d)(4)(iii)(B)Other Regulated Waste Containment --
910.1030(d)(4)(iii)(B)(1)Regulated waste shall be placed in containers which
are:1910.1030(d)(4)(iii)(B)(1)(i)Closable;1910.1030(d)(4)(iii)(B)(1)(ii)Constructed to
contain all contents and prevent leakage of fluids during handling, storage, transport or
shipping;1910.1030(d)(4)(iii)(B)(1)(iii)Labeled or color-coded in accordance with paragraph (g)(1)(i) this
standard; and1910.1030(d)(4)(iii)(B)(1)(iv)Closed prior to removal to prevent spillage or protrusion of
contents during handling, storage, transport, or shipping.1910.1030(d)(4)(iii)(B)(2)If outside contamination
of the regulated waste container occurs, it shall be placed in a second container. The second container shall
be:1910.1030(d)(4)(iii)(B)(2)(i)Closable;1910.1030(d)(4)(iii)(B)(2)(ii)Constructed to
contain all contents and prevent leakage of fluids during handling, storage, transport or
shipping;1910.1030(d)(4)(iii)(B)(2)(iii)Labeled or color-coded in accordance with paragraph (g)(1)(i) of
this standard; and1910.1030(d)(4)(iii)(B)(2)(iv)Closed prior to removal to prevent spillage or protrusion
of contents during handling, storage, transport, or shipping.
1910.1030(d)(4)(iii)(C)Disposal of all regulated waste shall be in accordance with applicable regulations of
the United States, States and Territories, and political subdivisions of States and Territories...1910.1030(d)(4)(iv)
1910.1030(d)(4)(iv)Laundry.
1910.1030(d)(4)(iv)(A)Contaminated laundry shall be handled as little as possible with a minimum of
agitation.
1910.1030(d)(4)(iv)(A)(1)Contaminated laundry shall be bagged or containerized at the location where it
was used and shall not be sorted or rinsed in the location of use.1910.1030(d)(4)(iv)(A)(2)Contaminated
laundry shall be placed and transported in bags or containers labeled or color-coded in accordance with paragraph
(g)(1)(i) of this standard. When a facility utilizes Universal Precautions in the handling of all soiled laundry, alternative
labeling or color-coding is sufficient if it permits all employees to recognize the containers as requiring compliance
with Universal Precautions.1910.1030(d)(4)(iv)(A)(3)Whenever contaminated laundry is wet and presents
a reasonable likelihood of soak-through of or leakage from the bag or container, the laundry shall be placed and
transported in bags or containers which prevent soak-through and/or leakage of fluids to the
exterior.1910.1030(d)(4)(iv)(B)The employer shall ensure that employees who have contact with
contaminated laundry wear protective gloves and other appropriate personal protective
equipment...1910.1030(d)(4)(iv)(C)1910.1030(d)(4)(iv)(C)When a facility ships contaminated laundry off-
site to a second facility which does not utilize Universal Precautions in the handling of all laundry, the facility
generating the contaminated laundry must place such laundry in bags or containers which are labeled or color-coded in
accordance with paragraph (g)(1)(i).
1910.1030(e)HIV and HBV Research Laboratories and Production Facilities.1910.1030(e)(1)This
paragraph applies to research laboratories and production facilities engaged in the culture, production, concentration,
experimentation, and manipulation of HIV and HBV. It does not apply to clinical or diagnostic laboratories engaged
solely in the analysis of blood, tissues, or organs. These requirements apply in addition to the other requirements of the
standard.1910.1030(e)(2) Research laboratories and production facilities shall meet the following
criteria:1910.1030(e)(2)(i)Standard Microbiological Practices. All regulated waste shall either be
incinerated or decontaminated by a method such as autoclaving known to effectively destroy bloodborne
pathogens.1910.1030(e)(2)(ii)Special Practices.1910.1030(e)(2)(ii)(A)Laboratory doors shall be
kept closed when work involving HIV or HBV is in progress...1910.1030(e)(2)(ii)(B)
1910.1030(e)(2)(ii)(B)Contaminated materials that are to be decontaminated at a site away from the work
area shall be placed in a durable, leakproof, labeled or color-coded container that is closed before being removed from
the work area1910.1030(e)(2)(ii)(C)Access to the work area shall be limited to authorized persons. Written



                                                                                                             12
policies and procedures shall be established whereby only persons who have been advised of the potential biohazard,
who meet any specific entry requirements, and who comply with all entry and exit procedures shall be allowed to enter
the work areas and animal rooms.1910.1030(e)(2)(ii)(D)When other potentially infectious materials or
infected animals are present in the work area or containment module, a hazard warning sign incorporating the universal
biohazard symbol shall be posted on all access doors. The hazard warning sign shall comply with paragraph (g)(1)(ii)
of this standard.1910.1030(e)(2)(ii)(E)All activities involving other potentially infectious materials shall be
conducted in biological safety cabinets or other physical-containment devices within the containment module. No work
with these other potentially infectious materials shall be conducted on the open
bench.1910.1030(e)(2)(ii)(F)Laboratory coats, gowns, smocks, uniforms, or other appropriate protective
clothing shall be used in the work area and animal rooms. Protective clothing shall not be worn outside of the work
area and shall be decontaminated before being
laundered...1910.1030(e)(2)(ii)(G)1910.1030(e)(2)(ii)(G)Special care shall be taken to avoid skin contact
with other potentially infectious materials. Gloves shall be worn when handling infected animals and when making
hand contact with other potentially infectious materials is unavoidable.1910.1030(e)(2)(ii)(H)Before disposal
all waste from work areas and from animal rooms shall either be incinerated or decontaminated by a method such as
autoclaving known to effectively destroy bloodborne pathogens.1910.1030(e)(2)(ii)(I)Vacuum lines shall be
protected with liquid disinfectant traps and high-efficiency particulate air (HEPA) filters or filters of equivalent or
superior efficiency and which are checked routinely and maintained or replaced as
necessary.1910.1030(e)(2)(ii)(J)Hypodermic needles and syringes shall be used only for parenteral injection
and aspiration of fluids from laboratory animals and diaphragm bottles. Only needle-locking syringes or disposable
syringe-needle units (i.e., the needle is integral to the syringe) shall be used for the injection or aspiration of other
potentially infectious materials. Extreme caution shall be used when handling needles and syringes. A needle shall not
be bent, sheared, replaced in the sheath or guard, or removed from the syringe following use. The needle and syringe
shall be promptly placed in a puncture-resistant container and autoclaved or decontaminated before reuse or
disposal.1910.1030(e)(2)(ii)(K)All spills shall be immediately contained and cleaned up by appropriate
professional staff or others properly trained and equipped to work with potentially concentrated infectious
materials...1910.1030(e)(2)(ii)(L)1910.1030(e)(2)(ii)(L)A spill or accident that results in an exposure
incident shall be immediately reported to the laboratory director or other responsible
person.1910.1030(e)(2)(ii)(M)A biosafety manual shall be prepared or adopted and periodically reviewed
and updated at least annually or more often if necessary. Personnel shall be advised of potential hazards, shall be
required to read instructions on practices and procedures, and shall be required to follow
them.1910.1030(e)(2)(iii)Containment Equipment.1910.1030(e)(2)(iii)(A)Certified biological
safety cabinets (Class I, II, or III) or other appropriate combinations of personal protection or physical containment
devices, such as special protective clothing, respirators, centrifuge safety cups, sealed centrifuge rotors, and
containment caging for animals, shall be used for all activities with other potentially infectious materials that pose a
threat of exposure to droplets, splashes, spills, or aerosols.1910.1030(e)(2)(iii)(B)Biological safety cabinets
shall be certified when installed, whenever they are moved and at least annually.1910.1030(e)(3)HIV and HBV
research laboratories shall meet the following criteria:..1910.1030(e)(3)(i)1910.1030(e)(3)(i)Each laboratory
shall contain a facility for hand washing and an eye wash facility which is readily available within the work
area.1910.1030(e)(3)(ii)An autoclave for decontamination of regulated waste shall be
available.1910.1030(e)(4)HIV and HBV production facilities shall meet the following
criteria:1910.1030(e)(4)(i)The work areas shall be separated from areas that are open to unrestricted traffic
flow within the building. Passage through two sets of doors shall be the basic requirement for entry into the work area
from access corridors or other contiguous areas. Physical separation of the high-containment work area from access
corridors or other areas or activities may also be provided by a double-doored clothes-change room (showers may be
included), airlock, or other access facility that requires passing through two sets of doors before entering the work
area.1910.1030(e)(4)(ii)The surfaces of doors, walls, floors and ceilings in the work area shall be water
resistant so that they can be easily cleaned. Penetrations in these surfaces shall be sealed or capable of being sealed to
facilitate decontamination...1910.1030(e)(4)(iii)1910.1030(e)(4)(iii)Each work area shall contain a sink for
washing hands and a readily available eye wash facility. The sink shall be foot, elbow, or automatically operated and
shall be located near the exit door of the work area.1910.1030(e)(4)(iv)Access doors to the work area or
containment module shall be self-closing.1910.1030(e)(4)(v)An autoclave for decontamination of regulated
waste shall be available within or as near as possible to the work area.1910.1030(e)(4)(vi)A ducted exhaust-
air ventilation system shall be provided. This system shall create directional airflow that draws air into the work area



                                                                                                           13
through the entry area. The exhaust air shall not be recirculated to any other area of the building, shall be discharged to
the outside, and shall be dispersed away from occupied areas and air intakes. The proper direction of the airflow shall
be verified (i.e., into the work area).1910.1030(e)(5)Training Requirements. Additional training requirements
for employees in HIV and HBV research laboratories and HIV and HBV production facilities are specified in
paragraph (g)(2)(ix).
1910.1030(f)Hepatitis B Vaccination and Post-exposure Evaluation and Follow-up --..1910.1030(f)(1)
1910.1030(f)(1)General.
1910.1030(f)(1)(i)The employer shall make available the hepatitis B vaccine and vaccination series to all
employees who have occupational exposure, and post-exposure evaluation and follow-up to all employees who have
had an exposure incident.
1910.1030(f)(1)(ii)The employer shall ensure that all medical evaluations and procedures including the
hepatitis B vaccine and vaccination series and post-exposure evaluation and follow-up, including prophylaxis,
are:1910.1030(f)(1)(ii)(A)Made available at no cost to the employee;1910.1030(f)(1)(ii)(B)Made
available to the employee at a reasonable time and place;1910.1030(f)(1)(ii)(C)Performed by or under the
supervision of a licensed physician or by or under the supervision of another licensed healthcare professional; and
1910.1030(f)(1)(ii)(D)Provided according to recommendations of the U.S. Public Health Service current at
the time these evaluations and procedures take place, except as specified by this paragraph
(f).1910.1030(f)(1)(iii)The employer shall ensure that all laboratory tests are conducted by an accredited
laboratory at no cost to the employee...1910.1030(f)(2)
1910.1030(f)(2)Hepatitis B Vaccination.1910.1030(f)(2)(i)Hepatitis B vaccination shall be made
available after the employee has received the training required in paragraph (g)(2)(vii)(I) and within 10 working days
of initial assignment to all employees who have occupational exposure unless the employee has previously received the
complete hepatitis B vaccination series, antibody testing has revealed that the employee is immune, or the vaccine is
contraindicated for medical reasons.1910.1030(f)(2)(ii)The employer shall not make participation in a
prescreening program a prerequisite for receiving hepatitis B vaccination.1910.1030(f)(2)(iii)If the employee
initially declines hepatitis B vaccination but at a later date while still covered under the standard decides to accept the
vaccination, the employer shall make available hepatitis B vaccination at that time.1910.1030(f)(2)(iv)The
employer shall assure that employees who decline to accept hepatitis B vaccination offered by the employer sign the
statement in Appendix A.
1910.1030(f)(2)(v)If a routine booster dose(s) of hepatitis B vaccine is recommended by the U.S. Public
Health Service at a future date, such booster dose(s) shall be made available in accordance with section (f)(1)(ii).
1910.1030(f)(3)Post-exposure Evaluation and Follow-up. Following a report of an exposure incident, the
employer shall make immediately available to the exposed employee a confidential medical evaluation and follow-up,
including at least the following elements:1910.1030(f)(3)(i)Documentation of the route(s) of exposure, and the
circumstances under which the exposure incident
occurred;..1910.1030(f)(3)(ii)1910.1030(f)(3)(ii)Identification and documentation of the source individual,
unless the employer can establish that identification is infeasible or prohibited by state or local
law;1910.1030(f)(3)(ii)(A)The source individual's blood shall be tested as soon as feasible and after consent
is obtained in order to determine HBV and HIV infectivity. If consent is not obtained, the employer shall establish that
legally required consent cannot be obtained. When the source individual's consent is not required by law, the source
individual's blood, if available, shall be tested and the results documented.1910.1030(f)(3)(ii)(B)When the
source individual is already known to be infected with HBV or HIV, testing for the source individual's known HBV or
HIV status need not be repeated.1910.1030(f)(3)(ii)(C)Results of the source individual's testing shall be made
available to the exposed employee, and the employee shall be informed of applicable laws and regulations concerning
disclosure of the identity and infectious status of the source individual.1910.1030(f)(3)(iii)Collection and
testing of blood for HBV and HIV serological status;1910.1030(f)(3)(iii)(A)The exposed employee's blood
shall be collected as soon as feasible and tested after consent is
obtained...1910.1030(f)(3)(iii)(B)1910.1030(f)(3)(iii)(B)If the employee consents to baseline blood
collection, but does not give consent at that time for HIV serologic testing, the sample shall be preserved for at least 90
days. If, within 90 days of the exposure incident, the employee elects to have the baseline sample tested, such testing
shall be done as soon as feasible.1910.1030(f)(3)(iv)Post-exposure prophylaxis, when medically indicated, as
recommended by the U.S. Public Health Service;1910.1030(f)(3)(v)Counseling;
and1910.1030(f)(3)(vi)Evaluation of reported illnesses.1910.1030(f)(4)Information Provided to the
Healthcare Professional.1910.1030(f)(4)(i)The employer shall ensure that the healthcare professional



                                                                                                           14
responsible for the employee's Hepatitis B vaccination is provided a copy of this
regulation.1910.1030(f)(4)(ii)The employer shall ensure that the healthcare professional evaluating an
employee after an exposure incident is provided the following information:1910.1030(f)(4)(ii)(A)A copy of
this regulation;1910.1030(f)(4)(ii)(B)A description of the exposed employee's duties as they relate to the
exposure incident;1910.1030(f)(4)(ii)(C)Documentation of the route(s) of exposure and circumstances under
which exposure occurred;..1910.1030(f)(4)(ii)(D)1910.1030(f)(4)(ii)(D)Results of the source individual's
blood testing, if available; and1910.1030(f)(4)(ii)(E)All medical records relevant to the appropriate treatment
of the employee including vaccination status which are the employer's responsibility to maintain.
1910.1030(f)(5)Healthcare Professional's Written Opinion. The employer shall obtain and provide the
employee with a copy of the evaluating healthcare professional's written opinion within 15 days of the completion of
the evaluation.1910.1030(f)(5)(i)The healthcare professional's written opinion for Hepatitis B vaccination shall
be limited to whether Hepatitis B vaccination is indicated for an employee, and if the employee has received such
vaccination.1910.1030(f)(5)(ii)The healthcare professional's written opinion for post-exposure evaluation and
follow-up shall be limited to the following information:1910.1030(f)(5)(ii)(A)That the employee has been
informed of the results of the evaluation; and1910.1030(f)(5)(ii)(B)That 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...1910.1030(f)(5)(iii)1910.1030(f)(5)(iii)All other findings or diagnoses shall remain
confidential and shall not be included in the written report.1910.1030(f)(6)Medical Recordkeeping. Medical
records required by this standard shall be maintained in accordance with paragraph (h)(1) of this
section.1910.1030(g)Communication of Hazards to Employees --
1910.1030(g)(1)Labels and Signs --
1910.1030(g)(1)(i)Labels.1910.1030(g)(1)(i)(A)Warning labels shall be affixed to containers of
regulated waste, refrigerators and freezers containing blood or other potentially infectious material; and other
containers used to store, transport or ship blood or other potentially infectious materials, except as provided in
paragraph (g)(1)(i)(E), (F) and (G).1910.1030(g)(1)(i)(B)Labels required by this section shall include the
following legend:




1910.1030(g)(1)(i)(C)These labels shall be fluorescent orange or orange-red or
predominantly so, with lettering and symbols in a contrasting
color.1910.1030(g)(1)(i)(D)Labels shall be affixed as close as feasible to the container by
string, wire, adhesive, or other method that prevents their loss or unintentional
removal...1910.1030(g)(1)(i)(E)1910.1030(g)(1)(i)(E)Red bags or red containers may be
substituted for labels.1910.1030(g)(1)(i)(F)Containers of blood, blood components, or
blood products that are labeled as to their contents and have been released for transfusion or other
clinical use are exempted from the labeling requirements of paragraph
(g).1910.1030(g)(1)(i)(G)Individual containers of blood or other potentially infectious
materials that are placed in a labeled container during storage, transport, shipment or disposal are
exempted from the labeling requirement.
1910.1030(g)(1)(i)(H)Labels required for contaminated equipment shall be in accordance with


                                                                                                        15
this paragraph and shall also state which portions of the equipment remain
contaminated.1910.1030(g)(1)(i)(I)Regulated waste that has been decontaminated need not be labeled or
color-coded.1910.1030(g)(1)(ii)Signs.1910.1030(g)(1)(ii)(A)The employer shall post signs at the
entrance to work areas specified in paragraph (e), HIV and HBV Research Laboratory and Production Facilities, which
shall bear the following legend:




(Name of the Infectious Agent)
(Special requirements for entering the area)
(Name, telephone number of the laboratory director or other responsible person.)

..1910.1030(g)(1)(ii)(B)1910.1030(g)(1)(ii)(B)These signs shall be fluorescent orange-red or
predominantly so, with lettering and symbols in a contrasting color.
1910.1030(g)(2)Information and Training.1910.1030(g)(2)(i)Employers shall ensure that all
employees with occupational exposure participate in a training program which must be provided at no cost to the
employee and during working hours.1910.1030(g)(2)(ii)Training shall be provided as
follows:1910.1030(g)(2)(ii)(A)At the time of initial assignment to tasks where occupational exposure may
take place;1910.1030(g)(2)(ii)(B)Within 90 days after the effective date of the standard;
and1910.1030(g)(2)(ii)(C)At least annually thereafter.1910.1030(g)(2)(iii)For employees who have
received training on bloodborne pathogens in the year preceding the effective date of the standard, only training with
respect to the provisions of the standard which were not included need be
provided.1910.1030(g)(2)(iv)Annual training for all employees shall be provided within one year of their
previous training...1910.1030(g)(2)(v)1910.1030(g)(2)(v)Employers shall provide additional training when


                                                                                                        16
changes such as modification of tasks or procedures or institution of new tasks or procedures affect the employee's
occupational exposure. The additional training may be limited to addressing the new exposures
created.1910.1030(g)(2)(vi)Material appropriate in content and vocabulary to educational level, literacy, and
language of employees shall be used.1910.1030(g)(2)(vii)The training program shall contain at a minimum
the following elements:1910.1030(g)(2)(vii)(A)An accessible copy of the regulatory text of this standard and
an explanation of its contents;1910.1030(g)(2)(vii)(B)A general explanation of the epidemiology and
symptoms of bloodborne diseases;1910.1030(g)(2)(vii)(C)An explanation of the modes of transmission of
bloodborne pathogens;1910.1030(g)(2)(vii)(D)An explanation of the employer's exposure control plan and
the means by which the employee can obtain a copy of the written plan;1910.1030(g)(2)(vii)(E)An
explanation of the appropriate methods for recognizing tasks and other activities that may involve exposure to blood
and other potentially infectious materials;..1910.1030(g)(2)(vii)(F)1910.1030(g)(2)(vii)(F)An explanation of
the use and limitations of methods that will prevent or reduce exposure including appropriate engineering controls,
work practices, and personal protective equipment;1910.1030(g)(2)(vii)(G)Information on the types, proper
use, location, removal, handling, decontamination and disposal of personal protective
equipment;1910.1030(g)(2)(vii)(H)An explanation of the basis for selection of personal protective
equipment;1910.1030(g)(2)(vii)(I)Information on the hepatitis B vaccine, including information on its
efficacy, safety, method of administration, the benefits of being vaccinated, and that the vaccine and vaccination will
be offered free of charge;1910.1030(g)(2)(vii)(J)Information on the appropriate actions to take and persons
to contact in an emergency involving blood or other potentially infectious
materials;1910.1030(g)(2)(vii)(K)An explanation of the procedure to follow if an exposure incident occurs,
including the method of reporting the incident and the medical follow-up that will be made
available;1910.1030(g)(2)(vii)(L)Information on the post-exposure evaluation and follow-up that the
employer is required to provide for the employee following an exposure
incident;..1910.1030(g)(2)(vii)(M)1910.1030(g)(2)(vii)(M)An explanation of the signs and labels and/or
color coding required by paragraph (g)(1); and
1910.1030(g)(2)(vii)(N)An opportunity for interactive questions and answers with the person conducting the
training session.
1910.1030(g)(2)(viii)The person conducting the training shall be knowledgeable in the subject matter covered
by the elements contained in the training program as it relates to the workplace that the training will
address.1910.1030(g)(2)(ix)Additional Initial Training for Employees in HIV and HBV Laboratories and
Production Facilities. Employees in HIV or HBV research laboratories and HIV or HBV production facilities shall
receive the following initial training in addition to the above training
requirements.1910.1030(g)(2)(ix)(A)The employer shall assure that employees demonstrate proficiency in
standard microbiological practices and techniques and in the practices and operations specific to the facility before
being allowed to work with HIV or HBV.1910.1030(g)(2)(ix)(B)The employer shall assure that employees
have prior experience in the handling of human pathogens or tissue cultures before working with HIV or
HBV...1910.1030(g)(2)(ix)(C)1910.1030(g)(2)(ix)(C)The employer shall provide a training program to
employees who have no prior experience in handling human pathogens. Initial work activities shall not include the
handling of infectious agents. A progression of work activities shall be assigned as techniques are learned and
proficiency is developed. The employer shall assure that employees participate in work activities involving infectious
agents only after proficiency has been demonstrated.
1910.1030(h)Recordkeeping --1910.1030(h)(1)Medical Records.1910.1030(h)(1)(i)The
employer shall establish and maintain an accurate record for each employee with occupational exposure, in accordance
with 29 CFR 1910.1020.1910.1030(h)(1)(ii)This record shall include:1910.1030(h)(1)(ii)(A)The
name and social security number of the employee;1910.1030(h)(1)(ii)(B)A copy of the employee's hepatitis
B vaccination status including the dates of all the hepatitis B vaccinations and any medical records relative to the
employee's ability to receive vaccination as required by paragraph (f)(2);1910.1030(h)(1)(ii)(C)A copy of all
results of examinations, medical testing, and follow-up procedures as required by paragraph
(f)(3);1910.1030(h)(1)(ii)(D)The employer's copy of the healthcare professional's written opinion as required
by paragraph (f)(5); and..1910.1030(h)(1)(ii)(E)1910.1030(h)(1)(ii)(E)A copy of the information provided to
the healthcare professional as required by paragraphs (f)(4)(ii)(B)(C) and
(D).1910.1030(h)(1)(iii)Confidentiality. The employer shall ensure that employee medical records required by
paragraph (h)(1) are:1910.1030(h)(1)(iii)(A)Kept confidential; and1910.1030(h)(1)(iii)(B)Not
disclosed or reported without the employee's express written consent to any person within or outside the workplace



                                                                                                        17
except as required by this section or as may be required by law.1910.1030(h)(1)(iv)The employer shall
maintain the records required by paragraph (h) for at least the duration of employment plus 30 years in accordance with
29 CFR 1910.1020.1910.1030(h)(2)Training Records.1910.1030(h)(2)(i)Training records shall
include the following information:1910.1030(h)(2)(i)(A)The dates of the training
sessions;1910.1030(h)(2)(i)(B)The contents or a summary of the training
sessions;1910.1030(h)(2)(i)(C)The names and qualifications of persons conducting the training;
and..1910.1030(h)(2)(i)(D)1910.1030(h)(2)(i)(D)The names and job titles of all persons attending the
training sessions.1910.1030(h)(2)(ii)Training records shall be maintained for 3 years from the date on which
the training occurred.1910.1030(h)(3)Availability.1910.1030(h)(3)(i)The employer shall ensure that
all records required to be maintained by this section shall be made available upon request to the Assistant Secretary and
the Director for examination and copying.
1910.1030(h)(3)(ii)Employee training records required by this paragraph shall be provided upon request for
examination and copying to employees, to employee representatives, to the Director, and to the Assistant Secretary.
1910.1030(h)(3)(iii)Employee medical records required by this paragraph shall be provided upon request for
examination and copying to the subject employee, to anyone having written consent of the subject employee, to the
Director, and to the Assistant Secretary in accordance with 29 CFR 1910.1020...1910.1030(h)(4)
1910.1030(h)(4)Transfer of Records.1910.1030(h)(4)(i)The employer shall comply with the
requirements involving transfer of records set forth in 29 CFR 1910.1020(h).1910.1030(h)(4)(ii)If the
employer ceases to do business and there is no successor employer to receive and retain the records for the prescribed
period, the employer shall notify the Director, at least three months prior to their disposal and transmit them to the
Director, if required by the Director to do so, within that three month period.1910.1030(h)(5)Sharps injury
log.1910.1030(h)(5)(i)The employer shall establish and maintain a sharps injury log for the recording of
percutaneous injuries from contaminated sharps. The information in the sharps injury log shall be recorded and
maintained in such manner as to protect the confidentiality of the injured employee. The sharps injury log shall contain,
at a minimum:
1910.1030(h)(5)(i)(A)The type and brand of device involved in the
incident,1910.1030(h)(5)(i)(B)The department or work area where the exposure incident occurred, and
1910.1030(h)(5)(i)(C)An explanation of how the incident occurred.1910.1030(h)(5)(ii)The
requirement to establish and maintain a sharps injury log shall apply to any employer who is required to maintain a log
of occupational injuries and illnesses under 29 CFR 1904.1910.1030(h)(5)(iii)The sharps injury log shall be
maintained for the period required by 29 CFR 1904.6.1910.1030(i)Dates --1910.1030(i)(1)Effective
Date. The standard shall become effective on March 6, 1992.1910.1030(i)(2)The Exposure Control Plan
required by paragraph (c) of this section shall be completed on or before May 5, 1992.1910.1030(i)(3)Paragraph
(g)(2) Information and Training and (h) Recordkeeping shall take effect on or before June 4,
1992.1910.1030(i)(4)Paragraphs (d)(2) Engineering and Work Practice Controls, (d)(3) Personal Protective
Equipment, (d)(4) Housekeeping, (e) HIV and HBV Research Laboratories and Production Facilities, (f) Hepatitis B
Vaccination and Post-Exposure Evaluation and Follow-up, and (g)(1) Labels and Signs, shall take effect July 6, 1992.

[56 FR 64004, Dec. 06, 1991, as amended at 57 FR 12717, April 13, 1992; 57 FR 29206, July 1, 1992; 61 FR 5507,
Feb. 13, 1996; 66 FR 5325 Jan., 18, 2001]




                                                                                                          18
Hepatitis B Vaccine Declination (Mandatory) - 1910.1030 App A

    Regulations (Standards - 29 CFR) - Table of Contents

•   Part Number:                          1910
•   Part Title:                           Occupational Safety and Health Standards
•   Subpart:                              Z
•   Subpart Title:                        Toxic and Hazardous Substances
•   Standard Number:                      1910.1030 App A
•   Title:                                Hepatitis B Vaccine Declination (Mandatory)


I understand that due to my occupational exposure to blood or other potentially infectious materials I may be at
risk of acquiring hepatitis B virus (HBV) infection. I have been given the opportunity to be vaccinated with
hepatitis B vaccine, at no charge to myself. However, I decline hepatitis B vaccination at this time. I understand
that by declining this vaccine, I continue to be at risk of acquiring hepatitis B, a serious disease. If in the future I
continue to have occupational exposure to blood or other potentially infectious materials and I want to be
vaccinated with hepatitis B vaccine, I can receive the vaccination series at no charge to me.

[56 FR 64004, Dec. 06, 1991, as amended at 57 FR 12717, April 13, 1992; 57 FR 29206, July 1, 1992; 61 FR
5507, Feb. 13, 1996]




                                                                                                                19
                    Gaston County Schools Policy
R 2.34      Bloodborne Pathogens

  I.     Purpose:
         The purpose of this policy is to limit occupational exposure of employees to
         blood and other potentially infectious body fluids and materials that may
         transmit bloodborne pathogens and lead to disease or death. All employees
         who could be “reasonably anticipated” as the result of performing required job
         duties to face contact with blood or other potentially infectious materials are
         covered by the OSHA Bloodborne Pathogens Standard and by this policy
         directive. “Occupational exposure” includes any reasonable anticipated skin,
         eye, mucous membrane, or parenteral (brought in the body through some way
         other than the digestive tract) contact with blood or other potentially
         infectious materials that may result from the performance of an employees’s
         duties. According to the North Carolina Department of Labor’s Occupational
         Safety and Health Bloodborne Pathogens Standard (printed 5/92), “Good
         Samaritan “ acts such as assisting a co-worker or student with a nose bleed
         would not be considered “reasonably anticipated occupational exposure.”
         Universal precautions shall be in force at all times as follows: in dealing with
         the cleaning or decontamination of any blood or body fluid, all blood, body
         fluid, and potentially infectious material shall be handled as if infected. The
         schools shall adhere to the program standards for the control of potential
         exposure to HIV and HBV as outlined in the proposed OSHA Rule
         “Occupational Exposure to Bloodborne Pathogens” standard 1910.1030 or the
         most current standards available.

  II.    Responsibilities:
         A. As part of this policy the following will be adhered to :
                        1. All elements of the Exposure Control Plan, including but
                            not limited to exposure determination, work practice
                            standards, Hepatitis B vaccination procedures, training
                            requirements, and record keeping shall be followed as set
                            forth in the Rules section.
                        2. All employees shall have access to a copy of this policy
                            and the Exposure Control Plan.
                        3. This policy will be revised and updated annually.
                        4. Testing and Examination: An employee who suspects that
                            he/she has a blood or body fluid exposure may request to
                            be tested at the department’s expense, provided that the
                            suspected exposure poses a significant risk of exposure as
                            defined in the rules of the Health Services Commission.
                            The source individual’s test results will be made available
                            to the exposed employee with or without the source
                            individual’s permission, as long as significant risk of
                            exposure has occurred (Communicable Disease Control
                            Measure 15A NCAC 19A.0202(4) adopted by the North


                                                                                      20
   Carolina Health Services Commission). The existing
   confidentiality rules and laws regarding employees with
   communicable diseases, including HIV or HIV-associated
   conditions shall be strictly adhered to.
5. Anti-Discrimination: There shall be no discrimination
   against any applicant or employee who has or is suspected
   of having HIV infection or AIDS. An employee with HIV
   infection or AIDS may continue to work as long as the
   employee is able to satisfactorily perform the duties of the
   job and there is no medical evidence indicating that the
   employee’s condition is a health threat to co-workers,
   students or the public.




                                                            21
R 2.34 Bloodborne Pathogens Policy

    I.      Specific Application
These rules apply to all employees in the Gaston County School system, hereafter
referred to as “the workplace”. All occupational exposures to blood or other potentially
infectious materials as defined by section 2.2 of this document are covered.
    II.     Definitions
The following definitions shall apply to these policies and guidelines:
            A. BLOOD means human blood, human blood components, and products
               made from human blood.
            B. 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).
            C. CONTAMINATED LAUNDRY means laundry which has been soiled
               with blood or other potentially infectious materials or which may contain
               sharp objects.
            D. CONTAMINATED SHARPS means any contaminated object that can
               penetrate the skin, including but not limited to needles, scalpels, broken
               glass and exposed ends of wires.
            E. COLLATERAL DUTY means a duty existing at the same time, but in a
               subordinate relationship to the work duties required by an employee’s job.
            F. 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.
            G. ENGINEERING CONTROLS means controls (e.g. sharps disposal
               containers, self-sheathing needles) that isolate or remove the bloodborne
               pathogens hazard from the workplace.
            H. 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.
            I. HAND WASHING FACILITIES means facilities providing an adequate
               supply of running, potable water; soap; and single use towels or hot air
               drying machines.
            J. LICENSED HEALTHCARE PROFESSIONAL is a person whose legally
               permitted scope of practice allows him or her to independently perform
               the activities required for Hepatitis B Vaccination and post-exposure
               evaluation and follow-up.
            K. HBV is the Hepatitis B Virus
            L. HIV is the human immunodeficiency virus, the virus that causes AIDS
               (Acquired Immunodeficiency Syndrome).
            M. OCCUPATIONAL EXPOSURE means reasonably anticipated skin, eye,
               mucous membrane, or a parenteral contact with blood or other potentially


                                                                                      22
   infectious materials that may result from the performance of an
   employee’s duties. “Good Samaritan Acts”, an employee’s rendering
   assistance to accident victims, and other exposures that cannot be
   “anticipated” do not constitute occupational exposure (page vii, North
   Carolina Occupational Safety and Health Bloodborne Pathogens Standard,
   March 6, 1992.
N. OTHER POTENTIALLY INFECTIOUS MATERIALS means:
        i. The following human body fluids: semen, vaginal secretions,
           cerebrospinal fluid, synovial fluid, pleural fluid, pericardial fluid,
           peritoneal fluid, amniotic fluid, saliva in dental procedures and 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;
       ii. Any unfixed tissue or organ ( other than intact skin) from a human
           ( living or dead); and
      iii. 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.

O. PARENTERAL means piercing mucous membranes or the skin barrier
   through such events as needle sticks, human bites, cuts and abrasions.
P. PERSONAL PROTECTIVE EQUIPMENT is specialized clothing or
    equipment worn by an employee for protection against a hazard, such as
    gloves, masks, goggles, or disposable gowns. 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.
Q. REASONABLY ANTICIPATED means that an exposure is certain,
    based on tasks assigned to the employee as a requirement of the job.
    Examples are job tasks where employees are required to handle blood or
    blood products, such as laboratory technicians, physicians, nurses, and
    emergency medical technicians. “Good Samaritan Acts”, an employee’s
    rendering of assistance to accident victims, and other exposures that
   cannot be “anticipated” do not constitute occupational exposure
   (Refernces: page vii, North Carolina Occupational Safety and Health
   Bloodborne Pathogens Standard, March 1992; Robin Sirkin, Industrial
   Hygienist, Health Compliance Office, OSHA, phone conversation of Sept
   23, 1992).
R. 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.



                                                                              23
            S. 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.
            T. STERILIZE means the use of a physical or chemical procedure to destroy
                all microbial life including highly resistant bacterial endospores.
            U. UNIVERSAL PRECAUTIONS is an approach to infection control.
                According to the concept of Universal Precautions, all human blood and
                certain human body fluids and contaminated materials are treated as if
                known to be infectious for HIV, HBV, and other bloodborne pathogens.
            V. WORK PRACTICE CONTROLS means controls that reduce the
                likelihood of exposure by altering the manner in which a task is
                performed (e.g., diapering students unable to control bodily excretion
                function, requiring that glass be picked up with tongs or a dust pan and
                brush).

III.   EXPOSURE CONTROL PLAN
       Each employer with employees having occupational exposure is required to have
       a written Exposure Control Plan. The Exposure control Plan must contain the
       following elements:

       A.      “Exposure Determinations:”
       B.      The schedule and methods of implementation for “Methods of
               Compliance”, Hepatitis B Vaccination and Post-Exposure Evaluation and
               Follow-up, Hazard Communication, and Record keeping; and
       C.      Procedures for the evaluation of circumstances surrounding an exposure
               incident. The Exposure Control Plan shall be reviewed and updated at
               least annually and whenever necessary to reflect new or modified tasks
               and procedures which affect occupational exposure and to reflect new or
               revised employee positions with occupational exposure (Section
               1910.1030, Bloodborne Pathogens. Federal Register, page 64175, Part
               11910-(amended), Subpart Z, page 64176, Vol. 56, No.235, December
               6,1991). The Exposure Control Plan shall be made available to employees
               upon request.

       1. Exposure Determination and Identification of Job Classifications and Exposure
          Categories
                               a. The work environment must be evaluated to
                                   determine actual and potential hazards, including
                                   biological hazards for HIV, HBV, and other
                                   bloodborne pathogens. Each employer with
                                   employees with occupational exposure is required




                                                                                      24
to prepare an Exposure Determination that includes
the following:
      (1) A list of all job classification in which
          ALL EMPLOYEES in those job
          classifications    have       occupational
          exposure;
      (2) A list of job classifications in which
          SOME EMPLOYEES have occupational
          exposure, and
      (3) A list of all tasks and procedures or
          groups of closely related tasks and
          procedures in which occupational
          exposure occurs. The tasks identified will
          be examined and a recommendation shall
          be made on how to reduce the potential of
          exposure to blood or other infectious
          materials through workplace controls,
          protective equipment, or other methods.

b. A sample Exposure Determination Report is
   included in Appendix C.
        (1) If an employer is unsure of the exposure
            status of an employee, the employer may
            administer the Exposure Determination
            Questionnaire to that employee to help
            analyze exposure status (see Appendix
            D). Exposure determination will be
            made without regard to the use of
            personal protective equipment.

c. Methods of Compliance and Schedule
       (1) Universal Precautions: Universal
           Precautions, as outlined by the Centers
           for Disease Control, shall be observed
           to prevent contact with blood and other
           potentially infectious materials (see
           Appendix C). Under circumstances in
           which differentiation between body
           fluid types is difficult or impossible, all
           body fluids shall be considered
           potentially infectious materials.

d. Engineering and Work Practice Controls
   Engineering and work practice controls shall be
   used to eliminate or minimize employee
  exposure. Where occupational exposure remains



                                                     25
after institution of these controls, personal
protective equipment shall also be used. These
engineering controls shall be examined and
maintained or replaced on a regular schedule to
ensure their effectiveness.

Hand washing
(1) Employers shall provide hand washing
    facilities which are readily accessible to
    employees. When provision of hand washing
    facilities in not feasible, the employer shall
    provide either an appropriate antiseptic hand
    cleanser in conjunction with clean cloth/paper
    towels or antiseptic towelettes. When
    antiseptic hand cleansers or towelettes are
    used, hands shall be washed with soap and
    running water as soon as feasible. Employers
    shall ensure that employees wash their hands
    immediately or as soon as feasible after
    removal of gloves or other personal protective
    equipment. Employers shall ensure that
    employees wash hands and any other skin
    with soap and water, or flush mucous
    membranes with water immediately or as soon
    as feasible following contact of such body
    areas with blood or other potentially infectious
    materials.
(2) Contaminated          Needles       and       other
    Contaminated Sharps
        a. Contaminated needles and other
             contaminated sharps shall not be bent,
             recapped, sheared, or broken before
             disposal, with the exceptions:
                  The employer can demonstrate
                     that no alternative is feasible or
                     that such action is required by a
                     specific medical procedure;
                     and /or
                  Such recapping or needle
                     removal must be accomplished
                     through the use of a mechanical
                     device or a one-handed
                     technique.
               Immediately or as soon as possible
               after use, contaminated sharps shall
               be placed in appropriate containers


                                                    26
      for disposal. These containers shall
      be (1) puncture resistant, (2) labeled
      or color-coded in accordance with
      this policy (3) leak proof on the sides
      and bottom. Warning labels shall be
      affixed to containers of regulated
      waste and containers used to store,
      transport or ship blood or other
      potentially infectious materials.
      Labels shall include the following
      legend:




      These labels shall be fluorescent
      orange     or      orange-red   or
      predominantly with lettering or
      symbols in a contrasting color.

      The label shall be an integral part of
      the container or shall be affixed as
      close as feasible to the container by
      string, wire, adhesive, or other
      method that prevents the loss or
      unintentional removal.

(b)   Other
      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 shall not be kept in
      refrigerators,   freezers,    shelves,
      cabinets or on countertops or bench
      tops where blood or other potentially
      infectious materials are present. All
      procedures involving blood or other
      potentially infectious materials shall
      be performed in such a manner as to


                                          27
               minimize       splashing,      spraying,
               splattering, and generation of
               droplets of these substances.
               Equipment,        such      as    sports
               equipment, which may become
               contaminated with blood or other
               potentially infectious materials shall
               be examined prior to servicing or
               shipping         and       shall      be
               decontaminated as necessary, unless
               the employer can demonstrate that
               decontamination of such equipment
               or portions of such equipment is not
               feasible. A readily observable label
               in accordance with this policy shall
               be attached to the equipment stating
               which portions remain contaminated.
               The employer shall ensure that this
               information is conveyed to all
               affected employees, the servicing
               representative,         and/or       the
               manufacturer, as appropriate, and
               prior to handling, servicing, or
               shipping      so     that    appropriate
               precautions will be taken.
e.   Personal Protective Equipment Provision
       (1) The employer shall provide, at no cost to
           the employee, appropriate personal
           protective equipment such as, but not
           limited to, gloves, resuscitation bags,
           mouthpieces, or ventilation devices.
           Equipment is considered “appropriate” if
           it does not permit blood or other
           bloodborne pathogens 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 the item which the
           protective equipment will be used.
       (2) Use
                 (a) The employer shall ensure that
                      the employee uses appropriate
                      personal protective equipment
                      unless the employer shows that
                      the employee temporarily and



                                                    28
               briefly declined use, when
               under rare and extraordinary
               circumstances, it was the
               employee’s          professional
               judgement that in the specific
               instance if used it would have
               posed an increased hazard to
               the safety of the worker or co-
               worker. When the employee
               makes this judgment, the
               circumstances       shall     be
               investigated and documented
               in order to determine whether
               changes can be instituted to
               prevent such occurrences in the
               future.
(3) Accessibility
    The employer shall ensure that
appropriate personal protective equipment is
readily accessible at the worksite. Hypo-
allergenic gloves, glove liners, powderless
gloves, or other similar alternatives shall be
readily accessible to those employees who
are allergic to the gloves normally provided.

(4)Repair and Replacement
The employer shall repair or replace
personal protective equipment as needed to
maintain its effectiveness, at no cost to the
employee. When personal protective
equipment is removed it shall be placed in
appropriately designated areas or containers
for washing, decontamination, or disposal.

(5)Gloves
Gloves shall be worn when it can be
reasonably anticipated that the employee
may have hand contact with blood, other
potentially infectious materials, mucous
membranes, and non-intact skin and when
handling or touching contaminated items or
surfaces.

(6)Housekeeping
Employers shall ensure that the worksite is
maintained in a clean and sanitary condition.



                                            29
       All equipment and envivronmental and
       working surfaces shall be cleaned and
       decontaminated with an appropriate
       disinfectant after contact with blood or other
       potentially infectious materials. Broken
       glassware which may be contaminated shall
       not be picked up directly with hands. It shall
       be cleaned up using mechanical means, such
       as a brush and dust pan, tongs, or forceps.
       Disposal of any contaminated materials shall
       be labeled with a fluorescent orange or
       orange-red label that is affixed as close as
       feasible to the container by string, wire,
       adhesive, or other method that prevents loss
       or unintentional removal. The marked
       material shall include the following label:




       Disposal shall be in compliance with Section
       3.3C-2 of this policy and guidelines.

f. Hepatitis B Vaccination and Post-Exposure
Evaluation and Follow-up
(1) General
The employer shall make available the Hepatitis B
Vaccine and vaccination series to all employees
who have occupational exposure risks; and post-
exposure evaluation and follow-up to all employees
who have had an actual exposure. The employer
shall ensure that all medical evaluations and
procedures including the Hepatitis B vaccine and
vaccination series and post- exposure evaluation
and follow-up shall be:
(aa) made available at no cost to the employee;
(bb) made available to the employee at a reasonable
time and place;
(cc) performed by or under the supervision of a
licensed physician or by or under the supervision of
another licensed healthcare professional; and


                                                  30
(dd) provided according to recommendations of the
U.S. Public Health Service current at the time these
evaluation and procedures take place.

g. Hepatitis B Vaccination
Hepatitis B Vaccination shall be made available
after the employee classified as having occupational
exposure has received the training required by the
policy, and within 10 working days of initial
assignment, unless the employee has previously
received the complete Hepatitis B Vaccination
series, antibody testing has revealed that the
employee is immune, or the vaccine is
contraindicated for medical reasons. The following
exemption was released by OSHA on July 6,1991:
OSHA will consider it a de minimis violation – a
technical violation carrying no penalties – if
employees who administer first aid as a collateral
duty to their routine work assignment are not
offered the Hepatitis B Vaccination until they give
aid involving blood or other potentially infectious
materials. The exemption would be limited to
persons who render first aid only as a collateral
duty, responding solely to injuries resulting from
workplace incidents, generally at the location where
the incident occurred. To merit the de minimis
classification, the employer must be sure that
reporting procedures are in place under the
exposure control plan to ensure that all first aid
incidents involving exposure are reported to the
employer before the end of the work shift during
which the incident took place, and that all other
criteria as outlined in the policies memorandum in
Appendix K are followed. In these circumstances,
no citations will be issued. The de minimis
classification for failure to offer Hepatitis B
Vaccination in advance of exposure would NOT
apply to personnel who provide first aid at a first aid
station, clinic or dispensary; or to health care,
emergency response, or public safety personnel
expected to render first aid in the course of their
work Please note that North Carolina OSHA has
not adopted this de minimis classification, and has
filed an objection with OSHA. This means that at
the date of this printing, the de minimis
classifications are not in effect in North Carolina.



                                                    31
(Reference: in personal conversation with J. Edgar
Geddie, Ph.D., Staff Industrial Hygienist, Bureau of
Education, Training, and Technical Assistance,
Division of Occupational Safety and Health, N.C.
Department of Labor, September 22,1992).

h. Post Exposure Evaluation and Follow-up
Following a report of an exposure incident, the
employer shall make immediately available to the
exposed employee a confidential medical evaluation
and follow-up, including at least the following
elements:
        (a) DOCUMENTATION of the routes of
            exposure, and the circumstances under
            which the exposure incident occurred.
        (b) IDENTIFICATION                      AND
            DOCUMENTATION                OF      THE
            SOURCE INDIVIDUAL, unless the
            employer       can      establish     that
            identification is infeasible or prohibited
            by state or local law. The employer will
            assure that the source individual’s blood
            is tested as soon as feasible and after
            consent is obtained, in order to
            determine and document the HBV and
            HIV infectivity status. If consent is not
            obtained, the employer shall establish
            that legally required consent cannot be
            obtained. When the source individual’s
            consent is not required by law, the
            source individual’s blood, if available,
            shall be tested and the results
            documented.       When       the   source
            individual is already known to be
            infected with HBV or HIV, testing for
            the source individual’s known HBV or
            HIV status need not be repeated. The
            results of the source individual’s testing
            shall be made available to the exposed
            employee where not prohibited by state
            or local law, and the employee shall be
            informed of applicable laws and
            regulations concerning disclosure of the
            identity and infectious status of the
            source individual. According to Chris
            Hoke, Assistant State Health Director,



                                                   32
    legal consent to release test results to the
    exposed employee does not have to be
    given by the source individual, based on
    the Health Services Commission’s
    Communicable         Disease       Control
    Measure 15A NCAC 19A.0202(4)

(c) COLLECTION AND TESTING of
    exposed employee’s blood for HBV and
    HIV serological status will be done as
    soon as feasible and after consent is
    obtained.

(d) POST-EXPOSURE PROPHYLAXIS,
    when medically indicated, will be made
    available as recommended by the U. S.
    Public Health Service, counseling and
    evaluation of reported illnesses will also
    be provided.

(e) INFORMATION will be provided to
    the healthcare professional responsible
    for the employee’s Hepatitis B
    Vaccination as follows: a copy o f the
    policy and the guidelines, a description
    of the exposed employee’s duties as
    they relate to the exposure incident,
    documentation of the routes of exposure
    and the circumstances under which
    exposures occurred, results of the source
    individual’s blood testing, if available,
    and all medical records relevant to the
    appropriate treatment of the employee
    including vaccination status which are
    the employer’s responsibility to
    maintain.

(f) The healthcare professional’s written
    opinion shall be obtained by the
    employer and provided to the employee
    within 15 days of the completion of the
    evaluation. The written opinion shall be
    limited to whether Hepatitis B
    Vaccination is indicated for the
    employee, and if the employee has
    received such a vaccination. The written



                                             33
           opinion for post-exposure evaluation
           and follow-up shall be limited to the
           following     information:     that    the
           employee has been informed of the
           results of the evaluation, and that 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 diagnoses shall remain
           confidential and shall not be included in
           the written report.

i. Training and Information
   General: It is recommended that all employees
   be offered training opportunities on the basic
   knowledge and prevention principles for HBV
   and HIV. Theses employees must be informed:
        That they are not 1st Responders, and
        What procedure to follow (including
          who to call) in case of an accident or
          event that would potentially expose them
          to blood or body fluids.
   Employees with occupational exposure are
   required to receive training that includes
   precautionary measures, epidemiology, modes
   of transmission, prevention of HBV and HIV,
   universal precautions, and reporting procedures.
   This training must be updated annually. New
   employees are required to be trained within 10
   days of employment, or within 10 days from the
   time of the initial assignment of a task with
   occupational exposure potential

j. Training Program Content
   Training programs for employees with
   occupational exposure will contain, but not be
   limited to the following:
       (1)     A copy of the workplace policy and
               guidelines as well as a copy of the
               OSHA Standard. The content of both
               shall be explained during training.
       (2)     An explanation of the epidemiology
               and symptoms of Bloodborne
               diseases.


                                                  34
       (3)     An explanation of the modes of
               transmission        of     bloodborne
               pathogens.
       (4)     An explanation of the appropriate
               methods for recognizing tasks and
               other activities that may involve
               exposure to blood and other
               potentially infectious materials.
       (5)     An explanation of selection, the uses
               and limitations of practices that will
               prevent or reduce exposure to
               bloodborne pathogens, including
               appropriate engineering controls,
               workplace practices, and use of
               protective equipment.
       (6)     Information on the types, proper
               uses, location, removal, handling,
               decontamination and/or disposal of
               protective equipment.
       (7)     Information on the Hepatitis B
               Vaccine, including information on its
               usefulness, safety, and the benefits of
               pre-vaccination        and        post-
               vaccination.
       (8)     An opportunity for interactive
               questions      with    the     persons
               conducting the training sessions.

k. Record Keeping and Surveillance

(1) Types of Records Kept
       a. Training Records, indicating the dates of
           training sessions; the content of training
           sessions; the names, qualifications, and
           job titles of the trainers; the names, job
           titles, and work locations of training
           participants.
       b. Results of an annual workplace survey
           for compliance with work practices and
           use of protective equipment. If
           noncompliance is noted, the conditions
           are to be documented along with
           corrective actions taken.
       c. Incident of exposure records, noting the
           conditions associated with each incident
           of exposure, and evaluation of these



                                                   35
          conditions, and information from the
          exposed employee’s healthcare provider,
          and a description of any corrective
          measures taken to prevent a recurrence
          or other similar exposure.
       d. Medical records shall be established and
          maintained for each employee. This
          record shall include:
                 The name and social security
                    number of the employee;
                 A copy of the employee’s
                    Hepatitis      B     Vaccination
                    records and medical records
                    relative to the employee’s
                    ability to receive vaccination or
                    the circumstances of an
                    exposure incident.
                 The employer’s copy of the
                    healthcare provider’s written
                    opinion; and
                 A copy of the information
                    provided to the healthcare
                    provider. Specific requirements
                    should not preempt North
                    Carolina OSHA record keeping
                    requirements.

(2) Confidentiality
    Confidentiality of the employee’s medical
    records will be maintained. The records will not
    be disclosed or reported to any person within or
    outside the workplace except as required by
    these policies and guidelines or as may be
    required by law. Employee medical and training
    records required by theses policies and
    procedure will be provided upon request for
    examination and copying to the subject
    employee and to anyone having the written
    permission and consent of the subject employee.

(3) Duration of Maintaining Records
   Training records will be maintained for three
    years. Employee medical records will be
    maintained for at least the duration of
    employment plus 30 years



                                                  36
(4) Surveillance
    A workplace survey will be conducted annually
    to monitor adherence to these policies and
    procedures. Any noncompliance and corrective
    actions taken will be noted.

l. Schedule of Implementation of Methods of
   Compliance
   Each employer is required to have a schedule
   for implementing the methods used to comply
   with the policy. A sample “Schedule” is
   included in Appendix C.




                                              37
      Section 2


Exposure Determination




                         38
         Job Classifications for Exposure to Bloodborne Pathogens
Classification I

Jobs in which required task routinely involve potential for mucous membrane or skin
contact with blood or body fluids or tissue. Training, hepatitis vaccine option and use of
appropriate protective measures are required for all employees who fall in these jobs.
(Example – school nurses)

Classification II

Jobs in which required tasks normally do not involve exposure to blood, body fluids or
tissues, but may require performing unplanned Classification I tasks. In these jobs, the
normal work routine involves no exposure to blood, body fluids or tissues. However,
exposure or potential exposure may be required as a condition of employment.
(Example – housekeepers and coaches)

Classification III (Personnel Not Covered by the Standard)

Jobs, in which exposure to blood, body fluids or tissue is not a part of the job description,
are not covered by this standard. The normal routine involves no exposure to blood, body
fluids or tissue and the worker can decline to perform tasks which involve a perceived
risk without retribution.

All employees who do not fit into Classification I or II will fall into a third classification
not covered by this standard. However, training will be available to all Gaston County
School Employees.




                                                                                             39
                       GASTON COUNTY SCHOOLS
                 BLOODBORNE PATHOGENS TRAINING
                      CLASSIFICATION I & II STAFF
                   (training required and vaccine offered)

      JOB                   TASK CAUSING RISK                 PROTECTIVE
 CLASSIFICATION                                                 BARRIER
   EC Teachers            Spills, contact with body              Gloves
                          fluids
     EC Assistants         Spills, contact with body              Gloves
                                      fluids
        Nurses                   First Aid/CPR          Gloves, face, mouth, body,
                                                          shoe covers as needed
      Custodians             Cleaning blood, body       Gloves, gown, other covers
                                    fluids                       as needed
   Coaches/Trainers               First Aid              Gloves, face, body, shoe
                                                            covers as needed
   First Responders              First Aid/CPR          Gloves, face, mouth, body,
                                                          shoe covers as needed
  Physical Education               First Aid             Gloves, face, body, shoe
      Teachers                                              covers as needed
    Shop Teachers                  First Aid             Gloves, face, body, shoe
                                                            covers as needed
  Health Occupations           Administering and         Gloves, face, body, shoe
       Teachers            supervising direct patient       covers as needed
                                       care
 Pre-K Teachers and         Spills, contact with body             Gloves
     Assistants                       fluids
  Campus Security            First Aid/CPR, contact               Gloves
     Associates                 with body fluids
      Plumbers              Contact with blood and        Gloves, face, body, shoe
                                    body fluids              covers as needed

                                 Classification III
                        No exposure except unplanned events
                                (training optional)

Administrators              Occupational Therapists               Secretaries
Teachers                    Physical Therapists                   Media Personnel
Teacher Assistants          Social Workers                        Speech Therapists
Psychologists               Counselors                            Bus Drivers
Food Service Personnel      Finance Office Personnel
An employee not in Classification I or II who feels he/she is at occupational risk
should complete Form 1.1 and return to Elaine Glenn in the Human Resources
Department for review.


                                                                                      40
41
42
   Section 3


Methods of Compliance




                        43
                                Universal Precautions
Universal Precautions is a method of infection control in which all human blood and
certain body fluids are treated as if known to be infectious for HIV, HBV and other
bloodborne pathogens.

Universal Precautions shall be observed by all Gaston County Schools Employees and
shall be recognized as the first line of defense against exposure to disease resulting from
bloodborne pathogens.

At minimum, the following standards of practice are required of all employees when
involved in a potentially contaminated situation.

Procedure for Universal Precautions:

   1. Wash hands with antiseptic towelettes (if hand washing with soap and water is not
       immediately available) if there is any possibility of contact with body fluids,
       blood or human tissue.
   2. Wear gloves when anticipating contact with blood, body fluids, human tissues,
       mucous membranes or contaminated surfaces, or if breaks in the skin are present.
   3. Wear an impervious apron if splattering of clothing is likely.
   4. Wear a mask if there is to be contact with an infectious disease spread by splatter
       droplets.
   5. Wear appropriate protective equipment at all times including mask and eye
       protection if aerosolization or splattering is likely to occur.
   6. Use disposable protective mouth covering when the need for resuscitation is
       likely.
   7. Handle sharp objects carefully.
       a. Discard any sharp objects such as needles into an impervious
       sharps disposal box.
   8. Immediately report and follow procedure outlined under Section 5, Exposure
      Incident Evaluation and Follow up, if there is mucosal splash or contamination
      of open wounds with blood or body fluids.
   9. Dispose of all spills which contain or may contain biological contaminants in
      accordance with procedures outlined in Section 4, Engineering Controls.

Universal Precautions apply to blood and other body fluids containing visible blood as
well as to cerebrospinal fluid, synovial fluid, pleural fluid, peritoneal fluid, pericardial
fluid, amniotic fluid, semen and vaginal secretions. Unless visible blood is evident,
universal precautions do not apply to feces, urine, nasal secretions, sputum, sweat, tears
and vomit.




                                                                                           44
                   Engineering and Work Practice Controls

Gaston County School System shall use engineering and work practice controls as the
primary method to eliminate or minimize employee exposure. When occupational
exposure remains after institution of these controls, personal protective equipment will
also be used. These engineering controls shall be examined or replaced on a regular
schedule to ensure their effectiveness.

Protective and safety devices contribute significantly to the protection of employees in
situations associated with a possibility of exposure to bloodborne pathogens. There is an
increased risk with failure of these devices. Therefore, the following procedure must be
followed by employees involved in a possible exposure to bloodborne pathogens:

       1. Personnel are responsible for proper use and routine care of health and safety
       devices and personal protective equipment.
       2. Personnel must recognize the possibility of failure of a safety device and adhere
       to the tenants of Universal Precautions without placing unjustifiable reliance on
       mechanical devices as the sole means of avoiding the risk of personal
       contamination.
       3. Each employee is responsible for reporting observed deficiency in existing
       devices.
       4. Engineering and safety devices shall be maintained in working order with
       manufacturers’ specification and common sense, whichever offers the greater
       degree of worker protection.




                                                                                           45
                                      Hand Washing


All employees should wash hands and any other skin with soap and water and flush
exposed mucous membranes with water immediately or as soon as feasible following
contact of such areas with blood or other potentially infectious materials.

Hand washing is the single most important means of preventing the spread of infection.
The principle of good hand washing is that of using friction to mechanically remove
microorganisms. If waterless hand cleaner is used, follow the directions on the
dispensing container.

Procedure for Hand Washing:

1.     Wash hands with soap and water.
2.     Rinse hands under running water.
3.     Dry hands well with paper towel.
4.     Use a paper towel to turn off the water. Manual controls are considered
       contaminated.
5.     Dispose of paper towel in trash or appropriate container.

Employees should wash their hands:

1.     When coming on duty.
2.     After personal use of toilet.
3.     After blowing or wiping the nose.
4.     After handling or caring for urinals, catheters or mucous membranes.
5.     Before and after snacking.
6.     Upon completion of duties.




.




                                                                                         46
                  Handling Contaminated Needles and Other
                           Contaminated Sharps


Extreme caution should be used when having contact with contaminated needles and
other contaminated sharps. They should not be bent, capped, sheared or broken before
disposal, with the following exceptions:

       1. The employer can demonstrate that no alternative is feasible or that such action
          is required by a specific medical procedure, and/or
       2. Such recapping or needle removal must be accomplished through the use of a
          mechanical device or a one-handed technique.

Immediately or as soon as possible after use, contaminated sharps should be placed in
appropriate containers for disposal. The containers shall be (1) puncture resistant,
(2) label or color coded in accordance with this policy, and (3) leak proof on the sides and
bottom. One container will be provided for each school and will be kept in a location
designated by the principal.




                                                                                         47
                         Availability and Accessibility of
                         Personal Protective Equipment


Engineering and work practices do not always eliminate occupational exposure. Personal
protective equipment must be used to prevent blood or other potential infectious material
from passing through it or coming in contact with the employee’s work or street clothes,
undergarments, skin, eyes, mouth or mucous membranes.

Gaston County Schools shall provide readily available protective equipment to all
employees. The following protective equipment will be available in designated areas:


Protective Equipment                  Location
Gloves                                All classrooms and School Buses
Protective Equipment Kits             School office, gymnasium, school buses, all sports
(containing gloves, face masks,       events, vocational shop, and classrooms for children
apron, eye protection, absorbent      with special needs when invasive procedures are
material, towelettes for hand         routinely performed.
washing and disinfecting, and a       Additional kits will be provided as needed.
secured red biohazard bag for
disposal).
Resuscitation equipment


It is the individual school’s responsibility to maintain an adequate supply of protective
equipment. Supplies may be ordered by submitting a supply requisition to the Facility
Services Supervisor.




                                                                                            48
                           Use of Protective Equipment


Gaston County Schools shall use engineering and work practice controls as the primary
method to eliminate or minimize employee exposure. When occupational exposure
remains after institution of these controls, personal protective equipment shall be used.

Protective equipment will be worn under the following guidelines:

  1. Gloves are to be worn when it can be reasonably anticipated that there will be
     contact with blood and body fluids or surfaces contaminated with blood and
     body fluids. Gloves are needed in the following circumstances:
     A. during any invasive procedure
     B. examining non-intact skin
     C. when examining someone who is bleeding
     D. when cleaning blood or body fluids
2. Face Protection
     A. Face protection must cover the eyes, nose and mouth.
     B. Face protection shall be used whenever splashes, sprays, splatter or droplets of
         blood and body fluids may be generated and contamination of eyes, nose or
         mouth can be reasonably anticipated.
     C. Face protection must be cleaned with a germicidal agent or replaced if it becomes
         contaminated with blood or body fluids.
3. Gowns and Protective Clothing
     A. Gowns which are resistant to blood and body fluids shall be worn whenever it
         is reasonable to anticipate that splashes of blood or body fluids will come in
         contact with clothing.
     B. Gowns and protective clothing shall be changed as soon as feasible after
        contamination with blood or body fluids.
4. Resuscitation Equipment
     A. Mouth to mouth resuscitation is to be avoided without proper protective        .
        equipment.
     B. Resuscitation devices with one-way valves will be used for resuscitation.
5. Disposal
     A. All personal protective equipment used should be properly disposed
        of before leaving the incident site.




                                                                                            49
                                   Food and Drink


Eating, drinking, smoking, application of cosmetics or lip balm, and the handling of
contact lens by personnel are prohibited in work areas where blood and body fluids are
handled, processed or stored. Food and drink shall not be kept in refrigerators, freezers,
shelves, cabinets or on counter tops or bench tops where blood or other potentially
infectious materials are present.




                                                                                         50
 Section 4




Housekeeping




               51
                            Housekeeping and Cleaning


Cleaning of potentially contaminated equipment and work areas

The work site must be maintained in a clean and sanitary condition. All equipment and
environmental and work surfaces shall be cleaned and decontaminated after contact with
blood or other potentially infectious materials.

Blood and bodily fluid Clean-up Kit Instructions

Open kit and put on the following personal protective equipment if needed:
      Disposable gloves
      Disposable face mask
      Disposable face shield
      Disposable apron
      Disposable shoe covers

Open clean-up absorbent pack and sprinkle absorbent material evenly over bodily fluid
spill (will absorb 80-100 times its weight).

After the spill gels (1-2 minutes) use the scoop/scraper to pick up material and put into
red biohazard bag and tie it shut. Keep personal protective equipment on.

Spray disinfectant over the spill area and thoroughly wipe down with disposable wiping
cloth.

Use disposable wiping cloth to wipe up the disinfectant, and then discard in second red
biohazard plastic bag.

Use antiseptic towelettes to clean hands and discard into red biohazard bag.

Close the red biohazard bag securely with twist tie to prevent leakage. Place bag into
biohazard box for pick up.

For routine cleanings with no visible blood, use the established regular cleaning
procedure. Contaminated hard surfaces e.g., desks, walls, and floors, should be cleaned
with a germicidal disinfectant. Contaminated carpet should be cleaned by using the
regular procedure and germicidal spray.

Contaminated clothing or throw rugs should be sprayed with a germicidal spray and
followed by routine laundering.




                                                                                            52
                           Housekeeping and Cleaning


All bins, pails, cans, and similar receptacles intended for reuse which have a reasonable
likelihood for becoming contaminated with blood or other potentially infectious materials
shall be inspected and decontaminated on a regular basis.

Kits will be located in the school office, gymnasium, school maintenance supply area,
vocational shop areas, school buses, and at all sports events.

Equipment such as sports equipment which may be contaminated with blood or other
potentially infectious material shall be examined prior to servicing or reusing and be
decontaminated by use of germicidal spray unless it can be demonstrated that
decontamination of such equipment or portions of such equipment is not feasible.

Broken glass which may be contaminated with blood shall not be picked up with the
hands. It shall be cleaned up using a mechanical means such as a brush and dust pan,
tongs, or forceps. Contaminated glass should be placed in a puncture proof container and
labeled with a biohazard sticker and stored for appropriate disposal.



                            Trash and Infectious Waste


Trash that is not contaminated shall be disposed of using the already established routine
at your school.

Contaminated waste, waste that has or is reasonably suspected to have the presence of
blood or other infectious materials on it, should be decontaminated with a germicidal
spray, and placed in a secured biohazard bag.

The contaminated waste and trash shall be placed in a designated area at each school for
pick up.




                                                                                         53
            Sharps and Biohazard Container Disposal Procedure


When containers are full, school will submit electronic Work Request to Facility Services
for pick up.

Custodial Supervisor will make arrangements for pick up and disposal of full containers.




                             Trash Container Cleaning


Each trash container will be inspected for presence of blood and/or body fluids. If visible
signs of blood and/or body fluids are present, remove container from room.
Contaminated trash container must be cleaned with a germicidal disinfectant using
Personal Protection Equipment and then returned to room.



                       Laundry and Handling Procedures


Contaminated laundry, e.g., sports uniforms, should be sprayed with a germicidal spray
and placed in a plastic bag. As soon as possible, contaminated laundry should be washed
in hot water at the school site.

Gloves should be worn when handling contaminated laundry.




                                                                                        54
              Section 5

Post Exposure Evaluation and Follow-up

         Hepatitis B Vaccine




                                         55
                   Post-Exposure Evaluation and Follow-up


Following a report of an exposure incident, (a specific eye, mouth, or other mucous
membrane, non-intact skin, parenteral contact with blood or other potentially infectious
material that results from the performance of an employees’ duties) the principal should
contact the School Nurse or Alice Ragan, Director of Health Services.

After an exposure incident has been confirmed and documented by the principal or
supervisor, the following procedure is to be followed:

       Principal completes worker’s compensation forms and exposure form 2.2,
        contacts Elaine Glenn, Human Resource Specialist, and sends copy of form 2.2 to
        Elaine Glenn.
       Human Resources will advise principal regarding forms and testing procedures.
       Designated personnel at school site will arrange for exposed employee to be
        tested at Caromont Occupational Medicine, 2525 Court Drive, Gastonia, N.C.
        28054, (704-834-3070). The person/persons to whom the employee is exposed
        will be requested to find an alternate source for testing and follow up. Results of
        the source individual’s testing shall be made available to the exposed employee
        in compliance with OSHA Bloodborne Pathogens Final Standard section
        1910.1030(f)(3)(ii)(c). Caromont Occupational Medicine will not be available to
        these persons for those purposes. Gaston County Schools will be responsible for
        costs incurred by all persons involved.
       Human Resources will remind Caromont of billing and processing procedures.
       Human Resources will be responsible to do all follow up with employee and
        inform employee regarding test results. Elaine Glenn, Human Resource
        Specialist, will operate as lead person. Employee’s school nurse will operate as a
        contact and support person.
       Employee will be instructed to follow-up with Caromont for HIV testing in six
        months and in one year.

Principal or supervisor is responsible for contacting the source and obtaining verbal
consent for HIV/HBV testing.

Principal or supervisor is responsible for assuring that all necessary forms are completed
and sent to personnel.




                                                                                        56
57
58
59
60
                              Hepatitis B Vaccine



Hepatitis B vaccine will be made available to all employees at no cost who are at risk for
occupational exposure and have received the training required by the policy.

Series of injection: initially, one (1) month later, and five (5) months later.

Training and vaccine must be completed within ten (10) working days of initial
assignment unless the employee has previously received the completed Hepatitis B
vaccination series, antibody testing reveals the employee is immune, or the vaccine is
contraindicated for medical reasons.

      Employees receiving the vaccine will make an appointment at Carolinas
       Healthcare Urgent Care – Cox Road, 603 Cox Road, Gastonia NC 28054
      Employees who receive a bill should forward to Elaine Glenn in Human
       Resources.




                                                                                         61
                            Gaston County Schools
                         BLOODBORNE PATHOGENS
                           HEPATITIS B VACCINE


                                What is Hepatitis B vaccine?
Hepatitis B is a non-infectious, synthetic vaccine. Non-infectious means that you cannot
actually get Hepatitis from the vaccine. It is made from yeast and not human blood
products. In the past, this vaccine was made from blood products. It offers 90%
effective protection in healthy adults after 3 doses.

                                  Who needs the vaccine?
Personnel in Classification I and II need this vaccine because of the potential risk of
exposure to blood in the performance of their duties. The initial training class is required
before receiving the vaccine.

                           What is the dosage and how is it given?
The dosage is 1cc. 5cc. equals 1 teaspoon. The shot is given in the upper arm in the
deltoid muscle. It is given 3 separate times with an initial dose, then another 1 month
later, and the final dose 5 months after the second.

                                       EXAMPLE
                                 January 1-----First Dose
                               February 1-----Second Dose
                                  July 1-----Third Dose

                                 Are there any side effects?
Side effects are rare. The main complaint in only 1%-10% of all people was local
redness and soreness at the site of injection. Some of these also experienced a slight
fever.

                          What about an allergy to the vaccine?
There should be no concerns unless there is an allergy to baker’s yeast or to a previous
dose of Hepatitis B vaccine.

                     Is there anyone who should not take the vaccine?
The vaccine is safe and can be used with other medications. A pregnant woman or
nursing mother should consult her doctor. People who are moderately or severely ill
should usually wait.

                  How long does the vaccine protect against Hepatitis?
At present, no booster shot is recommended after the series of three shots is completed.




                                                                                           62
Hepatitis B Vaccine-----cont.


                        When and where is the vaccine offered?
Carolinas Healthcare Urgent Care – Cox Road, 603 Cox Road, Gastonia N.C. 28054,
(704)852-9561; will administer the shots. Consult your principal so that time during work
hours will be made available to obtain the vaccine.
                              How much do I have to pay?
There is no charge to the employee. If you receive a bill, send it by school courier to
Elaine Glenn in Human Resources.

                      What do I have to do if I don’t want the vaccine?
You must complete the declination form. It will be kept in your employee record file. If
at a later date you change your mind and want the vaccine, notify Elaine Glenn in Human
Resources.




                                                                                      63
      Section 6




Hazard Communication




                       64
                 Labeling of Potentially Hazardous Materials


Warning labels shall be affixed to containers of regulated waste and containers used to
store, transport or ship blood or other potentially infectious materials. Labels shall
include the following legend:




These labels shall be fluorescent or orange-red or predominantly so with letters or
symbols in a contrasting color. The label shall be an integral part of the container or shall
be affixed as close as feasible to the container by string, wire, adhesive, or other method
that prevents the loss or unintentional removal.

Red bags will be used in Gaston County Schools and shall represent Biohazard waste.




                                                                                          65
      SECTION 7


TRAINING & INFORMATION




                         66
                                   SECTION 7
                            TRAINING & INFORMATION

GENERAL
It is recommended that all employees be offered training opportunities on the basic
knowledge and prevention principles for Bloodborne Pathogens. These employees must
be informed:
    1. that they are not first responders;
    2. The procedure to follow (including who to call) in case of an accident or event that
        would potentially expose them to blood or body fluids.

CLASSIFICATION I and II
 1. Employees with potential for occupational exposure (Classification I & II personnel)
    are required to receive training that includes precautionary measures, epidemiology,
    modes of transmission, prevention of Bloodborne Pathogens, universal precautions,
    and reporting procedures. This training must be updated annually. New
    Classification I & II employees are required to be trained within 10 days of
    employment or within 10 days of the time of the initial assignment of a task with
    occupational exposure potential. Training will be offered on the first and third
    Monday of each month from 1:00-3:30. Training is provided during working hours
    twice a month and as needed at other times during the year.
 2. Regarding personnel who fail to attend the required training at their scheduled time:
         a) trainer will send notification of failure to attend to school principal,
         b) trainer will send to Human Resources the sign in sheet from initial training
            class,
         c) Human Resources will complete follow up process with school
            administration to ensure employee receives required training.

TRAINING PROGRAM CONTENT
Training programs for employees with occupational exposure will contain, but not be
limited to the following:
   1. A copy of the workplace policy and guidelines as well as a copy of the OSHA
       Standard (the content of both shall be explained during training);
   2. An explanation of the epidemiology and symptoms of bloodborne diseases;
   3. An explanation of the modes of transmission of bloodborne pathogens;
   4. An explanation of the appropriate methods for recognizing tasks and activities that
       may involve exposure to blood and other potentially infectious materials;
   5. An explanation of selection, uses, and limitations of practices that will prevent or
       reduce exposure to bloodborne pathogens, including appropriate engineering
       controls, workplace practices, and use of protective equipment;
   6. Information on the types, proper uses, locations, removal, handling,
       decontamination and/or disposal of protective equipment;
   7. Hepatitis B Vaccine information including usefulness, safety, and the benefits of
       pre-vaccination and post-vaccination;
   8. An opportunity for interactive questions and answers with the persons conducting
       the training sessions.



                                                                                         67
               GASTON COUNTY SCHOOLS
            BLOODBORNE PATHOGEN TRAINING
                 CONTENT OF TRAINING
                  Category I & II personnel

I.    THE OSHA BLOOD BORNE PATHOGENS STANDARDS
II.   SIGNS AND SYMPTOMS OF BLOODBORNE DISEASES
      A. HIV
      1. Causative agent
      2. Infection with and without symptoms
      3. Opportunistic diseases
      4. Populations at risk
        a. Newborns of HIV positive mothers
        b. IV drug abusers
        c. Bisexual/homosexual men
        d. Heterosexual men and women with multiple partners
        e. Person with occupational risk
        f. Sex partner of HIV positive person
        g. Tattoo/ear piercing clients exposed to contaminated instruments
      5. Signs and Symptoms
      6. Prevention
             a. Avoiding high risk behaviors
                       abstinence
                       monogamy
                       safer sexual practices
                       no IV drug use or needle sharing
             b. Work practices
                       universal precautions
                       personal protective equipment
             c. Ensuring a safe blood supply
      B. Hepatitis B (HBV) and Hepatitis C (HCV)
      1. Causative agent
      2. Acute disease and carriers of the virus
      3. Populations at risk
             a. IV drug users
             b. Bisexual/homosexual men
             c. Heterosexual men and women with multiple partners
             d. People with occupational exposure
             e. Sex partners of infected persons
             f. Recipients of blood products (rare)
             g. Newborns of infected mothers
             h. Tattoo/ear piercing clients exposed to contaminated instruments




                                                                                  68
                        CONTENT OF TRAINING
                             (continued)


       4. Signs and Symptoms
       5. Prevention
             a. Avoiding high risk behaviors
                      Abstinence
                      Monogamy
                      Safer sex
                      No IV drug use/needle sharing
             b. Work practices
                       Universal precautions
                       Personal protective equipment
             c. Ensuring a safe blood supply
             d. Immunizations against HBV

III.   HOW BLOODBORNE DISEASES SPREAD
       A. HIV
        1. Exposure to blood and blood products
        2. Sexual contact
        3. Person to person contact with open lesions
        4. Infected mother to fetus or newborn, primarily at birth
       B. HBV and HCV
        1. Exposure to blood and blood products
        2. Sexual contact
        3. Person to person contact through open lesions
        4. Infected mother to fetus or newborn, primarily at birth
       C. How Bloodborne Pathogens spread in the workplace
       1. Parenteral exposure to blood
              a. Sharps
                        Handling sharps
       2. Non-intact skin, eyes, and mucous membranes exposure
              a. Traumatic physical altercation with infected person
              b. Handling or disposing of contaminated waste and linen
              c. Spills and splashes of blood and other body fluids


IV.    BLOOD/BODY FLUID SOURCES OF HIV, HBV, HCV, AND OTHER
       BLOODBORNE PATHOGENS
       A. Body Fluids to which Universal precautions apply
       1. Blood
       2. Semen
       3. Vaginal secretions
       4. Amniotic fluid
       5. Other body fluids containing visible blood


                                                                         69
                             CONTENT OF TRAINING
                                  (continued)

          B. Body fluids to which universal precautions do not apply unless visible
             blood is present (general infection control guidelines, such as wearing
             gloves and hand washing) still apply
          1. Feces
          2. Nasal secretions
          3. Sputum
          4. Sweat
          5. Tears
          6. Urine
          7. Vomit

V. YOUR AGENCY CONTROL PLAN
        A. What are task exposure categories
               Category I
               Category II
               Category III
         B. Job classifications/positions included in Categories I and II due to tasks

VI. STANDARD OPERATING PROCEDURES
        A. Universal Precautions---Always and All the time
        B. Personal Protective Equipment
        1. Gloves, aprons, shoe covers, eye wear, face shields/masks, CPR
           microshields
        2. Selection, location and Use for Specific Tasks
             a. Gloves –procedures that involve or potentially involve exposure to
                 blood and body fluids and for housekeeping and cleaning
                 equipment
             b. Aprons –for use when body fluids may be splashed
             c. Masks –for use whenever body fluids may be splashed/aerosolized
             d. Goggles, Glasses or Face Shields – for use when body fluids may
                 be splashed/aerosolized
             e. Appropriate protective shields for CPR and resuscitation
        3. Cleaning/Care/Storage/Disposal
             a. Items for reuse
             b. Disinfection
        4. How to request new supplies or repair
        C. Hygiene
        1. Covering any open wounds
        2. Using protective equipment at all appropriate times
        D. Hand washing
        1. How and When
        2. Antiseptic products to be used when no water is available
        E. Handling, disposing, labeling, transporting contaminated needles/sharps


                                                                                       70
                                       CONTENT OF TRAINING
                                            (continued)

            F. Eating and drinking in work areas
            G. Containers, labeling, transporting blood/ potentially infectious
               specimens
            H. Housekeeping
            1. Cleaning procedures for surfaces and equipment
            2. Decontamination procedures for surfaces and equipment
            3. Cleaning spills
            I. Disposal, labeling, storage and transporting sharps and regulated
               medical waste (red bags)
            J. Handling, labeling and transporting contaminated laundry
            K. Reusable items
            1. Linens
            L. Disposing of Disposable Items
            M. Analyzing Own Job
            1. Tasks to do in an emergency that involves exposure to bloodborne
               pathogens
            2. Procedures to follow when asked to perform task for which unprepared,
               e.g., not immunized or no training on how to conduct work practices
            3. Standard operating procedures to follow

VII. HEPATITIS B VACCINATION
     A. After 3 doses, 90% of healthy adults develop adequate antibody response
        (CDC: Pink Book, 2004).
     B. Dosage is 1ml. for 3 times; time 0, 1 month later, 6 months after the first
     C. Adverse effects
     D. Hypersensitivity rare
     E. Administration site --- deltoid; Route --- IM
     F. Time and location of vaccine administration

VIII. AN INADVERTENT EXPOSURE TO BLOODBORNE PATHOGENS
      A. What you do
             1. Where to locate emergency procedures
             2. Who to contact
             3. Flush area with water (and soap, if applicable)
             4. Report exposure immediately, reason for urgency
             5. Where, how, when to seek medical attention
       B. What is done for you: Post-exposure evaluation and follow-up
             1. Notify principal
             2. Complete exposure report
             3. Consult with Human Resources




                                                                                      71
                                      CONTENT OF TRAINING
                                           (continued)

IX. BIOHAZARD COMMUNICATIONS
      A. Materials classified as regulated medical wastes
           1. Sharps
           2. Blood-soaked items/materials
      B. How to recognize biohazard labels and colors (fluorescent orange or
         Orange-red with letters or symbols in contrasting color)
           1. Red bags and biohazard labels
           2. What the biohazard label or red bag means
      C. When to affix label or use red bag for storage and transport of sharps,
           regulated medical waste, and blood contaminated laundry

X. QUESTIONS AND ANSWERS

XI. POST TEST, EVALUATION AND FORMS




                                                                                   72
                            Gaston County Schools
                        Bloodborne Pathogen Training
                                    Agenda
                                Initial Training
                           Classification I & II Staff

Welcome and Program Overview
OSHA Bloodborne Pathogens Standards
What are Bloodborne Pathogens?
    Epidemiology
    Signs and Symptoms
    Modes of Transmission
    Prevention
Gaston County Schools Control Plan
    Exposure Categories
    Job Classifications
Standard Operating Procedures
    Universal Precautions
    Video
    What is Exposure

      Housekeeping

      Engineering Controls

      Protective Equipment

      Biohazard Communications
      Regulated Medical Waste
      Hepatitis B Vaccine
       1) Benefits/Contraindications
       2) Intervals/Safety/Methods of Administration

Procedure for Exposure
    Action to Take
    Person to Contact
    Post-Exposure Evaluation
    Follow-Up

Questions and Answers

Completing Paper Work
                                                         Reviewed 2/05



                                                                    73
74
                        Category I and II Employee Roster
OSHA Regulations dictate that Gaston County Schools identify those employees
whose job description potentially or routinely may bring them in contact with
another’s blood or body fluids. As a Category I or II employee, you fit this
description. Below you will find a list of these job titles. As a condition of that role,
you must complete an initial training process.
      EC Teachers                   EC Assistants      Nurses          Custodians
      Coaches/Trainers              First Responders   PE Teachers     Shop Teachers
      Plumbers                      PK Teachers        PK Assistants   Campus Security Associates
      Health Occupations Teachers

Please note your name and employment location below. This information will be
used to generate a login/password for you to complete this mandated training.
                      Name                          Employment Location


       1

       2

       3

       4

       5

       6

       7

       8

       9

       10

       11

       12

       13

       14

       15
                                                                                          5/09




                                                                                                 75
76
                             Gaston County Schools
                  Informed Consent for Hepatitis B Virus Vaccine

                                        For your information
                                        Please read carefully

The Hepatitis B Vaccine currently used is a non-infectious vaccine made from bread yeast (Saccharomyces
cerevisiae).

When injected into the deltoid muscle, the hepatitis vaccine has induced protection levels of antibodies in
more than 90% of healthy adults who received the recommended three doses of vaccine. Persons with
immune system abnormalities, such as dialysis patients, have less response to the vaccine, but over half of
those receiving the vaccine do develop antibodies. Full immunization requires three doses of vaccine over
a six-month period, although some persons may not develop immunity even after three doses. There is not
evidence that the vaccine has ever caused Hepatitis B. However, persons who have been infected with
Hepatitis B virus prior to receiving the vaccine may go on to develop clinical hepatitis in spite of
immunization. The duration of immunity is unknown at this time.

The incidence of side effects is low. Serious effects do not appear to be common, but have been identified
on rare occasions. Some persons experience tenderness and redness at the site of injection. Low grade
fever, rash, upper respiratory symptoms, nausea, joint pain, and mild fatigue are among reported side
effects. More serious side effects may be identified in the future after more extensive use of the vaccine.

I, the undersigned employee, acknowledge that I have read the above information about the Hepatitis B
Vaccine. All of my questions have been answered to my satisfaction, and I agree to accept the Hepatitis B
Vaccine, given in three (3) doses over a six month time period.

I understand that the manufacturer of the vaccine recommends that persons who are pregnant or breast
feeding not be given the Hepatitis B Vaccine until after delivery or breast feeding. Therefore, the vaccine
will not be administered to me if I am known to be pregnant or breast feeding until delivery has occurred or
breast feeding has stopped. I understand that I should voluntarily decline vaccination at the present time, if
I am pregnant or breast feeding.

I further understand the risks involved in making this decision, and I agree that the Gaston County Schools
System, its agents and employees, who are required by law or regulation to make the Hepatitis B Vaccine
available to me, are not legally responsible or liable for the side effects that may occur as a result of my
accepting the Hepatitis B Vaccine.



Date: _____________________________ Print Name: ___________________________

School: _____________________________________ Position:____________________

SS#:_______________________________Signature:____________________________

Witness: ____________________________


Hepatitis B Immunizations may be received ONLY at Cox Road Urgent Care
and ONLY after completing the Bloodborne Pathogen (BBP) Initial Training
                                Process

                                                                                                          77
            GASTON COUNTY SCHOOLS
        HEPATITIS B VACCINE DECLINE FORM
I understand that due to my occupational exposure to blood or other potentially infectious
materials that I may be at risk of contracting Hepatitis B virus (HBV) infection. I have
been given the opportunity to be vaccinated with Hepatitis B vaccine at no charge.
However, I decline the Hepatitis B vaccination at this time. I understand that by declining
this vaccine, I continue to be at risk of acquiring Hepatitis B, a serious disease. If in the
future, I continue to have occupational exposure to blood or other potentially infectious
materials and I want to be vaccinated with Hepatitis B vaccine, I can receive the
vaccination series at no charge. I am required to receive the vaccinations at the Gaston
County Health Department, and I must show documentation that I have been authorized
to receive the series of injections.


Name (print)
______________________________________________________________


Signature ______________________________________
Date______________________


Witness ________________________________________
Date_____________________


Work Site ______________________________________


                                                                                          78
                              Gaston County Schools
                      OSHA BLOODBORNE PATHOGENS TEST
                                INITIAL CLASS

School__________________________________Employee_______________________

Please circle correct answer.
    1.    T   F   Aids is the only disease carried by blood.
    2.    T   F   Bloodborne pathogens cause infection by entering your body through air.
    3.    T   F   Hepatitis B is not considered a Bloodborne pathogen.
    4.    T   F   Sharp objects contaminated with blood can be placed in the regular trash.
    5.    T   F   While on the job, protecting yourself from bloodborne pathogen diseases requires
                   knowing the facts and taking sensible precautions.
    6.    T   F   HIV, HBV, and HCV are spread only through sexual contact or by sharing needles.
    7.    T   F   Gaston County School system has an Exposure Control Plan in place.
    8.    T   F   It is my responsibility to locate the Exposure Control Plan in my school.
    9.    T   F   When necessary, help the injured person control bleeding only after protecting
                   yourself with gloves.
    10. T F       Gaston County Schools has identified the employees who are most at risk for
                   exposure to blood and body fluids.
    11. T F       The best way to protect yourself from an exposure to Bloodborne pathogens is
                   proper hand washing and using protective equipment.
    12. T F       Every time you remove gloves you must wash your hands with soap and running
                   water as soon as possible.
    13. T F       An exposure has occurred if blood enters an employee’s body through mucous
                   membranes (eyes, nose, mouth), broken skin, or being stuck with a contaminated
                   sharp.
    14.   T   F   It is my school’s responsibility to make protective equipment available to me.
    15.   T   F   The type of protective equipment varies with the task and degree of exposure.
    16.   T   F   Bloodborne pathogens kits should be on all school buses.
    17.   T   F   The mission of OSHA is to provide a healthy work environment and protect the
                   employees.
    18. T F       Hepatitis B vaccine helps protect most people from Hep. B infection.
    19. T F       If you have an accidental exposure, immediately wash exposed skin with soap and
                   water or flush exposed mucous membranes with water, and then report the incident
                   to your supervisor.
    20. T F       Red bags and bio-hazard containers must be used only if the amount of the blood is
                   30cc (2 tablespoons) or more.
    I have been informed regarding Gaston County Schools Bloodborne Pathogen
    Exposure Control Plan. I was given the opportunity to ask questions. I understand it
    is my responsibility to be knowledgeable of these policies and procedures in order to
    protect myself from bloodborne pathogens.
    **During the first week of returning to my school after this class, I will locate:
    Bloodborne Pathogen Manual, Protective Equipment kits, sharps container,
    corrugated container.

    Employee Signature____________________Position______________Date______

                                                                                    Revised 4/06


                                                                                                 79
                 BLOODBORNE PATHOGEN TRAINING
                   EMPLOYEE EVALUATION FORM

Please help to evaluate the Bloodborne Pathogens Training. Circle the number that best
describes your answer. Thank you.

The training helped understand:                            Agree Unsure Disagree

1. The OSHA Bloodborne Pathogens Standard                   1       2       3       4       5

2. The sources of blood and other potentially               1       2       3       4       5
   infectious materials.

3. The agency’s Bloodborne Pathogens Policy.                1       2       3       4       5

4. Standard operating procedure required by my job.             1       2       3       4       5

5. What to do in case of an exposure to blood or other       1      2       3       4       5
   Infectious material.

6. Why, when and how to get Hepatitis B vaccine.              1      2       3       4       5

7. How to dispose of and label biohazard materials            1      2       3       4       5
   and laundry.

8. How and with what to clean a contaminated surface          1      2       3       4       5

The information presented was:

Informative                                                   1      2       3       4       5

Too basic                                                     1      2       3       4       5

Too technical                                                 1      2       3       4       5

Not enough                                                    1      2       3       4       5

The trainer:

Was knowledgeable                                             1      2       3       4       5

Was easy to understand                                        1      2       3       4       5

Responded to questions                                        1      2       3          4       5

Reviewed 2/05


                                                                                                    80
   SECTION 8

ANNUAL REVIEW
      &
 SURVEILLANCE




                81
                         BLOODBORNE PATHOGEN
                            ANNUAL REVIEW



   All Gaston County School Employees who are Classification I and II must attend
    the Bloodborne Pathogen Initial Training and participate in an annual review.

   Human Resource Specialist, Elaine Glenn, will send to the principal of each
    school a list of Classification I and II personnel annually by September 1 with a
    reminder to update the list and have each employee complete the Annual Review
    Test and the Annual Review Form (available on-line or in the Bloodborne
    Pathogen Manual).

   The bloodborne pathogen annual review content should include:

    1)   Definition of OSHA and Bloodborne Pathogen standard;
    2)   Transmission of germs and infections;
    3)   Prevention of transmission of bloodborne pathogens;
    4)   Reporting an exposure;
    5)   Annual Review Test and Annual Review Form.

   The Annual Review Test and the Annual Review Form are to be given to
    Classification I & II employees by the principal. The completed forms are to be
    returned to the principal. The school nurse will be available at the school during a
    specific time to answer questions and/or show the bloodborne pathogens video for
    employees as needed. The principal will give the completed tests to the school
    nurse. The school nurse will review the tests to verify accurate employee
    knowledge. The school nurse will inform the principal and employee of incorrect
    answers and provide corrected information. The principal will return the
    Annual Review Test and Annual Review Form completed (and corrected
    answers reviewed with employee, if applicable) to Human Resource
    Specialist, Elaine Glenn, by October 1.




                                                                                     82
                         GASTON COUNTY SCHOOLS
                       OSHA BLOODBORNE PATHOGENS
                           ANNUAL REVIEW TEST

School________________________________Employee_________________________
Please circle correct answer
     1. T F Aids is the only disease carried by blood.
     2. T F Bloodborne pathogens cause infection by entering your body through air.
     3. T F Hepatitis B is not considered a bloodborne pathogen.
     4. T F Sharp objects contaminated with blood can be placed in the regular trash.
     5. T F While on the job, protecting yourself from bloodborne pathogen diseases
              requires knowing the facts and taking sensible precautions.
     6. T F HIV, HBV, and HCV are spread only through sexual contact or by sharing
              needles.
     7. T F Gaston County School system has an Exposure Control Plan in place.
     8. T F It is my responsibility to locate the Exposure Control Manual in my school.
     9. T F When necessary, help the injured person control bleeding only after
              protecting yourself with gloves.
    10. T F Gaston County Schools has identified the employees who are most at risk
              for exposure to blood and body fluids.
    11. T F The best way to protect yourself from an exposure to bloodborne pathogens
              is proper hand washing and using protective equipment.
    12. T F Every time you remove gloves you must wash your hands with soap and
             running water as soon as possible.
    13. T F An exposure has occurred if blood enters an employee’s body through
             mucous membranes (eyes, nose, mouth), broken skin, or being stuck with
             a contaminated sharp.
   14. T F It is my school’s responsibility to make protective equipment available to me
   15. T F The type of protective equipment varies with the task & degree of exposure.
   16. T F Bloodborne pathogens kits should be on all school buses.
   17. T F The mission of OSHA is to provide a healthy work environment and to
             protect the employees.
   18. T F Hepatitis B vaccine helps protect most people from Hep B infection.
   19. T F If you have an accidental exposure, immediately wash exposed skin with
            soap and water or flush exposed mucous membranes with water, and then
            report the incident to your supervisor.
   20. T F Red bags and bio-hazard containers must be used only if the amount of the
            blood is 30cc (2tablespoons) or more.
   I have been informed regarding Gaston County Schools Bloodborne Pathogen
Exposure Control Plan. I was given an opportunity to ask questions. I understand
it is my responsibility to be knowledgeable of these policies and procedures in order
to protect myself from bloodborne pathogens.
Employee signature___________________________Position__________Date________

Revised 4/06




                                                                                      83
                         GASTON COUNTY SCHOOLS
                       OSHA BLOODBORNE PATHOGENS
                          ANNUAL REVIEW FORM

School________________________Employee____________________Date_________
TO: Classification I and II personnel (Custodian, DEC teachers/assistants, First
Responders, PE teachers, Coaches, Trainers, Shop teachers, Pre-K teachers/assistants,
Campus security, Plumbers). Completion of this form is required to insure compliance
with Federal Law. Previous attendance at the initial two-hour class is required before
completing this review form. Inform your supervisor immediately if you have never
attended the two-hour class.
FROM:__________________________________________,Principal
        __________________________________________, School Nurse
Complete the blanks below and the attached true/false test and return to the
principal by__________________. The nurse will be available at this school on
_________________between the hours of ______________to answer questions.
The LOCATION of the following at this school are:
       Bloodborne Pathogen Exposure Control Manual__________________________;
                                                          (location)
       Protective Equipment Kits____________________________________________;
                                                           (location)
       Extra Disposable Gloves_____________________________________________.
                                                           (location)
AN OCCUPATIONAL EXPOSURE occurs when, in the performance of the employee’s
job, blood (or body fluids containing blood) come in contact with the employee’s non-
intact skin, mucus membrane (of the eyes, nose, or mouth) or he/she is stuck with a
contaminated sharp (one that had stuck someone else).
If an exposure occurs:
     Immediately wash the area with soap and water (wearing a glove, if applicable);
     Flush the mucus membrane with water (washing away from the other eye);
     If stuck with a contaminated sharp, promote bleeding before washing the area;
     Immediately inform the principal who will assist you to complete the exposure
        incident report form (master in exposure control manual) and send to DHR.
UNIVERSAL PRECAUTIONS must be practiced if there is potential for exposure to
blood or sharps in order to prevent an occupational exposure from occurring.
STEPS OF UNIVERSAL PRECAUTIONS:
     Hand washing;
     Personal Protective Equipment (Gloves, Protective Equipment Kit, CPR shield);
     Engineering & work practices (Sharps container for contaminated sharps and Bio-
        hazard Box for more than two tablespoons of blood);
     Disinfecting all surfaces and materials which may be contaminated by blood.
SIGN TO INDICATE UNDERSTANDING AND COMPLIANCE WITH ABOVE:
Employee signature_________________________________Date___________________

Revised 4/06



                                                                                   84
                            BLOODBORNE PATHOGENS
                                SURVEILLENCE



The Gaston County Schools OSHA Checklist and Workplace survey will be completed
by Principal or Assistant Principal twice a year. This will be completed by the 15th day of
the first semester and the 15th day of the second semester. Completed review survey will
be sent to Elaine Glenn, Human Resource Specialist.




                                                                                         85
                             Gaston County Schools
                              OSHA Checklist and
                              Workplace Survey

School:        _____________________________________________
Check             Items            Descriptions
Off
        Gloves                     Gloves available for teachers and staff
        Reusable gloves            Inspect for pinholes and wear
        Trash cans                 Inspect for blood; clean appropriately
        Spill procedure and kits   Review procedure and supplies for cleaning spills
        First Responders           Confirm CPR mouth pieces available
        Sharps Containers          Location in school
        Biohazard Container        Location in school
        Asbestos awareness         Review AHERA Manual for asbestos locations
        MSDS awareness             Review MSDS for product awareness

        Noncompliance              Note item of noncompliance:
                                   __________________________________________
                                   __________________________________________
                                   __________________________________________
                                   __________________________________________
                                   __________________________________________
        Actions Taken              Note action taken regarding above noncompliance:
                                   __________________________________________
                                   __________________________________________
                                   __________________________________________
                                   __________________________________________
                                   __________________________________________

        Date ________________      Principal/Asst Principal Signature :
                                   __________________________________________
                                   __________________________________________

 ***Check list to be completed by the 15th day of First Semester and the 15th day of
                               Second Semester***



2/05




                                                                                       86
    Section 9


RECORD KEEPING




                 87
RECORD KEEPING

TYPES OF RECORDS KEPT

The following types of records will be kept:

   1. Training Records:
          will indicate the dates of training sessions; the content of training sessions; the
   names, qualifications, and job titles of the trainer(s); the names, job titles, and work
   locations of training participants, and any relevant unanswered issues that were raised
   during training.

   2. Annual Workplace Survey Results:
           will indicate work practice compliance; conditions of noncompliance with
   corrective actions.

   3   Exposure Incident Records:
            will document an employee’s occupational exposure and include the
   conditions associated with each incident of exposure; an evaluation of these
   conditions, any information from the exposed employee’s health care provider, and a
   description of corrective measures taken to prevent a recurrence or other similar
   exposure.

   3. Medical Records:
             will be established and include the employee’s name, social security number,
   the Hepatitis B Immunization record, medical records relative to the employee’s
   ability to receive vaccination, the circumstances of the exposure incident, the
   employer’s copy of the health care provider’s written opinion, and a copy of the
   information provided to the health care provider.

   Specific requirements should not preempt North Carolina OSHA record keeping
   requirements.

   Confidentiality of the employee’s medical records will be maintained. The records
   will not be disclosed or reported to any person within or outside the workplace except
   as required by these policies and guidelines or as may be required by law.

   Duration of Maintaining Records is as follows:
     Training records will be maintained for three years. Employee medical records will
   be maintained for at least the duration of employment plus 30 years.




                                                                                          88
  APPENDIX




INTRODUCTION




               89
GASTON COUNTY SCHOOLS HAS ELECTED
TO PROVIDE AN OVERVIEW OF
BLOODBORNE PATHOGENS FOR ALL BUS
DRIVERS. AN INITIAL TRAINING WAS
PROVIDED IN AUGUST, 2005.

ALL NEW DRIVERS ARE REQUIRED, AS PART
OF THEIR ORIENTATION, TO ATTEND THE
“OVERVIEW OF BLOODBORNE PATHOGENS”
TRAINING SESSION PRIOR TO BECOMING A
LICENSED BUS DRIVER FOR GASTON
COUNTY SCHOOLS. THIS TRAINING IS
PROVIDED BY AN OFFICIAL IN THE
TRANSPORTATION DEPARTMENT.




                                    90
               BUS DRIVER’S TRAINING




                          Revised
                          April, 2006
  OVERVIEW OF BLOODBORNE PATHOGENS

I. Infection
 A. Bacteria

                                        91
B. Virus

II. How Bloodborne Pathogens Are Spread

III. Bloodborne Diseases
 A. HIV
 B. Hepatitis


IV. On The Job Exposure

V. Prevention
A. Universal Precautions
B. Handwashing
C. Gloves
D. Clean/care/storage/disposal

VI. Should An Incident Occur




                    INFECTION

A DISEASE PROCESS CAUSED BY A
PATHOGEN (GERM) THAT GETS INTO THE

                                          92
BODY AND OVER POWERS THE BODY’S
DEFENSE SYSTEM.

THE MOST COMMON PATHOGENS CAUSING
INFECTION ARE:

A. BACTERIA
    Generally treatable with antibiotics

B. VIRUSES
    a HIV ( Human Immunodeficiency Virus)
    b. Hepatitis




DISEASE MAY RESULT FROM EXPOSURE
TO SOMEONE’S INFECTED BLOOD OR
BODY FLUID.

                                            93
WAYS THIS TRANSMISSION OCCURS
INCLUDE:
-EXPOSURE TO BLOOD OR BODY FLUIDS

-BEING STUCK WITH SOMETHING SHARP
THAT HAS ALREADY STUCK SOMEONE ELSE

-BLOOD SPLASHED ONTO BROKEN SKIN; OR
INTO THE EYES, NOSE OR MOUTH

-CONTACT WITH OPEN LESIONS

-IV DRUG USE

-SEXUAL CONTACT

-INFECTED MOTHER TO INFANT BEFORE
BIRTH OR THROUGH BREAST FEEDING


      BLOODBORNE DISEASE

                  HIV

                                       94
   HUMAN IMMUNODEFICIENCY
          SYNDROME

ATTACKS THE BODY’S IMMUNE SYSTEM
LEAVING THE BODY UNABLE TO FIGHT
INFECTION.



MAY NOT SHOW RECOGNIZABLE SYMPTOMS
FOR UP TO TEN YEARS.



RESULTS IN AIDS (ACQUIRED
IMMUNODEFICIENCY SYNDROME) WHICH
ARE THE ILLNESSES RESULTING FROM A
DAMAGED IMMUNE SYSTEM. INFECTIONS
AT THIS POINT IN THE ILLNESS MAY
BECOME LIFE THREATENING


   SIGNS AND SYMPTOMS OF AIDS


FEVER

                                     95
DIARRHEA


FATIGUE


NIGHT SWEATS


WEIGHT LOSS


DISCOLORED AREAS OF THE SKIN




      BLOODBORNE DISEASE

               HEPATITIS

                               96
AN INFLAMMATION OF THE LIVER


CAUSES INCLUDE:

CHEMICAL – ALCOHOL OR OTHER DRUGS;
CANNOT BE SPREAD PERSON TO PERSON

VIRUSES – HEPATITIS A: SPREADS BY
CONTAMINATED FOOD OR WATER.
USUALLY LESS SEVERE ILLNESS
          HEPATITIS B & C: SPREADS BY
SEXUAL CONTACT, GETTING INFECTED
BLOOD INTO THE BODY THROUGH BROKEN
SKIN, MUCOUS MEMBRANES ( EYES, NOSE,
OR MOUTH) OR BY BEING STUCK WITH
SOMETHING SHARP THAT HAS ALREADY
STUCK SOMEONE ELSE. USUALLY A MORE
SEVERE INFECTION.




             HEPATITIS


                                        97
               SYMPTOMS



INITIAL:

GENERAL FATIGUE
JOINT AND MUSCLE PAIN
LOSS OF APPETITE




FOLLOWED BY:

NAUSEA
VOMITING
DIARRHEA OR CONSTIPATION
FEVER
JAUNDICE




                           98
 HEPATITIS B & C AND
HIV CANNOT BE SPREAD
 BY CASUAL CONTACT




  NOT BY DRINKING
     FOUNTAINS,
TELEPHONES OR EATING
      UTENSILS



   ON THE JOB EXPOSURE


                         99
SHARPS: BEING STUCK BY SOMETHING
SHARP THAT HAS ALREADY STUCK
SOMEONE ELSE

NON INTACT SKIN: EXPOSURE TO ANOTHER
PERSON’S BLOOD OR BODY FLUID ONTO
NON INTACT SKIN SUCH AS CUTS, SCRAPES,
CHAPPED HANDS, …OR AS A RESULT OF A
TRAUMATIC PHYSICAL ALTERCATION WITH
AN INFECTED PERSON

MUCOUS MEMBRANES: SPLASHING OR
SPLATTERING OF ANOTHER PERSON’S
BLOOD OR BODY FLUID INTO EYES, NOSE,
MOUTH OR ANY MUCOUS MEMBRANE…OR
AS A RESULT OF A TRAUMATIC PHYSICAL
ALTERCATION WITH AN INFECTED PERSON

INDIRECT CONTACT: SUCH AS IMPROPER
CLEANING OF BLOOD SPILL ONTO A BUS
SEAT, THEN BLOOD TRANSFERRED TO
ANOTHER PERSON’S HANDS AND POSSIBLY
ONTO FACE AND INTO MUCOUS
MEMBRANES




                                    100
    BLOODBORNE PATHOGENS JOB
         CLASSIFICATION

 ACCORDING TO THE GASTON COUNTY
 SCHOOLS’ BLOODBORNE PATHOGENS JOB
 CLASSIFICATION SYSTEM, BUS DRIVERS
 ARE CATEGORIZED AS CLASSIFICATION III
 EMPLOYEES.



         CLASSIFICATION III

JOBS IN WHICH EXPOSURE TO BLOOD OR
CONTAMINATED FLUIDS IS NOT A PART OF
THE JOB DESCRIPTION. NORMAL ROUTINE
INVOLVES NO EXPOSURE TO BLOOD AND
WORKER CAN DECLINE TO PERFORM TASKS
THAT INVOLVE A PERCEIVED RISK WITHOUT
RETRIBUTION.




    UNIVERSAL PRECAUTIONS

                                    101
TREAT ALL BLOOD

 AND ALL BODY

      FLUIDS

   AS THOUGH

   INFECTIOUS


 UNIVERSAL PRECAUTIONS

                         102
            PREVENTION


  SOMETIMES WE TEND TO VARY THE
LEVEL OF PROTECTION WE USE BASED ON
WHAT A PERSON LOOKS LIKE, THE
CIRCUMSTANCES SURROUNDING THE
INCIDENT OR WHERE HE OR SHE IS AT THE
TIME OF THE INCIDENT.
  HOWEVER, THE WORLD IS NOT THAT
SIMPLE! MOST OFTEN YOU WILL NOT KNOW
THE HEALTH STATUS OF THE PEOPLE YOU
WORK WITH OR CARE FOR. THE ONE TIME
YOU STOP BEING CAREFUL MAY BE THE
VERY TIME YOU BECOME INFECTED BY
SOMEONE WHO DOES NOT FIT YOUR IDEA
OF PEOPLE WHO ARE LIKELY TO BE
INFECTED.
  EACH TIME YOU GIVE CARE, FOLLOW
BASIC UNIVERSAL PRECAUTIONS.




                                    103
     UNIVERSAL PRECAUTIONS
             HANDWASHING

EMPLOYEES SHOULD WASH HANDS:



BEFORE EATING, DRINKING, APPLYING MAKE-UP
OR CONTACT LENS

AFTER REMOVING GLOVES AND EQUIPMENT

AFTER TOUCHING CONTAMINATED OBJECTS OR
CONTACT WITH WOUNDS OR BODY FLUIDS

AFTER VISIBLE CONTAMINATION

AS SOON AS POSSIBLE AFTER USING AN
ANTISEPTIC TOWELETTE OR HAND SANITIZER

HANDWASING IS THE SINGLE MOST
IMPORTANT PROCEDURE FOR
PREVENTING THE SPREAD OF INFECTION




                                         104
 HANDWASHING PROCEDURE


WASH HANDS WITH SOAP AND
WATER USING FRICTION TO MAKE
A GOOD LATHER

RINSE UNDER RUNNING WATER

DRY WELL WITH PAPER TOWELS

TURN OFF FAUCET WITH PAPER
TOWEL

DISPOSE OF PAPER TOWEL IN
TRASH




                             105
    UNIVERSAL PRECAUTIONS
             GLOVES



GLOVES SHOULD BE WORN WHEN
THERE MAY BE CONTACT WITH BLOOD,
BODY FLUIDS, CONTAMINATED ITEMS
OR CONTAMINATED SURFACES



DISPOSABLE GLOVES SHOULD BE USED
ONLY ONCE AND THEN DISCARDED




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 SHOULD AN INCIDENT OCCUR
   ON YOUR BUS INVOLVING
   BLOOD OR BODY FLUIDS:

1. THINK FIRST, TAKE INTO
CONSIDERATION THE SAFETY OF YOUR
STUDENTS AND YOURSELF

2. SECURE YOUR BUS AND STUDENTS IN
A SAFE PLACE. CALL 911 IF NECESSARY

3. NO STUDENT SHOULD BE
RESPONSIBLE FOR CLEANING UP A
BLOOD OR BODY FLUID SPILL

4. INJURED STUDENTS SHOULD BE
DIRECTED IN SELF CARE IF THEY ARE
ABLE

5. TAKE CARE OF ANY NOTED VICTIMS
USING UNIVERSAL PRECAUTIONS




                                    107
6. CLEAN UP ANY NOTED SPILLS USING
THE “CLEAN UP KIT” PROVIDED AND
UTILIZING UNIVERSAL PRECAUTIONS

7. DISPOSE OF ALL AFFECTED WASTE IN
THE BIOHAZARD BAG INCLUDED IN THE
“CLEAN UP KIT”

8. PROHIBIT SEATING IN THE AFFECTED
AREA

9. REPORT INCIDENT TO YOUR SCHOOL
ADMINISTRATOR IMMEDIATELY

10. YOUR SCHOOL ADMINISTRATOR
WILL HAVE THE BUS CLEANED
APPROPRIATELY AND WILL BE IN
CHARGE OF COMPLETING ALL
NECESSARY PAPERWORK

11. BIOHAZARD BAG CONTAINING ALL
INFECTIOUS WASTE SHOULD BE
DISPOSED OF IN THE PROPER
BIOHAZARD CONTAINER AT YOUR
SCHOOL

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